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J Neurotrauma. 2019 Apr 1;36(7):1136-1146. doi: 10.1089/neu.2018.5954. Epub 2018 Oct 19.

Disorders of Consciousness due to Traumatic Brain Injury: Functional Status Ten Years Post-Injury.

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1 Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana.
2 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.
3 Health Services Research and Development Service, Center of Innovation for Disability and Rehabilitation Research, and Defense and Veterans Brain Injury Center, James A. Haley Veterans Hospital, University of South Florida, Tampa, Florida.
4 College of Medicine, University of South Florida, Tampa, Florida.
5 TIRR Memorial Hermann, Houston, Texas.
6 Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.
7 Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania.
8 Departments of Neurology and Psychiatry, Center for Mental Health, Marcus Institute for Brain Health, University of Colorado School of Medicine, Gunnison, Colorado.
9 Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.


Few studies have assessed the long-term functional outcomes of patients with a disorder of consciousness due to traumatic brain injury (TBI). This study examined functional status during the first 10 years after TBI among a cohort with disorders of consciousness (i.e., coma, vegetative state, minimally conscious state). The study sample included 110 individuals with TBI who were unable to follow commands prior to inpatient rehabilitation and for whom follow-up data were available at 1, 2, 5, and 10 years post-injury. The sample was subdivided into those who demonstrated command-following early (before 28 days post-injury) versus late (≥ 28 days post-injury or never). Functional Independence Measure (FIM) at 1, 2, 5, and 10 years following TBI was used to measure functional outcomes. Measureable functional recovery occurred throughout the 10-year period, with more than two thirds of the sample achieving independence in mobility and self-care, and about one quarter achieving independent cognitive function by 10 years. Following commands prior to 28 days was associated with greater functional independence at all outcome time-points. Multi-trajectory modeling of recovery of three FIM subscales (self-care, mobility, cognition) revealed four distinct prognostic groups with different temporal patterns of change on these subscales. More than half the sample achieved near-maximal recovery by 1 year post-injury, while the later command-following subgroups recovered over longer periods of time. Significant late functional decline was not observed in this cohort. Among a cohort of patients unable to follow commands at the time of inpatient rehabilitation, a substantial proportion achieved functional independence in self-care, mobility, and cognition. The proportion of participants achieving functional independence increased between 5 and 10 years post-injury. These findings suggest that individuals with disorders of consciousness may benefit from ongoing functional monitoring and updated care plans for at least the first decade after TBI.


brain injuries; cognition; consciousness disorders; minimally conscious state; prognosis; rehabilitation outcome; vegetative state


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