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Objective To characterize the influence of additional (both prior and subsequent) traumatic brain injuries (TBIs) on recovery after a moderate to severe index TBI. Setting Traumatic Brain Injury Model Systems centers. Participants Persons with moderate to severe TBI (N = 5054) enrolled in the TBI Model Systems National Database with complete outcome data for the outcomes of interest at 1-, 2-, and 5-year follow-up. Design Secondary analysis of a prospective longitudinal data set. Main measures Prior and intercurrent TBI from the Ohio State University TBI Identification Method (OSU TBI-ID), Disability Rating Scale (DRS), and Functional Independence Measure (FIM). Results Prior moderate-severe TBIs significantly predicted overall level of functioning on the DRS, FIM Cognitive, and FIM Motor for participants with less severe index injuries. Moderate-severe intercurrent TBIs (TBIs subsequent to the index injury) were predictive of poorer functioning for both Index Severity groups, reflected in higher mean scores on the DRS in participants with less severe index injuries and lower mean Cognitive FIM in participants with more severe index injuries. Conclusion Multiple brain injuries, particularly those of moderate or greater severity, have a significantly greater impact on patients' level of functioning compared with a single injury, but not the rate or shape of recovery.

Objective Examine the prevalence of weight classifications and factors related to obesity/overweight among persons 1 to 25 years following traumatic brain injury (TBI) using the Traumatic Brain Injury Model Systems national database. Design Multicenter, cross-sectional, observational design. Setting Traumatic Brain Injury Model Systems inpatient rehabilitation facilities. Participants Persons (N = 7287) 1, 2, 5, 10, 15, 20, or 25 years after TBI who required inpatient acute rehabilitation. Main outcome measures Body mass index, demographic characteristics, functional, health, satisfaction with life, and global outcomes. Results Overall postinjury weight prevalence rates were 23% obese, 36% overweight, 39% normal, and 3% underweight. Higher rates for obesity and overweight problems were associated with increasing time since injury. Younger (18-19 years) and older (80+ years) age, those in a vegetative state, and those reporting excellent health were less likely to be obese. Individuals with a history of hypertension, heart failure, or diabetes were more likely to be obese. Conclusions Being obese or overweight presents a health risk in the years following rehabilitation for TBI. The findings support the need for longitudinal studies and highlight the advisability of monitoring weight and promoting healthy lifestyle behaviors over time in survivors of TBI.