Speed performance and long-term functional and vocational outcome in a group of young patients with moderate or severe traumatic brain injury

We studied specific aspects of speed performance in neuropsychological test s and functional and vocational long-term outcome among moderate or severe traumatic brain injury (TBI) patients admitted to a rehabilitation programm e. A group of 140 patients with mild, moderate or severe TBI,vas followed u p for a minimum of 5 years in a rehabilitation programme. Severity of TBI w as estimated using the Glasgow Coma Scale (GCS) scores on emergency hospita l admission. The patients, grouped by age at injury into the categories: 7 or younger, 8-16 and 17 years of age or older, were tested five or more gea rs post-injury with comprehensive neuropsychological tests, including a spe ed performance test with the Stroop material, the Purdue Pegboard (PB) test and simple visual and auditive reaction times. The outcome variables were functional outcome, as measured by the Glasgow Outcome Scale (GOS) score, a nd capacity for employment at the end of follow-up, i.e, on average 12 year s post-injury The patients,vith mild TBI mere excluded from further analysi s of outcome. The study was carried out at the Kauniala outpatient neurolog ical clinic. In the Stroop test, patients with a GOS score of 3 and patient s who were incapable of employment were slower (P = 0.0046 and P = 0.0015, respectively) than those with a GOS score of 1 or 2 and those capable of in dependent or subsidized employment, respectively. The PB test also differen tiated significantly between the patients with a GOS score of 3 and those w ith a GOS score of 1 or 2 at the end of follow-up (P = 0.0413), and predict ed incapacity for employment (P = 0.032), those with worse outcome being sl ower. Simple reaction times did not differ significantly between the GOS sc ores at the end of follow-up, and neither did they predict capacity or inca pacity for employment. Our data suggest that the Stroop and PB tests can he lp estimate functional outcome, as measured by the GOS, among patients with initially moderate or severe TBI and who were referred to a rehabilitation programme. The same tests could also be useful in predicting long-term voc ational outcome. Eur J Neurol 6:179-185 (C) 1999 Lippincott Williams & Wilk ins.