Sequelae and functional reintegration following prolonged post-traumatic sub-reactivity (study of 100 cases)

Summary

Within a large series of head injuries (around 800 cases hospitalized every year), the most severely ill patients are studied in a prognostic computer programme. An analysis has been carried out of one hundred unselected cases of severe head injury with deep degrees of subreactive state (more than 1 to 4 days in degrees III and II respectively, and an average of 40 days) with a late follow up of between 8 months to 7 years.

Neurological and psychological studies, as well as adaptation to family life and previous work, were carefully assessed. There is a close correlation between the duration of the subreactive state (S.R.S.) and post-traumatic amnesia (P.T.A.). Below 30 years of age one day of S.R.S. corresponds to two days of P.T.A. Above 40 years of age the correlation is one day of S.R.S. to about three days of P.T.A. Residual defects in memory, attention and concentration depend also on the duration of S.R.S. as expressed by length of P.T.A., as well as on the age of the patient.

Psychometric studies (Wais test, etc.) followed the same patterns. Full scale I.Q. was lower than 70 in 12 per cent of the cases. Manipulative I.Q. was significantly lower than verbal scores, and Digit symbol and Object assembly were the most severely affected subtests. All these deficits were more evident in those patients with the longer P.T.A.

Readaptation to work was related to the duration of the P.T.A. together with the age of the patient. Below 40 years of age 40 days of P.T.A. seemed to be the upper limit for a full return to work. Altogether only 15 of our 100 patients resumed their previous working status. Family inadaptation was the rule in patients aged more than 50 years and in younger ones only after 60 days of P.T.A.

Finally, some conclusions are reached concerning E.E.G. findings and other less frequent symptoms.