Co-occurring traumatic brain injury and acute spinal cord injury rehabilitation outcomes.

OBJECTIVE: To determine the impact of co-occurring traumatic brain injury (TBI) on functional motor outcome and cognition during acute spinal cord injury (SCI) rehabilitation. DESIGN: Prospective, longitudinal cohort. SETTING: Single-center National Institute of Disability and Rehabilitation Research SCI Model System. PARTICIPANTS: Persons aged 16 to 59 years (N=189) admitted for acute SCI rehabilitation during the 18-month recruitment window who met inclusion criteria. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM Motor Scale (Rasch transformed) and acute rehabilitation length of stay (LOS). RESULTS: In the tetraplegia sample, co-occurring TBI was not related to FIM Motor Scale scores or acute rehabilitation LOS despite having negative impacts on memory and problem solving. Persons with paraplegia who sustained co-occurring severe TBI had lower admission and discharge FIM Motor Scale scores and longer acute rehabilitation LOS than did persons with paraplegia and either no TBI or mild TBI. Persons with paraplegia and severe TBI had lower functional comprehension, problem solving, and memory and impairments on tests of processing speed compared with persons with paraplegia and no TBI, mild TBI, and moderate TBI. Persons with paraplegia and co-occurring mild and moderate TBI had equivalent acute rehabilitation motor outcomes and cognitive functioning compared with persons with paraplegia and no TBI. CONCLUSIONS: This study provides evidence that persons aged 16 to 59 years with paraplegia and co-occurring severe TBI had worse motor outcomes and longer acute rehabilitation LOS than did persons with paraplegia and no TBI. Impairments in processing speed, comprehension, memory, and problem solving may explain suboptimal motor skill acquisition. Research with larger samples is required to determine whether mild and moderate TBI impact acute rehabilitation motor outcomes and LOS.

The relationship between employment-related self-efficacy and quality of life following traumatic brain injury.

OBJECTIVES: This study examines the relative contribution of employment-related and general self-efficacy to perceptions of quality of life (QoL) for individuals with traumatic brain injury. DESIGN: Correlational. SETTING: Community-based research and training center. PARTICIPANTS: 427 individuals with self-reported TBI under the age of 65 were included in analysis. MAIN OUTCOME MEASURE: Employment-related self-efficacy, general self-efficacy, perceived quality of life (PQoL), unmet important needs (UIN). RESULTS: Significant correlations were found between income, injury severity, age at injury, and employment and the QoL variables. In addition, employment-related and general self-efficacy correlated positively with both PQoL and UIN. Employment-related and general self-efficacy accounted for 16% of the variance in PQoL and 9.5% of the variance in UIN, over and above other variables traditionally associated with QoL. CONCLUSIONS: These findings highlight the importance of including subjective appraisals of employment, such as perceived self-efficacy at the workplace, in assessing QoL and successful return to work following TBI.