Article

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.
DESIGN: Retrospective study. SETTING: Rehabilitation center. 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%), >/=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. INTERVENTIONS: None. MAIN
OUTCOME MEASURES: Recovery of consciousness and the FIM instrument. 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. 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.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS