The impact of adverse childhood experiences on functional recovery following traumatic brain injury-related rehabilitation in veterans.

INTRODUCTION

Adverse childhood experiences (ACEs) and childhood social determinants of health (SDOH) are associated with poorer health outcomes in adults, but their impact on rehabilitation and functional outcomes post-traumatic brain injury (TBI) is unclear.

OBJECTIVE

To examine the potential impact of ACEs/SDOH on symptom and functional outcomes following TBI-related rehabilitation in veterans.

METHODS

Participants included 140 veterans enrolled in Veterans Affairs (VA) polytrauma rehabilitation programs between 2010-2024 who completed supplemental assessment of ACEs, SDOH, and other childhood trauma.

RESULTS

Participants with more ACEs had significantly lower Functional Independence Measure (FIM) Total and Motor score improvements from admission to discharge. SDOH and other childhood trauma were also significantly correlated with lower FIM Motor score improvements. When controlling for hospitalization length, more ACEs were associated with lower FIM Motor score improvements (β = -.245, p = 0.02) and marginally associated with lower FIM Total score improvements (β = -.205, p = 0.06) following TBI-related rehabilitation.

CONCLUSIONS

Higher ACEs were associated with less FIM Motor function improvement following TBI-related rehabilitation in veterans. ACEs may be associated with differences in functional motor outcomes in veterans following TBI, contributing to heterogeneous rehabilitation outcomes. Systematic integration of potential childhood adversities into rehabilitation may optimize outcomes for veterans who have been disproportionately affected.