Douglas Nathan Williams (1987)

Clinical observations suggest that individuals with closed head injury show changes in self-awareness. Few studies have explored self-perception following brain trauma, or compared the perceptions of patients with those of their relatives. An inventory was developed for rating the (a) frequency, (b) severity, and (c) impact on the family of 60 symptoms associated with aftereffects of closed head injury. The questionnaire was administered to three groups of subjects and their respective family members, including (1) patients with mild to moderate impairment following closed head injury (n = 24), (2) normal controls (n = 32) and (3) patients experiencing chronic pain secondary to traumatic injury (n = 8). Scales resulting from factor analysis procedures with the data from the head injury subjects were compared to face valid scales based on areas of content. Prominent factors related to (a) cognitive control, (b) emotional control, (c) recent memory, and (d) avoidance behavior. Reliability seemed stable for all groups, except for the relatives of head injury subjects who reported either increased or decreased ratings of subjects' symptoms over time. Comparison among the three groups revealed that the head injury and pain groups gave significantly elevated symptom ratings as compared to the normal group. Responses of subjects and relatives within each group were generally consistent. Perspectives between severity for the subject and impact on the family also showed little significant difference. Independent variables which correlated with elevated scores for head injury subjects included high school educational level, time since injury of six to twelve months, duration of confused state of two to four weeks, expectation of not returning to pre-injury employment, and Digit Span subtest of the WAIS-R. These results might be generalized to persons who have sustained mild to moderate head injury.