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Vulnerability to disability following traumatic brain injury (TBI)
Abstracts from the 19th Annual Meeting
791
tionalized in the consensus statement from the 1997 Aspen Neurobehavioral Conference on Assessment, Prognosis and Treatment of Vegetative and Minimally Conscious States. The purpose of this study was to investigate severity of brain injury as operationalized as return to consciousness in predicting change in cognitive functioning. For this study, the Coma Recovery Scale (CRS) was used to assess recovery of consciousness from severe brain injury. The CRS is a standardized neurobehavioral exam that quantifies responsiveness during recovery after brain injury. The CRS was developed to assess the presence or absence of four to five responses in six modalities. These modalities are auditory, visual, motor, oromotor, communication, and arousal. Change in cognitive functioning was measured by change in the cognitive subscale of the Functional Independence Measure (FIM) from admission to discharge from rehabilitation. Twenty-five minimally responsive individuals (56 % male; M age = 38.5 years; age range, 14-89) were administered the CRS weekly during their rehabilitation stay until they had emerged from a minimally conscious state or were discharged. Individuals in the study had sustained traumatic brain injury (72%), stroke (24%), or hypoxic episode (4%). To reduce the number of predictor variables, a principal component analysis was performed on the times to responsiveness for the CRS subscales. The first factor accounted for 88% of the variance in time to responsiveness. Logistic regression analysis was used to predict change or no change in cognitive functioning as measured by the FIM. The responsiveness factor accounted for 60% of the variability in change in FIM score (p < 0.01) and correctly classified 22 (88%) individuals. Inspection of factor weights indicated time to object recognition was the highest loading on the responsiveness factor. Future research should investigate the importance of this milestone in recovery of consciousness from brain injury.
MacMillan, P. J., Martelli, M. F., & Zasler, N. D. Vulnerability to Disability Following Traumatic Brain Injury (TBI). There are an estimated 2 million TBIs each year in the United States and psychosocial and neurobehavioral impairments, versus physical ones, are the most disabling consequences. There is a great deal of individual variability in outcome following TBI that is poorly understood. To date, most studies of outcome have focused on the effect of postinjury variables. These studies have generally employed gross measures of physical and cognitive status versus quality of life and adaptation and have excluded persons with psychiatric and substance abuse histories. However, there is increasing appreciation that these and other preinjury characteristics, such as coping history, may mediate the variability with regard to outcomes (see Martelli, Zasler, & MacMillan, NeuroRehabilitation: An Interdisciplinary Journal, ll(a), 51-66, for a review and initial support for a vulnerability model of adjustment following TBI). In the present study, 45 adults at least 2 years postmoderate or severe TBI were evaluated. Preinjury psychiatric history and substance abuse history, in addition to social support following injury were measured to test the hypothesis that persons with more severe premorbid psychiatric and substance abuse histories as well as less social support following brain injury would demonstrate poorer adaptation following injury. Findings revealed that preinjury psychiatric and substance abuse history predicted employment status, ×2(2) (N = 45) = 25.3, p < .001. That is, 19 of 23 low vulnerability subjects were working versus only 2 of 20 high vulnerability subjects. Preinjury substance abuse history was also found to predict independent living status. Social support following TBI, however, only predicted significant others' rating of subject neurobehavioral status, and none of the independent variables were found to predict subject self assessment of neurobehavioral functioning. The present findings are interpreted to provide strong support for a vulnerability mode of adaptation following TBI.
791
tionalized in the consensus statement from the 1997 Aspen Neurobehavioral Conference on Assessment, Prognosis and Treatment of Vegetative and Minimally Conscious States. The purpose of this study was to investigate severity of brain injury as operationalized as return to consciousness in predicting change in cognitive functioning. For this study, the Coma Recovery Scale (CRS) was used to assess recovery of consciousness from severe brain injury. The CRS is a standardized neurobehavioral exam that quantifies responsiveness during recovery after brain injury. The CRS was developed to assess the presence or absence of four to five responses in six modalities. These modalities are auditory, visual, motor, oromotor, communication, and arousal. Change in cognitive functioning was measured by change in the cognitive subscale of the Functional Independence Measure (FIM) from admission to discharge from rehabilitation. Twenty-five minimally responsive individuals (56 % male; M age = 38.5 years; age range, 14-89) were administered the CRS weekly during their rehabilitation stay until they had emerged from a minimally conscious state or were discharged. Individuals in the study had sustained traumatic brain injury (72%), stroke (24%), or hypoxic episode (4%). To reduce the number of predictor variables, a principal component analysis was performed on the times to responsiveness for the CRS subscales. The first factor accounted for 88% of the variance in time to responsiveness. Logistic regression analysis was used to predict change or no change in cognitive functioning as measured by the FIM. The responsiveness factor accounted for 60% of the variability in change in FIM score (p < 0.01) and correctly classified 22 (88%) individuals. Inspection of factor weights indicated time to object recognition was the highest loading on the responsiveness factor. Future research should investigate the importance of this milestone in recovery of consciousness from brain injury.
MacMillan, P. J., Martelli, M. F., & Zasler, N. D. Vulnerability to Disability Following Traumatic Brain Injury (TBI). There are an estimated 2 million TBIs each year in the United States and psychosocial and neurobehavioral impairments, versus physical ones, are the most disabling consequences. There is a great deal of individual variability in outcome following TBI that is poorly understood. To date, most studies of outcome have focused on the effect of postinjury variables. These studies have generally employed gross measures of physical and cognitive status versus quality of life and adaptation and have excluded persons with psychiatric and substance abuse histories. However, there is increasing appreciation that these and other preinjury characteristics, such as coping history, may mediate the variability with regard to outcomes (see Martelli, Zasler, & MacMillan, NeuroRehabilitation: An Interdisciplinary Journal, ll(a), 51-66, for a review and initial support for a vulnerability model of adjustment following TBI). In the present study, 45 adults at least 2 years postmoderate or severe TBI were evaluated. Preinjury psychiatric history and substance abuse history, in addition to social support following injury were measured to test the hypothesis that persons with more severe premorbid psychiatric and substance abuse histories as well as less social support following brain injury would demonstrate poorer adaptation following injury. Findings revealed that preinjury psychiatric and substance abuse history predicted employment status, ×2(2) (N = 45) = 25.3, p < .001. That is, 19 of 23 low vulnerability subjects were working versus only 2 of 20 high vulnerability subjects. Preinjury substance abuse history was also found to predict independent living status. Social support following TBI, however, only predicted significant others' rating of subject neurobehavioral status, and none of the independent variables were found to predict subject self assessment of neurobehavioral functioning. The present findings are interpreted to provide strong support for a vulnerability mode of adaptation following TBI.