Late recovery from head injury: case report and review

Awareness of deficit after traumatic brain injury: a literature review

Much of the research literature on long term psychosocial adjustment to traumatic brain injury (TBI) suggests that persons with TBI do not adequately perceive their deficits of higher cortical functioning and, as a consequence, they may adopt maladaptive responses to their social environment. This issue poses a major challenge for occupational therapists and other rehabilitation professionals involved in the social and vocational rehabilitation of persons with TBI. However, the literature is characterised by disagreement concerning the nature and extent of unawareness of deficits in this group. In addressing this issue, several factors are considered: severity of injury, time since injury, prevailing neuropsychological and psychosocial perspectives, and access to intensive rehabilitation programmes. Implications for occupational therapists as practitioners and researchers are discussed.

18-Fluorodeoxyglucose positron emission tomography in children and adolescents with traumatic brain injury

Twenty-two previously normal children and adolescents who suffered a severe, non-penetrating traumatic brain injury had PET during rehabilitation at a median of 1.5 months after the injury. Outcome was assessed at a median of 25 months after brain injury. 16 subjects had CT or MRI within 24 days of PET and 11 subjects had a second PET at the point of outcome (median 28 months after first PET). The PET score (obtained by adding the score of 15 brain regions: normal metabolism = 1; reduced = 0) was significantly associated with the clinical outcome measure. PET earlier than 12 weeks after head trauma correlated with outcome, but later PET did not. PET scores improved significantly between rehabilitation and outcome for the 11 subjects who had two PETs, but improvement was not associated with improvement in clinical condition. PET score did not add to the amount of variance explained in the last regression model for prediction of outcome when the results of contemporaneous CT/MRI and clinical condition were taken into account. The data suggest that routine PET during rehabilitation is no more useful than contemporaneous CT or MRI for prediction of outcome.

The five year outcome of severe blunt head injury: a relative's view

A close relative of each of 42 severely head injured patients was interviewed at 5 years after injury, following initial study at 3, 6, and 12 months. Persisting severe deficits, in some cases worse than at 1 year, were primarily psychological and behavioural, although minor physical deficits, for example in vision, were also common. Relatives were under great strain; significantly more so than at 1 year. The best predictor of strain in the relative was the magnitude of behavioural and personality change in the patient.

Social adjustment after closed head injury: a further follow-up seven years after injury

A group of severely head injured patients were reassessed 7 years after injury. This group was the same as that previously reported 2 years after injury. There was no change in their physical or cognitive status; personality problems were still commonly reported but the less disabled had made further progress in returning to their former level of vocational and social activity.

Problems in measuring cognitive recovery after acute brain injury

The measurement of cognitive recovery after traumatic brain damage raises a number of methodological and practical problems. The precise schedule of testing, the specification of functions to be measured, the separation of practice from recovery, and the specification of appropriate control or comparison groups must all be considered by the researcher. In addition, strenuous efforts must be made to achieve as high a follow-up rate as possible.

Neuropsychological treatment and longtime follow-up in an aphasic patient with very severe head trauma

A 44-year old man with very severe head trauma had pronounced global aphasia and dyslogia for months. He received intensive neuropsychological treatment during the first two posttraumatic years and gradual improvement occurred. Notwithstanding sensory aphasia and at least moderate dementia, the patient then got sheltered work in a library. At that time a general follow-up examination took place and information on memory, language, and personality was obtained from the spouse. The procedure was repeated in exactly the same way ten years later. The great improvement in language and cognitive functions that had occurred during the decennium revealed itself in daily life as well as in clinical and psychometric findings. The case described shows that recovery neuropsychological functions can take place during many years after very severe head trauma.

Return to work after head injury: a review of post-war studies

The literature on occupational resettlement after head injury is confounded by varying standards of clinical severity and social outcome. A comparison of eleven key studies in the light of the authors' own research yielded a success rate ranging from 50 to 99 per cent, but this was based on superficial evidence. A more searching enquiry is needed, using objective methods and avoiding the technical inadequacies of most previous work. This would be unlikely to challenge the importance of age and length of post-traumatic amnesia as determinants of return to work, but should lead to a better understanding of other factors such as previous occupational status, cognitive deficits and personality changes.