ABSTRACT
Denny-Brown (1945) first observed that the presence of excitability and restlessness in patients who had experienced closed head injuries was predictive of delayed recovery and prolonged disability, including return to work. Levin and Grossman (1978) found that agitated patients on a neurosurgery unit were more likely to experience anxiety, depression, and thought disturbance after the resolution of the agitation and upon 3-month follow-up. Reyes, Bhattacharyya, and Heller (1981) found that restless and agitated patients demonstrated poorer long-term psychological adjustment; those with marked early agitation were more likely to require later institutionalization for behavioral disturbance. Despite the consistency of these findings, systematic research on the causes, correlates, and effects of agitation has been largely lacking. Most of the published literature has focused on interventions, particularly pharmacological interventions, for managing agitation during the acute phase of recovery. To some degree, clinical and other research efforts have been limited by two factors: (a) lack of agreement as to the definition of the construct, and (b) lack of an objective means of measuring it. A brief review of the existing literature in which agitation after traumatic brain injury (TBI) has been defined, as well as differences in presumed incidence arising from differences in definitions, are provided before addressing problems in measurement.
