title: Does history of substance use disorder predict acute traumatic brain injury rehabilitation outcomes?
abstract: OBJECTIVE
  The study explored whether premorbid substance use disorder (SUD) predicts acute traumatic brain injury (TBI) outcomes.
  
  
  METHODS
  143 participants with moderate (34.2%) and severe (65.8%) TBI were enrolled at two Level 1 trauma center inpatient brain injury rehabilitation units. Acute outcomes were measured with the Disability Rating Scale (DRS), the FIMTM; self and informant ratings of the Patient Competency Rating Scale (PCRS); self and family rating of the Frontal Systems Behavioral Scale (FrSBe), and the Neurobehavioral Rating Scale-Revised (NRS-R).
  
  
  RESULTS
  Hierarchical linear modeling revealed that SUD history significantly predicted trajectories of PCRS clinician ratings, PCRS self-family and PCRS self-clinician discrepancy scores, and more negative FrSBE family ratings. These findings indicate comparatively greater post-injury executive functions (EF) impairments, particularly self-awareness (SA) of injury-related deficits, for those with SUD history. No significant SUD*time interaction effect was found for FIM or NRS-R scores.
  
  
  CONCLUSIONS
  SUD history and TBI are associated with impaired SA and EF but their co-occurrence is not a consistent predictor of acute post-injury functional outcomes. Pre-morbid patient characteristics and rater expectations and biases may moderate associations between SA and recovery after TBI.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Janet P
authors.initials: JP
authors.lastname: Niemeier
authors.affiliation: Department of Neuropsychology, Carolinas Rehabilitation, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Shelley L
authors.initials: SL
authors.lastname: Leininger
authors.affiliation: Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Marybeth P
authors.initials: MP
authors.lastname: Whitney
authors.affiliation: Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Newman
authors.affiliation: Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hirsch
authors.affiliation: Department of Trauma Surgery, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Evans
authors.affiliation: Department of Trauma Surgery, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
authors.affiliation: Department of Trauma Surgery, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Toan T
authors.initials: TT
authors.lastname: Huynh
authors.affiliation: Department of Neuropsychology, Carolinas Rehabilitation, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Tami P
authors.initials: TP
authors.lastname: Guerrier
authors.affiliation: Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Perrin
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation*; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000534:rehabilitation*; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Traumatic brain injury; rehabilitation; substance use disorder