Longitudinal examination of resilience after traumatic brain injury


Marwitz, J. H., Sima, A. P., Kreutzer, J. S., Dreer, L. E., Bergquist, T. F., Zafonte, R., Johnson-Greene, D., & Felix, E. R. (2018). Longitudinal examination of resilience after traumatic brain injury: A Traumatic Brain Injury Model Systems Study. Archives of Physical Medicine and Rehabilitation, 99:264-71.


This study was an extension of a prior TBI Model System (TBIMS) multicenter study that provided evidence the resilience levels among adults at 3 months post moderate to severe TBI were relatively low in comparison to the general population. In this study, follow up time was extended with a total sample size of 180 subjects at 12 months post injury. Measures used for 3, 6, and 12 months addressed resilience, level of disability rating, life satisfaction, social relationships, and quality of life  related to anxiety and depression.  Variables in addition to demographic data were productivity level and substance use problems at time of injury.   Resilience was generally stable over time when not controlling for moderating variables.  However, when race, education, preinjury substance misuse, anxiety, satisfaction with life, and disability level were accounted for, resilience declined over the year post injury. The authors related their findings to another study involving resilience factors in the first 5 years following TBI (Hanks, Rapport, Perrine, & Millis, 2016) with suggestions for future research.  In terms of clinical application, the authors encouraged follow up beyond 3 months post injury with priority monitoring for persons in minority groups, pre-injury substance use problems, higher level anxiety, and higher level disability rating. 

I CHOSE THIS ARTICLE BECAUSE there is a paucity of resilience research specific to traumatic brain injury in comparison to a relatively large literature on resilience in other chronic diseases. For example, a recent systematic review of resilience literature focused on the diseases of cancer, stroke, heart disease, diabetes and COPD yielded 3,267 studies, only 17 of which met criteria for inclusion according to Cochrane guidelines (Kim, Lim, Kim & Park, 2018).  The study I summarized here appears to be a positive continuation along the lines of research focused on resilience in the TBI population, with the ultimate goal of fine-tuning treatment to modify resilience for improved long-term outcomes. 

THIS MONTH’S REHABILITATION SCIENCE SPOTLIGHT was chosen by Kier Bison, Ph.D., ABPP RP, Rehabilitation Psychologist at Baylor Scott & White Institute for Rehabilitation Day Neuro Program, Frisco TX and a Member of Division 22's Science Committee.