While the notion of heterogeneity in mTBI was not supported when severity was based on GCS scores, there was partial support when PTA duration was used as a measure of severity.

The long-term effects of severe penetrating head injury on adjustment levels were studied. Forty-one World War II veterans who suffered penetrating injury to the brain were interviewed 40 years after their initial injury using the Washington Psycho-Social Seizure Inventory (WPSI). The results support a comparable behavioral impact of right and left hemispheric lesions. Similarly, no significant relations were found between anterior and posterior locus of damage and psychosocial difficulties, although the results pertaining to the right-anterior group could be interpreted as suggestive of much greater maladjustment in all life dimensions assessed by the WPSI. Findings are discussed in terms of theoretical positions on hemispheric specialization and long-term expectancies that hold implications for planning rehabilitation programs for such patients.

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Age-related changes in the capacity for cognitive flexibility should be considered in social planning for the expanding elderly population and in the functional assessment of the individual geriatric patient. Current means for assessing conceptual flexibility are not particularly appropriate for use with the elderly. In the current study, a briefer and more tolerable measure of conceptual flexibility was derived from the Visual Verbal Test (VVT). This index correlated significantly with the number of perseverative errors but not the number of nonperseverative errors on the Wisconsin Card Sorting Test (WCST), attesting to its validity as a specific measure of the ability to shift mental set. A significant relationship between age and both this VVT measure of conceptual shift and the number of perseverative errors on the WCST was observed in a sample of 60 healthy elderly volunteers between the ages of 55 and 84, suggesting that cognitive flexibility is indeed negatively associated with age.

Despite controversy surrounding the concept of mild head injury (MHI), it is becoming evident that even a head trauma termed 'mild' may result in significant behavioural sequelae. The present study was an attempt at documenting structural cerebral damage, by way of computerized tomography, in a group of patients having suffered a MHI as defined by the Glasgow Coma Scale (GCS) score. A 1-year retrospective chart review identified 80 MHI patients who presented to the Emergency department of a lead hospital for trauma. Sixty-six per cent of these MHI patients were scanned. Evidence of intracranial abnormalities was obtained in 31% of the overall sample. Patients with a lower GCS score had a higher percentage of abnormal scans than those with a GCS score of either 14 or 15. The present findings suggest that a MHI can be associated with significant morbidity, and that a MHI group does not constitute a homogeneous pool of patients.

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