Commentary and perspectives on R.M. Allen's "The test performance of the brain injured"

Significant advances have occurred in the study of the neuropsychology of h ead injury since R.M. Alien's (1947) paper. These include better conceptual ization of brain-behavior relationships, advances in neuropsychological ins truments, normative data and assessment paradigms, structural and functiona l brain imaging techniques, greater understanding of the mechanisms of brai n injury, and the classification and quantification of brain injury. Howeve r, because of conceptual and merhodological problems there has been a relat ive lack of progress in understanding the etiology of symptoms in mild head injury. To date, studies of mild head injury have produced widely mixed fi ndings. Further, orthopedic injury, chronic pain, litigation, and other con ditions may also produce cognitive and behavioral changes similar to those seen in mild head injury. The authors outline a study design with two contr ol groups (other injury and noninjury) contrasted with mild closed head inj ury to resolve the issue of whether functional changes following an injury are due to a specific head injury effect or to more general injury factor(s ). Results of extant studies using this design are disucssed, along with fu ture directions for neuropsychological assessment. (C) 2000 John Wiley & So ns, Inc.