The data shows that neurobehavioural deficits after TBI do not show a general tendency to disappear over time. Some aspects related to self-appraisal, conceptual disorganization and affect may even deteriorate, thereby presenting a challenging problem for both the patients and relatives. This is in contrast to the parallel improvement of post-traumatic sensomotoric deficits.

While there is significant overall improvement of HRQoL over time, sTBI appears to bear major influence on post-traumatic HRQoL and outcome.

Despite intensive rehabilitation treatment, severe traumatic brain injury is still burdened with significant mortality and morbidity.

This study evaluates the impact of early-onset continuous rehabilitation treatment on the 1-year outcome of patients after severe traumatic brain injury. Immediately after recovery from mechanical ventilation, a total of 48 patients underwent a complex early rehabilitation treatment until they were discharged from hospital and local ambulant care was deemed sufficient. The follow-up examination took place 12 months after trauma. Data reveal that at 1 year 91.6% of the patients were completely or restrictedly independent of care and capable of carrying out activities of daily living, although they frequently were still suffering from marked behavioural and also from certain sensorimotor deficits. Only 45.8% of the patients were obviously able to work without restrictions or had returned to work. In those subjects who were not or only very restrictedly able to work, behavioural and speech deficits were significantly more frequent. Behavioural and speech deficits seem to represent the major cause that hinders professional reintegration. Rehabilitation therapy therefore should be specifically directed to improve these deficits.

The objective of this study was to assess the significance of an injury to the pontomesencephalic brainstem in severe traumatic brain injury [Glasgow coma score (GCS) below 8]. Forty victims of severe traumatic brain injury with and with out compounding pathologies almost equally distributed among both groups were studied. The outcome (mean follow-up, 11.3 months) was assessed by means of the Glasgow outcome score (GOS) and of the Disability rating scale (DRS). Injury of the brainstem was detected by electrophysiological investigation (evoked potentials, brainstem reflexes) and magnetic resonance imaging (MRI) carried out early after trauma. Statistical analysis (Wilcoxon signed rank test for matched pairs) revealed a significantly worse initial GCS (median 5 versus 6), GOS (median 3 versus 4), and DRS score (median 6 versus 2) for the group with brainstem lesions than for the group without such lesions. Moreover, there was a significant accumulation of lesions of the corpus callosum, the basal ganglia, and the (para-)hippocampal area detected by MRI in the brainstem lesion group. In addition, the finding of an abnormal cortical component of the median nerve evoked somatosensory potential was significantly more frequent in the patients with brainstem injury. Traumatic brainstem lesions diagnosed by MRI a nd/or electrophysiological investigation are associated with injury to other 'deeply' situated parts ofthe brain. The finding of a brainstem lesion influences to the outcome of patients after severe traumatic brain injury.