Background: There are limited data on the interactions between concomitant spinal cord injury (SCI) and traumatic brain injury (TBI) in terms of medical, psychological, functional, and community outcomes. Objective: To investigate the hypothesis that in addition to SCI-associated sensory-motor impairments, people with dual diagnosis would experience additional TBI-associated cognitive impairments that would have a negative impact on community reintegration. Methods: Cross-sectional, case-matched study comparing a consecutive sample of participants with dual diagnosis (n = 30) to an SCI group (n = 30) and TBI group (n = 30). Participants who were on average 3.6 years postrehabilitation discharge were interviewed using a battery of standardized outcome measures. Results: Length of rehabilitation stay was significantly longer in SCI and dual diagnosis participants. Fatigue, pain, sexual dysfunction, depression, and sleep disturbances were frequently reported by all groups. Similar levels of anxiety and depression were reported by participants in all groups, however TBI participants reported higher stress levels. All groups achieved mean FIM scores ≯ 100. The dual diagnosis and SCI groups received more daily care and support than TBI participants. Similar levels of community reintegration were achieved by all groups with a high level of productive engagement in work, study, or volunteer activities. Conclusions: The findings of this study do not support the hypotheses. Postrehabilitation functioning was better than anticipated in adults with dual diagnosis. The contribution of rehabilitation factors, such as longer admission time to develop compensatory techniques and strategies for adaptation in the community, may have contributed to these positive findings.

Macciocchi SN, Seel RT, Thompson N, Byams R, Bowman B. Spinal cord injury and co-occurring traumatic brain injury: Assessment and incidence. Arch Phys Med Rehabil. 2008;89:1350–1357.
Spinal cord injury and co-occurring traumatic brain injury: Assessment and incidence
Arch Phys Med Rehabil.
, vol. 
89
 (pg. 
1350
-
1357
)
Michael DB, Guyot DR, Darmody WR. Coincidence of head and cervical spine injury. J Neurotrauma. 1989;6:177–189.
Coincidence of head and cervical spine injury
J Neurotrauma.
, vol. 
6
 (pg. 
177
-
189
)
Bowman B, Macciocchi SN. Dual diagnosis: Diagnosis, management, and future trends. Top Spinal Cord Inj Rehabil. 2004;10:58–68.
Dual diagnosis: Diagnosis, management, and future trends
Top Spinal Cord Inj Rehabil.
, vol. 
10
 (pg. 
58
-
68
)
Granger C, Hamilton B, Sherwin F. Functional Independence Measure. Buffalo, NY: Uniform Data System for Medical Rehabilitation; 1986.
Functional Independence Measure.
Macciocchi SN, Bowman B, Coker J, Apple D, Leslie D. Effect of co-morbid traumatic brain injury on functional outcome of persons with spinal cord injuries. Am J Phys Med Rehabil. 2004;83:22–26.
Effect of co-morbid traumatic brain injury on functional outcome of persons with spinal cord injuries
Am J Phys Med Rehabil.
, vol. 
83
 (pg. 
22
-
26
)
Bradbury CL, Wodchis WP, Mikulis DJ, Pano EG, Hitzig SL, McGillivray CF, Ahmad FN, Craven BC, Green RE. Traumatic brain injury in patients with traumatic spinal cord injury: Clinical and economic consequences. Arch Phys Med Rehabil. 2008;89:S77–84.
Traumatic brain injury in patients with traumatic spinal cord injury: Clinical and economic consequences
Arch Phys Med Rehabil.
, vol. 
89
 (pg. 
S77
-
84
)
Macchioochi S, Seel RT, Warshowsky A, Thompson N, Barlow K. Co-occurring traumatic brain injury and acute spinal cord injury rehabilitation outcomes. Arch Phys Med Rehabil. 2012;93:1788–1794.
Co-occurring traumatic brain injury and acute spinal cord injury rehabilitation outcomes
Arch Phys Med Rehabil.
, vol. 
93
 (pg. 
1788
-
1794
)
Arzaga D, Shaw V, Vasile A. Dual diagnosis: The person with a spinal cord injury and a concomitant brain injury. SCI Nurs. 2003;20:86–92.
Dual diagnosis: The person with a spinal cord injury and a concomitant brain injury
SCI Nurs.
, vol. 
20
 (pg. 
86
-
92
)
Richards JS, Osuna FJ, Jaworski TM, Novack TA, Leli DA, Boll TJ. The effectiveness of different methods of defining traumatic brain injury in predicting postdischarge adjustment in a spinal-cord injury population. Arch Phys Med Rehabil. 1991;72:275–279.
The effectiveness of different methods of defining traumatic brain injury in predicting postdischarge adjustment in a spinal-cord injury population
Arch Phys Med Rehabil.
, vol. 
72
 (pg. 
275
-
279
)
Whiteneck G, Gerhart KA, Cusick CP. Identifying environmental factors that influence the outcomes of people with traumatic brain injury. J Head Trauma Rehabil. 2004;19:191–204.
Identifying environmental factors that influence the outcomes of people with traumatic brain injury
J Head Trauma Rehabil.
, vol. 
19
 (pg. 
191
-
204
)
Price P, Stephenson S, Krantz L, Ward K. Beyond my front door: The occupational and social participation of adults with spinal cord injury. OTJR Occup Particip Health. 2011;31:81–88.
Beyond my front door: The occupational and social participation of adults with spinal cord injury
OTJR Occup Particip Health.
, vol. 
31
 (pg. 
81
-
88
)
Whiteneck G, Meade MA, Dijkers M, Tate DG, Bushnik T, Forchheimer MB. Environmental factors and their role in participation and life satisfaction after spinal cord injury. Arch Phys Med Rehabil. 2004;85:1793–1803.
Environmental factors and their role in participation and life satisfaction after spinal cord injury
Arch Phys Med Rehabil.
, vol. 
85
 (pg. 
1793
-
1803
)
Callaway L, Sloan S, Winkler D. Maintaining and developing friendships following severe traumatic brain injury: Principles of occupational therapy practice. Austral Occup Ther J. 2005;52:257–260.
Maintaining and developing friendships following severe traumatic brain injury: Principles of occupational therapy practice
Austral Occup Ther J.
, vol. 
52
 (pg. 
257
-
260
)
Devitt R, Colantonio A, Dawson D, Teare G, Ratcliff G, Chase S. Prediction of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury. Disabil Rehabil. 2006;28:547–559.
Prediction of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury
Disabil Rehabil.
, vol. 
28
 (pg. 
547
-
559
)
Sherman JE, DeVinney DJ, Sperling KB. Social support and adjustment after spinal cord injury: Influence of past peer-mentoring experiences and current live-in partner. Rehabil Psychol. 2004;49:140–149.
Social support and adjustment after spinal cord injury: Influence of past peer-mentoring experiences and current live-in partner
Rehabil Psychol.
, vol. 
49
 (pg. 
140
-
149
)
Winkler D, Unsworth C, Sloan S, Winkler D, Unsworth C, Sloan S. Factors that lead to successful community integration following severe traumatic brain injury. J Head Trauma Rehabil. 2006;21:8–21.
Factors that lead to successful community integration following severe traumatic brain injury
J Head Trauma Rehabil.
, vol. 
21
 (pg. 
8
-
21
)
Huebner RA, Johnson K, Bennett CM, Schneck C. Community participation and quality of life outcomes after adult traumatic brain injury. Am J Occup Ther. 2003;57:177–185.
Community participation and quality of life outcomes after adult traumatic brain injury
Am J Occup Ther.
, vol. 
57
 (pg. 
177
-
185
)
Jennett B, Teasdale G. Aspects of coma after severe head injury. Lancet. 1977:878–881.
Aspects of coma after severe head injury
Lancet.
(pg. 
878
-
881
)
American Spinal Injury Association. International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients. Chicago: Author; 2000.
American Spinal Injury Association
International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients.
Shores EA, Marosszeky JE, Sandanam J, Batchelor J. Preliminary validation of a clinical scale for measuring the duration of post–traumatic amnesia. Med J Austral. 1986;144:569–572.
Preliminary validation of a clinical scale for measuring the duration of post–traumatic amnesia
Med J Austral.
, vol. 
144
 (pg. 
569
-
572
)
Gronwall D, Wrightson P. Duration of post-traumatic amnesia after mild head injury. J Clin Neuropsychol. 1980;2:51–60.
Duration of post-traumatic amnesia after mild head injury
J Clin Neuropsychol.
, vol. 
2
 (pg. 
51
-
60
)
Seekins T. Beyond Disability, Consumer Reporting Form, Secondary Condition Prevention Program. Montana: University of Montana; 1990.
Beyond Disability, Consumer Reporting Form, Secondary Condition Prevention Program.
Lovibond SH, Lovibond PF. Manual for the Depression, Anxiety, Stress Scales. Sydney, Australia: Psychology Foundation of Australia; 1995.
Manual for the Depression, Anxiety, Stress Scales.
Kelly G, Todd J, Simpson G, Kremer P, Martin C. The Overt Behaviour Scale (OBS): A tool for measuring challenging behaviours following ABI in community settings. Brain Inj. 2006;20:307–319.
The Overt Behaviour Scale (OBS): A tool for measuring challenging behaviours following ABI in community settings
Brain Inj.
, vol. 
20
 (pg. 
307
-
319
)
Tate RL. Assessing support needs for people with traumatic brain injury: The Care and Needs Scale (CANS). Brain Inj. 2004;18:445–460.
Assessing support needs for people with traumatic brain injury: The Care and Needs Scale (CANS)
Brain Inj.
, vol. 
18
 (pg. 
445
-
460
)
Tate RL, Hodgkinson A, Veerabangsa A, Maggiotto S. Measuring psychosocial recovery after traumatic brain injury: Psychometric properties of a new scale. J Head Trauma Rehabil. 1999;14:543–557.
Measuring psychosocial recovery after traumatic brain injury: Psychometric properties of a new scale
J Head Trauma Rehabil.
, vol. 
14
 (pg. 
543
-
557
)
Kettl P, Hershey M. Sexuality after spinal cord injury questionnaire. In: Davis C, Yarber W, Bauserman R, Schreer G, Davis S, eds. Handbook of Sexuality-Related Measures. 2nd ed. Thousand Oaks, CA: Sage Publications; 1998:179–181.
Sexuality after spinal cord injury questionnaire
Handbook of Sexuality-Related Measures.
(pg. 
179
-
181
)
Harrison-Felix C. The Craig Hospital Inventory of Environmental Factors. 2001. The Center for Outcome Measurement in Brain Injury. http://www.tbims.org/combi/chief. Accessed April 8, 2009. http://www.tbims.org/combi/chief
Soo C, Tate RL, Aird V, Allaous J, Browne S, Carr B, Coulston C, Diffley L, Gurka J, Hummell J. Validity and responsiveness of the Care and Needs Scale for Assessing Support Needs After Traumatic Brain Injury. Arch Phys Med Rehabil. 2010;91:905–912.
Validity and responsiveness of the Care and Needs Scale for Assessing Support Needs After Traumatic Brain Injury
Arch Phys Med Rehabil.
, vol. 
91
 (pg. 
905
-
912
)
Tonks J, Yates P, Frampton I, Williams WH, Harris D, Slater A. Resilience and the mediating effects of executive dysfunction after childhood brain injury: A comparison between children aged 9-15 years with brain injury and non-injured controls. Brain Inj. 2011;25:870.
Resilience and the mediating effects of executive dysfunction after childhood brain injury: A comparison between children aged 9-15 years with brain injury and non-injured controls
Brain Inj.
, vol. 
25
 pg. 
870
 
Catalano D, Chan F, Wilson L, Chiu C-Y, Muller VR. The buffering effect of resilience on depression among individuals with spinal cord injury: A structural equation model. Rehabil Psychol. 2011;56:200–211.
The buffering effect of resilience on depression among individuals with spinal cord injury: A structural equation model
Rehabil Psychol.
, vol. 
56
 (pg. 
200
-
211
)
Kuipers P, Kendall M, Fleming J, Tate R. Comparison of the Sydney Psychosocial Reintegration Scale (SPRS) with the Community Integration Questionnaire (CIQ): Psychometric properties. Brain Inj. 2004;18:161–177.
Comparison of the Sydney Psychosocial Reintegration Scale (SPRS) with the Community Integration Questionnaire (CIQ): Psychometric properties
Brain Inj.
, vol. 
18
 (pg. 
161
-
177
)
De Wolf A, Lane-Brown A, Tate RL, Middleton J, Cameron ID. Measuring community integration after spinal cord injury: Validation of the Sydney psychosocial reintegration scale and community integration measure. Qual Life Res. 2010;19:1185–1193.
Measuring community integration after spinal cord injury: Validation of the Sydney psychosocial reintegration scale and community integration measure
Qual Life Res.
, vol. 
19
 (pg. 
1185
-
1193
)
Engel S, Murphy GS, Athanasou JA, Hickey L. Employment outcomes following spinal cord injury. Int J Rehabil Res. 1998;21:223–229.
Employment outcomes following spinal cord injury
Int J Rehabil Res.
, vol. 
21
 (pg. 
223
-
229
)
Yasuda S, Wehman P, Targett P, Cifu D, West M. Return to work for persons with traumatic brain injury. Am J Phys Med Rehabil. 2001;80:852–864.
Return to work for persons with traumatic brain injury
Am J Phys Med Rehabil.
, vol. 
80
 (pg. 
852
-
864
)
Whiteneck G, Harrison–Felix CL, Mellick DC, Brooks CA, Charlifue SB, Gerhart KA. Quantifying environmental factors: A measure of physical, attitudinal, service, productivity, and policy barriers. Arch Phys Med Rehabil. 2004;85:1324–1335.
Quantifying environmental factors: A measure of physical, attitudinal, service, productivity, and policy barriers
Arch Phys Med Rehabil.
, vol. 
85
 (pg. 
1324
-
1335
)
Corrigan JD, Selassie AW, Oman JA. The epidemiology of traumatic brain injury. J Head Trauma Rehabil. 2010;25:72–80.
The epidemiology of traumatic brain injury
J Head Trauma Rehabil.
, vol. 
25
 (pg. 
72
-
80
)
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