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Rehabilitation services for the severely brain injured are often inadequate and one of the chief factors responsible is undue emphasis on the contribution of physical disability with scant attention to the serious emotional and intellectual handicaps incurred. Weakness, spasticity and dysphasis tend to recover eventually to a variable extent but mental handicap is often the cause of serious and lasting disablement. For a determination of the outcome of severe brain injury in terms of its effect on daily living, the relation between physical disability, mental handicap and social reintegration has been assessed quantitatively. Three assessment scales have been constructed and used in a study of 58 severely brain damaged patients. This revealed that the duration of post-traumatic amnesia correlates highly with the degree of social, mental and physical disability incurred. Daily living was affected primarily by impairment of intellect and personality and, to a lesser extent, by physical incapacity, but only rarely by the developments of symptoms of mental illness. Using the Wechsler Adult Intelligence Scale, the time course of cognitive recovery was also assessed. Recovery curves and the relation of cognitive impairment to social and physical handicap will be demonstrated.

Increasing numbers of those concerned with the primary treatment and later care of individuals who sustain head injuries are becoming interested in the development of methods for assessing the outcome of severe brain damage. In the past such methods seldom involved balanced consideration of the physical, mental and social sequelae of injury. Moreover rehabilitation, which should involve restoration of patients to their fullest physical, mental and social capability, is often biased towards the improvement of physical disability alone. The long lasting and chronically disabling mental changes which occur so frequently, and which tend to cause the greatest difficulties for patients in terms of their reintegration into society, usually receive scant attention. Assessment of outcome necessitates evaluation of the contribution of both physiogenic and psychogenic factors to the patient's mental state, and thus their respective contributions to the degree of social integration achieved. With these points in mind a pilot study was designed to evaluate three simple indices of outcome--namely neurophysical, mental and social assessment scales. The relation of each scale to the severity of brain damage, assessed in terms of post-traumatic amnesia, was examined. The relation of the scales to each other and to measures of cognitive function (the Wechsler Adult Intelligence Scale) were also considered, Results from 56 severely brain injured patients reveals a clear cut relation between the duration of post-traumatic amnesia and the measures of disability devised. Further, social disability was related to the level of physical and mental handicap, but it was the latter which caused the most severe problems. The level of intellectual recovery was related to all scales of disability and to the duration of post-traumatic amnesia, although the latter proved to be a less accurate predictor of the ultimate degree of intellectual recovery than was expected.