Journal
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Volume 94, Issue 10, Pages 1861-1869Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.apmr.2013.05.027
Keywords
Brain injuries; Consciousness disorders; Executive function; Outcome assessment (health care); Rehabilitation
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Funding
- Veterans Affairs Health Services Research and Development/Rehabilitation Research and Development Center of Excellence for Maximizing Rehabilitation Outcomes [COE-HFP 09-156]
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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 noncombat-related brain injury and disorder of consciousness (DOC) at the time of rehabilitation admission. Design: Retrospective study. Setting: Rehabilitation center. Participants: From January 2004 to October 2009, persons (N=1654) were admitted to the Polytrauma Rehabilitation System of Care. This study focused on the N=122 persons admitted with a DOC. Participants with a DOC were primarily men (96%), on active duty (82%), >= 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 Glasgow Coma Scale score was 3, and rehabilitation admission Glasgow Coma Scale score was 8. Individuals were admitted for acute neurorehabilitation approximately 51 days postinjury with a median rehabilitation length of stay of 132 days. Interventions: None. Main Outcome Measures: Recovery of consciousness and the FIM instrument. Results: Most participants emerged to regain consciousness during neurorehabilitation (64%). Average gains +/- SD on the FIM cognitive and motor subscales were 19 +/- 25 and 7 +/- 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. Conclusions: Despite complex comorbidities, optimistic outcomes were observed. Individuals with severe head injury because of blast-related etiologies have different outcomes 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. (c) 2013 by the American Congress of Rehabilitation Medicine
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