Abstract:
To evaluate distribution of levels of caregiver supervision at 1 year post traumatic brain injury, and to etermine where id = 395;
neuropsychological predictors of supervision level.

Design: Prospective longitudinal design, concurrent measurement of neuropsychological function and supervision level.

Setting: 17 TBI Model System centers.

Patients: 563 adults tested at 1 year post injury; sub-group of 452 studied for neuropsychological function in the absence of impairment in mobility or basic self-care, as assessed by high Motor FIM scores.

Main Outcome Measures: Supervision level measured by scores on Supervision Rating Scale (SRS).

Results: Two-thirds (69%) of the sample was rated as independent of supervision. Participants without significant dysfunction on Motor
FIM were grouped into supervision groups differing in intensity of time commitment from caregiver (Independent, Moderate Supervision, Heavy
Supervision). In univariate analyses, groups differed on demographic variables (education, race and productivity prior to injury), duration of altered consciousness, and all but one neuropsychological measure. A binomial regression model (complementary log-log model) revealed that supervision at 1 year was predicted by education and scores on the Trail Making Test, Part B and Digits Backward.

Conclusions: Findings confirm the importance of pre-injury status and measures of working memory/cognitive flexibility in predicting functional independence after TBI. The SRS appears prone to ceiling effects in persons followed prospectively after moderate to severe TBI.