title: Longitudinal outcome of patients with disordered consciousness in the NIDRR TBI Model Systems Programs.
abstract: Few studies address the course of recovery from prolonged disorders of consciousness (DOC) after severe traumatic brain injury (TBI). This study examined acute and long-term outcomes of persons with DOC admitted to acute inpatient rehabilitation within the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems Programs (TBIMS). Of 9028 persons enrolled from 1988 to 2009, 396 from 20 centers met study criteria. Participants were primarily male (73%), Caucasian (67%), injured in motor vehicle collision (66%), with a median age of 28, and emergency department Glasgow Coma Scale (GCS) score of 3. Participant status was evaluated at acute rehabilitation admission and discharge and at 1, 2, and 5 years post-injury. During inpatient rehabilitation, 268 of 396 (68%) regained consciousness and 91 (23%) emerged from post-traumatic amnesia (PTA). Participants demonstrated significant improvements on GCS (z=16.135, p≤0.001) and Functional Independence Measure (FIM) (z=15.584, p≤0.001) from rehabilitation admission (median GCS=9; FIM=18) to discharge (median GCS=14; FIM=43). Of 337 with at least one follow-up visit, 28 (8%) had died by 2.1 years (mean) after discharge. Among survivors, 66 (21%) improved to become capable of living without in-house supervision, and 63 demonstrated employment potential using the Disability Rating Scale (DRS). Participants with follow-up data at 1, 2, and 5 years post-injury (n=108) demonstrated significant improvement across all follow-up evaluations on the FIM Cognitive and Supervision Rating Scale (p<0.01). Significant improvements were observed on the DRS and FIM Motor at 1 and 2 years post-injury (p<0.01). Persons with DOC at the time of admission to inpatient rehabilitation showed functional improvement throughout early recovery and in years post-injury.
authors.affiliation: James A. Haley Veterans Hospital, Tampa, Florida 33612, USA. Risa.Richardson@va.gov
authors.forename: Risa
authors.initials: R
authors.lastname: Nakase-Richardson
authors.forename: John
authors.initials: J
authors.lastname: Whyte
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Giacino
authors.forename: Shital
authors.initials: S
authors.lastname: Pavawalla
authors.forename: Scott D
authors.initials: SD
authors.lastname: Barnett
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Yablon
authors.forename: Mark
authors.initials: M
authors.lastname: Sherer
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kalmar
authors.forename: Flora M
authors.initials: FM
authors.lastname: Hammond
authors.forename: Brian
authors.initials: B
authors.lastname: Greenwald
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Horn
authors.forename: Ron
authors.initials: R
authors.lastname: Seel
authors.forename: Marissa
authors.initials: M
authors.lastname: McCarthy
authors.forename: Johanna
authors.initials: J
authors.lastname: Tran
authors.forename: William C
authors.initials: WC
authors.lastname: Walker
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation*; D003244:Consciousness Disorders / Q000209:etiology / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D020127:Recovery of Function; D055815:Young Adult