What will be the outcome?

The following are the main factors that have been found to predict long-term outcome for head injured survivors:

(a) Severity of cognitive deficits including memory and learning impairment, attention/concentration problems, arousal deficits, slowed mental processing, psychomotor retardation, executive function impairment (e.g., deficiencies in planning, organization, problem solving, judgment, abstract reasoning, sequencing, mental flexibility, and shifting mental set), visuoperceptual-motor deficits, eye-hand incoordination, language and communication disorders such as aphasia, reading comprehension impairment, initiation problems, and decreased general intellectual functioning.

(b) Severity of psychosocial/emotional/interpersonaI deficits including loss of emotional control (disinhibition), impulsivity, problems with anger management, impatience, irritability, uncooperativeness, anxiety, adynamia (severely reduced initiative), passivity, apathy, withdrawal, interpersonal and conversational skill deficits, social inappropriateness, self-regulation problems, unrealistic expectations, psychiatric disorders (e.g., depression, psychosis, substance abuse), inability to profit from feedback or experience, and reduced self-awareness and insight.

(c) Severity of injury as measured by the Glasgow Coma Scale (see above), length of coma (see above), length of post-traumatic or anterograde amnesia (PTA) (survivor has no memory of recent events), total brain volume loss, and neuroimaging (e.g., CT Scan, NMI) has been shown to influence outcome. For example, severe TBI survivors experience higher unemployment rates than mild and moderate TBI survivors. However, more recently, the value of PTA, GCS, and LOC as predictors of long-term outcome for TBI survivors has been questioned.

(d) Pretrauma variables such as age at the moment of injury (TBI survivors over the age of 40 appear to have worse outcome than younger survivors), gender (there is some evidence for a differential effect from severity of brain damage on the sexes, with severe TBI samples showing a better outcome for women, and less severe samples showing a better outcome for men), and pretrauma education (while generally believed that the number of years of pretrauma education does not appear to affect postinjury outcome, there is some evidence that survivors with less than a high school education may have a worse outcome).

(e) Posttrauma environmental variables such as duration of vocational rehabilitation and community re-integration services (greater length of treatment associated with better outcomes), presence of a case manager for post-rehabilitation survivors (better outcome) and ,length of time since vocational rehabilitation program discharge (greater time since discharge associated with decreased outcome).

(f) Posttrauma substance abuse has also been associated with a decreased outcome.

In general, the TBI literature suggests that the cognitive and psychosocial/emotional/interpersonaI deficits associated with TBI exceed residual physical deficits and other factors as predictors of TBI outcome.