The relationship between neuropsychologic function and level of caregiver supervision at 1 year after traumatic brain injury

Objectives: To evaluate distribution of levels of caregiver supervision at 1 year after traumatic brain injury, and to determine neuropsychologic predictors of supervision level. Design: Prospective longitudinal design, concurrent measurement of neuropsychologic function and supervision level. Setting: Seventeen Traumatic Brain Injury Model Systems centers. Participants: A total of 563 adults tested at 1 year postinjury; and a subgroup of 452 studied for neuropsychologic function in the absence of impairment in mobility or basic self-care, as assessed by high FIM(TM) instrument motor scores. Interventions: Not applicable. Main Outcome Measure: Supervision level measured by scores on Supervision Rating Scale (SRS). Results: Two thirds (69%) of the sample was rated as independent of supervision. Participants without significant dysfunction on motor FIM were grouped into supervision groups differing in intensity of time commitment from caregiver (independent, moderate supervision, heavy supervision). In univariate analyses, groups differed on demographic variables (education, race, productivity prior to injury), duration of altered consciousness, and all but 1 neuropsychologic measure. A binomial regression model (complementary log-log model) revealed that supervision at 1 year was predicted by education and scores on the Trail Making Test Part B and digits backward. Conclusions: Findings confirm the importance of preinjury status and measures of working memory and cognitive flexibility in predicting functional independence after TBI. The SRS appears prone to ceiling effects in persons followed prospectively after moderate to severe TBI.