Lois C. Peters

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.

Family environment as perceived by children with a chronically ill parent

Thirty-three index children, aged 12-18 years, with a non-hospitalized multiple sclerotic patient and 33 control subjects were administered the Family Environment Scale, a scale that measures perception of family environment on the dimensions of family relationships, personal growth, and system maintenance. Subjects in the index group were each matched with a control subject on the basis of sex, age, number of siblings in the family, and socioeconomic status. Results indicated that in comparison with control group families, index group families were higher on the conflict subscale and lower on cohesion, intellectual-cultural orientation, moral-religious emphasis, and organization subscales. These findings are explained using a family systems analysis. The potential assets of utilizing a family systems orientation to explain these findings and the heuristic values of this framework are highlighted.

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.

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.