Rehabilitation of cognitive and behavioral dysfunction in head injury

The agitated patient with brain injury and the rehabilitation staff: bridging the gap of misunderstanding

Patients with brain injury at the agitated stage of recovery present a unique challenge to rehabilitation staff. The staff's patience is tested, and their personal comfort is threatened frequently during their interactions with patients. How can a healthcare team increase its comfort level and competence when working with these patients? Rehabilitation specialty programs work effectively when all staff members are competent to understand and meet the daily challenges of working with their patients. An educational program about agitated patients with brain injury targeted to certified nursing assistants carried over to the staff's job performance and to increased staff confidence.

Social cognitive factors in brain injury-associated personality change

Often social difficulties are the most enduring difficulties after a head injury. The social deficits most frequently reported by relatives 6-12 months post-injury include egocentric styles of social interaction characterized by family members as a change in the head-injured patient's personality style. The described characteristics of head-injured patients in terms of social perspective-taking abilities are similar to those of children reported in the cognitive developmental literature. To demonstrate the nature of the social deficits in head-injured participants, social perspective-taking paradigms in the development literature were used to construct a task to be administered to both head-injured and non-head-injured adults. Results of the comparison between the two groups suggest deficits in social perspective-taking abilities in head-injured adults similar to the level demonstrated by pre-adolescent children.

Using stimulus equivalence procedures to teach name-face matching to adults with brain injuries

On pretests, 3 men with brain injuries matched dictated names of three therapists to written names, but did not match dictated or written names to photos, produce correct names in response to photos, locate offices given written names, or name therapists on sight. Match-to-sample training established conditional relations between dictated names and photos. Posttests showed the emergence of untrained conditional relations involving photos and written names, indicating development of three classes of equivalent stimuli (each containing a dictated name, photo, and written name). For 1 participant, conditional relations involving photos of office nameplates were also examined, but did not emerge pre- or posttraining. Two participants produced names orally when given photos and sorted written names and faces together after training; the 3rd participant was unavailable for these posttests. After training, 1 participant located and named all three therapists in their offices.

Family response in head injury: denial ... or hope for the future?

Denial is often seen as a major obstacle to successful adaptation in the family of the head-injured. In fact, it is typically inadequately understood in the rehabilitation setting. The term is frequently used in a simplistic way, with the social and cultural factors behind the denial, particularly the stigma of head injury, not examined or confronted. There is very little hard data on what constitutes successful family adaptation over the long term. Professionals have a tendency to focus exclusively on the patient's deficits and the family's difficulties, ignoring the positive ways in which people cope. This article suggests that there is a need for a paradigm shift, based on the transactional theory of stress and coping, in which denial is seen as a positive response in some situations. Instead of becoming locked into trying to dispel what is usually called denial and adopting an adversary stance to the family, it may be more beneficial for rehabilitation staff to work together with family members to understand why head injury is so difficult to deal with, develop positive models for living with the sequelae, and encourage hope for the future.