Gulf War and Health Volume 7: Long-Term Consequences of Traumatic Brain Injury (2009) / Chapter Skim
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9 SOCIAL FUNCTIONING
9 SOCIAL FUNCTIONING
Pages 301-332
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From page 301... ...
(1993) evaluated work status in a group of 520 Vietnam War veterans who sustained penetrating head injury in 1967–1970 and were seen for a 15-year followup.
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From page 302... ...
After adjustment for confounders (age, sex, marital status, educational level, pay grade, months in current grade, years of active-duty service, injury severity, and preinjury "adverse action," disciplinary action recorded in a soldier's personnel file) , head injury was related to an increased risk of behavioral separation (relative rate [RR]
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From page 303... ...
1–6 days, 69%; TFC 7–13 days, 59%; TFC 14–28 days, 31%; TFC over 28 days, 10%; Glasgow Coma Scale (GCS) 9–12, 64%; GCS 6–8, 38%; GCS 3–5, 26% (p < 0.05 by Tukey's post hoc comparison for each TBI severity group indicated vs trauma controls)
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From page 304... ...
(1978) examined 54 people who had closed head injuries and 35 controls with traumatic limb fractures and no head injury, matched on age and socioeconomic status.
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From page 305... ...
Return to work by 6 months after head injury was significantly associated with injury severity. A higher percentage of TBI participants who had less severe injuries than of those with longer periods of PTA were back at work by 6 months after injury.
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From page 306... ...
Although all had GCS scores in the range of 13 to 15, subjects with mild TBI and additional injuries suffered significantly more severe TBI using other indices, than those with only TBI, for example, mean Abbreviated Injury Scale (AIS) head score in mild TBI with additional injuries was 2.3 compared with a mean score in isolated mild TBI of 1.9 (p = 0.0001)
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From page 307... ...
The mild closed head injured subjects all had their first assessed GCS equal to 13–15, none decreased to below 13 while they were in the hospital, and all had PTA of less than 24 hours. Social functioning was assessed with the Rivermead Head-Injury Follow-up Questionnaire (RHIFQ)
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From page 308... ...
(2002) examined CT findings on TBI subjects and compared them with vocational outcome in a group of Vietnam War veterans participating in the Vietnam Head Injury Study.
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From page 309... ...
All the TBI subjects had closed head injuries, and 90% had mild injuries. The rate of return to work was similar in TBI subjects (61%)
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From page 310... ...
which may have been due to a number of factors including milder injuries in the sample, or people living in nursing homes or other sheltered environments not responding to the recruitment efforts. Social Relationships None of the secondary studies was devoted primarily to this topic, but some papers included information on social integration after TBI (Dikmen et al., 1993, 2003; Engberg and Teasdale, 2004; Kersel et al., 2001; Vanderploeg et al., 2007; Walker and Eruclei, 1969; Whiteneck et al., 2004)
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From page 311... ...
(1986) examined resumption of leisure and recreational activities in 19 persons with mild TBI.
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From page 312... ...
in persons with TBI than in friend controls on all subscales at 1 and 2 years after injury except eating at 2 years after injury. The SIP Physical Summary Score showed a steeper drop in the first year than the SIP Psychosocial Summary Score.
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From page 313... ...
(2006) studied functional status with the Psychosocial Health Scales of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36)
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From page 314... ...
Depending on severity and acuteness, TBI can affect all aspects of functioning, including such activities of everyday life as personal care, ambulation, mobility, and higher-level psychosocial functioning -- employment, social relationships, independent living, recreation, and so on. TBI clearly has adverse effects on social functioning.
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From page 315... ...
SOCIAL FUNCTIONING 315 The committee concludes, on the basis of its evaluation, that there is sufficient evidence of an association between sustaining a moderate to severe TBI and long term adverse social-function outcomes, particularly unemployment and diminished social relationships. The committee concludes, on the basis of its evaluation, that there is inadequate or insufficient evidence to determine whether an association exists between sustaining a mild TBI and long-term adverse social functioning, including unemployment, diminished social relationships, and decrease in the ability to live independently.
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From page 316... ...
; decreased risk of medical adverse action mean AIS head in discharge by 0.64 times head injured group compared with orthopedic fighting, 2.4 group (median, 2.0) Ommaya et Retrospective 2,226 TBI discharged 1,778 mild TBI Examined discharge ORs, (95% CIs)
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From page 317... ...
: minimum term injuries) wards; those with healthy Ss left Army earlier may be more 25,575 healthy Army milder injuries that than Ss in either injury group; like people who subject did not require median survival times, healthy sustain TBI; All had served for >1 inpatient Ss 1.74 years, TBI Ss 3.91 type of year before 1994, management not years, lower-limb fracture Ss employment excluding basic included 4.39 years could be training, and were Oldest Ss (>34 years old)
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From page 318... ...
Head injury injury severity 93 GCS <8; 56 9– 12; 213 13–15 Dikmen et Prospective 466 Ss with TBI (91% Severity mild to 1 year after injury Global outcome: TCs Dependent al., 1995 cohort of original sample) severe; both blunt outcome on GOS, functioning significantly variables (Includes from 3 prospectiive and penetrating independent living, better on GOS than TBI at 1 presented as subjects longitudinal studies; included; evidence employment, year after injury (p < 0.001)
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From page 319... ...
TC 93%, TFC <1 h 89%, 1– 24 h 89%, 25 h–6 days 74%, 7–13 days 49%, 14–28 days 55 %, >29 days 23% Employment: fewer head injured working at 1 year than TC (p < 0.05) ; increasing levels of head injury severity significantly related to decreasing % returned to work (p < 0.001)
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From page 320... ...
; no difference between head injured, TC on returning to school; no relationship with TBI severity Income: head injured earned significantly less in year after injury than TC (p < 0.05) ; as TBI severity increased, income decreased SIP: head injured report significantly more dysfunction than TC, especially on psychosocial (p < 0.01)
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From page 321... ...
Oddy et al., Prospective 54 closed head injured 48% PTA 1–7 Return to work, Return to work 4–6 mo after Closed head Small samples 1978 cohort (close relative also days; 52% PTA >7 contact with friends,injury of preinjury full-time injured, interviewed) ; 16–39 days; 90% road leisure activities, workers: controls years old; PTA >24 h; traffic accidents; family life, marital PTA 1–7 d, 71% full-time, matched on admitted to 1 of 7 50% 16–20 years relationships 10% part-time age, hospitals in Surrey, old, 80% <25 PTA >7 d, 29% full-time, socioeconomic Sussex, or Southwest years old Compared before 21% part-time status (not London injury (as reported Controls, 63% full-time, 33% sex-matched)
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From page 322... ...
Controls: 58% 0 symptoms, 20% >3 symptoms Edna and Prospective 485 closed-head Closed head injury Questionnaire on Employment: None No information Cappelen, cohort injured admitted in with LOC, skull social, working Overall head injured: on demographic 1987 1979–1980 to 3 fracture, or outcome 3–5 years unemployed 12% before, 27% comparison of general-surgery intracranial after injury; 85% after closed head department and 1 hematoma; 89% response rate in Controls: 5% before, 16% injured, controls neurosurgery GCS 13–15 closed head injured, after department in controls Unemployment rate increased Trondelag, Norway; more (p < 0.01) in closed 15–64 years old at head injured than in controls injury More unemployment in those 89 controls admitted >45 years old (16% before, with acute 53% after)
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From page 323... ...
motor deficits associated with post injury nonattendance, OR, 11.29 (1.55–68.65) Stulemeijer Retrospective 299 mild TBI 18–60 Mild TBI defined 6 mo after injury: Change in work: 35% mild Analyses 52% of mildet al., 2006 cohort years old admitted to as impact to head Rivermead Post- TBI with additional injuries, adjusted for TBI sample, ED level 1 trauma with or without Concussion 14% isolated mild TBI, 2% of age, sex, AIS 61% of control center in Netherlands; LOC <30 min, Questionnaire; SF- controls report change in work head score sample 89 sustained with or without 36 physical (p = 0.0001)
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From page 324... ...
0.01) but no difference on other outcomes Heitger et Prospective 37 mild closed head Mild closed head RHIFQ, SF-36 at 6, SF-36: no significant Controls al., 2007 cohort injured; mean age, injury based on 12 mo after injury differences between mild matched to 29.1 years; mean first assessed GCS closed-head injured, controls mild closed education, 13.6 years; of 13–15 without on SF-36 at 6, 12 mo head injured all employed or in decreasing below RHIFQ: not administered to on age, sex, school, none involved 13 at any time in controls; 27% mild closed years of with litigation; hospital; PTA <24 head injured report mild or education excluded Ss if any h in all cases worse change on one or more evidence of alcohol or activities at 6 mo, 23% report drugs at time of injury mild or worse change at 12 or regular use of mo; 49% at 6 mo, 61% at 12 psychoactive drugs or mo report no changes history of drug abuse compared with before injury or if had pre-existing on any activity neurologic or
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From page 325... ...
56% PTA 8-28 to be less socially rewarding Matched on moderate to 25 Orthopedic days; as a result of changes in their age; sex; mean severe head controls (20 men and 12% PTA >28 social behavior premorbid IQ injury. 7 females)
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From page 326... ...
; no other significant Counting GCS of 15, no differences students and documented LOC or homemakers as PTA, normal CT, if Return to normal living: mild independent done, no TBI mean, 69.23; no mild TBI occupations may documentation in mean, 73.91; not significantly have influenced chart regarding brain different results because it injury) ; age 19–58 may be easier years; 64% male; Return to work: 44% mild for these Ssthan average ISS, 18; TBI returned, workers to average LOS, 22.71 41% no mild TBI returned; return to their days; English- not significantly different; major activity speaking return to work examined by after TBI Excluded anyone with type of occupation grouped as severe disfigurement, independence and decision amputation, spinal- making (including student, cord injury homemaker, professional or semiprofessional,
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From page 327... ...
, none (did not qualify on either measure) ; percentage of mild TBI cases in expected direction, but no significant differences between mild TBI and no mild TBI Note: AFQT= Armed Forces Qualification Test, AIS = Abbreviated Injury Score, CDC = Centers for Disease Control and Prevention, CI = confidence interval, DVA = Department of Veterans Affairs, ED = emergency department, EDH = epidural hematoma, FC = friend controls, FIM = Functional Independence Measure, FSE = Functional Status Examination, GCS = Glasgow Coma Scale, GOS = Glasgow Outcome Scale, GPA = grade-point average, ICD = International Classification of Diseases, ISS = Injury Severity Score, LOC = loss of consciousness, LOS= length of stay, MCS = Mental Component Summary, MVA = motor-vehicle accident, NP = neuropsychologic, OR = odds ratio, PTA = posttraumatic amnesia, PTSD = posttraumatic stress disorder, RA = retrograde amnesia, RHIFQ = Rivermead Head Injury Follow-up Questionnaire, RR = relative risk, SIP = Sickness Impact Profile, SO = significant other, TBI = traumatic brain injury, TC = trauma controls, TFC = time to follow commands, WRAMC = Walter Reed Army Medical Center.
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From page 328... ...
2000. Factors predicting return to work following mild traumatic brain injury: A discriminant analysis.
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From page 329... ...
2001. Psychosocial functioning during the year following severe traumatic brain injury.
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From page 330... ...
1993. Residual impairments and work status 15 years after penetrating head injury: Report from the Vietnam Head Injury Study.
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From page 331... ...
2003. Demographic, medical, and psychiatric factors in work and marital status after mild head injury.
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