Traumatic head injury: restlessness and agitation as prognosticators of physical and psychologic improvement in patients.

Eighty-seven traumatic head injury patients were followed from admission to post-discharge, spanning a period of 5 years or more. Using objective criteria, post-traumatic activity level (PTAL) was evaluated on admission and compared with cognitive and overall status at discharge. Further comparisons were made with follow-up data. Twelve patients were agitated., 32 restless, 17 appropriately active, 16 sluggish, and 10 immobile. Eighty-three percent of the agitated, 84.3% of the restless, 70.6% of the appropriately active, 18.8% of the sluggish, and 10% of the immobile patients showed improvement. At discharge, 41.6% of the agitated and 42.4% of the restless patients also needed supervision. Improvement was related to PTAL, with appropriately active restless patients demonstrating the greatest overall return of function. Rehabilitation of sluggish and immobile patients was not as dramatic. The majority of patients were able to return to the community; however, agitated patients showed a tendency to be committed for psychologic reasons to alternative medical facilities. Long-term improvement is also related to PTAL. At discharge, restlessness and agitation is related to improved physical functioning and inversely related to psychological adjustment. During follow-up, the appropriately active and the restless patients showed the greatest tendency to becoming cognitively functional.