The relationship of the area of injury to the brain and outcome after severe closed head injury

The purpose of this study was to determine what effect the area of injury has on outcome after closed head injury. Specific problems to be investigated included: (a) the effect of initial muscle tone problems on the functional outcome of the individual, (b) the relationship of the age group of an individual at the time of injury and the residual muscle tone problems, (c) the relationship of the onset of therapies, functional outcome, duration to ambulation, and age group, and (d) the relationship of initial computed tomographic scan findings to initial muscle tone after closed head injury. The subjects of this study included persons' medical records (N = 37) who entered an acute care hospital with an admitting diagnosis of severe head injury or subsequent review of the chart revealing closed head injury. The subjects had been admitted to the hospital between the dates of January 1, 1993 and December 31, 1994, and had been discharged alive from the hospital at the time of review. Subjects with a history of substance abuse, psychiatric problems, neurological disease or processes, and persons with self -inflicted injuries or ventilator dependent at the time of discharge were excluded. Results showed that the demographics of this study are consistent with previous findings for head injured populations. There was a trend for persons with good recovery to exhibit normal muscle tone, and persons with severe disability at discharge to have moderate or severe muscle tone. Older persons tended to have greater percentages of severe muscle tone and normal muscle tone than the younger persons, while younger persons tended to have mild or moderate tone. The relationship between the onset of therapy and the duration to ambulation was statistically significant. There was a trend for persons who began therapy within the first four days after admission to have better functional outcomes than those persons who began therapy after the fifth day. Finally, those with abnormal muscle tone tended to require a longer duration fi"om admission to ambulate. This study highlights the importance of timely and appropriate therapeutic intervention after severe closed head injury. Finally, persons with abnormal muscle tone frequently had an extra-axial hematoma present or injury to the deep cerebellar nuclei.