Recovery curves for patients who have suffered very severe brain injury

Abstract

Twenty-nine patients were admitted to a study of recovery of function following very severe brain injury and contributed detailed information towards the plotting of recovery curves. The patients were followed up longitudinally for periods of up to one year two months, and comprised three cohorts: those entering the study zero to 12 months, 13-24 months and 25 plus months post injury. Every two weeks, nurses completed a structured observation schedule containing 13 scales. Also every two weeks, patients were directly observed using a time sampling technique with 12 categories of behaviour. Recovery upon entry into the study was steeper in the first three months and then slowed, but did not asymptote in the period of observation, and recovery was best for those in the zero to 12 months post injury group. An overall recovery curve from the time of injury was plotted, which showed a steeper rise in the first year, but recovery clearly continued for three or four years. Marked individual differences were noted. Most recovery related to attempts to communicate, general alertness, motor control and more normalized mood. Implications for treatment are discussed.

Get full access to this article

View all access options for this article.

References

Kolb B. , Whishaw IQ Fundamentals of human neuropsychology, third edition. New York: WH Freeman, 1990.

Bennett-Levy J. , Polkey CE , Powell GE Self-report of memory skills after temporal lobectomy: the effect of clinical variables. Cortex 1980; 16: 543-57.

Blakemore CB , Falconer MA Long-term effects of anterior temporal lobectomy on certain cognitive functions. J Neurol Neurosurg Psychiatry 1967; 30: 364-67.

Gronwall D. Cumulative and persisting effects of concussion on attention and cognition . In: Levin HS , Eisenberg HM , Benton AL eds. Mild head injury. New York: Oxford University Press, 1989.

Barth JT , Alves WM , Ryan TV et al. Mild head injury in sports: neuropsychological sequelae and recovery of function. In: Levin HS , Eisenberg HM , Benton AL eds. Mild head injury. New York: Oxford University Press, 1989.

Levin HS , Grossman RG , Rose JE , Teasdale G. Long term neuropsychological outcome of closed head injury. J Neurosurg 1979; 50: 412-22.

Thomsen IV Late outcome of very severe blunt head trauma: a 10-15 year second follow up. J Neurol Neurosurg Psychiatry 1984 ; 47: 260-68.

Brooks N. , Campsie L. , Symington C. , Beattie A. , McKinlay W. The five year outcome of severe blunt head injury: a relative's view . J Neurol Neurosurg Psychiatry 1986; 49: 764-70.

Medical Disability Society. Report of the Working Party on the management of traumatic brain injury. London: The Development Trust for the Young Disabled , 1988.

10.

Powell GE , Wilson SL The Royal Hospital baseline for recovery of function following severe head injury. Paper presented to the XXIV World Congress of Psychology, Sydney, Australia, 1988 .

11.

Golden CJ A standardized version of Luria's neuropsychological tests. In: Filskov S , Boll TJ eds. Handbook of clinical neuropsychology. New York : Wiley-Interscience, 1981 .

12.

Malkmus D. , Booth B. , Kodimer C. Rehabilitation of the head-injured adult: comprehensive cognitive management . Downey California: Professional Staff Association of Rancho Los Amigos Hospital Inc., 1980 .