Research Article Prescribing Multiple Neurostimulants during Rehabilitation for Severe Brain Injury Amy A. Herrold, 1,2,3 Theresa Louise-Bender Pape, 1,2,4 Ann Guernon, 1,5 Trudy Mallinson, 6 Eileen Collins, 1,2,7 and Neil Jordan 1,2,3 1 Edward Hines Jr. VA Hospital Research Service, P.O. Box 5000, S. Fith Avenue (M/C 151H), Hines, IL 60141, USA 2 he Department of Veterans Afairs (VA), Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, P.O. Box 5000, S. Fith Avenue (M/C 151H), Hines, IL 60141, USA 3 Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive Chicago, IL 60611, USA 4 Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Oice of Medical Education (1574), 345 E. Superior Street Chicago, IL 60611, USA 5 Research Department, Marianjoy Rehabilitation Hospital, 26W171 Roosevelt Road, Wheaton, IL 60187, USA 6 Department of Clinical Research and Leadership, he George Washington University, 2100 Pennsylvania Avenue, Washington, DC 20037, USA 7 Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, Room 716, Chicago, IL 60612, USA Correspondence should be addressed to Amy A. Herrold; amy.herrold@va.gov Received 29 August 2014; Revised 26 November 2014; Accepted 30 November 2014; Published 22 December 2014 Academic Editor: Gabriel Y. F. Ng Copyright © 2014 Amy A. Herrold et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Despite a lack of clear evidence, multiple neurostimulants are commonly provided ater severe brain injury (BI). he purpose of this study is to determine if the number of neurostimulants received during rehabilitation was associated with recovery of full consciousness or improved neurobehavioral function ater severe BI. Method. Data from 115 participants were extracted from a neurobehavioral observational study database for this exploratory, retrospective analysis. Univariate optimal data analysis was conducted to determine if the number of neurostimulants inluenced classiication of four outcomes: recovery of full consciousness during rehabilitation, recovery of full consciousness within one year of injury, and meaningful neurobehavioral improvement during rehabilitation deined as either at least a 4.7 unit (minimal detectable change) or 2.58 unit (minimal clinically important diference) gain on the Disorders of Consciousness Scale-25 (DOCS-25). Results. Number of neurostimulants was not signiicantly ( > 0.05) associated with recovery of full consciousness during rehabilitation, within one year of injury, or meaningful neurobehavioral improvement using the DOCS-25. Conclusions. Receiving multiple neurostimulants during rehabilitation may not inluence recovery of full consciousness or meaningful neurobehavioral improvement. Given costs associated with additional medication, future research is needed to guide physicians about the merits of prescribing multiple neurostimulants during rehabilitation ater severe BI. 1. Introduction Severe brain injury (BI) results in loss of consciousness for a period of time greater than 24 hours. he transition from unconsciousness to recovery of full consciousness is described clinically according to three states of disordered consciousness: comatose, vegetative state (VS), and the mini- mally conscious state (MCS). Each state is deined by varying levels of arousal and awareness, ranging from the absence of arousal and sleep wake cycles in the comatose state to inconsistent but deinite behavioral indicators of self- or environmental awareness in MCS [1–6]. Hindawi Publishing Corporation e Scientific World Journal Volume 2014, Article ID 964578, 7 pages http://dx.doi.org/10.1155/2014/964578