Functional Outcomes in Traumatic Disorders of Consciousness: 5-Year Outcomes From the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems

Whyte, John; Nakase‐Richardson, Risa; Hammond, Flora M.; McNamee, Shane; Giacino, Joseph T.; Kalmar, Kathleen; Greenwald, Brian D.; Yablon, Stuart A.; Horn, Lawrence J.

doi:10.1016/j.apmr.2012.10.041

Cited by 116 publications

(99 citation statements)

References 12 publications

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“…Many of the individuals classified as non-command following at the time for rehabilitation admission progressed as expected to a higher level of function prior to discharge. 32,33 The medical status of the non-command following is highly complex. There are many reasons why an individual may lack command following after TBI (e.g., concurrent anoxic insult, impaired arousal, apraxia, and aphasia).…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Mortality following Traumatic Brain Injury among Individuals Unable to Follow Commands at the Time of Rehabilitation Admission: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study

Greenwald

Hammond

Harrison-Felix

et al. 2015

Journal of Neurotrauma

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Severe traumatic brain injury (TBI) has been associated with increased mortality. This study characterizes long-term mortality, life expectancy, causes of death and risk factors for death among patients admitted within the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems Programs (TBIMS) who lack command following at the time of admission for inpatient TBI rehabilitation. Of the 8,084persons enrolled from 1988 and 2009, 387 from 20 centers met study criteria.Individuals with moderate to severe TBI who received inpatient rehabilitation were 2.2 times more likely to die than individuals in the U.S. general population of similar age, gender and race, with an average life expectancy (LE) reduction of 6.6 years. The subset of individuals who were unable to follow commands on admission to rehabilitation were 6.9 times more likely to die, with an average LE reduction of 12.2 years. Relative to the US general population matched for age, gender and race/ethnicity, these non-command following individuals were over 4 times more likely to die of circulatory conditions, 44 times more likely to die of pneumonia and 38 times more likely to die of aspiration pneumonia. The subset of individuals with TBI who are unable to follow commands upon admission to inpatient rehabilitation are at a significantly increased risk of death when compared to the US general population, and compared to all individuals with moderate to severe TBI receiving inpatient rehabilitation. Respiratory causes of death predominate compared to the general population.

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Section: Study Strengths and Limitationsmentioning

confidence: 99%

Mortality following Traumatic Brain Injury among Individuals Unable to Follow Commands at the Time of Rehabilitation Admission: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study

Greenwald

Hammond

Harrison-Felix

et al. 2015

Journal of Neurotrauma

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“…33 However, the point at which connectivity profiles are stabilized has yet to be identified, and it is plausible that connectivity alterations evident early after injury might endure beyond a critical early window of clinical recovery, typically regarded as the first year postinjury. [34][35][36][37] In the present investigation, we probed longitudinal connectivity changes in a subset of individuals from our TBI group, comparing connectivity profiles derived from rs-fMRI in the subacute phase (approximately 3 months postinjury) to those in the chronic phase. Our aim was to outline the developmental trajectory of any identified changes between the TBI and HC groups, as well as to examine whether functional connectivity changes during the chronic phase are gradually evolving phenomena or if they are relatively more immediate effects of brain injury.…”

mentioning

confidence: 99%

Chronology and Chronicity of Altered Resting-State Functional Connectivity after Traumatic Brain Injury

Venkatesan

Dennis

Hillary

2015

Journal of Neurotrauma

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Whereas traumatic brain injury (TBI) results in widespread disruption of neural networks, changes in regional resting-state functional connectivity patterns after insult remain unclear. Specifically, little is known about the chronology of emergent connectivity alterations and whether they persist after a critical recovery window. We used resting-state functional magnetic resonance imaging and seed-voxel correlational analyses in both cross-sectional and longitudinal designs to probe intrinsic connectivity patterns involving the posterior cingulate cortex (PCC) and hippocampi, regions shown to be important in the default mode network (DMN) and vulnerable to neuropathology. A total of 22 participants in the chronic stage of moderateto-severe TBI and 18 healthy controls were included for cross-sectional study. Longitudinal analyses included 13 individuals in the TBI group for whom data approximately 3 months after injury (subacute) were available. Overall, results indicated dissociable connectivity trajectories of the PCC and hippocampi during recovery from TBI, with PCC alterations characterized by early hypersynchrony with the anterior DMN that is gradually reduced, and hippocampal changes marked by increasing synchrony with proximal cortex and subcortex. The PCC also showed increasing antiphase synchrony with posterior attentional regions, and the hippocampi showed decreasing antiphase synchrony with frontal attentional regions. Antiphase synchrony of the hippocampus and dorsolateral prefrontal cortex at the subacute stage of TBI was positively associated with attentional performance on neuropsychological tests at both the subacute and chronic stages. Our findings highlight the heterogeneity of regional whole-brain connectivity changes after TBI, and suggest that residual connectivity alterations exist in the clinically stable phase of TBI. Parallels between the chronicity of the observed effects and findings in neurodegenerative disease are discussed in the context of potential long-term outcomes of TBI.

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“…10 Furthermore, clinically meaningful change in NBF may have prognostic value by quantifying the likelihood and magnitude of long-term functional recovery. 4,20 In addition, such information is important for research planning. For example, computing sample size for a clinical trial requires an estimate of the size of the treatment effect that might be reasonable, meaningful, and clinically relevant.…”

Section: S Evere Acquired Brain Injury (Bi) Ismentioning

confidence: 99%

“…1 While some persons recover full consciousness quickly, others evolve into vegetative (VS) or minimally conscious states (MCS), which may be transient or prolonged conditions. [2][3][4] Neurorehabilitation for persons in states of severely impaired consciousness (SIC) focuses on optimizing recovery through clinical management [5][6][7][8][9] and on the provision of therapeutic rehabilitation interventions. 10 The current standard for evaluating change in neurobehavioral function (NBF) is via clinical observation of behavior in response to sensory stimuli, 9,11 although measures of neural responsivity that may detect prebehavioral changes are being examined for reliability (eg, functional imaging, P300, positron emission tomography, electroencephalography).…”

Section: S Evere Acquired Brain Injury (Bi) Ismentioning

confidence: 99%

Responsiveness, Minimal Detectable Change, and Minimally Clinically Important Differences for the Disorders of Consciousness Scale

Mallinson

Pape

Guernon

2016

Journal of Head Trauma Rehabilitation

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The DOCS-25 is a responsive, clinician-observed assessment tool for capturing change in neurobehavioral function in adults recovering from severe TBI. This is the first study to provide evidence for the size of neurobehavioral function change that might indicate meaningful recovery in patients with severe TBI. Results from this study may support future research by better informing sample size calculations for clinical trials and also assist clinicians in identifying when variation in level of consciousness is consequential enough to warrant changes in intervention.

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Functional Outcomes in Traumatic Disorders of Consciousness: 5-Year Outcomes From the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems

Cited by 116 publications

References 12 publications

Mortality following Traumatic Brain Injury among Individuals Unable to Follow Commands at the Time of Rehabilitation Admission: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study

Mortality following Traumatic Brain Injury among Individuals Unable to Follow Commands at the Time of Rehabilitation Admission: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study

Chronology and Chronicity of Altered Resting-State Functional Connectivity after Traumatic Brain Injury

Responsiveness, Minimal Detectable Change, and Minimally Clinically Important Differences for the Disorders of Consciousness Scale

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