Rehabilitation of the Severely Brain-Injured

This edition discusses the many recent advances in the treatment of the brain-injured adult. Focuses on practical treatment approaches which recognize that many brain-injured adults remain seriously disabled for life. Gives full consideration to pharmacological approaches, in their own right and as part of an integrated behavioural approach to rehabilitation. Suggests new models of care for the brain-injured adult living in the community.

Gordon Muir Giles is Director of Neurobehavioral Programs with the Guardian Health Group, and Assistant Professor of Occupational Therapy at Samuel Merritt College, Oakland, California, USA Jo Clark-Wilson is Director of Head First Assessment and Case Management Services, Cranbrook, UK.

Contributors

xi

Preface

xiii

Gordon Muir Giles

Jo Clark-Wilson

Acknowledgements

xvii

Brain-Injury rehabilitation: from theory to practice

1

(26)

Gordon Muir Giles

Severity of brain injury

2

(5)

Family and social consequences of brain injury

7

(1)

Theories of recovery after brain injury

8

(1)

Restitution

9

(1)

Substitution

10

(2)

Is rehabilitation effective?

12

(4)

Cognitive rehabilitation models

16

(2)

Models of therapy

18

(3)

A functional behavioural-learning approach to brain-injury rehabilitation

21

(4)

Conclusion

25

(1)

Summary

26

(1)

Medical considerations in brain-injury rehabilitation

27

(12)

Martyn J. Rose

Introduction

27

(2)

Mechanisms of injury

29

(1)

What goes wrong?

30

(1)

Natural history of recovery

31

(2)

Mechanisms of recovery

33

(1)

Organization of services

33

(1)

General Principles of management

34

(1)

Medical assessment

35

(3)

Conclusion

38

(1)

The pharmacotherapeutic management of behavioral and emotional disturbances following brain injury

39

(15)

Tom W. Freeman

Behavioural syndromes

41

(5)

Strategies for intervention

46

(8)

The practice of behavioural treatment in the acute rehabilitation setting

54

(27)

James C. Wilson

William Dailey

Acute rehabilitation

55

(1)

Initial rehabilitation

55

(2)

Specialized management of behaviours related to medical complications

57

(2)

Cognitive impairments

59

(2)

Types of problem

61

(6)

Behaviour-management approaches

67

(2)

Interventions

69

(10)

Conclusion

79

(2)

Management of behavioural disregulation and non-compliance in the post-acute severely brain-injured adult

81

(16)

Gordon Muir Giles

Types of behaviour disorder

81

(3)

Basic principles of learning theory

84

(1)

Behavioural interventions

85

(3)

Applications of learning principles to behavioural change

88

(8)

Summary

96

(1)

Functional skills training following severe brain injury

97

(38)

Gordon Muir Giles

Jo Clark-Wilson

Assessment

99

(1)

Retraining methods

100

(1)

Antecedent control

101

(1)

Engaging the patient in therapeutic activities

102

(2)

Elimination of unwanted behaviours

104

(2)

Skill building

106

(4)

Assessment and training in specific areas

110

(24)

Outcome studies

134

(1)

Motor learning following brain injury

135

(18)

Mary Beth Badke

Gordon Muir Giles

Jill Kerry

Motor control

135

(1)

Components of a motor control model and related dysfunction

136

(5)

Assessment

141

(4)

Motor learning principles

145

(1)

Factors affecting performance and learning

146

(7)

Rehabilitation of physical deficits in the post-acute brain-injured adult: four case studies

153

(11)

Jennifer Hooper-Roe

Introduction

153

(2)

Case studies

155

(8)

Conclusion

163

(1)

Treating cognitive/language and oral motor dysfunction in the brain-injured adult

164

(20)

Ann L. Dill

Gordon Muir Giles

Evaluation of the minimally responsive patient

165

(1)

Coma

166

(1)

Formal rating and assessment systems

167

(3)

Acute evaluation and treatment

170

(8)

Treatment principles and methods

178

(5)

Conclusion

183

(1)

Lack of insight following severe brain injury

184

(27)

Gordon Muir Giles

Definition of terms

186

(2)

The nature of self-awareness

188

(2)

Dynamic theories of denial

190

(1)

Metacognition

191

(1)

Cognitive behavioural models of self-awareness

191

(1)

Stress and coping

192

(1)

Denial in neurological illness

193

(5)

The neuropsychological account of lack of insight

198

(4)

The psychological account of lack of insight

202

(4)

Assessment

206

(1)

Treatment

207

(2)

Summary and conclusions

209

(2)

Vocation and occupation

211

(18)

Jo Clark-Wilson

Factors influencing work entry or re-entry after brain injury

211

(5)

Approaches to facilitate work entry

216

(11)

Occupational activities and leisure time

227

(1)

Conclusion

228

(1)

Problems in implementing an integrated programme for brain-injury rehabilitation

229

(12)

Gordon Muir Giles

Ian Fussey

The rehabilitation team

229

(1)

The problem of role definition

230

(2)

Functional behaviour management: a user's guide

232

(1)

Functional assessment

233

(1)

Specific techniques in functional behaviour management

234

(4)

Why behavioural management may fail

238

(1)

A note on working with the families of brain-injured people

239

(1)

Conclusion

240

(1)

The social and emotional consequences of severe brain injury: a social work perspective

241

(22)

Mary Roberts Less

Introduction

241

(1)

Family needs in the acute stage of recovery

241

(5)

The social work role

246

(2)

Counselling

248

(3)

The experience of readjustment - some family profiles

251

(6)

The family and the rehabilitation team

257

(1)

The social worker and the rehabilitation team

258

(1)

Planning for future needs

259

(2)

Conclusion

261

(2)

Community reintegration after brain injury

263

(9)

Catherine Johnson

Background

263

(1)

What is community reintegration?

264

(1)

Community reintegration - how to do it?

265

(6)

Conclusions

271

(1)

Future directions in brain-injury rehabilitation

272

(8)

Gordon Muir Giles

Introduction

272

(2)

Developments in rehabilitation

274

(3)

The structure of service provision

277

(3)

References

280

(30)

Index

310

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Rehabilitation of the Severely Brain-Injured Adult

Summary

Author Biography

Table of Contents

Supplemental Materials