RECOVERY OF ARM FUNCTION IN PATIENTS WITH PARESIS AFTER TRAUMATIC BRAIN INJURY

Objective: To characterize the frequency of recovery of arm paresis in patients with traumatic brain injury (TBI) admitted to rehabilitation . Design: Retrospective review identifying a cohort of patients with m oderate or severe arm paresis after TBI followed at least 6 months pos tinjury. Setting: Freestanding acute rehabilitation hospital TBI unit. Patients and Methods: Forty-four patients with moderate to severe arm paresis were selected from 264 consecutive admissions and characteriz ed by injury pathology subtype, injury severity (duration of unconscio usness [loss of consciousness, LOG] and posttraumatic amnesia [PTA]), age, and level of paresis according to Brunnstrom Stages of Recovery ( BS 1 to 6). Patient groups with and without arm paresis were compared according to these variables (t tests and chi(2)). Main Outcome Measur es: Recovery of arm paresis to isolated motor function (BS 5 or 6) and time to achieve recovery. Recovered and nonrecovered patients were co mpared (Mann-Whitney, t tests, and chi(2)) on injury severity, initial level of paresis, age, time to rehabilitation admission, and patholog y subtype. Time to recovery was compared for patients at different lev els of initial paresis, ranges of LOC, and pathology subtypes (Mann-Wh itney and Kruskal-Wallis tests). Results: Forty-four patients (17%) ha d moderate (BS 3 to 4) or severe (BS 1 to 2) paresis at rehabilitation admission. They were more severely injured than nonparetic patients b ased on longer LOC (p < .002) and PTA (p < .009). Thirty-six patients (82%) recovered by 6 months; 72% of these recovered by 2 months. If st ill paretic at 2 months, only 56% recovered. Mean recovery time was 6. 9 weeks (SD, 6.1) from injury. Time to recovery was best predicted by initial level of paresis and injury severity (r(2) = .48), but not age . Patients with diffuse injury tended towards a more protracted recove ry (7.9 weeks, SD 6.5) than patients with focal injury (4.2 weeks, SD 3.9) (p = .08) and only those with diffuse injury showed further recov ery after 3 months. Conclusions: Arm paresis after TBI is relatively i nfrequent. Most patients recover by 2 months but later recovery is pos sible, especially in patients with primarily diffuse brain damage. Rec overy is highly related to initial impairment, injury severity, and di stribution of brain injury. (C) 1998 by the American Congress of Rehab ilitation Medicine and the American Academy of Physical Medicine and R ehabilitation.