The long-term outcome of head injury: Implications for service planning

Abstract

As most of those experiencing traumatic brain injury tend to be young, disabled survivors will be gradually accruing in each locality as each year passes. How many need continuing care a decade after injury? How many need day care, or need help with finding work, or continuing support for carers? 190 patients who had been admitted to two UK regional neurosurgical units on average some 7 years earlier were followed up. With an average age of 29 years these patients stayed in hospital for an average 33 days. At follow-up 23% were classified as having moderate disability or worse on the Glasgow Outcome Scale, including 7.4% who had died subsequent to discharge. Survivors were given a neuropsychological assessment and a socioeconomic interview. Of the survivors, 17% had failed to make a good recovery, but 36% were failing to occupy their time in a meaningful way. Age over 30 at time of injury, not occupied before injury, and above-average length of stay were some of the predictors for failing to occupy time. Quality of life was severely curtailed for those who could not occupy their time, as was the case for their carers. Appropriate counselling, vocational evaluation and family support in the early years following injury may help to improve quality of life for both the head-injured person and their carers.

A survey of vocational status 10 years after traumatic head injury

“…Some studies suggest a general trend of increasing rates of RTW and full-time employment with greater elapsed time since injury (Stambrook et al, 1990). In reviewing the literature of long-term vocational outcomes of at least 10 years post-injury, there is also marked variation in RTW rates (Miller & Stern, 1965;Adey, 1967;Rusk, Block & Lowman, 1969;Bruckner & Randle, 1972;Dresser et al, 1973;Lundholm, Jepsen & Thomval, 1975;Gilchrist & Wilkinson, 1979;Lewin, Marshall & Roberts, 1979;Reyes, Bhattacharyya & Heller, 1981;Sweeney & Smutok, 1983;Thomsen, 1984;Rappaport, HerreroBacke, Rappaport & Winterfield, 1989;Tate, Lulham, Broe, Strettles & Pfaff, 1989;Thomsen, 1992;Kraft, Schwab, Salazar & Brown, 1993;Schwab, Grafman, Salazar & Kraft, 1993;Sbordone, Liter & Pettler-Jennings, 1995;Tennant, MacDermott & Neary, 1995). The percentage of subjects returning to work ranged from 38.9% to 75%.…”

“…The actual nature of employment was described in five studies documenting very long-term outcomes of 10 years or more (Dresser et al, 1973;Kraft et al, 1993;Rusk et al, 1969;Thomsen, 1984Thomsen, , 1992. Other studies differentiated work into categories as full-time, part-time and self employed (Dresser et al, 1973;Rappaport et al, 1989;Sweeney & Smutok, 1983;Tate et al, 1989;Tennant et al, 1995;Thomsen, 1984Thomsen, , 1992, and some also used change in social position to describe vocational outcome (Bruckner & Randle, 1972;Lundholm et al, 1975) (see Table 1). …”

Partner relationships, functioning, mood and global quality of life in persons with spinal cord injury and traumatic brain injury

“…The study was undertaken an average of 4 years post injury. 26 In another study 27 it was found that QL was severely reduced for those TBI persons who could not occupy their time.…”

Caregiver stress in traumatic brain injury

“…TBI causes huge upheaval to family life; once discharged from hospital, many patients require continuing care (Tennant et al, 1995) and the responsibility of care is mostly provided by family members and spouses (Knight et al, 1998). Statutory services in the UK provide acute care and a limited range of rehabilitative services.…”