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The severity of head injury can also be indexed on the basis of neurological and neuroradiological tests. Increased reflexes and muscle tone (e.g., spasticity), abnormal movements (e.g., tremors), difficulty in swallowing and slurring of speech are all indicators on a neurological examination of a moderate to severe head injury. Findings from neuroradiological tests using computer assisted brain scans have proven useful in visualizing the damage caused to the brain.
Computerized Axial Tomography (CAT) and Magnetic Resonance Imaging (MRI) provide scans of the structural integrity of the brain and may reveal physical changes such as hematomas and diffuse axonal injuries.
Positron Emission Tomography examines brain function as opposed to structure and provides a view of more subtle effects of trauma to the brain which might not be seen by the CAT or MRI scans.
Attempts have also been made to predict the outcome for persons who has suffered a head injury and to assess the stages in recovery following their emergence from coma. The Glasgow Coma Scale is one of the most widely used scales for describing the severity of head injury and predicting the person's likelihood of recovery.
This scale rates the severity of person's injury based on his/her ability to open his/her eyes, move and speak. The more severe the injury the lower is the performance as reflected in the score on the scale. A very low score suggests a very severe injury and little likelihood of total recovery.
The Glasgow Coma Scale is very useful for predicting early outcome from a head injury, for example, whether the person will survive. It is not as useful for estimating how someone will eventually function in daily living nor what degree of independent living they might achieve. Other scales such as the Ranchos Los Amigos Scale of Cognitive Functioning have proven more valuable for predicting these later outcomes.
This scale, divided into eight stages which progress from coma to appropriate behaviour and cognitive functioning, is useful in following the recovery of the head injury survivor and in determining when he/she is ready to begin a structured rehabilitation program. However, many changes in cognitive, memory and motor functions predictive of whether the person can return to gainful employment or to school are not identified with this scale.
More detailed assessments by neuropsychologists, speech pathologists, and physical and occupational therapists are needed to identify these deficits.
The effects of head injury most often observed in these assessments can be classified generally into three categories: physical, cognitive and behavioural.
The physical effects of head injuries include such symptoms as seizures, loss of motor speed and coordination and the presence of abnormal movement such as tremors and spasticity.
Cognitive changes involve disorders of attention, concentration and memory, problems with understanding or producing speech, difficulties with initiating and planning daily activities, and poor reasoning and judgement. The behavioural effects include agitation and irritability, verbal and physical aggressiveness, impulsivity, depression and suicidal thoughts, and an egocentric or self-centred orientation in interpersonal relationships.
While the physical and behavioural effects of head injury present significant challenges for rehabilitation, the cognitive deficits are often the most difficult for the caregivers, family members and prospective employers to deal with. The relative "invisibility" of these deficits in comparison to the more obvious physical and behavioural effects is one of the key reasons for this fact.
The relative impact of cognitive deficits is the greatest in the case of mild to moderate head injuries where there may be negligible physical symptoms. In such cases the head injury survivor looks "normal" and people around him/her are often unable to understand why he/she cannot, for example, act appropriately or remember instructions.
Identification of these effects of head injury is a very important first step in helping the person and his/her family. Too often, though, this assessment and early treatment stage is where the process stops.
Until recently less than ten percent of head injury survivors received the more long term rehabilitation programs needed to enable them to attain the maximal possible recovery. This situation has been due largely to the lack of long term care programs and the difficulty on the part of the head injury survivor and his/her family to find the funds to pay for these services.
