LONG-TERM NEUROPSYCHOLOGICAL OUTCOME AND LOSS OF SOCIAL AUTONOMY AFTER TRAUMATIC BRAIN INJURY

Objective: To assess which social activities were still impaired 5 yea rs after a traumatic brain injury (TBI) in adults, and which neuropsyc hological impairments were associated with this loss of social autonom y. Design: Cross-sectional study of 79 patients selected from the foll ow-up cohort of an epidemiologic survey of 2,116 TBI patients. Setting : The present study was of ambulatory patients seen at hospital or at their homes. The inception cohort was from the trauma center of a univ ersity hospital and from a general hospital that is representative of level II trauma centers in Aquitaine, France. Patients: Seventy-nine p atients selected from a representative sample of 407 patients who were included in the 5-year follow-up study of the initial cohort (conveni ence sample). Main Outcome Measures: Glasgow Outcome Scale (GOS) and l oss of social autonomy as assessed by the European Brain Injury Societ y's European Head Injury Evaluation Chart; assessment of neurobehavior al impairments by means of the Neurobehavioral Rating Scale-Revised. R esults: Up to 16 patients suffered disability for at least one social skill because of cognitive/behavioral reasons. Seven needed full-time supervision. Performing administrative tasks and financial management, writing letters and calculating, driving, planning the week, and usin g public transport were the most impaired social abilities. Loss of so cial autonomy was mainly observed in severely injured patients. Univar iate analysis showed that mental fatigability, motor slowing, memory d ifficulties, and disorders of executive function were associated with low scores on the GOS, unemployment, and difficulties in shopping, usi ng public transport, and performing financial management and administr ative tasks. Conclusion: Persistent impairments of executive functions and speed of psychomotor processing are major factors associated with loss of social autonomy and inability to return to work long after TB I in adults. Improving these impairments in concrete social situations represents a major challenge for cognitive rehabilitation. (C) 1997 b y the American Congress of Rehabilitation Medicine and the American Ac ademy of Physical Medicine and Rehabilitation.