Comparing Functional Status and Community Integration in Severe Penetrating and Motor Vehicle-Related Brain Injuries

Objective: To examine the functional status of persons surviving a severe penetrating traumatic brain injury (TBI) resulting from a gunshot wound who require inpatient rehabilitation. Design: Data were collected prospectively at 4 different time periods: rehabilitation admission and discharge and year I and year 2 postinjury. Setting: Rehabilitation hospital within a Traumatic Brain Injury Model System. Participants: Forty-five persons with severe penetrating brain injury and 45 persons involved in a motor vehicle crash (MVC). Interventions: Not applicable. Main Outcome Measures: Disability Rating Scale (DRS), FIM instrument, and Community Integration Questionnaire (CIQ). Results: Results indicated functional improvements for both the penetrating and motor vehicle severe TBI groups on the DRS and the FIM from rehabilitation admission to discharge. Follow-up data at I and 2 years postinjury revealed continued improvements on the DRS and FIM measures for both groups, with the greatest improvement in recovery during the first year. In addition, improved community reintegration emerged between I and 2 years postinjury for both groups, as measured by the CIQ. There was a small significant difference on the outcome measures between the 2 groups in the course of their recovery. Conclusions: Persons who survive severe penetrating brain injuries and who require inpatient rehabilitation may show continuing improvement in functioning over time. For persons receiving inpatient rehabilitation services, initial improvement is most likely to occur during the hospital stay and continue postinjury, with the largest improvement in the first year after injury. Community reintegration can also be expected over time. One can expect similar outcomes for individuals who sustain a severe penetrating brain injury and a severe brain injury ensuing from an MVC.