Allan D. Moore

Effects of mild, moderate and severe closed head injury on long-term vocational status

Survival from significant closed head injury (CHI) is frequently associated with cognitive defects, physical impairment, personality change, interpersonal difficulty and, in general, some degree of social dependence. Here we report a multidimensional assessment of quality of life of a sample of 131 male head-injury patients suffering a range of severities of insult with specific emphasis on vocational outcome. Of those patients who sustained a severe injury and were employed full-time prior to the CHI, only 55% were able to return to this level of employment. No differences were found between the moderate and severe groups in pre- or post-CHI occupational status, as measured by the Blishen (1967) quantitative social economic index, although both groups declined from pre- to post-CHI. Lower post-CHI occupational status was associated with lower GCS on admission and longer lengths of post-traumatic amnesia, with patient self-report of physical, cognitive and psychosocial difficulties, including spousal reports of confusion, belligerance, verbal expansiveness and the decreased ability to perform socially-expected activities. Stepwise multiple regression analysis accounted for 38% of variance in post-injury vocational status, with lower pre-injury vocational status, greater age, high physical and psychological difficulties and lower admission Glasgow Coma Scale score variables forming the regression equation. Implications are discussed in terms of rehabilitation issues, including vocational programming and planning.

Psychosocial sequelae of closed head injury: effects on the marital relationship

Head injury frequently produces physical and psychological sequelae involving cognitive, behavioural, and personality disturbances which are chronic and perhaps even permanent. Clinically, it is apparent that the marital relationships of head injury patients face initial disruption as well as ongoing challenges in dealing with the physical, neuropsychological, and emotional changes post-injury. However, there is little empirical data to substantiate these observations. In this study, the marital relationships of 55 male head injury patients were assessed, based on the spouses self-report obtained through interview and questionnaires. The sample was divided into three groups according to the severity of the injury: mild (N = 10), moderate (N = 25) and severe (N = 20). Based on a one-way multivariate analysis of variance, dyadic consensus, affectional expression, and overall dyadic adjustment were significantly lower for wives in the severe group than the moderate group. Affectional expression was also lower in the severe group than the mild group. Stepwise multiple regression analysis determined that 47% of the variance of overall dyadic adjustment could be accounted for by three variables (multiple R = 0.69, p less than 0.001). Dyadic adjustment was greater when wives reported a lower level of financial strain, perceived their spouse to have a relatively low level of general psychopathology or maladjustment, and when the injury was relatively mild based on GCS scores. The implications for intervention in rehabilitation at the marital level are highlighted.

Coping strategies and locus of control following traumatic brain injury: relationship to long-term outcome

Cluster-analytic techniques were used to categorize coping strategies (CS) measured by the Ways of Coping--Revised Scale, and locus of control (LOC) beliefs measured by the Multidimensional Health Locus of Control Scale in 53 male traumatically brain-injured (TBI) persons. A cluster characterized by comparatively higher use of self-controlling and positive reappraisal CS and lower external LOC was associated with significantly lower mood disturbance and physical difficulties and a trend to be less depressed. The age of the neurologically injured patient and Taylors (1983) cognitive adaptation theory may be important aspects of recovery from TBI and other neurological conditions.

Head injury and spinal cord injury: Differential effects on psychosocial functioning

Closed-head injury (CHI) and spinal cord injury (SCI) cause significant permanent alterations in life style, social-role functioning, and psychological status. While the cognitive effects of CHI are well known, there have been questions concerning the psychosocial sequelae from CHI, and whether they are unique to this disability group rather than representing general effects of a life-threatening medical emergency with permanent life-altering consequences. This issue was examined with samples of ambulatory moderate (n = 31) and severe (n = 17) CHI patients and wheelchair-dependent SCI (n = 24) patients. Results indicate that there were no significant differences between the groups on pre- and post injury demographic factors. However, while the moderate CHI and SCI groups were equivalent on many indicators of psychosocial outcome, the severe CHI group was more depressed, angry and hostile, and confused and bewildered. As well, wives of the severe CHI patients rated their husbands as more belligerent, negative, helpless, suspicious, withdrawn and retarded, and with more general psychopathology than did wives of moderate CHI or wives of SCI patients. Implications of these findings for preventative psychosocial rehabilitation are discussed.

Centripetal and centrifugal family life cycle factors in long-term outcome following traumatic brain injury

The family life cycle model categorizes stresses on family systems in terms of their source and their effects on family members. Centripetal forces bring members together while centrifugal forces lead to loosened intrafamilial ties. This study examined the association of normative, developmental and centripetal illness-related family forces with patient outcome. Hypothesized centripetal and centrifugal forces acting on 65 families of married male TBI patients were used as independent variables in stepwise multiple regressions with criterion measures of quality of life outcome used as dependent measures. Centripetal variables included measures of family coping, marital adjustment, and number of years married. Centrifugal variables included number of children, age of oldest child, and amount of perceived financial strain. Regression equations obtained had multiple Rs ranging from 0.623 to 0.407 (p values < 0.017). Results suggest that families normatively dealing with the developmental stage of the family with young children may face unique challenges when a husband sustains a TBI, particularly when financial strain exists. Stages in family development involving conflict between centripetal and centrifugal forces may be most problematic for families to resolve, and potentially the most effective periods for intervention.

Cognitive moderators in adjustment to chronic illness: Locus of control beliefs following traumatic brain injury

Abstract Locus of control (LOC) beliefs and quality of life outcomes were assessed in 54 male patients with moderate (n = 32) or severe (n = 22) traumatic brain injuries (TBI). There were no differences in LOC beliefs between the moderate and severe groups as measured by either the Multidimensional Health Locus of Control Scale (MHLC) or the Revised Internal-External Scale (RIES). Correlation coefficients calculated between LOC scales and multidimensional measures of quality of life ranged from -0.22 to 0.42. Multiple regression analyses, in which Glasgow Coma Scale scores and years of education were initially “forced” as the primary initial predictors, indicated that LOC beliefs were related significantly to outcome, even after removing the influence of injury severity and education. The results suggest that postinjury, cognitive factors, such as LOC beliefs, may play an important role in recovery from TBI. Furthermore, these factors may be amenable to intervention by the rehabilitation team in a way tha...

Long-term multi-dimensional outcome following isolated traumatic brain injuries and traumatic brain injuries associated with multiple trauma

We retrospectively investigated long-term, multi-dimensional quality-of-life outcomes in 68 male patients who suffered pure head injuries and 63 male head-injured patients with associated multiple trauma. Results indicated that patients sustaining associated multiple trauma were significantly younger and more deeply comatose on admission. Trends were found to suggest that patients sustaining associated multiple trauma also remain in coma longer, and experience more difficulties in social interaction and overall psychosocial functioning, but less difficulties in mobility compared with pure-head-injured patients. These findings should be taken into account in the evaluation of results of treatment as well as in the planning and allocation of resources for head-injured patients.

Coping Patterns Associated with Long-Term Outcome from Traumatic Brain Injury Among Female Survivors

In this study, we investigated the relationship between coping strategy and long-term outcome from traumatic brain injury (TBI) in a sample of 72 female TBI patients an average of five years post-injury. Using cluster analytic techniques based on two subscale sets from the Ways of Coping Questionnaire-Revised (WOC-R), we derived clinically relevant cluster groups based on coping strategy and validated the groups on demographic, injury-related, and quality of life measures. Results suggested that coping strategies characterized by low overall coping and positive reappraisal were associated with relatively good outcome, while those characterized by high overall coping and a combination of self-blame and escape avoidance were associated with relatively poorer outcome. These results are similar to those obtained with male samples, but societally linked gender stereotypes may contribute to unique coping and restriction of coping strategy for female TBI patients.