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Traumatic brain injury occurring with spinal cord injury: significance for rehabilitation

Journal of Rehabilitation, April-June, 1993 by Mary Alice Povolny, Steven P. Kaplan

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Davidoff, Morris, Roth and Bleiberg (1985) found that traumatic SCI is related to increased risk for cognitive dysfunction. They administered the Halstead Category Test (HCT) of the Halstead-Reitan Neuropsychological Battery (HRNB) (Golden, 1979; Hevern, 1980; Reitan & Davison, 1974) to 30 inpatients within eight weeks of injury. The researchers found that 57% of the subjects had HCT scores suggestive of abnormal cognitive functioning.

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Wilmot, Cope, Hall and Acker (1985) found results of decreased cognitive functioning similar to Davidoff et al. (1985). They administered a series of motor free tests aimed at assessing cognitive impairment. Forty-three of the 67 patients (64%) scored in the impaired range on the test battery. Evidence of poor premorbid academic history was present in 19 (44%) of those with impaired performance on the neurological evaluation, 56% of the subjects had no previous record of scholastic difficulties. These studies were limited by their lack of controls, that is, criteria for impairment relied on levels of abnormality defined by test results in the general population and this should be taken into account when interpreting the results. Premorbid factors such as age, years of education, socioeconomic group or drug dependency may have influenced the performance of patients on the neuropsychological test battery (Davidoff et al. 1985).

Roth, Davidoff, Thomas, Dijkers, Berent, Klisz, and Yarkony (1987), in a preliminary study, administered a motor free neurologic test battery to 80 spinal cord injured patients, and 60 non-injured control subjects. Impairment levels were defined as scores which were more than two standard errors below mean values of the control subjects. Based on these definitions, abnormalities were found on all tests for between one-half and two-thirds of the subjects. By using control subjects, the researchers were able to demonstrate that neuropsychological deficits are common among spinal cord injured patients.

Roth, Davidoff, Thomas, Doljanac, Dijkers, Berent, Morris, and Yarkony (1989) conducted a further study utilizing control groups and assessing neuropsychological deficits in persons with SCI. Demographic factors were closely matched between patients and controls. Deficits were demonstrated by the subject group compared to controls on each test ranging from 10% to 40% below average levels. The Roth group compared test results of patients with SCI with those of controls and found persons with SCI demonstrated poor attention span and limited initial learning ability. They discovered other common neuropsychological deficits, including poor concentration ability, impaired memory function, and altered problem solving ability.

Silver, Morris and Otfinowski (1980) reviewed associated injuries in patients with SCI. Based on 100 consecutive admissions, they found that 75% of the patients had associated injuries, the most common being TBI, with chest injuries being the next most frequent. This study found 50 head injuries, 41 including a short period of unconsciousness. Nine of the head injuries were more serious, as shown by the length of pre- and post-traumatic amnesia, with subsequent confusion. Five had fractures of the skull and three had body fluids escaping from the ears or nose.

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Traumatic brain injury occurring with spinal cord injury: significance for rehabilitation

Journal of Rehabilitation, April-June, 1993 by Mary Alice Povolny, Steven P. Kaplan

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