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

Abstract

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.

Photobiomodulation using low-level laser therapy (LLLT) for patients with chronic traumatic brain injury: a randomized controlled trial study protocol

“…Traumatic brain injury (TBI) is one of the main problems in the public health system due to its magnitude and clinical and social consequences [ 1 ]. It is the main cause of disability in young adults, with an estimated 2 million visits to emergency services in the United States in 2009 [ 2 ].…”

Interplay Between Cognitive and Bowel/Bladder Function in Multiple Sclerosis

“…Specifically, attention and information processing speed are essential in integrating the awareness of bowel and bladder filling and the possibility/impossibility of voiding depending on the context. Strengthening the concept of cognitive voiding, it has been demonstrated that cognitive rehabilitation programs aimed at reinforcing dual task abilities and attention focus are also able to improve bowel/bladder function [ 26 , 27 ].…”

Recovery of a Patient from a Seemingly Vegetative State

“…Another series of 9 patients with severe TBI and initial glascow coma scale scores 3-6, reported full functional recovery of all nine patients by 8 to 15 months. They received outpatient rehabilitation from 3 to 9 months, the details of which are not specified [3,4].…”