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Functional Changes between One and Five Years after Injury

Categories: Recovery - Long Term

The Question

What changes in functional ability and employability take place between one and five years after traumatic brain injury?

Past Studies

Past Studies show that emerging from a coma, communicating, and caring for oneself are among dramatic changes that can take place during the first year following a traumatic brain injury. After the first year, more subtle improvements can still take place. These changes can include improvements in behavior, attention, speech, and independent functioning. Researchers seek to dispel the myth that improvements stop after one year. It is important to consider, in past studies, how the researchers obtained their data when measuring long term gains. There has not been a lot of research that used good methods and a large number of people to evaluate long term functional changes for individuals with traumatic brain injury.

This Study

This study focused on 301 individuals that received inpatient rehabilitation for traumatic brain injury. The researchers obtained medical record information about the participants by interview and examination of their data in the Traumatic Brain Injury Model Systems National Database. The researchers used sections of the Disability Rating Scale (DRS) to measure function and employability. The DRS measures general functional changes over the course of recovery. The researchers created a point system to categorize the amount of change in functioning that individuals made between one and five years after injury.

The researchers found that the majority of participants (76%) stayed at the same level of functioning between one and five years after injury. Eighteen percent of the individuals improved, and seven percent became worse. Higher abilities to process thoughts and produce body movements were factors associated with improved functional ratings. Lower thought processing speed and poor attention span were factors linked with decreased functional ratings.

The majority of the participants (79%) remained at the same level of employability between one and five years after injury. Seventeen percent of the individuals improved, and five percent became worse. Racewas a factor associated with improved employability ratings. Individuals that belonged to an ethnic minority group were 2.3 times more likely to improve their employability score. Reduced eye openingabilities, when tested initially in the Emergency Department, was a factor associated with decreased employability ratings.

Who May Be Affected By These Findings

Individuals with traumatic brain injury and their loved ones, healthcare providers, researchers.


The point scale used by the researchers to measure change in this study was designed to identify large amounts of change. Because of this, the point scale may not have indicated all change that occurred, especially small amounts of change. Therefore, the results of this study may underestimate changes that have occurred.

Bottom Line

Although the majority of participants did not make meaningful changes during year one to five, some individuals made dramatic gains and a small number of individuals became worse. It appears that some individual characteristics and abilities at the one-year mark may be predictive of future functional and employability changes.

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Find This Study

Hammond, F. M., Grattan, K. D., Sasser, H., Corrigan, J. D., Rosenthal, M., Bushnik, T., & Shull, W. (2004). Five years after traumatic brain injury: A study of individual outcomes and predictors of change in function. NeuroRehabilitation, 19,

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