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Examining Acute Rehabilitation Outcomes for Children With Total Functional Dependence After Traumatic Brain Injury: A Pilot Study

Kramer, Megan E. PhD; Suskauer, Stacy J. MD; Christensen, James R. MD; DeMatt, Ellen J. MA; Trovato, Melissa K. MD; Salorio, Cynthia F. PhD; Slomine, Beth S. PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: September/October 2013 - Volume 28 - Issue 5 - p 361–370
doi: 10.1097/HTR.0b013e31824da031
Original Articles

Objective: To examine in a pilot cohort factors associated with functional outcome at discharge and 3-month follow-up after discharge from inpatient rehabilitation in children with severe traumatic brain injury (TBI) who entered rehabilitation with the lowest level of functional skills.

Participants: Thirty-nine children and adolescents (3–18 years old) who sustained a severe TBI and had the lowest possible rating at rehabilitation admission on the Functional Independence Measure for Children (total score = 18).

Methods: Retrospective review of data collected as part of routine clinical care.

Results: At discharge, 59% of the children were partially dependent for basic activities, while 41% remained dependent for basic activities. Initial Glasgow Coma Scale score, time to follow commands, and time from injury to rehabilitation admission were correlated with functional status at discharge. Time to follow commands and time from injury to rehabilitation admission were correlated with functional status at 3-month follow-up. Changes in functional status during the first few weeks of admission were associated with functional status at discharge and follow-up.

Conclusions: Even children with the most severe brain injuries, who enter rehabilitation completely dependent for all daily activities, have the potential to make significant gains in functioning by discharge and in the following few months. Assessment of functional status early in the course of rehabilitation contributes to the ability to predict outcome from severe TBI.

Supplemental Digital Content is Available in the Text.

Kennedy Krieger Institute, Baltimore, Maryland (Drs Kramer, Suskauer, Christensen, Trovato, and Salorio and Mrs DeMatt); and Departments of Psychiatry and Behavioral Sciences (Drs Salorio and Slomine), Physical Medicine and Rehabilitation (Drs Suskauer, Christensen, Trovato, Salorio, and Slomine), and Pediatrics (Drs Suskauer and Christensen), Johns Hopkins University School of Medicine, Baltimore, Maryland.

Corresponding Author: Stacy J. Suskauer, MD, Kennedy Krieger Institute, Pediatric Rehabilitation, 707 North Broadway, Baltimore, MD 21205 (

This work was supported by National Institutes of Health and award K23HD061611 (Dr Suskauer) from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins