care-giving experiences. Adverse experience or burden was systematically related to increased TBI severity, worse cognitive outcome, increased dependence on others, reported change in the injured, and changes in the life of the significant other as a function of care-giving.


Dikmen et al. (2003) examined preinjury to postinjury changes in various facets of everyday life at 3–5 years after injury in subjects who had mild to moderate to severe TBI. Limitations were seen in all activities, including personal care, ambulation, travel, home management, and social relationships; the most affected were work, leisure and recreation, social relationships, and ambulation. The degree of limitations was related to the severity of TBI.


Machamer et al. (2005) used the same cohort to examine stability of work up to 3–5 years after injury. Amount of time worked after injury was related to severity of injury and associated impairments, in addition to preinjury work stability and earnings. Once a person returned to work, the ability to maintain uninterrupted employment was related to premorbid characteristics, such as being older, having higher income, and having had a preinjury job with benefits.


Pagulayan et al. (2006) used a subset of the same cohort as Dikmen et al. (2003) to examine recovery of function on the SIP at 1, 6, and 12 months and 3–5 years after injury. Significant limitations in all activities were seen at 1 month after injury compared with both friend controls and trauma controls. By 1 year, however, the TBI group still had problems compared with healthy friend controls but not with trauma controls except for leisure and recreation.


McLean and colleagues (1993) assessed psychosocial recovery at 1 and 12 months after head injury in 102 hospitalized patients (they were a subsample of Dikmen et al., 1995c). The reference group included 102 friend controls matched for age, education, sex, and race. At 12 months after injury, the head-injured patients differed significantly in seven symptoms on the Head Injury Symptom Checklist: dizziness (p < 0.01), blurred vision (p < 0.001), concentration (p < 0.001), noise (p < 0.05), irritability (p < 0.01), temper (p < 0.01), and memory (p < 0.001). The median number of symptoms presented at 1 year was 5 in those with severe head injury, 2 in those with moderate head injury, 3 in those with mild head injury, and 2 in controls. The severely injured had significantly more symptoms than those with moderate injury or friend controls.

Jennett (Oxford, Rotterdam, Cardiff, and Manchester) Studies

Jennett and Lewin (1960) studied traumatic epilepsy in 1,000 patients (infants to 65 years old) who sustained nonmissile head injuries and were admitted to the Radcliffe Infirmary in Oxford from November 1948 to February 1952. The cohort consisted of the first 1,000 cases of the Roberts (1979) studies below. Criteria for admission included some period of unconsciousness; 58% of the patients had PTA lasting less than 1 hour and fewer than 20% over 24 hours, and fewer than 50% had a fractured skull (Jennett, 1975). Of the 1,000, 46 (5%) had no history of epilepsy but experienced early epilepsy within a week of admission (the 14 patients with a history of epilepsy were excluded). An unselected series of 821 patients was admitted directly from the accident site and immediately placed under care; 31 (4%) experienced early epilepsy within a week of admission. A selected series of 179 patients was transferred from other hospitals and in general was considered more severe and complicated; 15 (8%) experienced early epilepsy. Of the total population, 90 patients died, including 8 (9%) who had early epilepsy. Of the 75 children under 5 years old and the 122 who were 6–15 years old, 9% and 3%, respectively, had early epilepsy. Early epilepsy was more frequent in patients who experienced



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