| Research TBI Model Systems |
| Predicting Outcomes: Time until Commands are Followed Appears Useful |
| The Question: Is measurement of time until motor localization occurs compared to time until commands are followed useful in predicting outcome after traumatic brain injury? Past Studies have used the length of time that an individual is unconscious in as a predictor of the individual’s future recovery of abilities (outcome). The length of unconsciousness has generally been measured as the time from injury until a person consistently follows verbal commands (spoken instructions). An increased length of unconsciousness is associated with poorer long-term outcomes. Common impairments include decreased levels of independent functioning and greater emotional and thought processing difficulties. Historically, the length of time from injury until an individual follows commands has been the best predictor of outcomes, but it has some limitations. For instance, individuals who cannot hear, cannot move, or are too agitated may not be physically able to follow commands. One past study suggests that the time from injury until an individual produces ”localizing” motor movements (body motions that target a particular painful or irritating event, such as grabbing the hand of an examiner that is pinching their skin) would be a more reliable indicator of emergence from coma and a predictor of outcome. Theorists suggest that individuals with language comprehension problems would be more likely to produce localizing movements earlier than they would follow commands. This study evaluated the length of time to follow commands compared to the length of time to produce localizing motor movements as a measure in predicting outcome from traumatic brain injury. The researchers examined the medical records of 496 individuals with traumatic brain injury from the Traumatic Brain Injury Model System national database. The researchers used standardized measures to evaluate outcomes. The researchers found that time until commands were followed was a better predictor of outcomes than time until localizing motor movements occurred. Time until commands were followed was a superior predictor even for individuals with poor language comprehension. The ability to produce localizing motor movements was a less powerful predictor of outcomes. Who May Be Affected By These Findings: Individuals with traumatic brain injury, insurers, rehabilitation personnel, researchers. Caveats: This study is limited because the researchers obtained all of their data from the individuals’ medical records. If the researchers examined the individuals using consistent testing methodologies, perhaps more accurate results would be obtained. Bottom Line: The researchers found that time until commands were followed was a better predictor of outcomes than time until localizing motor movements occurred. Find This Study: Whyte, J., Cifu, D., Dikmen, S., & Temkin, N. (2001). Prediction of functional outcomes after traumatic brain injury: A comparison of 2 measures of duration of unconsciousness. Archives of Physical Medicine and Rehabilitation, 82, 1355-1359. |
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