title: Effects of concomitant spinal cord injury and brain injury on medical and functional outcomes and community participation.
abstract: BACKGROUND
  There are limited data on the interactions between concomitant spinal cord injury (SCI) and traumatic brain injury (TBI) in terms of medical, psychological, functional, and community outcomes.
  
  
  OBJECTIVE
  To investigate the hypothesis that in addition to SCI-associated sensory-motor impairments, people with dual diagnosis would experience additional TBI-associated cognitive impairments that would have a negative impact on community reintegration.
  
  
  METHODS
  Cross-sectional, case-matched study comparing a consecutive sample of participants with dual diagnosis (n = 30) to an SCI group (n = 30) and TBI group (n = 30). Participants who were on average 3.6 years postrehabilitation discharge were interviewed using a battery of standardized outcome measures.
  
  
  RESULTS
  Length of rehabilitation stay was significantly longer in SCI and dual diagnosis participants. Fatigue, pain, sexual dysfunction, depression, and sleep disturbances were frequently reported by all groups. Similar levels of anxiety and depression were reported by participants in all groups, however TBI participants reported higher stress levels. All groups achieved mean FIM scores > 100. The dual diagnosis and SCI groups received more daily care and support than TBI participants. Similar levels of community reintegration were achieved by all groups with a high level of productive engagement in work, study, or volunteer activities.
  
  
  CONCLUSIONS
  The findings of this study do not support the hypotheses. Postrehabilitation functioning was better than anticipated in adults with dual diagnosis. The contribution of rehabilitation factors, such as longer admission time to develop compensatory techniques and strategies for adaptation in the community, may have contributed to these positive findings.
authors.affiliation: School of Community Health, Charles Sturt University , Albury, NSW , Australia.
authors.forename: Melissa T
authors.initials: MT
authors.lastname: Nott
authors.affiliation: Brain Injury Rehabilitation Service , Westmead Hospital, Sydney, NSW , Australia.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Baguley
authors.affiliation: Spinal Injuries Unit, Royal Rehabilitation Centre Sydney, Sydney, NSW , Australia.
authors.forename: Roxana
authors.initials: R
authors.lastname: Heriseanu
authors.affiliation: Spinal Injuries Unit, Royal Rehabilitation Centre Sydney, Sydney, NSW , Australia.
authors.forename: Gerard
authors.initials: G
authors.lastname: Weber
authors.affiliation: NSW Statewide Spinal Cord Injury Service , Sydney, NSW , Australia.
authors.forename: James W
authors.initials: JW
authors.lastname: Middleton
authors.affiliation: Department of Psychology, Macquarie University , Sydney, NSW , Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Meares
authors.affiliation: Department of Psychology, Macquarie University , Sydney, NSW , Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Batchelor
authors.affiliation: Concord Centre for Mental Health, Concord Hospital , Sydney, NSW , Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jones
authors.affiliation: Spinal Injuries Unit, Royal Rehabilitation Centre Sydney, Sydney, NSW , Australia.
authors.forename: Claire L
authors.initials: CL
authors.lastname: Boyle
authors.affiliation: Occupational Therapy Department, Balmain Hospital , Sydney, NSW , Australia.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chilko
keywords: community participation; functional outcomes; rehabilitation; spinal cord injuries; traumatic brain injuries