Rehabilitation after head injury--1: Cognitive problems.

In the course ofmy travels I saw two young people at two stages of their lengthy rehabilitation after severe head injury in road accidents. At a regional neurological unit a boy of 18 was taking his first steps nine months after his injury; I met him nine months later at a day rehabilitation centre, walking well and talking much more easily. The girl, also about 18, I first saw 11 months after her accident, barely conscious, in the rehabilitation department of a large residential home. Two years later she was still there, and I watched her in the physiotherapy room practising single steps and single sounds with great concentration; she was said to have guts and her family hoped to have her home one day. But intensive, specialist rehabilitation is available to few, and at some centres that do provide it courses may be too short.' The problem is sizable. Head injuries treated in hospital number 250 a year per 100000 population, with a prevalence of 150 survivors with major disability per 100000.2 According to another estimate, each year 210 people are left "totally" disabled and a further 1500 "severely" disabled3; while it was estimated in 1967 that some 1000 people a year were left as "lamebrains" with permanent psychological impairment.4 Less than a fifth of survivors of severe head injury would be classified as severely disabled, mentally or physically, six months later.' But they are mainly young, with years of disability ahead of them. Some survivors moreover pose enormous problems of long term care (2 February, p 369); I saw one man unnecessarily in a teaching hospital seven years after his accident, because his wife would not have him and nowhere else would either.