ADAPTIVE FUNCTIONING FOLLOWING TRAUMATIC BRAIN INJURY AND ORTHOPEDIC INJURY - A CONTROLLED-STUDY

Objective: To study adaptive functioning after severe traumatic brain injury (TBI). Design: Case-control study. Setting: A university hospit al and three regional and four community hospitals. Subjects: A consec utive series (n = 24) of children age 5 through 14 years who suffered severe TBI were individually matched to subjects who sustained a mild TBI and to a second group who sustained an orthopedic injury with no e vidence of TBI. Main Outcome Measures: Standardized adaptive functioni ng, intellectual, psychiatric, and neuroimaging assessments were condu cted on average 2 years after injury. Results: Severe TBI was associat ed with significantly (p <.05) lower Vineland Adaptive Behavior compos ite, communication, and socialization standard scores and lower Child Behavior Checklist parent-rated social competence scores compared with children with orthopedic injury. Severe TBI and mild TBI subjects wer e significantly (p <.05) more impaired than orthopedic subjects on tea cher-rated adaptive function. Family functioning, psychiatric disorder in the child, and IQ were significant variables, explaining between 2 2% and 47% of the variance in adaptive functioning outcomes. Conclusio ns: Severe TBI is associated with significant deficits in child adapti ve functioning. This association appears to be mediated by family dysf unction, child psychiatric disorder, and intellectual deficits. (C) 19 98 by the American Congress of Rehabilitation Medicine and the America n Academy of Physical Medicine and Rehabilitation.