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EDITORIALS: Simon Fleminger and Jennie Ponsford Long term outcome after traumatic brain injury BMJ 2005; 331: 1419-1420 [Full text]

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Add the Forensic Aspects.......

Clive Leslie Carpel   (18 December 2005)

Deficiencies in Rehabilitation after Traumatic Brain Injury

Peter J Hutchinson, John D Pickard   (5 January 2006)

Add the Forensic Aspects....... 18 December 2005
Clive Leslie Carpel, Psychiatrist Semi-Retired 90 Hashalom Blvd Tel Aviv Israel 67321 Send response to journal: Re: Add the Forensic Aspects.......	I heartily endorse strengthening the "forgotten" aspect of the brain injury complex. The neuropsychiatric problematics are, as noted, often set aside and at first, less obvious than the cognitive disturbances. The time factor has been noted as one of the cardinal aspects when the prognosis is assessed, and is often a very long-term matter,as yet not clearly defined. The forensic psychiatric aspects of the injury are not mentioned. It is ironic that the snail`s pace of the legal system, may finally be of help in the long run, since the injured party may still exhibit changes, for better or worse, in the drawn-out years preceding the final determination of the disability. Competing interests: None declared
Deficiencies in Rehabilitation after Traumatic Brain Injury 5 January 2006
Peter J Hutchinson, Senior Academy Fellow and Hon Consultant Neurosurgeon University of Cambridge, CB2 2QQ, John D Pickard Send response to journal: Re: Deficiencies in Rehabilitation after Traumatic Brain Injury	Editor, The editorial “Long term outcome after traumatic brain injury” by Fleminger and Ponsford (BMJ 2005;331 1419-20 17th Dec 2005) highlights the need for more attention to be paid to neuropsychiatric functioning. The authors state that early post-injury assessments concentrate more on physical disability than cognition. Unfortunately our experience is that neither is addressed adequately. In 2000 we set up the Eastern Region Head Injury Study Group in order to quantify the requirements of patients with traumatic brain injury. This has identified major deficiencies in the rehabilitation of these patients with absolutely no provision for rapid assess rehabilitation in the East of England.1 The tendency for patients being left to languish on general medical, surgical and orthopaedic wards continues both to their detriment and to those requiring admission to acute district general hospital beds. In a six month period, 37 patients with major head injury were transferred back from the Regional Neurosurgical Unit to inappropriate District General Hospital beds and within the Regional Neurosurgical Unit 1500 bed days were occupied by patients who were appropriate for acute rehabilitation.2 Furthermore, this represents the needs of the severely injured. The rehabilitation needs of the much larger cohort of moderately injured within our region is currently unknown. While we support the arguments of Fleminger and Ponsford, neuropsychiatry sequelae are only a small component of the much larger problem of physical, cognitive and vocational rehabilitation. We anxiously await the deliberations of the implementation group for the National Service Framework for long term conditions. PJ Hutchinson Senior Academy Fellow and JD Pickard Professor of Neurosurgery Department of Clinical Neurosciences University of Cambridge Addenbrooke’s Hospital Cambridge CB2 2QQ pjah2@cam.ac.uk 1 Pickard JD, Seeley HM, Kirker SG, Maimaris C, McGlashan K, Roels E, Greenwood R, Steward C, Hutchinson PJ, Carroll G. Mapping rehabilitation resources for head injury. J R Soc Med 2004;97:384-9. 2 Bradley LJ, Kirker SG, Corteen E, Seeley HM, Pickard JD, Hutchinson PJ. Acute Neurosurgical Bed Occupancy and Rapid Access Rehabilitation Br J Neurosurg abstract in press. Competing interests: None declared