Outcome of severe damage to the central nervous system. Scale, scope and philosophy of the clinical problem.

The recovery process after acute brain damage has attracted little interest from either basic or clinical scientists who seem to be most concerned with the acute stage. Much might be learnt about the mechanisms of the nervous system from study of the recovery process. The number of patients with permanent brain damage is growing as the result of the increased survival rate from such common conditions as severe head injury and non-geriatric stroke. Response to this problem has largely come from other disciplines, and in the form of supportive care rather than scientific enquiry. Such an enquiry might seek to answer three outstanding questions. (1) What is the nature of the persisting disability? (2) Can more scientifically based rehabilitation, including physical, mental and social components, either accelerate the rate of recovery or reduce the degree of ultimate disability? (3) Can the ultimate outcome be predicted in the acute stage; and can the amount of further improvement be estimated in the later stages of recovery?