chart, most particularly that it is reliable and valid, and is designed to be completed by any professional who works with head injury. There is only one area dealing with medical matters that will need perusal of the case sheet and the assistance of a physician, but it must be a physician skilled in the assessment of TBI.
Although the chart has demonstrated satisfactory reliability and validity, it is still under further development. The current database (495 patients) has been derived from the version of the chart reported in this chapter, but already a further version is being developed that will have a number of changes. It will be shorter: Items with high numbers of missing values or low frequency of endorsement are removed. A user's manual is being developed to supply specific operational definitions for the presence and severity of particular problems, and the layout is to be changed to make it as easy as possible to administer.
Work on the current chart has identified a number of areas that need further development. The chart is readily used by specialists in TBI, but few nonspecialists use it currently, although one aim of the initial research contract was to develop a procedure that could be used by nonspecialists. The latter have not used it because it is simply too long for their needs. Therefore, the intention now is to develop a further "mini" chart in which the main problems contributing to outcome are outlined -- a chart that the nonspecialist can complete in a very short time (chart having perhaps only 20 items). Furthermore, it is obvious that the chart is not totally appropriate for children. It does not allow a detailed examination of the family and educational situation, and therefore we are keen to develop a chart aimed specifically at the head-injured child. A further area of development concerns emotional and behavioral symptomatology. Certainly the chart contains a substantial amount of information here, but it is not in any particular taxonomic scheme. Therefore, we plan to develop a chart based on the DSM-III-R to allow formal diagnoses of mental disorder to be made. Clearly this will require specialist examination by a clinical psychologist or psychiatrist. These developments form the basis of further research proposals that are being submitted to the European Community.
The work of achieving the final document is supported by a grant from the Directorate of Scientific Affairs of the Commission of the European Communities, and coordinated by the European Brain Injury Society (EBIS). The following experts were most particularly