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The Wessex Head Injury Matrix (WHIM) main scale: A preliminary report on a scale to assess and monitor patient recovery after severe head injury.
SHIEL, A., Horn, S.A., WILSON, B.A., Watson, M.J., Campbell, M.J., and McLellen, D.L.
Clinical Rehabilitation, 14, 320-328, 2000.
Year of publication:
This study aimed to develop a behavioural assessment based on observations of patients recovering after severe head injury whereby data could be collected by observation and by testing everyday tasks. A prospective observational study of a cohort of 88 consecutive hospital admissions with severe head injury was carried out in two district hospitals in the UK. Eighty-eight patients who comprised consecutive admissions with severe traumatic head injury were recruited to the study. Ages ranged from 14 to 67 years, mean coma duration was 14 days and mean duration of Post Traumatic Amnesia (PTA) was 56 days. Fifty-eight items of behaviour were identified. Paired preference analysis was used to identify a sequence of recovery of these behaviours. The sequence began with arousal and led into behaviours signalling recovery of social interaction and communication. Subsequent behaviours indicated increasing cognitive organisation and return of orientation and memory. The behaviours on the scale are hierarchical and range from coma to emergence from Post Traumatic Amnesia (PTA). The results further demonstrate that while individual patients will show some departures from the sequence identified, the scale helps to make explicit the earliest stages of natural recovery patterns after head injury.