Abstract
Macciocchi S, Seel RT, Warshowsky A, Thompson N, Barlow K. Co-occurring traumatic
brain injury and acute spinal cord injury rehabilitation outcomes.
Objective
To determine the impact of co-occurring traumatic brain injury (TBI) on functional
motor outcome and cognition during acute spinal cord injury (SCI) rehabilitation.
Design
Prospective, longitudinal cohort.
Setting
Single-center National Institute of Disability and Rehabilitation Research SCI Model
System.
Participants
Persons aged 16 to 59 years (N=189) admitted for acute SCI rehabilitation during the
18-month recruitment window who met inclusion criteria.
Interventions
Not applicable.
Main Outcome Measures
FIM Motor Scale (Rasch transformed) and acute rehabilitation length of stay (LOS).
Results
In the tetraplegia sample, co-occurring TBI was not related to FIM Motor Scale scores
or acute rehabilitation LOS despite having negative impacts on memory and problem
solving. Persons with paraplegia who sustained co-occurring severe TBI had lower admission
and discharge FIM Motor Scale scores and longer acute rehabilitation LOS than did
persons with paraplegia and either no TBI or mild TBI. Persons with paraplegia and
severe TBI had lower functional comprehension, problem solving, and memory and impairments
on tests of processing speed compared with persons with paraplegia and no TBI, mild
TBI, and moderate TBI. Persons with paraplegia and co-occurring mild and moderate
TBI had equivalent acute rehabilitation motor outcomes and cognitive functioning compared
with persons with paraplegia and no TBI.
Conclusions
This study provides evidence that persons aged 16 to 59 years with paraplegia and
co-occurring severe TBI had worse motor outcomes and longer acute rehabilitation LOS
than did persons with paraplegia and no TBI. Impairments in processing speed, comprehension,
memory, and problem solving may explain suboptimal motor skill acquisition. Research
with larger samples is required to determine whether mild and moderate TBI impact
acute rehabilitation motor outcomes and LOS.
Key Words
List of Abbreviations:
ANCOVA (analysis of covariance), AMS (American Spinal Injury Association Motor Score), ASIA (American Spinal Injury Association), GCS (Glasgow Coma Scale), LOC (loss of consciousness), LOS (length of stay), PTA (posttraumatic amnesia), SCI (spinal cord injury), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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References
- Cognitive dysfunction and mild closed head injury in traumatic spinal cord injury.Arch Phys Med Rehabil. 1985; 66: 489-491
- Closed head injury in acute traumatic spinal cord injury: incidence and risk factors.Arch Phys Med Rehabil. 1988; 69: 869-872
- A controlled study of neuropsychological deficits in acute spinal cord injury patients.Paraplegia. 1988; 27: 480-489
- Spinal cord injury and concomitant traumatic brain injury: results of a longitudinal investigation.Am J Phys Med Rehabil. 1988; 67: 211-216
- The effectiveness of different methods of defining traumatic brain injury in predicting post-discharge adjustment in a spinal cord injury population.Arch Phys Med Rehabil. 1991; 72: 275-279
- Spinal cord injury and co-occurring traumatic brain injury: assessment and incidence.Arch Phys Med Rehabil. 2008; 89: 1350-1357
- Cognitive dysfunction in spinal cord injury patients: sensitivity of the Functional Independence Measure.Arch Phys Med Rehabil. 1990; 71: 326-329
- Cognitive impairment in persons with recent spinal cord injury: findings and implications for clinical practice.NeuroRehabil. 1991; 3: 79-85
- Neuropsychological impairments after spinal cord injury: a comparative study with mild traumatic brain injury.Rehabil Psychol. 2003; 48: 151-156
- Traumatic brain injury in patients with spinal cord injury: clinical and economic consequences.Arch Phys Med Rehabil. 2008; 89: S77-S84
- Effect of co-morbid traumatic brain injury on functional outcome of persons with spinal cord injuries.Am J Phys Med Rehabil. 2004; 83: 22-26
- Mild head injury classification.Neurosurgery. 1990; 27: 422-428
- Neuropsychologic and functional outcome after complicated mild traumatic brain injury.Arch Phys Med Rehabil. 2008; 89: 904-911
- International standards for neurological classification of spinal cord injury.J Spinal Cord Med. 2003; 26: S50-S56
- Construct validity and dimensional structure of the ASIA motor scale.J Spinal Cord Med. 2006; 29: 39-45
- Relationships between impairment and physical disability as measured by the Functional Independence Measure.Arch Phys Med Rehabil. 1993; 74: 566-573
- The structure and stability of the Functional Independence Measure.Arch Phys Med Rehabil. 1994; 75: 127-132
- The reliability of the Functional Independence Measure: a quantitative review.Arch Phys Med Rehabil. 1996; 77: 1226-1232
- Measurement characteristics of the Functional Independence Measure.Top Stroke Rehabil. 1994; 1: 1-15
- Continuous Visual Memory Test professional manual.Psychological Assessment Resources, Odessa1988
- Administration and scoring manual for the Wechsler Adult Intelligence Scale –.3rd edition. The Psychological Corporation, San Antonio1997
- Hopkins Verbal Learning Test-Revised manual.Psychological Assessment Resources, Lutz2001
- Symbol Digit Modalities Test.Western Psychological Services, Los Angeles1995
- Short Category Test booklet.Western Psychological Services, Los Angeles2000
- Validity of the Orientation Log relative to the Galveston Orientation and Amnesia Test.J Head Trauma Rehabil. 2000; 15: 957-961
Article info
Publication history
Published online: February 27, 2012
Footnotes
Supported by the National Institute on Disability and Rehabilitation Research, US Department of Education (grant no. H113G030004).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
In-press corrected proof published online on Apr 4, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
