PI Brief Update

Factors Affecting Good Functional Recovery Following Traumatic Brain Injury - Implications on Future Health, Well Being and Employment Status - Dr Karen Addy, Consultant Clinical Neuropsychologist

11/10/13. Traumatic brain injuries are a common consequence of high impact road traffic accidents with estimates suggesting that 25% of all brain injuries occur in this manner. In addition evidence suggests that road traffic accidents account for a far greater proportion of moderate-to-severe head injuries (Wasserberg 2002) due to the mechanisms of force applied to the brain during such accidents. Outcome following a brain injury is dependent upon several factors:

• The severity of the injury sustained (low Glasgow coma scale, loss of consciousness, prolonged post traumatic amnesia)

• The area / areas of the brain affected by the initial injury and any secondary injury

• Social support

• Previous educational / occupational abilities

• Co-morbid mental health problems, drug / alcohol use, social issues.

In addition the actual effects of the traumatic brain injury suffering a brain injury increased the probability of the later development of epilepsy (Angers & Cohen, 2000) with the severity of the injury, incidence of skull fracture and age (being over 65 years old) associated with the greater risk, with reports suggesting the highest risk groups having a 24.3% chance of later developing epilepsy (Englander et al, 2003) which in itself can lead to significant functional and emotional problems.

The mechanisms of recovery from traumatic brain injuries are poorly understood, and there is a large degree of variability. However research indicates that recovery from a traumatic brain injury tends to follow a negatively accelerating curve with rapid improvement noted in the first three to six months. Following which slight improvements maybe noted in cognitive skills, functional ability and emotional adjustment and this may continue at a slow rate for several years however it is widely accepted that following a moderate to severe traumatic brain injury the individual will have lasting impairments. The degree to which these impairments impact upon the individuals functional and occupational life vary depending upon the individuals ability to adjust, the environment they live within and how this adapts to them and the extend of their cognitive impairments. As a consequence a majority of people with a severe traumatic brain injury are unable to return to employment and may require up to 24 hour care and support to complete functional tasks and activities of daily living. Such injuries can be catastrophic leading to permanent disability and dependence on others. As such traumatic brain injuries in the context of road traffic accidents can often be the start of a complete change of life for not only the person affected with the traumatic brain injury but also for their wider family. As such a psychological and neuropsychological assessment is an essential part of the medico- legal process for these individuals.

References:

David, Flemminger, Kopelman, Loveston & Mellers (2009) Lishman’s Organic Psychiatry. Whiley-Blackwell Press.

Lezak, Howieson & Lorning (2010) Neuropsychological Assessment; Oxford Press.

Synder, P.J, Nussbaum, P.D & Robins, D.L (2006) Clinical Neuropsychology. American Psychological Association.

Wasserberg J (2002); Treating head injuries. BMJ. 31 :454-5

Dr Karen Addy (www.hughkochassociates.co.uk) regularly holds clinics in Anglesey, Chester, Liverpool, Llandudno and Manchester.

More information can be found at www.hughkochassociates.co.uk

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