Co-Occurring Traumatic Brain Injury and Acute Spinal Cord Injury Rehabilitation Outcomes

Macciocchi S, Seel RT, Warshowsky A, Thompson N, Barlow K. Co-occurring traumatic brain injury and acute spinal cord injury rehabilitation outcomes. Arch Phys Med Rehabil 2012;93:1788-94. Objective: To determine the impact of co-occurring traumatic brain injury (TBI) on functional motor outcome and cognition during acute spinal cord injury (SCI) rehabilitation. Design: Prospective, longitudinal cohort. Setting: Single-center National Institute of Disability and Rehabilitation Research SCI Model System. Participants: Persons aged 16 to 59 years (N = 189) admitted for acute SCI rehabilitation during the 18-month recruitment window who met inclusion criteria. Interventions: Not applicable. Main Outcome Measures: FIM Motor Scale (Rasch transformed) and acute rehabilitation length of stay (LOS). Results: In the tetraplegia sample, co-occurring TBI was not related to FIM Motor Scale scores or acute rehabilitation LOS despite having negative impacts on memory and problem solving. Persons with paraplegia who sustained co-occurring severe TBI had lower admission and discharge FIM Motor Scale scores and longer acute rehabilitation LOS than did persons with paraplegia and either no TBI or mild TBI. Persons with paraplegia and severe TBI had lower functional comprehension, problem solving, and memory and impairments on tests of processing speed compared with persons with paraplegia and no TBI, mild TBI, and moderate TBI. Persons with paraplegia and co-occurring mild and moderate TBI had equivalent acute rehabilitation motor outcomes and cognitive functioning compared with persons with paraplegia and no TBI. Conclusions: This study provides evidence that persons aged 16 to 59 years with paraplegia and co-occurring severe TBI had worse motor outcomes and longer acute rehabilitation LOS than did persons with paraplegia and no TBI. Impairments in processing speed, comprehension, memory, and problem solving may explain suboptimal motor skill acquisition. Research with larger samples is required to determine whether mild and moderate TBI impact acute rehabilitation motor outcomes and LOS.