Outcome 5 years post traumatic brain injury with further reference to neurophysical impairment and disability

School of Physiotherapy, University of South Australia.
Brain Injury (Impact Factor: 1.81). 10/1997; 11(9):661-75. DOI: 10.1080/026990597123214
Source: PubMed


The assessment of recovery and outcomes post-traumatic brain injury (TBI) has often been poorly researched and reported in past literature. Indeed, an accurate documentation of outcomes in this population had never been performed in the state of South Australia. To redress this situation this study collected data on people who had sustained a TBI 5 years previously, using medical records, personal interview/questionnaire and neurophysical assessment in order to investigate broad outcomes as well as the specific nature and prevalence of any residual physical impairment and disability. The results (n = 67) indicate that the subjects' living arrangements had not altered significantly, and nearly half had returned to some form of paid work, though over 50% were reliant on the welfare system. The majority (57%) felt they had improved in all areas, 19% partially improved and 8% felt they had actually deteriorated. Considering the physical data, the most frequent areas of residual impairment were headaches, followed by balance difficulties and fatigue/weakness. Functionally, 30% had some degree of deficit in upper limb activity and 9% required assistance for particular transfer tasks. Overall balance was impaired in 34% and gait was altered in 24% with 9% reliant on wheelchairs for mobility. Such data may be used in the education of people with TBI and those who live and/or work with them, as well as in future studies assessing the impact of various factors on recovery and outcomes. Evidence was also provided that residual physical issues should be considered along with the more researched areas of cognition and psychosocial issues.

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    • "Hellawell et al. [33] 1999 5 Results illustrated the legacy of moderate head injury in influencing many aspects of everyday life, supporting the argument that the needs of patients with moderate to severe head injury should not be overlooked. Hillier et al. [34] 1997 5 This study collected data on patients who had sustained a TBI 5 years previously. The results indicated that the subjects' living arrangements had not altered significantly, and nearly half of the patients had returned to some form of paid work. "
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    ABSTRACT: Development of reliable procedures to assess fitness to safe driving after traumatic brain injury (TBI) is a crucial step in rehabilitation. However, prior studies are highly inconsistent in the choice of measures recommended for predicting driving fitness from different pre-driving measures. In the present paper the relevant literature is reviewed with the aim of shedding light on the reasons for these inconsistencies. The discrepant results reflect investigative choices which differ in five aspects: (1) the type of predictors used as pre-driving screening; (2) the type of measures considered as the criterion for the determination of fitness to drive after TBI; (3) the severity of the TBI in the sample of patients studied; (4) the extent of the neural structures damaged by TBI and the overlap of these areas with those involved in driving tasks; (5) the length of the follow-up considered. The strengths and weaknesses of the different methods and measures are discussed with their implications for future research and clinical rehabilitation. Encouraging findings come from recent studies that combined together medical, psychosocial, and personality measures, thereby improving the explanatory power of the predictors used. The use of post-injury driving fitness measures with great ecological and external validity seems equally promising in assessing actual driving in the real world.
    Neurorehabilitation 02/2006; 21(1):81-92. · 1.12 Impact Factor
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    • "Therealizationthatimbalancecouldresultfromtraumaticbraininjurytookhold inthemid90saspatientsrespondingtopost-TBIquestionnairesconsistentlyreported thisamongtheirotherdisabilities.Abouthalfofallparticipants(severitylevelsranging frommildtosevere)reporteddysfunctionduetotheirinjuryina5yearpost-TBIsurvey andphysicianassessmentstudyappraisingbalanceimpairment[53].Asimilartypeof scoredsurveywasusedtoassesstherecoveryofnormalbalanceinagroupofcollegiate footballplayerswithlesssevereTBls[54].Thislongitudinalanalysisusedafewclinical measurementsofbalance,includingswayduringtandemstanceandwhilestandingona foamsurface.Theirresultsindicatedthatstandingbalancecontrolhadfullyrecovered afterasingledaypost-injury,whiletheirarrayofotherdeficitspersisteduptofivedays post-injury.Boththefunctionalityandsensitivityofthemeasurementsemployedinthese studiesleaveroomforquestioning. "

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    ABSTRACT: To investigate the relationship of psychiatric functioning with psychosocial functioning at 1 year following traumatic brain injury (TBI), after controlling for relevant demographic, injury-related, and concurrent factors. Prospective 1-year longitudinal study. Participants were 122 individuals with TBI and 88 proxy informants. Rehabilitation hospital. The Structured Clinical Interview for DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision)) Axis I Disorders, Hospital Anxiety and Depression Scale, Sydney Psychosocial Reintegration Scale, and Glasgow Outcome Scale--Extended. At 1 year postinjury, occupational activities were the area of most change after TBI followed by interpersonal relationships and independent living skills, according to the Sydney Psychosocial Reintegration Scale. The majority of participants were rated as having moderate disability on the Glasgow Outcome Scale--Extended. After controlling for relevant background factors, preinjury, acute postinjury, and concurrent psychiatric disorders were significantly related to 1-year psychosocial outcome. Screening in the acute postinjury stage for presence of preinjury psychiatric history or current distress may help identify individuals who require more intensive rehabilitation and psychiatric support and more active postdischarge monitoring. Further research exploring potential causal mechanisms for these findings is required.
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