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CCN 07-133 – HSR&D Study

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CCN 07-133
Measurement and Outcomes Post Severe Brain Injury
Theresa Louise-Bender Pape DrPH MA BS
Edward Hines Jr. VA Hospital, Hines, IL
Hines, IL
Funding Period: July 2007 - December 2010

BACKGROUND/RATIONALE:
This project is a prospective measurement and outcomes study of persons in a state of disordered consciouness after severe brain injury. Medical and rehabilitation management during coma recovery and scientific investigations of coma recovery have been hampered by an inability to provide evidence based prognoses and to measure treatment effects. This project aims to enhance the provision of healthcare services to our veterans and military personnel who are in states of disordered consciousness after incurring severe TBI.

OBJECTIVE(S):
The purpose of this study is to enhance neurobehavioral measurement and prognostication after severe TBI. This will be done in Three Steps: (1) Enhance the Disorders of Consciousness Scale (DOCS), (2) Examine the performance characteristics of the finalized DOCS, and (3) Explore associations between the DOCS and other variables known or thought to be important to outcome prediction. The research objectives are to shorten the DOCS from 23 items (20-30 minutes) to 15-20 items (15-20 minutes) while improving the predictive value of the DOCS; thereby enhancing clinical utility, to determine what performance characteristics of the DOCS are important to predicting recovery of consciousness and 1-year functional outcomes and to determine how DOCS change performs as a predictor variable in a model including other variables known or thought to be important to outcome prediction.

METHODS:
This study builds on previous research and it is the third phase of a longitudinal measurement and outcomes study. Persons > = 18 years of age with severe TBI who have been unconscious for > = 28 days consecutively and are within 180 days of injury are eligible for study enrollment. Target sample size is 193 subjects who are each followed for one year. The independent variables being collected and examined for prognostic utility include the DOCS and other Neurobehavioral Variables, Injury and Lesion Characteristics, Physiological Data, Etiology, Cause of Injury, Demographics, Comorbidities, Rehabilitation Services received and indices of Injury Severity. The primary outcome is recovery of consciousness within the first year of injury and the secondary outcome is functional outcome 1-year after injury.

FINDINGS/RESULTS:
For persons with prolonged disorders of consciousness after a severe brain injury, findings indicate that the DOCS test can be shortened to 20 test items with some loss in precision, but with an overall high level of predictive accuracy. The accuracy of predicting recovery and lack of recovery of consciousness is balanced. In summary, the DOCS measures, after rater severity/leniency calibration, are strong predictors of recovery of consciousness at two time points in the first year of recovery.

IMPACT:
The significance of the research is related to the VA's mission to provide medical care that maximizes each veteran's quality of life.. This research addresses the VA's mission to provide veterans and service members with evidence based medical rehabilitation.

PUBLICATIONS:

Journal Articles

  1. Pape TL, Guernon A, Lundgren S, Patil V, Herrold AA, Smith B, Blahnik M, Picon LM, Harton B, Peterson M, Mallinson T, Hoffmann M. Predicting levels of independence with expressing needs and ideas 1 year after severe brain injury. Rehabilitation Psychology. 2013 Aug 1; 58(3):253-62.
  2. Pape TL, Brady SL. Swallowing Evaluation and Treatment for Individuals with Disordered Consciousness. The ASHA Leader. 2011 May 17; 5(17):2011.
  3. Saban KL, Smith BM, Collins EG, Pape TL. Sex differences in perceived life satisfaction and functional status one year after severe traumatic brain injury. Journal of women's health (2002). 2011 Feb 1; 20(2):179-86.
  4. Pape TL, Tang C, Guernon A, Lundgren S, Blahnik M, Wei Y, Querubin M, Zollman F, Soneru I. Predictive value of the Disorders of Consciousness Scale (DOCS). PM & R : the journal of injury, function, and rehabilitation. 2009 Feb 1; 1(2):152-61.
Journal Other

  1. Blahnik M, Schettler SM, Lundgren SM, Smith B, Guernon A, Pape T. Comparison of the Galveston Orientation Amnesia Test and the Disorders of Consciousness Scale on Autonomy with Cognitive Functioning One Year Post Severe Brain Injury. [Abstract]. The Clinical Neuropsychologist. 2010 May 1; 24(4):564.
Conference Presentations

  1. Baldassarre M, Pape TL, Herrold AA, Chin A. Impact of Pain on the Neuropsychological Profile of Veterans with a History of Mild Traumatic Brain Injury. Poster session presented at: National Academy of Neuropsychology Annual Conference; 2012 Nov 8; Nashville, TN.
  2. Sindelar B, Pape TL. Neurobehavioral improvement in severe TBI patients with a positive blood alcohol level on initial hospital admission. Poster session presented at: Federal Interagency Conference on Traumatic Brain Injury; 2011 Jun 13; Washington, DC.
  3. Pape TL, Smith BM, Wei Y, Guernon A, Tang C, Lundgren S, Picon L, Blahnik M, Kieffer K, Schettler S. Predicting More and Less Independence with Expression 1-Year after Severe Brain Injury. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 16; National Harbor, MD.
  4. Schettler S, Blahnik M, Lundgren S, Pape TL. Relationships between the Galveston Orientation and Amnesia Test, Disorders of Consciousness Scale and Functional Independence Measure of Cognitive Functioning One year Post Brain Injury. Poster session presented at: International Neuropsychological Society Annual Meeting; 2011 Feb 2; Boston, MA.
  5. Pape TL, Patil V, Crane TA, Smith BM, Guernon A, Wei Y, Tang C, Querubin M, Brkic N, Tsai S. Methylphenidate Effect on Time to Consciousness up to 1-Year. Poster session presented at: American Congress of Rehabilitation Medicine / American Society of Neuroradiology Annual Meeting; 2010 Oct 21; Quebec, Canada.
  6. Pape TL, Wei Y, Smith BM, Guernon A, Tang C, Lundgren S, Picon L, Blahnik M, Kieffer K, Schettler S, Peterson M, Patil V, Hoffman M, Demarest D. Predicting Autonomy with Expression 1 Year after Severe Brain Injury. Poster session presented at: American Congress of Rehabilitation Medicine / American Society of Neuroradiology Annual Meeting; 2010 Oct 21; Quebec, Canada.
  7. Pape TL. Neural Plasticity in Neurorehabilitation: Transcranial Magnetic Stimulation. Paper presented at: Spinal Cord and Brain Injury Neuro-Rehabilitation Symposium; 2010 Apr 30; Lexington, KY.
  8. Pape TL. Modality Specific Measures for Predicting Outcomes after Severe TBI. Poster session presented at: American Speech-Language-Hearing Association Annual Convention; 2008 Nov 1; Chicago, IL.
  9. Pape TL. Assessment & Treatment Planning for Individuals with Disorders of Consciousness. Paper presented at: American Speech-Language-Hearing Association Annual Convention; 2008 Nov 1; Chicago, IL.
  10. Pape TL. Perceived Life Satisfaction One Year Post Severe Traumatic Brain Injury. Poster session presented at: International Society for Quality of Life Research Annual Meeting; 2008 Oct 1; Montevideo, Uruguay.


DRA: Military and Environmental Exposures, Acute and Combat-Related Injury, Brain and Spinal Cord Injuries and Disorders
DRE: Diagnosis, Treatment - Observational
Keywords: Outcomes - Patient, Risk Factors, TBI, Traumatic Brain Injury
MeSH Terms: none

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