Neil A. Rutterford

Demographic and cognitive predictors of long-term psychosocial outcome following traumatic brain injury

Demographic factors and cognitive impairment have been found previously to have associations with outcome after brain injury. Kendall and Terry (1996) suggest that preinjury psychosocial functioning, neurological factors, and cognitive impairment have a direct relationship with multidimensional psychosocial adjustment, but that cognitive impairment also has an indirect relationship by means of the mediation of appraisal and coping variables. The aim of this study was to explore these theoretical relationships at very late stages of recovery after brain injury. A total of 131 participants who were more than 10 years after injury (mean = 15.31 yr) completed a neuropsychological assessment, plus outcome measures that included employment status, community integration, life satisfaction, quality of life (QoL), and emotion. Results indicated that injury severity was predictive of life satisfaction; gender and relationship status predicted community integration; and age at injury predicted employment status. Impairment in working memory directly predicted all outcomes except QoL and anxiety. An indirect relationship was also evident between working memory, life satisfaction, and depression. Results partially support Kendall and Terrys model but the variables that significantly influence outcome seem to be determined by the outcome dimensions selected.

Evaluating A Theory of Stress and Adjustment When Predicting Long Term Psychosocial Outcome After Brain Injury

Kendall and Terry (1996) include many psychosocial predictors in their theoretical model that explains individual differences in psychosocial adjustment (Lazarus & Folkman, 1984). The model depicts appraisal and coping variables as mediating relationships between situation factors, environmental and personal resources, and multidimensional outcome. The aim of this study was to explore these theoretical relationships at very late stages of recovery from traumatic brain injury. A total of 131 participants who were more than 10 years post-injury (mean = 15.31 years) completed several psychosocial measures relating to outcome dimensions comprising employment, community integration, life satisfaction, quality of life (QoL), and emotion. There was no evidence that appraisal and coping variables mediated relationships between psychosocial and any of the outcome variables. However, when appraisal and coping variables were combined with psychosocial variables as direct predictors of outcome, every outcome except employment status was reliably predicted, accounting for between 31 and 46% of the variance. Personality significantly influenced all predicted outcomes. Self-efficacy contributed to the prediction of all outcomes except QoL. Data did not support for the theory of stress and adjustment as a framework for explaining the nature of predictive relationships between psychosocial variables and very long-term, multidimensional outcome after brain injury.

Long-term effect of head trauma on intellectual abilities: a 16-year outcome study

Background: Intelligence was assessed in a group of 74 people with head injury, 16 years after injury (mean 16.77 years; range 10–32 years), and compared with their performance when assessed at an early stage in recovery (mean 1.05 years). Aims: To confirm the presence of long-term impairment relative to estimates of pre-accident ability, to confirm signs of deterioration between early (T1) and late (T2) measures, and to examine relationships between severity of injury, time since injury, length of education, sex and age, and performance on intelligence tests at T2. Expected outcomes: On the basis of evidence from other studies, a significant difference was expected between estimates of pre-accident intelligence and abilities measured at T1 and T2. Deterioration in performance between T1 and T2, and relationships between demographic variables, severity of injury and intellectual performance were also expected. Results and conclusion: The data supported long-term intellectual impairment, but there was no deterioration in abilities between T1 and T2. Performance on intelligence tests was associated with years of education but not with other factors.

Relationships Between Measured Cognitive Ability and Reported Psychosocial Activity After Bilateral Frontal Lobe Injury: An 18-Year Follow-Up

This case study illustrates a well‐established paradox often seen after serious frontal injury. Some individuals have little or no neurological abnormality, perform well on cognitive tests, and display an apparently “normal” social appearance, yet have serious, if subtle, neurobehavioural disability that prevents reliable and efficient performance in a number of daily activities. In this case study, we report the psychosocial progress of a young man who suffered serious bilateral frontal injury in a road traffic accident at the age of 20 years. He made a good neurological recovery and relatively few cognitive deficits were recorded. His performance on a range of neuropsychological tests, including specialist tests of “frontal function”, was mainly in the above average or superior range. In contrast, observations of his functional activities revealed a number of dysexecutive problems that had an adverse impact on his life. Changes in his personality and social behaviour, reflecting a number of “frontal” characteristics, only marginally improved as a result of post‐acute neuropsychological rehabilitation. He did not receive long‐term professional support but, with the passage of time and continued support from his family, he has married and manages to maintain a basic level of social integration, but not one commensurate with his pre‐accident potential. Problems of planning, organisation, initiative, and self‐awareness that were not recognised early in his recovery, and are not evident from neuropsychological assessment, remain as major obstacles to full social independence.

The impact of mild developmental learning difficulties on neuropsychological recovery from head trauma

Objectives: To investigate the prevalence of mild developmental learning difficulties (MDLD) in a group of patients who had sustained head trauma, to determine the impact on cognitive and neurobehavioural recovery. Methods: A case-control design comprised 136 consecutive cases (55 MDLD; 81 control). Information regarding a history of MDLD was obtained during clinical interview, with neurobehavioural problems recorded using a checklist. Neuropsychological assessment and questionnaire measures of anxiety and depression were completed. Results: Between group cognitive differences were only found on Digit Symbol (p < 0.01) and Trails B (p < 0.05) tests. The MDLD group reported a higher incidence of impulsive aggression and mood swings (both p < 0.01). Adjustment problems in the MDLD group were inferred from higher anxiety and depression ratings (both p < 0.05). Conclusions: The MDLD group did not appear to display a more generalized deficit in cognitive functions. However, neurobehavioural problems, plus the incidence and degree of affective changes, suggest greater psychological vulnerability than controls.

A comparison of the validity of self-report measures amongst people with acquired brain injury: A preliminary study of the usefulness of EuroQol-5D

EuroQol-5D has been used as a means of assessing health service effectiveness. This study examines its validity regarding people with acquired neurological disorders. Fifty-two participants with such disorders were studied. Each person completed the EuroQol-5D and the Dysexecutive Questionnaire (DEX-S). In addition, ratings were made by therapists regarding them using a modified version of the EuroQol-5D, DEX-O, and Barthel ADL (Activities of Daily Living) Index. A subsample was followed up and the procedure repeated (mean 10 months later). Results using the DEX support previous research that demonstrated that people with acquired neurological disorders tend to underestimate their difficulties. In contrast, lack of differences between EuroQol-5D ratings made by patients and staff was attributed to a weakness in the scale in that it primarily measures physical difficulties. EuroQol-5D ratings made by staff did not change on repeat assessment, despite several months exposure to neuro-rehabilitation. However, ratings made by patients suggested significant improvement. Although only a small number were followed up, repeat DEX ratings suggested both groups perceived significant improvement regarding cognitive, emotional, and behavioural sequela of brain injury; however, patients persisted in underestimating their extent. It was concluded that failure to capture the rich diversity of difficulties associated with acquired neurological disorders, too narrow a range of ratings available, and reliance on self-report, conspired to undermine the validity of EuroQol-5D. Consequently, its usefulness with this population should be questioned.