Posttraumatic Confusion Predicts Patient Cooperation During Traumatic Brain Injury Rehabilitation

Abstract

Scant research has examined the relationship between posttraumatic confusion (PTC) and cooperation during rehabilitation from moderate to severe traumatic brain injury. In this study, PTC and cooperation were examined in a prospective cohort of 74 inpatients with traumatic Brain Injury. Confusion was measured using the Confusion Assessment Protocol. Cooperation was rated on a 0-100 scale by rehabilitation therapists. Using multiple regression analysis, PTC significantly predicted cooperation (R(2) = 0.33, P < 0.001). Age at injury, education, days since injury, and Glasgow Come Scale scores were not significant predictors. Bivariate analyses indicated that four PTC symptoms significantly predicted poorer cooperation: daytime hypersomnolence (ρ = -0.42, P < 0.001), agitation (ρ = -0.39, P = 0.001), psychosis (ρ = -0.39, P = 0.001), and cognitive impairment (ρ = -0.24, P = 0.04). Results provide empirical support that PTC is associated with poorer cooperation and empirical justification for interventions to manage confusion during early recovery from traumatic brain injury.

Cognitive impairment, clinical symptoms and functional disability in patients emerging from the minimally conscious state

“…A growing body of literature focused on describing PTCS with a standardized assessment tool, the Confusion Assessment Protocol (CAP), (Sherer et al, 2005) has allowed clinicians and researchers to reliably and comprehensively assess this phase of recovery. Several studies have identified the confusional state as a prognostic indicator for poor cooperation during rehabilitation (Silva et al, 2012) and decreased productivity and employment at 1 year after TBI (Nakase-Richardson, Yablon, & Sherer, 2007;Sherer, Yablon, & Nick, 2013).…”

Comparison of Diagnostic Sleep Studies in Hospitalized Neurorehabilitation Patients With Moderate to Severe Traumatic Brain Injury

“…3 Sleep disturbance also challenges early TBI rehabilitation efforts because of daytime sleepiness and reduced benefit from rehabilitation. 4 Given that sleep disturbance is also a risk factor for the development of other medical disorders [5][6][7][8][9][10] and has the potential to impact long-term morbidity, early detection and treatment of sleep disorders are needed. 1,[11][12][13][14][15][16] Despite increasing awareness of high rates of OSA among individuals with TBI and the potential for negative impact, early assessment with gold standard sleep diagnostic methods (level 1 polysomnography [PSG]) is rarely conducted with hospitalized patients, given funding constraints, access to qualified personnel, short lengths of stay, and behavioral impediments to cooperating with the study.…”

Predictors of Agitated Behavior During Inpatient Rehabilitation for Traumatic Brain Injury

“…1,2 When present, agitation can be distressing for the patient, family, and staff, elevating the risk of injury to self and others and posing a significant barrier to participation in rehabilitation. [3][4][5][6][7] Unfortunately, few wellcontrolled interventional studies are currently available to guide the management of agitation. 8,9 Despite the weak evidence base, pharmacologic interventions are being used to manage agitation both directly and indirectly.…”