The Influence of Agitation on Recovery from Traumatic Brain Injury

Past Studies 

Past Studies have estimated that as many as one-third of individuals with traumatic brain injury experience agitation during their recovery. Agitation refers to extreme behavior, including restlessness, big mood swings, aggressiveness, and taking action without thinking about what one is doing first. Agitation can begin during the early stages of brain injury recovery, when an individual is not fully conscious or when cognition (thinking skills) is impaired. Past researchers have suspected that agitation may interfere with the rehabilitation process and result in less than desired outcomes for recovery. Individuals with traumatic brain injury and agitation are more likely to be discharged to facilities that can provide constant supervision than to home. Research about agitation has been limited.

This Study

This Study included 340 individuals with traumatic brain injury who were consecutively admitted to one inpatient traumatic brain injury rehabilitation unit. The majority of the participants were white, male, and had received moderate to severe brain injures. The average age was 33 years old. The participants’ medical records were examined to determine background information and details about their recovery levels at discharge from inpatient rehabilitation. Phone and mail surveys were used to obtain data, including levels of life satisfaction and productivity, one year after the individuals were discharged from inpatient rehabilitation. Life satisfaction referred to happiness with very general basic life areas. Productivity was defined as an individual’s return to work or school after experiencing brain injury, if the individual was working or in school at the time of the brain injury. Thirty-six percent of the participants showed agitation during their inpatient rehabilitation period. The most important finding from this study involves the relationship between agitation, cognitive skills, and outcomes. The presence of agitation during rehabilitation reflected lower cognitive (thinking) skills at admission. Individuals who experienced agitation had greater difficulty at admission with remembering things or solving problems. Lower cognitive skills at admission were found to be associated with a longer length of stay, decreased likelihood of being discharged to home, and poorer cognitive skills at discharge. Probably because agitation was associated with lower cognition, agitation was also found to be associated with poorer outcomes. In particular, individuals with agitation that lasted for more than 10 days spent a longer length of time in rehabilitation than those without agitation. Those individuals with agitation that lasted 26 days or longer were less likely to be discharged to home. At one year after inpatient rehabilitation, there appeared to be no relationship between the presence of agitation during the individuals’ rehabilitation stays and their reported levels of life satisfaction or productivity.

Who May Be Affected By These Findings

Individuals with traumatic brain injury and their loved ones, healthcare providers, researchers

Caveats

The researchers found that impaired cognitive functioning at admission to inpatient rehabilitation was linked with both the occurrence of agitation and longer lengths of rehabilitation stay. The researchers believe that agitation and impaired cognition are related and influence each other, with impaired cognition having a greater effect on outcomes. The researchers express concern about the use of medications that reduce agitation, but also cause sleepiness and decreased cognitive functioning, thus creating a potentially negative outcome. They suggest that the treatment of agitation should begin with an examination of the treatment of cognitive impairments. These researchers did not address or control the use of medication interventions in this study, which may have effected their results.

Bottom Line

Individuals with traumatic brain injuries who experienced agitation for more than 26 days while in inpatient rehabilitation were more likely to spend longer lengths of time in rehabilitation and were less likely to be discharged to home. They also experienced greater difficulties with thinking skills and physical abilities when they were discharged from inpatient rehabilitation. The researchers found that impaired cognitive functioning at admission to inpatient rehabilitation was linked with both the occurrence of agitation and longer lengths of rehabilitation stay. The researchers believe that agitation and impaired cognition are related and influence each other, with impaired cognition having a greater effect on outcomes.

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