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Behavioural predictors of outcome after severe head injury.
Shiel, A., WILSON, B.A., Horn, S., Watson, M., Evans, J., Pickard, J., & McLellan, D.L.
In J. Ponsford, P. Snow, & V. Anderson (Eds.), International Perspectives in Traumatic Brain Injury: Proceedings of the 5th Conference of the International Association for the Study of Traumatic Brain Injury and 20th Conference of the Australian Association for the Study of Brain Impairment (pp. 411-414). Queensland: Australian Academic Press.
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The purpose of this study was to evaluate outcome at four years after severe head injury and to establish which, if any, of the early behaviours observed in a prospective study were predictive of outcome. In a previous study (Horn et al., 1994) we developed a set of observational scales - The Wessex Head Injury Matrix (WHIM). The scale was designed to assess patients after head injury, to monitor recovery and to set goals for rehabilitation. It was developed by carrying out a prospective observational survey of 88 severely head injured patients and recording the behaviours observed during recovery. The behaviours were operationally defined and have been divided into three main subscales - a cognitive scale which includes cognitive, communication, social, alertness and attentional behaviours and a gross motor and an upper limb scale. The items on the scales were ordered by means of a paired preference analysis. Studies of reliability and validity of the scales have also been undertaken. This study was a follow-up study of the original sample. Of the original group, 64 were contacted and invited to participate in the follow-up study. Of these, 14 refused to participate and 11 did not reply. Of those not contacted, 6 were untraceable, 2 had died and initial data on the remainder was inadequate. Forty-one patients were included in the study. They were assessed on a range of tests of cognition, function, motor skills, dependency, social circumstances, social behaviour and employment. Eight of the sample were very severely impaired and unable to complete the cognitive tests and were assessed on behavioural scales and scales of dependency. The sample ranged in age at the time of follow-up from 20-71 years with a mean age of 35.2. Coma duration and duration of post traumatic amnesia were measured prospectively during the first study and mean coma duration was 14.21 days and mean duration of PTA 66.82 days. The relationships between the time taken for early behaviours to recover and the later outcome was calculated using nonparametric correlations and multiple regressions. Psychosocial variables such as change in social circumstances and employment were significantly associated with a combination of early attentional, cognitive, social and communication behaviours (p values < .001). Cognitive functions were significantly associated to the early attentional variables (p < .001). The results of the study suggest that early recovery of attention after severe head injury may be predictive of cognitive outcome, but that psychosocial outcome is also associated with recovery of other cognitive and social skills. However, the mechanism by which this occurs is not clear. It may be that those patients who show early recovery of attention and cognition may have greater spontaneous recovery or it may be that those patients whose attentional and cognitive skills recovery quickly are better able to benefit from rehabilitation thereby having a better outcome.