This study aimed to describe the recovery of impairments after severe traumatic brain injury (TBI) over a 3-year period. An inception cohort over 2 years was recruited from 11 brain injury rehabilitation units participating in a state-wide program. The 131 individuals with TBI were assessed at admission to the rehabilitation program, 18 months and 3 years post-trauma. This report described results from the Disability Rating Scale (DRS) and Mayo-Portland Adaptability Index (MPAI). Regression analyses, examining the influence of five acute injury variables on DRS and MPAI, revealed that posttraumatic amnesia (PTA) was a significant individual predictor. Data were thus analysed according to duration of PTA: 1 to 2 weeks (n = 19), 2 to 4 weeks (n = 44) and more than 4 weeks (n = 68). At program admission there was poorer overall level of functioning on the DRS in the longest PTA group, but no difference between the shorter PTA groups. Significant improvements occurred on the DRS for all PTA groups over the first 18 months posttrauma, with improvements continuing between 18 months and 3 years. At the 3-year follow-up, frequency data from the MPAI indicated that clinically significant impairments in mobility, hand function, communication and behaviour were uncommon in the shorter PTA groups, although 36% to 47% continued to experience cognitive impairments. Impairments were common in the longest PTA group in some areas, particularly cognition where two thirds or more continued to experience clinically significant impairments in attention, memory and novel problem-solving. These results confirm the predictive significance of PTA duration regarding longer-term level of recovery. They also highlight the limitation in classifying the ‘severe’ TBI category as an homogenous group: significant subgroup differences occurred on medical and functional variables at program admission, 18 months and 3 years posttrauma. These data further substantiate the persistence of neuropsychological impairments in the face of good physical recovery at all levels of severity within the severe TBI group.

This study investigated the generalisability of the Rapid Screen of Concussion (RSC; a series of brief computerised tests) and the Digit Symbol Substitution Test (DSS; Wechsler, 1981) for discriminating between concussion (mTBI) and orthopaedic patient groups in two different centres, the Royal Brisbane Hospital, Brisbane (N = 177) and St. Vincent's Hospital, Sydney (N = 211). Group differences and interactions were assessed between test centre (Sydney or Brisbane) and injury type (mTBI or orthopaedic control) on a composite variable of the RSC and DSS subtests. Age, education and number of standard drinks of alcohol consumed were covaried for these analyses. While the mTBI patients obtained lower scores than orthopaedic patients, there were no significant differences between Brisbane and Sydney participants in performance on the RSC and DSS. There was no significant interaction between injury type and test centre. Similarities of correct classification rates of the RSC and DSS for Brisbane and Sydney were examined using a double cross-validation technique. When cross-validating from the Brisbane to Sydney sample it was revealed that sensitivity was 73% in Brisbane and 71% in Sydney, while specificity for the two samples was 76% and 67%, respectively. When cross-validating from the Sydney sample to the Brisbane sample sensitivity was 64% and 63%, respectively. Specificity was 81% in Sydney and 80% in Brisbane. These results indicated that correct classification rates were sufficiently similar between the cities and that the RSC and DSS could be generalised. When samples were combined, sensitivity was found to be 66% while specificity was 80%. The RSC and DSS are recommended as adjunct procedures to medical diagnoses of mTBI.

Normative and reliability data for the Excluded Letter Fluency (ELF) Test are provided. A stratified random sample of 399 healthy young adults aged 18 to 34 years from Sydney, Australia, completed the ELF Test as well as a full-length WAIS-R, as part of a larger battery of tests. After a 1-year interval 99 of these individuals were retested on the same forms of the tests. The influence of age, sex and education was investigated on the ELF and only education was found to have a significant overall effect on the total scores. However, gender was found to have an effect on the error scores, with males making more rule-breaks than females. Tables are provided for converting ELF raw scores, corrected for years of education, to standard scores with 90% and 95% confidence intervals for both test and retest purposes. A table for calculating the base rate of errors, for males and for females, on the ELF is also provided.

In the last 10 to 15 years there has been much development in the knowledge base that underpins clinical neurospychology. The aim of this article is to highlight new information about normal development in the intact brain and discuss the implications that this knowledge has had on paediatric brain injury. A personal perspective of the impact of this area of developing knowledge on clinical practice is illustrated using two recent clinical cases. A second article will discuss the impact on adult neuropsychology and will appear in a subsequent issue.