Descriptive Characteristics and Rehabilitation Outcomes in Active Duty Military Personnel and Veterans With Disorders of Consciousness With Combat- and Noncombat-Related Brain Injury

作者：Nakase Richardson Risa^*; McNamee Shane; Howe Laura L; Massengale Jill; Peterson Michelle; Barnett Scott D; Harris Odette; McCarthy Marissa; Tran Johanna; Scott Steven; Cifu David X

来源：Archives of Physical Medicine and Rehabilitation, 2013, 94(10): 1861-1869.

DOI：10.1016/j.apmr.2013.05.027

• Brain injuries
• Consciousness disorders
• Executive function
• Outcome assessment (health care)
• Rehabilitation

Objective: To report the injury and demographic characteristics, medical course, and rehabilitation outcome for a consecutive series of veterans and active duty military personnel with combat- and noncombat-related brain injury and disorder of consciousness (DOC) at the time of rehabilitation admission. %26lt;br%26gt;Design: Retrospective study. %26lt;br%26gt;Setting: Rehabilitation center. %26lt;br%26gt;Participants: From January 2004 to October 2009, persons (N=1654) were admitted to the Polytrauma Rehabilitation System of Care. This study focused on the N=122 persons admitted with a DOC. Participants with a DOC were primarily men (96%), on active duty (82%), %26gt;= 12 years of education, and a median age of 25. Brain injury etiologies included mixed blast trauma (24%), penetrating (8%), other trauma (56%), and nontrauma (13%). Median initial Glasgow Coma Scale score was 3, and rehabilitation admission Glasgow Coma Scale score was 8. Individuals were admitted for acute neurorehabilitation approximately 51 days postinjury with a median rehabilitation length of stay of 132 days. %26lt;br%26gt;Interventions: None. %26lt;br%26gt;Main Outcome Measures: Recovery of consciousness and the FIM instrument. %26lt;br%26gt;Results: Most participants emerged to regain consciousness during neurorehabilitation (64%). Average gains +/- SD on the FIM cognitive and motor subscales were 19 +/- 25 and 7 +/- 8, respectively. Common medical complications included spasticity (70%), dysautonomia (34%), seizure occurrence (30%), and intracranial infection (22%). Differential outcomes were observed across etiologies, particularly for those with blast-related brain injury etiology. %26lt;br%26gt;Conclusions: Despite complex comorbidities, optimistic outcomes were observed. Individuals with severe head injury because of blast-related etiologies have different outcomes and comorbidities observed. Health-services research with a focus on prevention of comorbidities is needed to inform optimal models of care, particularly for combat injured soldiers with blast-related injuries.

• 出版日期2013-10