All ETDs from UAB

Advisory Committee Chair

Thomas Novack

Advisory Committee Members

Amy Knight

Olivio Clay

Matthew Thompson

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

Disorientation and cognitive impairment are commonly experienced in acute moderate to severe TBI patients and deficits early in recovery are predictive of worse long-term outcome. Hence, tracking recovery over time is a significant aspect of rehabilitation research. The Orientation-Log (O-log) and Cognition-Log (Cog-log) are important clinical measures used to monitor cognitive progress during treatment and previous research has shown them to be predictive of long-term outcome. This study used two-level growth curve modeling to, 1) determine the growth trajectory of orientation and cognition in persons with moderate to severe TBI in acute rehabilitation, as determined by the O-log and Cog-log, 2) examine the influence of patient and injury severity characteristics on the growth trajectories, and 3) determine whether the growth trajectories are predictive of long-term functional and psychosocial outcomes at one and two years post-injury. Participants were adults enrolled in the University of Alabama at Birmingham TBI Model Systems database (N=276). Results indicate that individuals generally recover from disorientation and cognitive dysfunction in mostly linear fashion, at a rate of nine and six points over 10 days, respectively. Additionally, indices of injury severity are stronger predictors of the O-log than patient characteristics and age, years of education, and indices of injury severity are important predictors of Cog-log growth parameters. No significant relationships between the growth parameters and employment and driving status at one and two year’s post-injury were detected. Results showed rate of change on the O-log and Cog-log has greater power to predict distal outcomes than initial scores. Specifically, those who improved more quickly on the O-log endorsed less disability and greater functioning at one-year post-injury, as well as greater independence at one and two years post-injury. Moreover, those who improved more quickly on the Cog-log endorsed less disability and greater participation across domains of productivity, social relations, and out and about at two years post-injury. The findings of this study provide a more accurate picture of how individuals recover neurocognitively from moderate to severe TBI and underscore the notion that recovery from TBI is a complex, multifactorial process.

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