Relationship between strength, balance, and swallowing deficits and outcome after traumatic brain injury: A multicenter analysis

Objective: To examine the relation among strength, balance, and swallowing deficits, as measured on rehabilitation admission, and functional outcome at discharge and 1 year after traumatic brain injury (TBI). Design: Multicenter analysis of consecutive admissions to designated Traumatic Brain Injury Model Systems (TBIMS) facilities. Setting: Seventeen TBIMS centers. Participants: Adults and children older than 16 years of age with TBI (N = 2363) enrolled in the national database from January 1989 to November 2000. Interventions: Not applicable. Main Outcome Measures: Transfers, locomotion, stairs, lower-body dressing, grooming, bathing, upper-body dressing, toileting, and eating as measured by the FIM instrument at acute rehabilitation discharge and at 1 year after TBI. Results: Lower-extremity strength less than 3/5 on admission to acute rehabilitation was associated with increased need for assistance in locomotion, transfers, and lower-body dressing and less than 3/5 upper-extremity strength was associated with the need for assistance in self-care at rehabilitation discharge and at 1 year postinjury. Similar relations were found between impaired swallowing and assistance with eating, grossly impaired dynamic sitting, or standing balance and assistance with locomotion, transfers, eating, and self-care at rehabilitation discharge and at 1 year after TBI. Conclusions: Assessments of physical strength, swallowing ability, and dynamic balance on acute rehabilitation admission are helpful as screening tests in predicting the need for assistance of another person for mobility and self-care at rehabilitation discharge. This association remains strong at 1 year after TBI. By using this information, clinicians should initiate therapeutic interventions that optimize rehabilitation of the identified impairments and should make necessary arrangement for the patient's anticipated postdischarge needs. Further studies are necessary to delineate the amount of unique variance that these early physical examination findings contribute to outcome prediction. (C) 2004 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.