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

Article type: Research Article

Authors: Niemeier, Janet P.^{a; *} | Leininger, Shelley L.^b | Whitney, Marybeth P.^a | Newman, Mark A.^a | Hirsch, Mark A.^a | Evans, Susan L.^c | Sing, Ronald F.^c | Huynh, Toan T.^c | Guerrier, Tami P.^b | Perrin, Paul B.^d

Affiliations: [a] Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC, USA | [b] Department of Neuropsychology, Carolinas Rehabilitation, Carolinas Medical Center, Charlotte, NC, USA | [c] Department of Trauma Surgery, Carolinas Medical Center, Charlotte, NC, USA | [d] Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA

Correspondence: [*] Address for correspondence: Janet P. Niemeier, Ph.D., ABPP (RP), Professor, Senior Director of Research, Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Room 1159, 1100 Blythe Boulevard, Charlotte, NC 28203, USA. Tel.: +1 704 355 2046; Fax: +1 704 355 0709; E-mail: Janet.niemeier@carolinashealthcare.org.

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, substance use disorder, rehabilitation

DOI: 10.3233/NRE-161328

Journal: NeuroRehabilitation, vol. 38, no. 4, pp. 371-383, 2016