The stages of recovery from severe head injury with special reference to late outcome.

Ten years research into the physical and psychosocial consequences of severe brain damage in adults has revealed substantial information about the process of recovery. The main features are evidence that the greater part of physical and mental recovery occurs within six months of injury and that in most cases the mental consequences of injury outweigh the physical ones and place the greater burden upon the injured person's relatives. Impairment of memory is the most common cognitive disorder and alterations in personality often occur also and are the most taxing of the mental deficits for all concerned. The process of recovery has three stages, in the first the patient is unconscious, in the second he or she regains full consciousness signified by the end of the period of post traumatic amnesia and continues to show evidence of rapid improvement in basic physical and mental functions. The rate of recovery shows within six months of injury in most cases and this represents the end of the second stage. In the third stage, which may last for many months, both the patient and his or her relatives adapt to the residual disabilities of the former. Methods of managing the three stages should include physical, psychological and social techniques and the way in which they may be linked to the patients' differing physical and psychosocial needs during the three stages of recovery are briefly discussed.