Hamish P. D. Godfrey

Course of insight disorder and emotional dysfunction following closed head injury: A controlled cross-sectional follow-up study

Closed-head injury (CHI) patients at either 6 months (n = 24), 1 year (n = 19), or 2 to 3 years (n = 23) postinjury, were compared with a group of orthopedic control (OC) patients (n = 27). CHI patients assessed at 6 months postinjury experienced a Post-Traumatic Insight Disorder, in which they underreported the severity of their behavioural impairments. CHI patients in the 1 year and 2 to 3 year follow-up groups evidenced both greater insight about their level of behavioural impairment, and higher levels of emotional dysfunction. These findings suggested that the return of insight is associated with increased risk for emotional dysfunction. Implications of these findings for assessment and treatment of closed-head injury patients are discussed.

Caring for a family member with a traumatic brain injury

The responses to a questionnaire on subjective burden are reported for 52 primary caregivers of a group of persons with traumatic brain injuries sustained an average of 6 years previously. The aim of the study was to examine satisfaction with social support, perception of coping skills, and appraisal of symptoms as predictors of strain in the carers. A range of responses, both positive and negative, to the work of caring for a relative with a head injury was reported. A high prevalence rate of emotional and behavioural changes in the persons with head injuries was found and the amount of distress caused by these symptoms was found to be predictive of burden. The other factor important in predicting burden was the carers ratings of their satisfaction with their ability to cope with the work of caregiv ing. Social support, injury severity, and the demographic characteristics of the persons with head injury and their carers were not significant predictors. Depression in the carers was also investigated and the variable most predictive of elevated depression scores was coping satisfaction. These findings reinforce the importance of strengthening carers coping resources in rehabilitation work with head injured persons and their families.

Post-traumatic amnesia and Glasgow Coma Scale related to outcome in survivors in a consecutive series of patients with severe closed-head injury

A consecutive series of 93 severe closed-head injury (SCHI) patients, discharged from hospital in a conscious state, were rated on the Glasgow Outcome Scale at 6 and 12 months post-injury. Patients were included in this study if they had a period of post-traumatic amnesia (PTA) exceeding 24 h. Approximately 80% of patients had made a good recovery by 12 months post-injury; a better outcome than has been found in studies using the presence of coma during the first 6 h post-admission to hospital to define severe head injury. When analysed individually, duration of PTA and Glasgow Coma Scale scores on admission to hospital were both strongly correlated with outcome. Only duration of PTA, however, contributed significantly to outcome variance when potential outcome predictors were assessed using a stepwise multiple regression analysis. The definition of severe head injury, the higher than usual incidence of good recovery in the present study, and the relationship between injury severity and outcome are discussed.

Caregiver depression following traumatic brain injury (TBI): a consequence of adverse effects on family members?

Many studies have demonstrated that the behaviour of individuals with traumatic brain injury (TBI) predicts the emotional adjustment of their caregivers. The primary objective of the present study was to obtain an understanding of potential moderating and mediating variables between carer depression and analogous stressors. Seven sets of predictor variables (demographic variables, concurrent stressful life events, behavioural problems, social role problems, extent of adverse effects on family members, appraisal, and support) and the criterion variable of depression in caregivers were examined. Fifty-eight carers participated in the study at 6 months, 1 year, 2 years, or 3 years following injury. The number of adverse effects on family members (other than the informant) was the only stressor significantly related to carer depression. However, carer appraisal of adverse family effects was found to mediate the relationship between stressor and depression, and carer perception of support effectiveness was found to moderate the effect of adverse family effects on depression. Forty-six per cent of the variance in caregiver depression was accounted for by carers appraisal of adverse family effects and the interaction of adverse family effects and support effectiveness. These findings highlight the importance of supporting families as a whole in the rehabilitation of persons with TBI.Many studies have demonstrated that the behaviour of individuals with traumatic brain injury (TBI) predicts the emotional adjustment of their caregivers. The primary objective of the present study was to obtain an understanding of potential moderating and mediating variables between carer depression and analogous stressors. Seven sets of predictor variables (demographic variables, concurrent stressful life events, behavioural problems, social role problems, extent of adverse effects on family members, appraisal, and support) and the criterion variable of depression in caregivers were examined. Fifty-eight carers participated in the study at 6 months, 1 year, 2 years, or 3 years following injury. The number of adverse effects on family members (other than the informant) was the only stressor significantly related to carer depression. However, carer appraisal of adverse family effects was found to mediate the relationship between stressor and depression, and carer perception of support effectiveness was found to moderate the effect of adverse family effects on depression. Forty-six per cent of the variance in caregiver depression was accounted for by carers appraisal of adverse family effects and the interaction of adverse family effects and support effectiveness. These findings highlight the importance of supporting families as a whole in the rehabilitation of persons with TBI.

Some normative, reliability, and factor analytic data for the revised UCLA Loneliness scale

Normative statistics are provided for the UCLA Loneliness Scale based on the results of a sample of 978 adult subjects collected during a general population health survey. Factor analysis of the data revealed that the scale had a two factor structure; positively worded items loaded on one factor and negatively worded items on the other. Results from the factor analysis were used to construct two equivalent 10-item short forms of the scale. Previous findings that the scale is highly reliable were confirmed.

Conversation with traumatically brain-injured individuals : a controlled study of behavioural changes and their impact

The conversations of 62 traumatically brain-injured (TBI) patients, assessed between 6 months and 3 years post-injury, were compared with those of an orthopaedic control (OC) group (n = 25). Conversations involving TBI subjects were rated as significantly less interesting, less appropriate, less rewarding and more effortful than interactions involving OC subjects, and were characterized by differences in the frequency of prompt usage and turn duration. Furthermore, measures of turn duration and prompt frequency were significantly associated with the perceived quality of conversation. These findings provide a microbehavioural description of the social process through which TBI individuals fail to adequately reinforce others.

Emotional Adjustment Following Traumatic Brain Injury: A Stress- Appraisal-Coping Formulation

This article conceptualizes emotional adjustment to traumatic brain injury (TBI) within a stress-appraisalcoping (SAC) model. In this model the emotional adjustment of the individual with TBI is seen as a response to neuropsychological symptoms and associated losses. This response is mediated, howev

The Profile of Functional Impairment in Communication (PFIC): a measure of communication impairment for clinical use

This article describes the construction of the Profile of Functional Impairment in Communication (PFIC), a scale designed for the assessment of communication impairments following traumatic brain injury. The measure comprises 10 feature summary scales, assessing severity of impairment, and 84 specific behaviour items, assessing the frequency of specific communication impairments. To assess the psychometric properties of the scale, videotaped dyadic social interactions of 20 patients with traumatic brain injury were rated by eight trained raters. The feature summary scales were found to have acceptable inter-rater reliabilities, and high concurrent validity and internal consistency. Four case descriptions are presented to illustrate the clinical application of the PFIC. It is concluded that the PFIC is a useful measure for the identification of specific communication impairments in clinical practice.

Social interaction and speed of information processing following very severe head-injury

Eighteen adults who had suffered a very severe closed head-injury more than 18 months previously and required long-term rehabilitative support were compared with a closely matched control group. Unlike previous studies, which have reported negative personality change involving an increase in aversive behaviour, our behavioural observation data suggest that a global reduction in behavioural productivity, or negative symptomatology, characterizes social interaction by this group. This resulted in their being judged less socially skilled, less likeable and less interesting, and thus less reinforcing to interact with. Speed of information processing was specifically impaired for the closed head-injury group, although this did not correlate with global behavioural ratings of social interaction behaviour. It is suggested that low behavioural productivity may be associated with family burden, and that the low quantity of social interaction experienced by severely head-injured adults may reflect the unreinforcing nature of their interactions.

Utility of a demographic equation in detecting impaired NART performance after TBI

OBJECTIVES This study applies a demographic regression equation devised by Crawford, Allan, Cochrane, and Parker (1990) to determine its utility in New Zealand, and to determine the proportion of persons with traumatic brain injury (TBI) with impaired performance on the National Adult Reading Test (NART). METHOD The NART was administered to 80 community participants, 65 people with traumatic brain injury (TBI), and 27 orthopaedic controls. The Crawford et al. (1990) equation was applied to all three samples. RESULTS The Crawford et al. (1990) equation was applicable in the New Zealand community sample. It was found that 30% of the TBI sample had impaired performance on the NART. Using corrected NART scores, a significantly larger proportion of the TBI sample was detected as intellectually impaired than in the control sample. CONCLUSION Nearly one-third of the TBI sample evidenced impaired performance on the NART. Consequently, clinicians that use the NART in assessing people with TBI should use the demographic equation to check the accuracy of NART performances, and correct the NART scores if this is indicated.