SUMMARY A five year follow-up study was conducted with two groups of head-injured children, 131 younger than 9 years old at time of injury and 100 older than 9 years. The four aspects studied were neuropsychological function, neurological status, EEG status, and school progress. There was an extended recovery process over time, as well as evidence of a differential rate of recovery for the four aspects measured.Our understanding of the natural history of head injuries in children can best be increased by prospective, long-term, multidimensional studies. The paucity of such clinical studies has been commented on (Black et al., 1971;Lishman, 1973;Klonoff and Paris, 1974). A study which would add to our knowledge of the head-injured child should be broad in scope. Firstly, it should include: antecedentfactorsconstitutional predisposition, premorbid personality, age, sex, environmental hazards; circumstances at time of head injury-the nature and extent of injury, resilience of the neural apparatus in childhood, the nature of intervention and management during the acute and postacute phases; and consequence factors-the effect of brain damage on general adaptation and maturation, on the development of post-traumatic epilepsy, effect on education, transaction with family, and the role of compensation and litigation. Secondly, it should encompass a variety of clinical examinations including neurological, electroencephalographic, and psychological. Thirdly, the study should address itself to the interaction of effects, namely, the differentiation of immediate from short-term or long-term effects, and the nature and course of reconstitution.This study accordingly set out to investigate prospectively a head-injured group of children from the time of trauma (hospitalisation) to the fifth year after trauma, within the context of the model noted above. Previous publications have reported our methods, and the immediate and short-term effects
The purpose of the 23 year follow up study was to determine the relationship between trauma variables including measures of head injury and very long-term sequelae. The study included 159 individuals with a mean age 31-40 years, of whom approximately 90% were admitted to hospital with a mild head injury during childhood (mean age 7.96). Extent of head injury was determined by unconsciousness, neurological status, skull fracture, EEG, post-traumatic seizures and a composite measure. The composite measure of neurological variables was the best predictor of long-term outcome. In addition, IQ recorded in the postacute phase was a reliable predictor of long-term outcome. Of the sample, 32-7% reported physical complaints and 17*6% reported current psychological/ psychiatric problems unrelated to the head injury. Subjective sequelae (physical, intellectual and emotional) specified as due to the head injury were reported by 31% of the sample, and the sequelae were found to be related to the extent of the head injury and initial IQ. There were no discernible relationships between attribute variables including premorbid status and age with subjective sequelae. There were, however, significant relationships between subjective sequelae and objective, psychosocial measures of adaptation including educational lag, unemployment, current psychological/psychiatric problems and relationships with family members. Finally, there appeared to be continuity of complaints elicited during the five year follow up of the original project and current sequelae. The severity of the head injury was identified as the primary contributory factor in the reconstitution process and in the prediction of long term outcomes. (7 Neurol Neurosurg Psychiatry 1993; 56:410-415)
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