NeuroRehabilitation 19 (2004) 25–35 25 IOS Press Five years after traumatic brain injury: A study of individual outcomes and predictors of change in function Flora M. Hammond a,∗ , Karyn D. Grattan a , Howell Sasser b , John D. Corrigan c , Mitchell Rosenthal d , Tamara Bushnik e and William Shull f a Department of Physical Medicine and Rehabilitation, Charlotte Institute of Rehabilitation, Carolinas HealthCare System, Charlotte, NC, USA b R. Stuart Dickson Institute for Health Studies, Carolinas HealthCare System, Charlotte, NC, USA c Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA d Kessler Medical Rehabilitation Research and Education Corporation, West Orange, NJ, USA e Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, USA f Department Rehabilitation Medicine, University of Pennsylvania, Philadelphia, PA, USA Abstract. Objective: Study functional changes between one and five years after traumatic brain injury (TBI). Design: Prospective cohort. Setting and participants: TBI Model Systems National Database subjects using cohort with complete one and five year data (n = 301). Main outcome measures: Disability Rating Scale (DRS) Level of Functioning and Employability Items. Results: On Level of Functioning, 53 (18%) individuals improved, 228 (76%) stayed the same, and 20 (7%) worsened by more than one point from Year 1 to Year 5. On Employability, 50 (17%) individuals improved, 237 (79%) stayed the same, and 14 (5%) worsened by greater than one point. Level of Functioning improvement was predicted by FIM TM -Motor, FIM TM -Cognitive, Rey Auditory Verbal Learning Test, Symbol Digit Modalities Test (written and oral), and Wechsler Adult Intelligence Scale-Revised Block Design, and worsening predicted by Symbol Digit Modalities Test (written and oral). Improvement in Employability was predicted by race, while Glasgow Coma Scale Eye Opening was predictive of worsening. Conclusions: Although the majority did not demonstrate meaningful change on the DRS items from year 1 to 5, some individuals made dramatic gains and a minority declined. There are demographic and functional indicators present at one-year post-injury that may be predictive of subsequent change. Keywords: Brain injury, outcome, function, disability rating scale, prediction, employment 1. Introduction The first thing a family wants to know regarding their loved one with traumatic brain injury (TBI) is the ∗ Flora M. Hammond, M.D., Director, Brain Injury Research, De- partment of Physical Medicine and Rehabilitation, Charlotte Insti- tute of Rehabilitation, 1100 Blythe Blvd., Charlotte, NC 28203, USA. Tel.: +1 704 355 4330; Fax: +1 704 355 0709; E-mail: Flora.hammond@carolinashealthcare.org. prognosis for recovery. What are long-term outcomes after TBI? Do individuals with brain injury improve over time? A myth exists that significant change does not occur after one year. This phenomenon is often referred to as the “plateau” and can lead to anxiety, depression, and loss of hope among patients, families, and clinicians. Emerging from coma to walk, commu- nicate, and perhaps care for oneself within the first year certainly constitutes a tremendous amount of change. Though often less dramatic or noticeable, improve- ISSN 1053-8135/04/$17.00  2004 – IOS Press and the authors. All rights reserved