Stambrook M, Moore A D, Peters L C, Deviaene C, Hawryluk G A
Society for Manitobans With Disabilities, Winnipeg, Manitoba, Canada.
Brain Inj. 1990 Apr-Jun;4(2):183-90. doi: 10.3109/02699059009026164.
Survival from significant closed head injury (CHI) is frequently associated with cognitive defects, physical impairment, personality change, interpersonal difficulty and, in general, some degree of social dependence. Here we report a multidimensional assessment of quality of life of a sample of 131 male head-injury patients suffering a range of severities of insult with specific emphasis on vocational outcome. Of those patients who sustained a severe injury and were employed full-time prior to the CHI, only 55% were able to return to this level of employment. No differences were found between the moderate and severe groups in pre- or post-CHI occupational status, as measured by the Blishen (1967) quantitative social economic index, although both groups declined from pre- to post-CHI. Lower post-CHI occupational status was associated with lower GCS on admission and longer lengths of post-traumatic amnesia, with patient self-report of physical, cognitive and psychosocial difficulties, including spousal reports of confusion, belligerance, verbal expansiveness and the decreased ability to perform socially-expected activities. Stepwise multiple regression analysis accounted for 38% of variance in post-injury vocational status, with lower pre-injury vocational status, greater age, high physical and psychological difficulties and lower admission Glasgow Coma Scale score variables forming the regression equation. Implications are discussed in terms of rehabilitation issues, including vocational programming and planning.
严重闭合性颅脑损伤（CHI）幸存者常常伴有认知缺陷、身体障碍、性格改变、人际交往困难，总体而言，存在一定程度的社会依赖。在此，我们报告了对131名男性颅脑损伤患者样本的多维生活质量评估，这些患者遭受了不同程度的损伤，特别强调了职业结局。在那些遭受严重损伤且在颅脑损伤前全职工作的患者中，只有55%能够恢复到之前的工作水平。根据布利申（1967年）的定量社会经济指数衡量，中度和重度组在颅脑损伤前后的职业状况没有差异，尽管两组从颅脑损伤前到损伤后都有所下降。颅脑损伤后较低的职业状况与入院时较低的格拉斯哥昏迷量表（GCS）评分以及较长的创伤后遗忘期有关，患者自我报告存在身体、认知和心理社会方面的困难，包括配偶报告患者有困惑、好斗、言语啰嗦以及进行社会期望活动的能力下降。逐步多元回归分析解释了损伤后职业状况38%的方差，损伤前较低的职业状况、较大的年龄、严重的身体和心理困难以及较低的入院格拉斯哥昏迷量表评分变量构成了回归方程。我们从康复问题的角度进行了讨论，包括职业规划和计划。
