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SUMMARY The emotional characteristics of head injury patients referred for neuropsychological testing were examined as a function of the time since injury. Patients referred more than 6 months from injury were more emotionally distressed on the MMPI and Katz Adjustment Scale (relatives form) compared to those tested 6 months or earlier. The more chronic head trauma patients were more anxious and depressed, more confused in their thinking, and more socially withdrawn compared to the acute patient group. These differences in emotional functioning appeared to be independent of level of neuropsychological impairment and the initial length of coma. Premorbid personality and increased awareness of impaired functioning with the passage of time are discussed as possible mediators of enhanced emotional distress in some chronic head injury patients.Cognitive deficits following significant craniocerebral trauma have been shown to improve with the passage of time. The rate and eventual level of recovery is known to be related to the severity of injury.'-3 Emotional recovery following such injuries may parallel improvements in cognitive functioning,3 but in some cases emotional functioning may actually deteriorate with the passage of time.4 It has been our impression that increased emotional distress often parallels the patient's increased awareness of cognitive, social and vocational limitations, which occur as overall cognitive confusion lessens. Premorbid personality characteristics5 6 also seem to relate to heightened psychopathology in some chronic patients. It is becoming increasingly more apparent that emotional and personality adjustment following head injury can have a significant effect on rehabilitation outcome.78The purpose of the present study was to compare the degree of emotional distress in chronic and acute head injury patients. It was predicted that patients referred for neuropsychological evaluation longer than 6 months after trauma would exhibit greater emotional distress than those tested 6 months or less from the time of injury. As the degree of emotional Address for reprint requests: David J Fordyce, Ph.D., Depart-ment of Clinical Neuropsychology, Presbyterian Hospital, Northeast 13th and Lincoln Blvd.,

Relatives, treatment staff, and brain-injured individuals often have widely different perspectives about the nature and magnitude of dysfunction following brain injury, and these appear to have consequences for psychosocial adjustment and rehabilitation. To permit us to assess these differences, 28 seriously brain-injured individuals completed a behavioral competency rating scale along with standard measures of neuropsychological, emotional, and psychological functioning before and after a 6-month intensive rehabilitation program. Relatives and members of the treatment staff independently completed the same rating scale. Three comparison groups were formed retrospectively on the basis of staff-patient differences in perceived dysfunction. Group 1 patients and staff members rated similar levels of dysfunction both before and after rehabilitation. Group 2 and Group 3 patients, by comparison with staff members, greatly underestimated their initial levels of dysfunction. Over the course of rehabilitation, the perspectives of Group 2 patients and staff aligned, while Group 3 patients became more emotionally distressed and their perspectives actually diverged from those of staff. Early vocational outcome was related to level of neuropsychological and psychosocial functioning at the end of rehabilitation, but not to final staff-patient differences in perspective. The sources of these different perspectives and their implications for rehabilitation treatment are discussed.Facilitating recovery from serious brain injury is a complex and poorly understood rehabilitation enterprise. It requires an understanding of each individual's particular physical, cognitive, emotional, and interpersonal strengths and weaknesses. Our knowledge of rehabilitation strategies appropriate for serious brain injury is rapidly increasing (

Seventy-five percent of patients undergoing coronary bypass grafting have a significant impairment in regional cerebral perfusion compared with published age-matched controls, which may contribute to their proclivity for cerebral complications.

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