Prognostic significance of motor subtype during acute recovery from traumatic brain injury
Abstract
The present study aimed to cross-validate a previously established motor subtyping schema for delirium (Meagher, Moran, Raju, Leonard, Donnelly, Saunders, & Trzepacz, 2008) on a traumatic brain injury (TBI) population and evaluate the impact of different types of motor disturbance on delirium recovery and TBI prognosis. Principal Components Analysis (PCA), Fisher's Exact Tests and Fisher's T-tests were conducted to evaluate the validity of motor subtype groups in delirious TBI patients and to determine a cutoff criteria for subtypes of motor disturbance. Growth Curve Models and Analyses of Variance (ANOVAs) were conducted to investigate the effects of motor disturbance presentation on delirium recovery and TBI prognosis. Seventythree TBI patients with and without delirium were included in the study (Delirious: n = 35; nondelirious n = 38). Four agitated items and seven hypomotoric items were identified for inclusion in the subtyping criteria. Cutoff scores of two symptoms with severity ratings ≤ 2 (0-3 point scale) allowed the best inclusiveness for delirious patients while also providing relative specificity for delirium. Despite similar ratings of delirium severity, motor subtype (agitated, hypomotoric, mixed or none) was a significant predictor of delirium recovery, with hypomotoric patients demonstrating the flattest recovery slope. Significant differences in hospital admission and discharge motor functioning were also found between motor subtypes (admit motor: F(3, 28) = 3.19, p = .039, r = .51; discharge motor: F(3, 28) = 8.18, p < .001, r = .68). The largest outcome was found among delirious patients with no motor disturbance ( M = 61.89, SD = 6.97) followed by agitated ( M = 60.86, SD = 14.02), mixed (M = 54.00, SD = 15.12) and then hypomotoric presentations ( M = 32.92, SD = 19.56). Overall, the results provided strong support for the presence of motor subtypes associated with delirium following TBI. The construct validity and clinical applicability of the motor subtype groups were strengthened by the identification of quantitative differences among the groups in delirium recovery and TBI prognosis. Methodological difficulties were identified and recommendations for future research were made.
Degree
Ph.D.
Advisors
Conger, Purdue University.
Subject Area
Psychology|Clinical psychology
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