TRAUMATIC BRAIN INJURY 1997

Australian and US teams explored and exploded the myths that TBI patients are preoccupied with physical disabilities and consequently underestimate the severity of their other impairments.

Patients usually reported lesser degrees of physical impairment than did their nominated significant others[1].

In neurobehavioural functioning[2], family members were in general agreement with patient's estimates, but judged communication as significantly more competent.

With the exception of meal preparation and housekeeping, there was near perfect agreement on measures of psychosocial performance between victims and their families[3].

PRACTICE POINT

Victims of Traumatic Brain Injury tend to underrate their physical disabilities and are generally accurate in estimates of their levels of cognitive and social functioning


After comparable Severe TBI, those who screened positive for alcohol or drugs performed significantly worse on neuropsychological testing during rehabilitation[4].

In another Australian study[5], electrical potentials measured over the brain during testing events were impaired in both TBI and drinking populations, and significantly impaired if both conditions were present.

PRACTICE POINT

Drug and alcohol use must be considered when interpreting both neuropsychological testing and Event Related Potentials results during recovery from TBI


There is considerable agreement between patients and relatives regarding amount of alcohol use, except for the severely injured[6]. The majority of drinkers are contemplating, or are ready to take, action on alcohol abuse during early recovery after TBI[7], providing a window of opportunity for motivational interviewing interventions.

PRACTICE POINT

TBI patients are more realistic about their related alcohol problems than is generally believed


Patients with a history of drug or alcohol abuse, and those who attended rehabilitation drunk, were over-represented in the patients lost to a longitudinal study[8] of outcome.

PRACTICE POINT

Studies reporting rates of return to school or work after TBI may be systematically over-optimistic because large numbers of substance abusers are lost to follow-up

TBI patients have a 50% probability of divorce or separation within 5-8 years of injury[9]. Factors determining likelihood of marital breakdown include severity of injury, relationship length and time since the injury.

PRACTICE POINT

Factors in the 50% probability of marital breakdown include length of

1. post-traumatic amnesia
2.
pre-injury relationship
3. time since injury


A third of 65 patients referred to a treatment clinic for Chronic Pain had a history and symptoms of previously untreated or undiagnosed Mild Traumatic Brain Injury[1].

PRACTICE POINT

MVA clients with upper body Chronic Pain or cognitive problems should be investigated for undiagnosed MTBI?

Copyright 2008 Electronic Handbook of Legal Medicine