Articles from prior issues of The Advocate

July/August 2001

Traumatic Brain Injury: Predicting Who Makes It Back And Who Does Not
by Dan Morris, Oregon DDS and Shari Bratt, Nebraska DDS

CRAIG BEAVER, PHD, THE DIRECTOR OF Neuropsychological Services at the Idaho Elks Rehabilitation Hospital in Boise, discussed his clinical experience and statistics surrounding the evaluation of traumatic brain injured individuals in his presentation to the NADE audience. He noted a number of problems for the Head Injured including that 60-80 percent of these individuals who return to work become unemployed within 90 days due to multiple problems that include cognitive, emotional, and physical barriers to returning to work. This trend is changing due to support network programs such as job coaching. The number of mild to moderate TBI cases is increasing and more people are surviving these injuries. Depression increases in time, with a significant amount of anxiety (50 percent), and a resistance to seeking or accepting assistance in treatment for these conditions; and reporting a divorce rate of 85 percent.

So what do you look for in determining the ability to return to work? In terms of success rates in returning to work, important pre-injury factors are age, employment history, drug and alcohol use, and prior psychiatric history. After age 50 there is decreased resiliency. If the individual was unemployed prior to the head injury, then there is a substantially poorer outlook for employment in the future. If there were DA/A problems before the injury they will tend to be increased (Blood Alcohol of .20 +, increases the likely long-term biochemical damage). If there was a history of mental illness, the mental problems will not be improved by the head injury.

Dr. Beaver reviewed the Glasgow Coma Scale (GCS), and discussed specific statistical relationships relating to the scale. The scale goes from 3 to 15 and has three components to consider: eye opening, verbal skills, and motor skills. The more frontal the injury, the poorer the outcome. It is important that all areas of cognitive ability be sampled. Significant delay in response to commands was a factor likely to result in an increased level of disability. He also noted that the level of disability increases with secondary injury or complications.

In discussing testing instruments, Dr. Beaver notes that memory is a better indicator of performance or disability for this population than IQ. He feels a “Global” test of function is the best predictor, commenting that while some tests are sensitive for brain injury, they are poor predictors of outcomes. He reviewed nine components that he feels are essential in a Neurobehavioral Asessment:

Motivation,

Intellectual Assessment,

Motor function

Attention and concentration

Language (both written and expressive),

Visual perception,

Memory (emphasizing multifaceted,

And including Verbal language based as well as nonverbal, and immediate recall as well as retention),

Executive function (e.g. problem solving, reorganization, planning, self-awareness), and some measure of Affective issues (e.g., MMPI for depression, anxiety, and insight).

In conclusion, Dr. Beaver, urged an in depth consideration of the long-term adjustment difficulties experienced by this population since there is no simple predictor of outcome.