Citation

Nakase-Richardson R, McNamee S, Howe LL, Massengale J, Peterson M, Barnett SD, Harris O, McCarthy M, Tran J, Scott S, Cifu DX. Arch. Phys. Med. Rehabil. 2013; 94(10): 1861-1869.

Affiliation

Mental Health and Behavioral Science Service, James A. Haley Veterans Hospital Tampa, Florida; Department of Psychology, University of South Florida Tampa, Florida; Center of Excellence for Maximizing Rehabilitation Outcomes Tampa, Florida. Electronic address: Risa.Richardson@va.gov.

Copyright

(Copyright © 2013, Elsevier Publishing)

DOI

10.1016/j.apmr.2013.05.027

PMID

23810353

Abstract

OBJECTIVE: To report the injury and demographic characteristics, medical course, and rehabilitation outcome for a consecutive series of veterans and active duty military personnel with combat and non-combat related brain injury and disorder of consciousness at time of rehabilitation admission. DESIGN: Retrospective Study. SETTING: VHA Polytrauma Rehabilitation Center's Emerging Consciousness Program (ECP). PARTICIPANTS: From Janauary of 2004 to October of 2009, N=1654 persons were admitted to the Polytrauma Rehabilitation System of Care. This study focused on the N=122 persons admitted with a disorder of consciousness (DOC). Participants with DOC were primarily male (96%), active duty (82%), with ≥ 12 years of education, and a median age of 25. Brain injury etiologies included mixed blast trauma (24%), penetrating (8%), other trauma (56%), and nontrauma (13%). Median initial GCS was 3 and rehabilitation admission GCS was 8. Individuals were admitted for acute neurorehabilitation approximately 51 days post injury with a median rehabilitation length of stay of 132 days. INTERVENTION: None MAIN OUTCOME MEASURES: Recovery of consciousness. Functional Independence Measure. RESULTS: A majority of participants emerged to regain consciousness during neurorehabilitation (64%). Average gains on the Functional Independence Measure Cognitive and Motor subscales were 19 (SD 25) and 7 (SD 8) respectively. Common medical complications included spasticity (70%), dysautonomia (34%), seizure occurrence (30%), and intracranial infection (22%). Differential outcomes were observed across etiologies particularly for those with blast-related brain-injury etiology. CONCLUSION: Despite complex comorbidities, optimistic outcomes were observed. Individuals with severe head injury due to blast-related etiologies have different oucomes and comorbidities observed. Health-services research with a focus on prevention of comorbidities is needed to inform optimal models of care particularly for combat-injured soldiers with blast-related injuries.

Language: en