According to the CDC, the leading cause of TBI is falls, particularly for young children and adults over 65. Other common causes of TBI include accidental blunt force trauma, motor vehicle accidents, and violent assaults. If you have had a TBI, rehabilitation (or rehab) will be an important part of your recovery

1. REHABILITATION AFTER TRAUMATIC
BRAIN INJURY
Geetesh Kumar Singh
M.A. IV - Semester
Department of Psychology
DAV PG College, B.H.U. - Varanasi

2. TRAUMATIC BRAIN INJURY
A. Closed Brain Injury
B. Open (Penetrating) Brain Injury
C. Acquired Brain Injury (ABI)
“Damage to living brain tissue by an external mechanical forces or
motion. It is usually characterized by a period of altered consciousness
(amnesia or coma) that can be very brief (minutes) or very long”
Types of Traumatic Brain Injury

3. MAJOR DEFICITS OCCURS AFTER TBI
• Attention (Focus attention, sustained attention, selective attention,
divided attention)
• Memory (Visual memory, auditory memory, working memory, eispodic
memory, semantic memory, working memory, procedural memory)
• Executive function (Initiation, processing speed, problem solving,
planning)
• Perception and praxis (Visuo-spatial, visuo-perceptual, Unilateral
neglect, inattention, apraxia, agnosia, prosopagnosia)
• Language (Aphasia: Broca's, Wernicke's, transcortical motor/sensory
or mixed, conductive, global)

4. HEAD INJURY ASSOCIATED WITH A LOSS OF
CONSCIOUSNESS OR CONFUSION WAS AS FOLLOWS
Cognitive impairments are common after stroke and TBI
• Alcohol abuse/dependence (24.5%)
• Phobic disorder (11.2%)
• Major depression (11.1%)
• Drug abuse/dependence (10.9%)
• Dysthymia (5.5%)
• Obsessive– compulsive disorder (4.7%)
• Schizophrenia (3.4%)
• Panic disorder (3.2%)
• Bipolar disorder (1.6%) (Silver et al., 2001)

5. ASSESSMENT AFTER TRAUMATIC
BRAIN INJURY OR STROKE
GCS 1 2 3 4 5 6
Eye
Does not open
eyes
Opens eyes in response
to painful stimuli
Opens eyes in
response to voice
Opens eyes
spontaneously
N/A N/A
Verbal Makes no sounds Incomprehensible sounds
Utters incoherent
words
Confused, disoriented
Oriented,
converses
normally
N/A
Motor
Makes no
movements
Extension to painful stimuli
(decerebrate response)
Abnormal flexion to
painful stimuli
(decorticate response)
Flexion / Withdrawal to
painful stimuli
Localizes painful
stimuli
Obeys
commands
Glasgow Coma Scale (GCS)
Generally, brain injury is classified as:
 Severe, with GCS < 8–9
 Moderate, GCS 8 or 9–12 (controversial)
 Minor, GCS ≥ 13.

6. OTHER ASSESSMENT TOOLS OF TBI
• Advocacy Activity Scale (AAS)
• Agitated Behavior Scale (ABS)
• Apathy Evaluation Scale (AES)
• Cognitive Log (Cog-Log)
• Confusion Assessment Protocol (CAP)
• Disability Rating Scale (DRS)
• Community Integration Questionnaire (CIQ)
• The Family Needs Questionnaire (FNQ)

7. FACTORS THAT INFLUENCE
NEUROPSYCHOLOGICAL TEST RESULTS AFTER
1. Lesion location
2. Size (extent) of lesion
3. Severity of the initial brain injury
4. Pathological nature of the lesion
5. Developmental (biological and psychosocial) stage
6. Chronicity of the lesion
7. Personal reactions to altered functioning
8. Materials (methods) used to elicit disturbances in higher cerebral functioning
9. Cooperation and motivation of the person to perform on the test
10. Sensitivity and sensibility of the examiner

8. APPROACHES TO COGNITIVE REHABILITATION
 Cognitive retraining (Sohlberg & Mateer, 1989)
Attempt to assist recovery by stimulation e.g. computer games. Little evidence for
effectiveness. Problems with generalisation.
 Holistic approach (Prigatano, 1999)
Include focus on emotional adjustment and self-esteem.
Not well evaluated. Cognitive problems need to be allowed for in psychotherapy.
May be an implicit part of the combined approach.
 “Combined” approach (e.g. Wilson, 2001)
Use cognitive analysis and behavioural observation to deduce reasons for task
failure. Teach task-specific skills and compensations. Some success in controlled
studies.

9. NEUROPSYCHOLOGICAL REHABILITATION FOR TBI
1. Social Rehabilitation in Practice :The Liverpool Hospital Approach
A. Individuals are unselected
B. Needs-driven rehabilitation
C. Community-based therapy
programs
D. Individually-focused
rehabilitation

10. NEUROPSYCHOLOGICAL REHABILITATION FOR TBI
2. Training of attention and memory
a. Cognitive training
b. Behavioural training
c. Mnemonic training
3. Training executive functions
a. Environment modification
b. Techniques of cognitive intervention
c. Training of specific abilities or tasks
d. Communication training, including communicative pragmatic.
4. Problem Solving Training (PST)
a. Problem formulation (goal setting)
b. Creating possible solutions (‘brain-storming’)
c. The selection of a single solution (resolution and option evaluation)
d. Verification of the desired results (recognition and correction of one’s mistakes).

11. 5. Holistic rehabilitation
The principles of a holistic model of rehabilitation originated in Poland in the
1960s and were developed by such pioneers of rehabilitation as Wiktor Dega.
This programm covered:
a) cognitive rehabilitation
b) Individual and group rehabilitation with the use of a therapeutic milieu
c) Vocational rehabilitation
d) Family psychotherapy
Components of a holistic rehabilitation programme for TBI patients
• Development of self-awareness, skills applicable to social conditions
• Development of the therapeutic milieu: ‘Academy of Life’ programme
• Team of specialists in the rehabilitation of patients with brain injuries
• Large number of staff in relation to the number of patients
NEUROPSYCHOLOGICAL REHABILITATION FOR TBI

12. Components of a holistic rehabilitation programme for TBI patients
• Cognitive-behavioural approach combined with new neurotechnologies
(neurofeedback, rTMS)
• Therapy planning in accordance with the microgenetic theory of the
symptom covering an individualised goal setting.
• Incorporating the family and those near the patient into the rehabilitation
process
• Attempts to take up employment and start an independent existence
• Systematic monitoring of the results of interaction.
6. Training in day-to-day abilities and skills
These include both more complex activities, such as doing the shopping or
using public transport, to more basic skills, such as cooking, cleaning or
dressing oneself.
NEUROPSYCHOLOGICAL REHABILITATION FOR TBI

13. 7. Emotional therapy and control of social behaviours
i. Individual psychotherapy
ii. Group therapy
iii. Behavioral training
iv. Pharmacological treatment in the most serious cases
8. Family participation and family education
Active participation during the process of rehabilitation of those
closest to the patient is a necessary condition for the patient’s return
to a relatively normal life and given special education to family
members to cope with patient emotional and psychological
problems.
NEUROPSYCHOLOGICAL REHABILITATION FOR TBI

14. REHABILITATION AFTER TBI SUMMARY
 Brain injury and stroke are 2 common causes of brain damage and
can lead to a range of cognitive disabilities.
 A “combined” approach to rehabilitation uses behavioural &
neuropsychological assessments to analyse the reasons for everyday
problems and to suggest solutions.
 Learning to compensate for permanent deficits is an important part of
long-term recovery. There is evidence that we can facilitate
compensatory learning.

15. Thank You