Long-term effects of severe penetrating head injury on psychosocial adjustment.

Abstract

The long-term effects of severe penetrating head injury on adjustment levels were studied. Forty-one World War II veterans who suffered penetrating injury to the brain were interviewed 40 years after their initial injury using the Washington Psycho-Social Seizure Inventory (WPSI). The results support a comparable behavioral impact of right and left hemispheric lesions. Similarly, no significant relations were found between anterior and posterior locus of damage and psychosocial difficulties, although the results pertaining to the right-anterior group could be interpreted as suggestive of much greater maladjustment in all life dimensions assessed by the WPSI. Findings are discussed in terms of theoretical positions on hemispheric specialization and long-term expectancies that hold implications for planning rehabilitation programs for such patients.

Very Late Outcome After Focal Wartime Brain Wounds

“…Several factors probably contribute, including sample bias: the older subjects who are able and willing to participate in research are more likely to be a fit, selected sample. Second, brighter subjects have more compensatory strategies available, if not a more effective neuronal reserve: Teuber's (1975) studies and the work of Grafman and his team (1988) point in that direction. The problem, however, is not simple: many tests in common use have ceiling effects so that the more subtle effects of injury in the intellectually gifted are not observed, as individual case studies suggest (Brodal, 1973;Newcombe, & Ratcliff, 1979).…”

“…Teuber (1975) reported a marked difference between the pre-induction intelligence test scores in US World War I1 veterans and those of the 700 men who served in the Korean campaign. There are no doubt additional and important factors of a psychological nature that will be considered after a review of the behavioural indices of outcome.…”

“…The injuries occur in healthy young-adult brains; the lesions are not progressive and can be remarkably focal, as recent postmortem data have indicated (Newcombe, Ratcliff, & Damasio, 1987;Oppenheimer, Marshall, & Newcombe, 1987). As Teuber (1975) pointed out, these men "can be studied because they have incurred particular injuries, and not -as in most clinical situations -because they have particular after-effects, or believe that they do" (p.159). Given the neuropsychological evidence and postmortem data, it is surprising that these penetrating brain injuries have sometimes been regarded as comparable to the diffuse blunt head injuries due to traffic, sporting accidents, and falls.…”

“…However, the task is timed; it is, therefore, possible that a (generalised) reduction in speed of informationprocessing per se characterises the large lesions. Teuber (1975) noted "the exquisitely significant and persistent alterations in function that are tied to particular cerebral systems" (p. 167). First, persistent and remarkably stable field defects (Teuber et al, 1960).…”

“…In general, Teuber (1975) considered that the "far-reaching restitution of function" in his veterans remained "essentially unexplained". "If it were understood", he added "we might be better able to deal with the fundamental questions of how cerebral structure is related to function, and of how one might hasten or extend the recovery process after initial functional loss" (p. 1 60).…”