Emotional and cognitive consequences of head injury in relation to the glasgow outcome scale.

OBJECTIVE: There is current debate over the issue of the best way of assessing outcome after head injury. One criticism of scales of disability and handicap such as the Glasgow outcome scale (GOS) is that they fail to capture the subjective perspective of the person with head injury. The aims of the study were to investigate aspects of the validity of structured interviews for the GOS, and address the issue of the relation between the GOS and subjective reports of health outcome. METHODS: A total of 135 patients with head injury were assessed using the GOS and an extended GOS (GOSE) and other measures of outcome and clinical status at 6 months after injury. RESULTS: There were robust correlations between the GOS and measures of initial injury severity (particularly post-traumatic amnesia) and outcome assessed by disability scales (particularly the disbility rating scale (DRS)); however, associations with cognitive tests were generally modest. There were also strong correlations with self report measures of health outcome: both the GOS and GOSE were related to depression measured by the Beck depression inventory, mental wellbeing assessed by the general health questionnaire, and to all subscales of the short form-36. The GOS scales were also strongly associated with frequency of reported symptoms and problems on the neurobehavioural functioning inventory. CONCLUSIONS: The GOS and GOSE show consistent relations with other outcome measures including subjective reports of health outcome; they thus remain useful overall summary assessments of outcome of head injury.

Assessing disability after head injury: improved use of the Glasgow Outcome Scale.

OBJECT: The Glasgow Outcome Scale (GOS) is widely used to assess outcome after head injury, but is recognized as having a number of shortcomings that are highlighted and investigated in this study. The authors pursued two goals: 1) investigating the practicality of using a standard set of questions as part of a structured interview to assign GOS scores, and 2) studying the role of preinjury problems in confounding postinjury assessment of disability. METHODS: Several of the major limitations of the GOS appear to arise from the use of a format that encourages impressionistic ratings. In the present study the authors examined the use of a standard interview for assessing the GOS covering five areas of social disability. Ratings were made for 80 head-injured patients. The results show that the rating based on the GOS provides an assessment of disability that is more complete than that given by an alternative scale of functional disability (Disability Rating Scale [DRS]) and much more complete than an assessment of physical disability (Barthel Activities of Daily Living [ADL] index). A measure of preinjury dependency was made revealing that, within this sample, 20% of patients required supervision in basic ADL before their injury. CONCLUSIONS: Assignment of GOS scores based on information obtained using a structured interview format provides a more comprehensive assessment of disability than using the DRS or the ADL index. There is a need to standardize attitudes about preinjury dependency in assessing disability after head injury.

Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use.

The Glasgow Outcome Scale (GOS) is the most widely used outcome measure after traumatic brain injury, but it is increasingly recognized to have important limitations. It is proposed that shortcomings of the GOS can be addressed by adopting a standard format for the interview used to assign outcome. A set of guidelines are outlined that are directed at the main problems encountered in applying the GOS. The guidelines cover the general principles underlying the use of the GOS and common practical problems of applying the scale. Structured interview schedules are described for both the five-point GOS and an extended eight-point GOS (GOSE). An interrater reliability study of the structured interviews for the GOS and GOSE yielded weighted kappa values of 0.89 and 0.85, respectively. It is concluded that assessment of the GOS using a standard format with a written protocol is practical and reliable.

Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow Outcome Scale.

The Glasgow Outcome Scale (GOS), two decades after its description, remains the most widely used method of analyzing outcome in series of severely head-injured patients. This review considers limitations recognized in the use of the GOS and discusses a new approach to assessment, using a structured questionnaire-based interview. Assignments can be made to an extended eight-point scale (GOSE) as well as the original five-point approach-in each case, with a high degree of interobserver consistency. The assignments are coherent with the principles of the World Health Organization classification of impairments, disabilities, and handicaps, and their validity is supported by strong associations with the results of neuropsychological testing and assessment of general health status. The need to allow for disability existing before injury, issues concerning the time of assessment after injury, and subdivisions of the scale into "favorable" and "unfavorable" categories are discussed. It is concluded that, in its improved structured format, the Glasgow Outcome Scale should remain the primary method of assessing outcome in trials of the management of severe head injury.

Is left always right? Directional deviations in visual line bisection as a function of hand and initial scanning direction.

Directional deviations in visual line bisection were investigated using normal subjects. Significant main effects were found for hand and initial scan direction resulting from significantly greater deviations to the left by the left hand compared with the right hand and by a scan from the left compared with a scan from the right. These results suggest that the amelioration of neglect can only be inferred from the left hand deviations of neglect patients if they are significantly leftwards of the objective middle and that the degree of leftward deviation in normal subjects results from an interaction between right hemispheric activation and unilateral allocation of attention.

Spatial field advantages for tactile line bisection as a function of hemispheric specialisation inferred from dichotic listening.

Thirty left-ear advantaged (LEA) and 30 right-ear advantaged (REA) right-handed subjects performed tactile line bisection (TLB) in left and right spatial fields, and at midline. REA subjects were found to perform significantly better in the right spatial field than in the left and LEA subjects significantly better in the left than in the right. Significant directional deviations were found only at midline with the left hand deviating to the right and the right hand to the left. These findings suggest that TLB is primarily a spatial task subserved by feedforward motor processes and that directional deviations are due to the differential scaling of egocentric space.

A behavioral approach to the control of thumbsucking in the classroom.

The purpose of the present study was to determine whether classroom thumbsucking could be controlled by making social reinforcement contingent upon appropriate behaviors incompatible with thumbsucking. The classroom thumbsucking behavior of three 8-yr-old elementary school children was observed and recorded by two observers. Sixteen experimental lessons were divided into sets of baseline, reinforcement, reversal, and representation of reinforcement. The effect of the experimental treatment was determined by the changes in the total thumbsucking level for each subject during each lesson. Results indicated noticeable decreases in thumbsucking rate for all three subjects during lessons in which social reinforcement was made contingent upon appropriate behavior. Two of the three subjects showed sudden increases in thumbsucking time during lessons when social reinforcement for appropriate responses was withheld; the third subject showed continued low thumbsucking time during these lessons.