Recovery of Impairments After Severe Traumatic Brain Injury: Findings From a Prospective, Multicentre Study

Abstract

This study aimed to describe the recovery of impairments after severe traumatic brain injury (TBI) over a 3-year period. An inception cohort over 2 years was recruited from 11 brain injury rehabilitation units participating in a state-wide program. The 131 individuals with TBI were assessed at admission to the rehabilitation program, 18 months and 3 years post-trauma. This report described results from the Disability Rating Scale (DRS) and Mayo-Portland Adaptability Index (MPAI). Regression analyses, examining the influence of five acute injury variables on DRS and MPAI, revealed that posttraumatic amnesia (PTA) was a significant individual predictor. Data were thus analysed according to duration of PTA: 1 to 2 weeks (n= 19), 2 to 4 weeks (n= 44) and more than 4 weeks (n= 68). At program admission there was poorer overall level of functioning on the DRS in the longest PTA group, but no difference between the shorter PTA groups. Significant improvements occurred on the DRS for all PTA groups over the first 18 months posttrauma, with improvements continuing between 18 months and 3 years. At the 3-year follow-up, frequency data from the MPAI indicated that clinically significant impairments in mobility, hand function, communication and behaviour were uncommon in the shorter PTA groups, although 36% to 47% continued to experience cognitive impairments. Impairments were common in the longest PTA group in some areas, particularly cognition where two thirds or more continued to experience clinically significant impairments in attention, memory and novel problem-solving. These results confirm the predictive significance of PTA duration regarding longer-term level of recovery. They also highlight the limitation in classifying the ‘severe’ TBI category as an homogenous group: significant subgroup differences occurred on medical and functional variables at program admission, 18 months and 3 years posttrauma. These data further substantiate the persistence of neuropsychological impairments in the face of good physical recovery at all levels of severity within the severe TBI group.

The influence of attention and arousal on emotion perception in adults with severe traumatic brain injury

“…This finding is consistent with the high prevalence rates for apathy (43-78%) in people with severe TBI (Kant et al, 1998;Lane-Brown and Tate, 2009;Oddy et al, 1985) with clinically significant degrees of apathy occurring in 15% at 18 months post-trauma (Tate et al, 2006). Apathy is evidenced by lowering of arousal and motivation resulting in difficulties maintaining initiative, low spontaneity and cognitive flexibility (Kinsella et al, 1991;Tate, 1999).…”

“I’ve never been a yes person”: Decision-making participation and self-conceptualization after severe traumatic brain injury

“…Individuals who have sustained TBI frequently experience changes in their physical, cognitive, behavioral, emotional, and/or psychosocial functioning, leading to longer-term disability. [16][17][18] Decision-making impairment is a common neurobehavioral consequence of severe TBI. [19] Decision-making difficulties primarily relate to damage to the prefrontal areas and frontal systems, which are particularly vulnerable to injury in TBI.…”

Rehabilitation after traumatic brain injury : an Australian context

“…aphasia or visuo consuctive functions Tate et al, 1991 . More recently, our research team has replicated this pattern, using a statewide cohort n 131 from 11 brain injury rehabilitation units Tate et al, 2006 . Patients were assessed at rehabilitation admission with the Mayo Portland Adaptability Inventory MPAI Malec & Lezak, 2003 .…”