The Impact of Mild Traumatic Brain Injury on Cognitive Functioning Following Co-occurring Spinal Cord Injury

Archives of Clinical Neuropsychology, 2013 · DOI: 10.1093/arclin/act049 · Published: September 20, 2013

Spinal Cord Injury Mental Health Brain Injury

Simple Explanation

This study investigates the cognitive effects of mild traumatic brain injury (MTBI) in individuals who also have a spinal cord injury (SCI). The researchers compared the neuropsychological test performance of people with both SCI and MTBI to those with SCI alone to see if the MTBI had any additional impact on cognitive function. The study found that having an MTBI in addition to an SCI did not result in significantly worse cognitive performance compared to having only an SCI. Other factors, such as education level, race, and pre-existing learning problems, were more strongly associated with cognitive test scores. These findings suggest that the presence of a single MTBI may not have a substantial long-term impact on cognitive function in individuals with SCI, and that other factors should be considered when evaluating cognitive performance in this population.

Study Duration

18-month period

Participants

117 participants: 53 with SCI and co-occurring MTBI, 64 with SCI alone

Evidence Level

Cohort study

Key Findings

1
Persons who sustained traumatic SCI and co-occurring MTBI did not evidence significantly greater impairment on neuropsychological tests when compared with persons who sustained a traumatic SCI alone.
2
The aggregated MTBI effect size of 20.16 at 26–76 days post-injury in our sample is consistent with the MTBI aggregated effect size of 20.14 at 31–92 days post-injury reported by Rohling and colleagues (2011).
3
Socio-demographic, pre-injury, and medical covariates explained more variance in neuropsychological test performance than MTBI.

Research Summary

This study examined the impact of MTBI on cognitive function in individuals with SCI. Participants were tested between 26 and 76 days post-injury. The study found no significant difference in neuropsychological test performance between those with SCI and MTBI and those with SCI alone. The researchers concluded that a single MTBI does not significantly impact cognitive functioning following SCI, and other factors should be considered.

Practical Implications

Clinical Assessment

Clinicians should consider pre-injury learning problems and co-occurring trauma as potential contributors to lower than expected neuropsychological test performance following MTBI.

Test Interpretation

Considering race, ethnicity, culture, and education is essential in post-MTBI test score interpretation.

Diagnosis

Using lower than expected neuropsychological test scores as the primary basis for diagnosing MTBI .30 days post-injury will likely result in high rates of false positive diagnoses.

Study Limitations

1
The study was unable to systematically examine risk factors for reduced cognitive efficiency, including depression, pain disorders, and insomnia.
2
Effort testing was not conducted, which may have identified suboptimal effort as a covariate of lower than expected test performance.
3
The sample was predominately young, that is, ,40 years old, and our results cannot be generalized to older persons with MTBI.

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