Original article| Volume 93, ISSUE 10, P1788-1794, October 2012

Co-Occurring Traumatic Brain Injury and Acute Spinal Cord Injury Rehabilitation Outcomes

Published:February 27, 2012DOI:


      Macciocchi S, Seel RT, Warshowsky A, Thompson N, Barlow K. Co-occurring traumatic brain injury and acute spinal cord injury rehabilitation outcomes.


      To determine the impact of co-occurring traumatic brain injury (TBI) on functional motor outcome and cognition during acute spinal cord injury (SCI) rehabilitation.


      Prospective, longitudinal cohort.


      Single-center National Institute of Disability and Rehabilitation Research SCI Model System.


      Persons aged 16 to 59 years (N=189) admitted for acute SCI rehabilitation during the 18-month recruitment window who met inclusion criteria.


      Not applicable.

      Main Outcome Measures

      FIM Motor Scale (Rasch transformed) and acute rehabilitation length of stay (LOS).


      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.


      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)
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