Subjective impairment and social recovery after closed head injury

S U M M AR Y The level of social recovery achieved by a representative series of 50 young adults was assessed six months after a severe closed head injury (post-traumatic amnesia>24 hours). Work, leisure activities, and contact with friends were the areas of life most affected, whereas family life and marital relationships appeared to withstand changes at this stage in the recovery process. Many patients were still suffering from subjective symptoms, but these appeared to have relatively minor effects on ability to resume normal activities. Physical disability was a much more important factor at this stage. A control group of patients with limb injuries suffered similar disruption of their lives, but reported few subjective complaints. Previous studies of recovery and rehabilitation after closed head injury have been unsatisfactory in several respects. First, there have been am-biguities in selection criteria and in the description of study populations. Despite the wealth of evidence showing that duration of unconscious-ness and post-traumatic amnesia (PTA) are good prognostic indices, other criteria have often been preferred. Thus patients have been selected on either multiple factors (Hpay, 1971) or idiosyn-cratic factors, such as length of time in hospital (London, 1967). Many studies have selected patients by criteria which ultimately depend upon local service arrangements, since only patients treated in a particular specialist unit are include