The impact of compensation on late mortality after traumatic brain injury: A multi-centre study.

OBJECTIVES: To determine the impact of financial compensation on long-term mortality in adults with severe traumatic brain injury (TBI). DESIGN, SETTING AND PARTICIPANTS: An inception cohort of 2545 adults consecutively discharged from three metropolitan, post-acute inpatient rehabilitation services of the NSW Brain Injury Rehabilitation Programme from 1 July 1990 to 1 October 2007. MAIN OUTCOME MEASURE: Survival status at 1 October 2009. RESULTS: Compensation data were available for 1851 (73%) participants, with 826 (45%) receiving financial compensation. Yearly standardized mortality ratios remained elevated above general population norms for six to ten years for both groups. Compensation had a protective effect on mortality risk as a univariate predictor. However, when considered in multivariate Cox regression analysis, compensation had minimal effect on mortality risk when modelled with non-modifiable demographic factors and pre-existing medical history. Conversely, compensation trended towards a protective effect when modelled with post-injury variables. CONCLUSIONS: Financial compensation had a protective effect against late mortality following rehabilitation for severe TBI through complex interactions with rehabilitation service variables but not with injury-related variables. This finding suggests that wider access to compensation (and hence rehabilitation) through recently implemented schemes (e.g., NSW Lifetime Care and Support) may further improve life expectancy for this clinical population.

Quantifying patterns of upper limb motor change following BTX-A injection in adult spasticity management.

OBJECTIVE: To evaluate the capacity of the Upper Limb Performance Analysis: Comparative Analysis of Performance-Motor (CAP-M) to quantify change in adults with focal spasticity following injection of Botulinum Toxin-A (BTX-A) as a focal treatment for positive Upper Motor Neuron (UMN) features. METHODS: Twenty-three adults with moderate-to-severe spasticity were assessed pre- and post-BTX-A injection using CAP-M. Post-hoc video analysis of three sub-tests from the Action Research Arm Test were analysed against expected movements for each task. RESULTS: Post-injection, spasticity as measured by Modified Ashworth and Tardieu Composite scores decreased significantly (p < 0.001). Grouped CAP-M data showed a significant reduction (z = 2.1-2.7, ES = 0.51-0.56) in positive UMN features, with 145 fewer Excessive movements recorded. In addition, 31 more Expected movements were demonstrated (z = 2.9, ES = 0.60), consistent with 'unmasking' of movements. CONCLUSION: CAP-M analysis revealed that BTX-A injection decreased unwanted movement almost 5-times more frequently than 'unmasking' hidden voluntary muscle activity during active simulated tasks. In this way, CAP-M was able to simultaneously assess positive and negative UMN features. This quantitative framework may have greater functional relevance than traditional uni-dimensional, passive spasticity measures such as MAS and Tardieu Scale.

Measuring task performance after acquired brain injury: Construct and concurrent validity of 'Upper Limb Performance Analysis'.

OBJECTIVE: This preliminary investigation studies selected aspects of validity of the Upper Limb Performance Analysis (ULPA), an occupation-based functional upper limb (UL) measure. METHODS: The study investigated the ULPA-Task Performance Mastery (ULPA-TPM) in 35 community dwelling adults with upper motor neuron syndrome following acquired brain injury and 26 healthy controls. Construct and concurrent validity of the ULPA were determined via group discrimination between adults with and without ABI; and ABI participants who were and were not referred for UL spasticity management with botulinum toxin-A injections (injected and non-injected group). Concurrent validity was examined by investigating the relationships between the ULPA and an existing functional UL measure, the Action Research Arm Test, using Spearman's rank-order correlation. RESULTS: Significant differences in UL performance were demonstrated between the ABI and the Control group on all ULPA sub-scales (including: Omission (z = -2.6 to -3.6, rspb = 0.37-0.48), Accuracy (z = -5.8 to -6.0, rspb = 0.78-0.82), Repetition (z = -5.1 to -5.4, rspb = 0.63-0.73) and Timing errors (z = -5.9 to -6.2, rspb = 0.77-0.88). Those in the Injected group demonstrated more task performance errors than the Non-injected group, with significant differences in Accuracy (z = -2.1 to -2.4, rspb = 0.37-0.45), Repetition (z = -2.5 to -2.1, rspb = 0.43) and Timing (z = -2.0, rspb = 0.37). CONCLUSIONS: This study demonstrated good construct and concurrent validity of the ULPA-TPM.