Illustration from Abnormal Psychology and Modern Life
What are the phases or steps involved in rehabilitation?
No two brain injuries are alike and the course of rehabilitation is different for each participant. Individuals progress through rehabilitation at their own pace and require unique rehabilitation programs. In the acute or medical phase, the emphasis is on enhancing natural recovery and establishing strategies that promote independence. In the post-acute phase, the emphasis is on teaching functional skills and bringing rehabilitation into the individual's home, work, community and school.
What happens after rehabilitation ends?
For some people rehabilitation is a lifelong process. They may continue to benefit from various rehabilitation therapies to maintain skills and to learn new skills required by their increased independence and community mobility. Many individuals return to their pre-injury roles at home, at work and in the community. There are also people who require continued support and assistance in certain aspects of their lives. This support and assistance may come from family members, trained rehabilitation professionals and paraprofessionals. The goal of rehabilitation is to assist each person in returning to a life of independence, self-worth and dignity. As people with brain injury go through the aging process, specialized support services are needed to assist them in maintaining their independence.
What happens to children with severe brain injuries?
Children with severe brain injury have the advantage of age on their side. Young children can train their brains to replace lost functions more easily than adults can with similar injuries. Yet, brain injury for children can create many cognitive or learning problems. Additionally, psychological and behavioural problems may affect school re-entry and a return to family and peers. Many children require rehabilitation that extends into the school environment to achieve success.
Do some people remain in a coma forever?
The term coma is generally used to describe a person whose ability to respond to stimuli is significantly reduced. However the term can be misleading. In some cases, the significant alterations of consciousness that we see in severe brain injury persist. The term persistent vegetative state is used to describe individuals who do not recover from coma following their injuries. Little is known about what people hear or see while in a coma. We believe that people in a state of coma are aware of their environments, of people and of events. This understanding has dramatically changed how individuals in comas are treated. A prolonged state of diminished consciousness is called a minimally conscious state and requires an effective program that:
• Provides gentle, but consistent stimulation.
• Involves all of a person's senses.
• Enables an individual to interact with his or her environment.
What is a "locked-in" syndrome?
For a long time we thought that individuals who were in a state of diminished consciousness were unable to respond. Through years of working with people with severe brain injuries and diminished responding capacities we have learned that the person may be receiving information but be unable to produce an effective response. Some people may communicate with an eye blink, a facial gesture or even by moving a toe. The term "locked in" syndrome has been used to describe the state in which the person has become unable to effectively respond to stimulation. Rehabilitation services for these individuals may focus on developing a communication system in addition to maintaining physical conditioning and health.
What are cognitive problems?
Cognitive problems are specific skill deficits that may occur following a brain injury. Some of the most common cognitive problems are:
• Arousal or over-stimulation
• Attention and filtering
• Information coding and retrieval (memory)
• Learning, both using old information and acquiring new information
• Problem Solving
• Higher-level thinking skills known as executive skills. Some cognitive problems clear over time and through rehabilitation, while others may persist and require specific rehabilitation interventions. There is a relationship between cognitive problems and neurobehavioural problems.
What are neurobehavioural problems?
Neurobehavioural problems are behaviour problems that are attributed to specific aspects of a brain injury. Sometimes normal inhibitions and judgment are reduced due to the injury. Individuals may develop difficulty with self-regulation or self-control, impulse control, over arousal, frustration tolerance and problems in perception. They may overreact to situations, get angry without provocation, or behave in socially inappropriate ways. In some cases, medications are effective in assisting them with behaviour control. A neuropsychologist may help design an appropriate behaviour learning strategy.
What causes the inability to control anger and aggression after injury?
There is a correlation between the location of the brain lesion and the appearance of anger and aggression. This trait is frequently present when the lesions affect the frontal lobe. Anger and aggression seem to be caused by a reduction of impulse control as the result of the brain lesions.
What causes difficulty controlling emotions and inappropriate sexual behaviour?
This is similar to the question about anger and aggression. Following a brain injury, some people lose appropriate boundaries when they experience sadness, happiness, and sexual feelings. This loss of inhibition and impulse control can result from the location of their brain lesions, or the trauma of the brain injury. Often a psychiatrist or psychologist who specializes in neurological cases is needed to help the person deal with the injury in a healthy way.
What is a brain stem injury?
The brain stem controls many physiologic systems. An injury to the brain stem is likely to create problems in mobility (gait), motor control and central functions. This could result in difficulty standing, walking, getting in and out of a bed or chair, lifting, throwing, catching, feeding oneself, writing, and performing other normal daily activities. People with brain stem injuries tend to require a prolonged period of medical supervision and may have long-term physical deficits related to their brain stem injuries.
What is a frontal lobe injury?
The frontal lobes control many cognitive and behavioural functions through complex processes of integrating and mediating responses. Neuropsychologists relate executive deficits (problems in higher-level thinking) to frontal lobe injuries. Many aspects of frontal lobe function are important for the control of our thinking and behaviour. Frontal lobe injuries are common due to the structure of the brain and adjacent skull areas.
Most severe brain injuries involve the effects of one or both of the following:
• Contra coup injuries in which the brain moves in a back and forth motion, striking the skull.
• Rotational or shearing injuries, which are caused by the sideways movement or twisting of the brain inside the skull, stretching and tearing neurons that form essential connections.
Does the location of an injury effect severity?
The location of the injury can affect the severity of the problems experienced by individuals throughout the course of their recovery, rehabilitation, and lifetime. The brain is a complex part of our neuroanatomy. Controls for physical, cognitive, emotional and behavioural functions are all brain-based. We see few simple injuries. Most are complex and affect more than one aspect of brain-based functions. Certainly specific or "focal" injuries produce specific deficits and problems. The circuitry of the brain is extremely complex.
What are neuromotor problems?
Neuromotor problems are physical movement and body control difficulties resulting from injury to the motor control areas of the brain. People may experience difficulty:
• Initiating or starting a movement
• Maintaining muscle control
• Sustaining a movement
• Executing a complex movement such as walking Specific therapies can help a person regain motor control and maximize motor skills. Much of our ability to live with independence relates to our capacity to perform motor tasks.
In your opinion, what is the likelihood of a person returning to a life of independence after a brain injury?
Although there are no guarantees, many people are able to make dramatic strides. We see continued improvement, sometimes years after the injury. In many cases people are able to return to lives filled with purpose and meaning with the people they love.
