Rehabilitation of the adult with head trauma.

The changes incurred as a result of brain injury are often devastating. The approaches outlined in this article merely scratch the surface because the list of possible deficits is inexhaustible. The behavioral and cognitive capacity during the various phases of recovery dictate the intervention method that will be appropriate and successful, with concepts and tasks progressing from the simple to the more complex. When confusion, agitation, and inappropriate behavior are evident, safety is a prime concern. Some individuals do not progress beyond this stage. Placement and appropriate future planning are major issues in this situation. When behavior becomes more appropriate, inpatient rehabilitation efforts will be most beneficial and successful, with the focus on helping the individual regain functional skills. Improvement may be rather dramatic during this time, especially when compared with previous stages. Recovery beyond this point, with intact memory, goal-directed behavior, adequate socialization skills, and vocational rehabilitation, occurs over an extended period of time, perhaps years. With discharge, new concerns for the individual and family emerge as the reality of the situation becomes clearer. Health care providers in the community setting must recognize the effects of injury on the individual and the resulting psychosocial stresses and strains on the individual and family. Adequate neuromedical and neuropsychological follow-up are essential during the outpatient recovery phase to monitor progress and provide input for future plans.