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Acquired Brain Injury (ABI) is currently recognized by the World Health Organization as being an issue of public health, usually resulting in disorders which impact the different areas of human functioning – biological, psychological and social. Developments in medicine and in acute and sub-acute healthcare now permit a good level of physical-functional recovery. It is the psychological effects however (cognitive, emotional and behavioral) - most persistent in the long term - which are the main cause of the difficulties that ABI patients have in reintegration into their various life contexts. For this reason, ABI has been referred to as a ‘silent epidemic’.
The critical relevance of neuropsychological rehabilitation in post ABI recovery has been widely recognized by the different professionals involved in continuous rehabilitation services (Cicerone et al., 2011). The holistic approach (Ben-Yishay et al., 1985) is one of several theoretical models currently available to guide neuropsychological rehabilitation. Programs inspired by this approach have been put forward as good practice for rehabilitation in the post-acute stage.
The rapid progress being made in the use of information and communication technologies (ICT) in clinical settings has led to the development of a variety of tools which can be used in rehabilitation, such as software for cognitive training in virtual reality environments and electronic reminders, amongst others. Traditional approaches in general and the holistic model in particular will surely benefit from merging clinical practice with new technologies.
The aim of this chapter is to explain the concepts and definitions that relate to the condition of ABI; to present the two main causes of ABI, its epidemiology and severity; to describe the various consequences for human functioning relative to participation in different spheres: personal, family and social; to address the recovery process, its mechanisms and different phases; to describe the historical development of neuropsychological rehabilitation in order to frame the holistic model as a consistent and current proposal for intervention; to advocate the use of new technologies as a complementary tool of intervention within the clinical setting of neurorehabilitation, and to present a proposal for the integration of these new approaches with the holistic model.
Key Terms in this Chapter
Stroke: Focal neurological changes with sudden onset caused by a pathological mechanism at a vascular level.
Plasticity: The ability of the brain to adapt functionally so as to perform the same function using areas of the brain not originally intended for that purpose.
Neuropsychological Rehabilitation: Based on two main mechanisms: the plasticity of the brain, which has an inherent capability to recover from damage; and the adaptability of the person, which allows us to adjust to new circumstances by changing our behavior.
Holistic Approach: One of several theoretical models used in neuropsychological rehabilitation.
Rehabilitation Tools: A diverse range of devices, which includes software for cognitive training in virtual reality environments and electronic reminders.
Post-Concussion Syndrome: Existence of one or more symptoms such as headache, fatigue, malaise, irritability, nausea, sensitivity to light or noise, blurred or double image, forgetfulness, difficulty concentrating, slowed thinking, sleep disturbances, tinnitus, anxiety, depression or frustration.
Hemorrhagic Stroke: Injury caused by bleeding which may derive from a failure as a consequence of congenital malformation, an aneurysm, or even be related to diseases in which a change in blood clotting occurs.
Brain Injury: Occurs when the brain loses some of its normal function due to cell death; it is followed by visible changes in brain morphology. The two most common causes are traumatic brain injury and stroke.
Front Syndrome: Characterized by irritability, intolerance, aggression, impulsivity and disinhibition.
Recovery: Restitution or restoration of affected functions to a level qualitatively similar to the pre-morbid. Recovery may occur spontaneously and based on natural biological mechanisms but it may also be aided by rehabilitation programs.
Ischemic Stroke: Occurs when blood flow is stopped, depriving the neuronal tissue of oxygen and glucose. This can lead to occlusion or embolism forming a thrombosis.
Acquired Brain Injury: Recognized by the World Health Organization as a public health issue, usually resulting in impairments which have impact on the different areas of human functioning – biological, psychological and social.
Traumatic Brain Injury: An assault on the brain caused by an external force, capable of producing changes to or decreasing the state of consciousness, resulting in deficits to cognitive ability or physical functioning.