Journal of Rehabilitation Research & Development (JRRD)

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Volume 51 Number 7, 2014
   Pages 1057 — 1068

Abstract — Changes in cognition and continence as predictors of rehabilitation outcomes in individuals with severe traumatic brain injury

David S. Kushner, MD;* Doug Johnson-Greene, PhD

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL

Abstract — The study objective was to examine postacute changes in bowel and bladder continence and cognition after severe traumatic brain injury (TBI) in persons with long-term functional recovery to full independence. This case series included nine patients initially admitted to inpatient rehabilitation (IR) with severe TBI who had returned to prior responsibilities and functional independence by 8 to 15 mo. Patients had initial Glasgow Coma Scale scores of 3 to 6, posttraumatic amnesia durations of 18 to 70 d, time-to-follow-commands of 16 to 56 d, initial abnormal brain computed tomography scans, and initial pupil abnormalities. IR Functional Independence Measure (FIM) cognitive and sphincter score improvements were compared with national TBI FIM data from Uniform Data Systems for Medical Rehabilitation (UDSMR) for 2010 (n = 16,368). All patients had IR improvements in cognitive and sphincter FIM scores approximately twice the national UDSMR data for 2010. All patients had combined IR discharge sphincter FIM scores that were 12 or greater, indicating independence to modified independence with bowel and bladder function with no incontinence. Five participants (55%) were admitted to IR with sphincter FIM scores of 11 to 12, indicating recovery of continence during acute care. These findings suggest potential usefulness of IR cognitive FIM score changes and of the recovery of bowel and bladder continence for predicting favorable functional outcomes following severe TBI.

Key words: fecal incontinence, Functional Independence Measure score, outcomes assessment, postacute change, prediction, prognosis, rehabilitation, TBI, traumatic brain injury, urinary incontinence.


View HTML ¦ View PDF ¦ Contents Vol. 51, No.7

This article and any supplementary material should be cited as follows:
Kushner DS, Johnson-Greene D. Changes in cognition and continence as predictors of rehabilitation outcomes in individuals with severe traumatic brain injury. J Rehabil Res Dev. 2014;51(7):1057–68.
http://dx.doi.org/10.1682/JRRD.2014.01.0002
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Last Reviewed or Updated  Thursday, November 13, 2014 12:47 PM

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