The influence of post-traumatic syndrome in determining capacity to return to work after closed head injury.

Neuropsychological deficits following closed head injury are responsible for a significant part of the post-traumatic syndrome. Nonetheless such deficits frequently elude standard neurological examination and head injured subjects are not recognised as suffering from any impairments, despite these having a significant effect on their ability to return to work. As a result, subjects are refused disability status, resulting in a large number of litigation appeals. The criteria for determining disability status after head injury are often inadequate, as they do not take into account the post-traumatic syndrome, and medical experts, if they are sensitive to these issues are left in a quandary as to how to justify their decisions before the courts. Equally, psychological assessment, where it is included, is frequently limited to the examination of intellectual functions and memory, which are not always grossly disturbed in these cases. It is recommended that neuropsychological assessments should form part of routine practice in the evaluation of outcome in closed head injury and the test instruments be of adequate sensitivity to measure the deficits occurring after head injury. However, it is necessary to bear in mind that these subjective symptoms, which in reality hamper subjects' ability to return to work, may be the result of disruption of fine cognitive functions, which are inaccessible to currently available test methods.