PSYCHOSOCIAL OUTCOME 5-8 YEARS AFTER SEVERE TRAUMATIC BRAIN-LESIONS AND THE IMPACT OF REHABILITATION SERVICES

This study addresses three questions. First, what is the long-term psy chosocial outcome for severely head-injured patients? Second, is an in creased survival rate associated with an increase in the number of pat ients with a poor quality of life? Third, do rehabilitation services a ffect the final outcome? The long-term outcome was assessed by means o f questionnaires for self-ratings, interviews with patients and relati ves and neurophysical examinations. One hundred and six patients initi ally judged as good recovery/moderate disability (GR/MD) 6 months post -injury participated in the study. Forty to 50% of these patients show ed co-ordination disturbances; more than 20% had speech disorders and cranial nerve deficits. Twenty-eight per cent had psychiatric symptom scores on the Hopkins Symptom Checklist (HSCL) indicating need of trea tment. Social function according to the Social Adjustment Scale-Self-R eport (SAS-SR) showed that 40% had problems concerning interpersonal r elations and 20-30% had problems within the field of leisure activitie s, but few problems were reported on work activities and economy. The Comprehensive Psychopathological Rating Scale (CPRS) revealed that hos tile feelings, failing memory and fatiguability were common symptoms a nd were reported by relatives in 71%, 52% and 48%, respectively, but t he mean distress levels were moderate. A correlation was seen between quality of life reported by relatives and the degree of mental and soc ial disability according to the Bond Outcome Scale, but the correlatio n to neurophysical handicap was rather weak. The majority of patients were able to return to a productive social life. The proportion of pat ients with a poor long-term outcome did not increase after introductio n of an aggressive management protocol for head injuries. Data indicat ed that improvements in facilities for rehabilitation may positively a ffect psychosocial adjustment.