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Groupings of Persons With Traumatic Brain Injury: A New Approach to Classifying Traumatic Brain Injury in the Post-Acute Period

Sherer, Mark PhD, ABPP, FACRM; Nick, Todd G. PhD; Sander, Angelle M. PhD; Melguizo, Maria MS; Hanks, Robin PhD; Novack, Thomas A. PhD; Tulsky, David PhD; Kisala, Pamela MA; Luo, Chunqiao MS; Tang, Xinyu PhD

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

The Journal of Head Trauma Rehabilitation: March/April 2017 - Volume 32 - Issue 2 - p 125–133
doi: 10.1097/HTR.0000000000000207
Focus on Clinical Research and Practice, Part 1

Objective: To (1) identify groups of persons with traumatic brain injury (TBI) who differ on 12 dimensions of cognitive function: cognitive, emotional, and physical symptoms; personal strengths; physical functioning; environmental supports; and performance validity; and (2) describe patterns of differences among the groups on these dimensions and on participation outcome.

Setting: Three centers for rehabilitation of persons with TBI.

Participants: A total of 504 persons with TBI living in the community who were an average (standard deviation) of 6.3 (6.8) years postinjury and who had capacity to give consent, could be interviewed and tested in English, and were able to participate in an assessment lasting up to 4 hours.

Design: Observational study of a convenience sample of persons with TBI.

Main Measures: Selected scales from the Traumatic Brain Injury Quality of Life measures, Neurobehavioral Symptom Inventory, Economic Quality of Life Scale, Family Assessment Device General Functioning Scale, measures of cognitive function, Word Memory Test, and Participation Assessment with Recombined Tools–Objective (PART-O) scale.

Results: Cluster analysis identified 5 groups of persons with TBI who differed in clinically meaningful ways on the 12 dimension scores and the PART-O scale.

Conclusion: Cluster groupings identified in this study could assist clinicians with case conceptualization and treatment planning.

TIRR Memorial Hermann, Houston, Texas (Drs Sherer and Sander); Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas (Drs Sherer and Sander); Department of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock (Drs Nick and Tang and Mss Melguizo and Luo); Department of Physical Medicine and Rehabilitation/Center for Trauma Rehabilitation, Harris Health System, Houston, Texas (Dr Sander); Department of Physical Medicine and Rehabilitation, Wayne State University Medical School, Rehabilitation Institute of Michigan, Detroit (Dr Hanks); Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham (Dr Novack); Department of Physical Therapy, University of Delaware College of Health Sciences, Newark (Dr Tulsky and Ms Kisala); and Kessler Foundation, West Orange, New Jersey (Dr Tulsky).


Corresponding Author: Mark Sherer, PhD, ABPP, FACRM, TIRR Memorial Hermann, 1333 Moursund St, Houston, TX 77030 (

The authors dedicate this article to the memory of Dr Todd G. Nick, a great statistician and a great friend.

This research was supported by US Department of Education National Institute on Disability and Rehabilitation Research grants H133B090023 and H133A120020.

The authors declare no conflicts of interest.

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