Traumatic brain injury (TBI) often exerts a major impact upon the family with high levels of stress and distress, particularly amongst primary carers, disruption to family life style and functioning, changes in family roles, and marital and sexual difficulties. In response to the documented impact upon the family a range of family services have been advocated including family education, counselling and support. This paper outlines family services developed within a community head injury service in the UK. The family assessment programme comprises a relatives' screening questionnaire and structured interview schedules and ratings scales, some drawn from the family assessment literature, others developed within the service. Four components of family intervention are described: an annual series of educational workshops; follow-up workshops; individual family support; and specialist marital counselling. Our experience of providing these family services over the last 7 years is discussed along with the need for further evaluation of family assessment and interventions after TBI.

A group of severely head injured patients were reassessed 7 years after injury. This group was the same as that previously reported 2 years after injury. There was no change in their physical or cognitive status; personality problems were still commonly reported but the less disabled had made further progress in returning to their former level of vocational and social activity.

Twenty five severely head injured patients from two specialist neurological rehabilitation centres were interviewed on average seven months post-injury. Changes in self-concept were investigated through the completion of scales of anxiety and depression, an attitude questionnaire relating to physical disability and semantic differential ratings of Present Self, Past (pre-morbid) Self, Future Self, a Typical Person and a Typical Head Injured Person. Psychological distress in terms of anxiety and depressions was common. Patients viewed themselves as having changed substantially as a result of their head injury on a wide range of constructs, yet confidently anticipated a return to Past (pre-morbid) Self within a year, even though Past Self was rated more positively overall than a Typical Person. While differing dramatically from Past Self, Present Self was rated more positively in some respects than the concept of a Typical Head Injured Person, which was perceived as markedly different from that of a Typical Person. Whilst unrealistic expectations may initially serve to protect the profoundly disabled individual and even motivate him towards recovery, in the long run they are more likely to hamper rehabilitation and adjustment. Effective intervention calls for awareness of the patient's own perspective as well as the relatives' reactions to the overt disabilities.

Stressful life events over the previous two years were more often reported by a group of 24 young adolescents referred to psychiatric outpatient clinics than by a carefully matched control group. Family support was rated by the patient group as less satisfactory during the same period. These findings taken together suggest that developmental stress is not the only, nor necessarily the most important, source of disturbance in the post‐pubertal years.

SummaryThe development of a close liaison multidisciplinary approach to the rehabilitation of the severely brain-damaged individual is described. The treatment programme, based within a single location, consists of a blend of individual and group therapy for the combined retraining of physical, functional and social skills.RésuméDans cet article, on décrit l'organisation d'une étroite approche interdisciplinaire dans la rééducation fonctionnelle du sujet ayant subi un traumatisme craˇnio-cérébral grave. Le programme de prise en charge qui est appliqué dans une et meme institution et consiste en une approche thérapeutique à la fois individuelle et par groupe visant ainsi à obtenir une bonne récupération physique, fonctionnelle et réinsertion sociale.ZussammenfassungDie Entwicklung eines Programms enger multidisziplinaerer Zusammenarbeit in der Rehabilitation von Patienten mit schweren Hirnschäden wird beschrieben. Dieses in einem einzigen Gebäude zusammengefasste Behandlungsprogramm besteht aus einer Palette von Einzel- und Gruppentherapien für das kombinierte Training physischer, funktioneller and sozialer Funktionen.Key Words: Head injuryRehabilitation Additional informationNotes on contributorsA. F. TredreIt is with great sadness that we have to inform the readership of the Journal that shortly after completing the final editorial work on this Special Issue, Professor Kalman Jacob Mann was seriously injured in a car accident and subsequently died.Professor Mann was responsible for establishing the two Hadassah Hospitals and Community Health Centres in Jerusalem and for the past 20 years headed the Presidium of Yad Sarah, Israel's largest community based, volunteer operated organization which provides a spectrum of free or nominal cost home care services nation-wide.We offer our condolences to his family and friends, and trust that this Special Issue stands as a testament to his work in the field.

The Family Environment Scale (Moos, 1974) was completed by 24 youngadolescents newly referred to psychiatric clinics and 24 control subjects from local schools, who were individually matched on several variables. Findings confirmed that the perceptions of the disturbed adolescents were less satisfactory, whether in terms of impaired relationships or restricted opportunities for personal growth. Examples are given of how the Scale might contribute to both clinical practice and research.