Brain Injury Rehabilitation: A neurofunctional approach by GORDON MUIR GILES AND JO CLARK-WILSON

By GORDON MUIR GILES AND JO CLARK-WILSON

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Seventy-two percent of survivors experienced a change in functional status. Whilst only a small proportion of patients required additional help with activities of daily living, many had changed living situations, had more family visits or made increased use of statutory services. As well as a predictor of general outcome, age is also a predictor of return to work. In a study by Brooks et al. (1987) increased age did not become a factor until the age of 45, but from 45 years of age, the older the individual, the lower their chances of returning to work.

The influences of environmental and personality resources are discussed in Chapter 2. Here it is important to note the dangers of treating traumatic brain injury as an isolated phenomena strictly within the medical model. At the extreme, the interaction of brain injury and environmental factors is demonstrated by the work of Lewis et al. 1986, 1988. They examined the neuropsychiatric, psychoeducational and family characteristics of juveniles condemned to death and of a general sample of death row inmates.

There is increasing evidence that changes in the CNS take place 30 Theories of recovery following brain injury normally as a response to change in both the internal and external environment. Changes in dendritic arborization may be a normal process in man and may partially subserve new learning. , 1988). As Laurence and Stein (1978) point out, these changes do not represent alterations in the rules of how the brain operates. While it is possible that there is a limited time during the recovery process during which rehabilitation may be effective (a 'window effect') and that this may occur during 'spontaneous' recovery, there is no direct evidence to support this notion (Teuber 1975).

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