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NeuroRehabilitation. 2016 Apr 6;38(4):371-83. doi: 10.3233/NRE-161328.

Does history of substance use disorder predict acute traumatic brain injury rehabilitation outcomes?

Author information

1
Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC, USA.
2
Department of Neuropsychology, Carolinas Rehabilitation, Carolinas Medical Center, Charlotte, NC, USA.
3
Department of Trauma Surgery, Carolinas Medical Center, Charlotte, NC, USA.
4
Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.

Abstract

BACKGROUND/OBJECTIVE:

The study explored whether premorbid substance use disorder (SUD) predicts acute traumatic brain injury (TBI) outcomes.

METHODS:

143 participants with moderate (34.2%) and severe (65.8%) TBI were enrolled at two Level 1 trauma center inpatient brain injury rehabilitation units. Acute outcomes were measured with the Disability Rating Scale (DRS), the FIMTM; self and informant ratings of the Patient Competency Rating Scale (PCRS); self and family rating of the Frontal Systems Behavioral Scale (FrSBe), and the Neurobehavioral Rating Scale-Revised (NRS-R).

RESULTS:

Hierarchical linear modeling revealed that SUD history significantly predicted trajectories of PCRS clinician ratings, PCRS self-family and PCRS self-clinician discrepancy scores, and more negative FrSBE family ratings. These findings indicate comparatively greater post-injury executive functions (EF) impairments, particularly self-awareness (SA) of injury-related deficits, for those with SUD history. No significant SUD*time interaction effect was found for FIM or NRS-R scores.

CONCLUSIONS:

SUD history and TBI are associated with impaired SA and EF but their co-occurrence is not a consistent predictor of acute post-injury functional outcomes. Pre-morbid patient characteristics and rater expectations and biases may moderate associations between SA and recovery after TBI.

KEYWORDS:

Traumatic brain injury; rehabilitation; substance use disorder

PMID:
27061165
DOI:
10.3233/NRE-161328
[Indexed for MEDLINE]

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