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 hospital and three regional and four community hospitals. Subjects: A consecutive 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 evidence of TBI. Main Outcome Measures: Standardized adaptive functioning, intellectual, psychiatric, and neuroimaging assessments were conducted on average 2 years after injury. Results: Severe TBI was associated with significantly (p <.05) lower Vineland Adaptive Behavior composite, 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 were significantly (p <.05) more impaired than orthopedic subjects on teacher-rated adaptive function. Family functioning, psychiatric disorder in the child, and IQ were significant variables, explaining between 22% and 47% of the variance in adaptive functioning outcomes. Conclusions: Severe TBI is associated with significant deficits in child adaptive functioning. This association appears to be mediated by family dysfunction, child psychiatric disorder, and intellectual deficits. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.