Researchers Discover Link Between Continence and Traumatic Brain Injury Recovery

Researchers in the Department of Physical Medicine and Rehabilitation have discovered that the recovery of bowel and bladder continence by the time of discharge from inpatient rehabilitation can be used as an indicator of the potential for a favorable long-term functional recovery for severe traumatic brain injury patients. David S. Kushner, M.D., associate professor of physical medicine and rehabilitation and Director of the University of Miami Rehabilitation Program at HealthSouth Miami, was initially surprised at the simplicity of the evidence he was seeing in traumatic brain injury patients.

“I have a series of patients who have suffered severe traumatic brain injuries. We use the Functional Independence Measure scale to score the level of their cognitive, physical and bowel/bladder continence upon admission and discharge to rehabilitation,” Kushner said. “After reviewing my patients’ scores, one of the things I noticed was that all my patients with long-term positive outcomes, who upon admission were mostly incontinent, became continent by the time of discharge. Bowel and bladder continence appeared to be a marker of improvement for brain injury.”

His findings were recently published in the Journal of Rehabilitation Research & Development. Co-authored by Douglas Johnson-Greene, Ph.D., M.P.H., Director of Rehabilitation Psychology and Clinical Neuropsychology and Vice Chair of the Department of Physical Medicine and Rehabilitation, the findings were consistent in all patients in the case series. Other studies published since 1999 have reported conflicting results regarding predictors of functional outcomes in severe brain injury patients, partly because of their complexity.

Kushner said that patient outcomes are usually projected by complicated measures that may involve numerous clinical factors that can be unreliable and are complex even for clinicians to understand, let alone family members awaiting word on a loved one’s potential for recovery.

“Unlike neuroimaging, combinations of other clinical factors or complex predictive studies, families understand this indicator. By the time of discharge from acute care and inpatient rehabilitation, you can tell families that their loved one should make a good functional recovery. Something as simple to understand as bowel and bladder continence may be very reassuring to family members,” he said.

Kushner and Johnson-Greene’s department has been awarded a traumatic brain injury model systems grant from the U.S. Department of Education’s National Institute on Disability and Rehabilitation Research to collect more data from brain injury patients. They will further explore continence as a potential indicator of good functional outcome in severe traumatic brain injury. In addition, Kushner hopes that other physicians and researchers will further investigate what they have discovered because, Kushner said, “it could be a simple, easy marker of recovery.”

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