• Risa Nakase-Richardson, Shane McNamee, Laura L Howe, Jill Massengale, Michelle Peterson, Scott D Barnett, Odette Harris, Marissa McCarthy, Johanna Tran, Steven Scott, and David X Cifu.
• Mental Health and Behavioral Science Service, James A. Haley Veterans Hospital, Tampa, FL; Department of Psychology, University of South Florida, Tampa, FL; Center of Excellence for Maximizing Rehabilitation Outcomes, Tampa, FL. Electronic address: Risa.Richardson@va.gov.
• Arch Phys Med Rehabil. 2013 Oct 1;94(10):1861-9.

ObjectiveTo report the injury and demographic characteristics, medical course, and rehabilitation outcome for a consecutive series of veterans and active duty military personnel with combat- and noncombat-related brain injury and disorder of consciousness (DOC) at the time of rehabilitation admission.DesignRetrospective study.SettingRehabilitation center.ParticipantsFrom January 2004 to October 2009, persons (N=1654) were admitted to the Polytrauma Rehabilitation System of Care. This study focused on the N=122 persons admitted with a DOC. Participants with a DOC were primarily men (96%), on active duty (82%), ≥12 years of education, and a median age of 25. Brain injury etiologies included mixed blast trauma (24%), penetrating (8%), other trauma (56%), and nontrauma (13%). Median initial Glasgow Coma Scale score was 3, and rehabilitation admission Glasgow Coma Scale score was 8. Individuals were admitted for acute neurorehabilitation approximately 51 days postinjury with a median rehabilitation length of stay of 132 days.InterventionsNone.Main Outcome MeasuresRecovery of consciousness and the FIM instrument.ResultsMost participants emerged to regain consciousness during neurorehabilitation (64%). Average gains ± SD on the FIM cognitive and motor subscales were 19 ± 25 and 7 ± 8, respectively. Common medical complications included spasticity (70%), dysautonomia (34%), seizure occurrence (30%), and intracranial infection (22%). Differential outcomes were observed across etiologies, particularly for those with blast-related brain injury etiology.ConclusionsDespite complex comorbidities, optimistic outcomes were observed. Individuals with severe head injury because of blast-related etiologies have different outcomes and comorbidities observed. Health-services research with a focus on prevention of comorbidities is needed to inform optimal models of care, particularly for combat injured soldiers with blast-related injuries.Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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