After Severe Traumatic Brain Injury

What are predictive criteria of  successful rehabilitation?

  1. A desire and a personal engagement in a rehabilitation program:

    The injured person’s motivation – and his family circle’s – is the first and crucial factor of success. Without his desire, one can do nothing.

    However, it is not easy. The patient will have to give up, in most cases, his former situation, his former hopes. Moreover, he will have to agree to commit himself in a long-term program, whose limits are those of the economic situation, the small number of programs and adapted networks, available professionals, to accompany him in this rehabilitation.

  2. A sufficient awareness and an acceptance of his handicap and of the subsequent limits:

    This criterion is rather specific to traumatic brain injured persons.

    They are often impaired by an anosognosia and/or a denial of their difficulties. Anosognosia and denial are generally partial and likely to decrease with time and rehabilitation.

    This long and difficult work is necessary to another work: the one that consists, not to fully accept the handicap – one knows how much it is difficult! – but to “live with” the handicap.

    This adjustment, we can even say this resilience, requires a personal step, supported by the family, the psychologist and the rehabilitation team.

    It often takes several years but, when it succeeds, it represents one of the most beautiful achievements of the human life. I still hear this patient telling me: “today, I am better than before my accident”

  3. A sufficient emotional stabilisation:

    This other progressive criterion can be a major obstacle at the beginning of the rehabilitation, but is likely to decrease during this one.

    More than the physical or even intellectual consequences, are the mood disorders and the behaviour problems which represent the main obstacle to rehabilitation of severe traumatic brain injured persons (FAYADA, 2004 (2). How can we imagine the social rehabilitation and, a fortiori, professional rehabilitation, of a teenager or of a young adult irritable, even aggressive, oversensitive? Rejection and exclusion are not far away!

    This is again a long and difficult work of emotional re-stabilisation, which implies “re-socialisation”. It requires much patience and pedagogy from the family and the professionals, a progressive immersion in the social environment, psychotherapy, sometimes even drugs.

  4. A family partner and a professional referent:

    One of the largest chances of rehabilitation lies in the family.

    Happy is he who has near him a father and a mother, a spouse, a brother or a sister, at least one of them who is rather available, who listens to him, respects him and helps him regain self-confidence, to leave the isolation in which he is left too often.

    The meeting between G. and M., both traumatic brain injured persons, brought them reciprocal esteem and love which make it possible to build a future.  It truly transformed their life.

    In the years after leaving the rehabilitation centre, the presence of a professional referent is also a good asset. More than the doctor (with appointments less frequent), a psychologist, a speech therapist can help the patient, each week, to find a way and a future, to answer to the crises, to the specific needs, while being surrounded of a professional network involved in the follow-up of traumatic brain injured patients. It is the advantage of the “case management”.

  5. To rebuild his/ her identity, a new “ego”

    This does not mean asking the patient to give up his former identity, his personality forged before the accident,  “the man of always”, who goes on living in him.

    This is about, starting from a sufficient awareness and acceptance of the handicap, as a long-term rehabilitation, to rebuild “the new man”, who finds little by little commitments, based above all on his own strengths as on his weaknesses, which will draw a new and realistic project of life.

    I am thinking of the letter of this 40-year-old man, who has agreed to resume a part-time work, and who is involved in helping the others, which he had not been able to do before.

These criteria were formulated on the basis of the experience of G. PRIGATANO, 1997 (3), of Y. BEN-YISHAY, 2000 (1), and our own experience.

These are criteria of psychological, social and existential nature, the three most important fields in the quality of life of severe traumatic brain injured patients, more than the physical, functional or cognitive fields, as the QOLBI questionnaire validation study shows it (TAZOPOULOU, in press (4).

We are waiting for the validation of the five predictive criteria stated; taking them into account in the decisions of socio-professional orientation, for example within the framework of the UEROS (French Unit for Evaluation, Retraining and Social-vocational Orientation in Brain Injured People), already appeared effective.

Keep in mind, to conclude, with Marguerite YOURCENAR (5) “… that the graph of a human life is not composed, though it is said, of an horizontal line and of two perpendiculars, but well rather of three sinuous, endlessly stretched lines, constantly brought closer and diverging constantly: what a man believed to be, what he wanted to be, and what he was.”

 

Pr. J-L TRUELLE
Service de médecine physique et réadaptation
C.H.U. Raymond-Poincaré
92380 GARCHES
E.mail : jean-luc.truelle@wanadoo.fr

References:

  1. BEN-YISHAY Y., DANIELS-ZIDE E. Examined lives: Outcomes After Holistic Rehabilitation 
    Rehabilitation psychology, 2000;2:112-129
  1. FAYADA C. TRUELLE J.L. Les troubles affectifs et comportementaux des adultes traumatisés crâniens graves
    La lettre du neurologue, 2004 ;5 :149-150

     

  2. PRIGATANO G. Personal communication,1997

     

  3. TAZOPOULOU E., TRUELLE J.L, MONTREUIL M., NORTH P. Quality of life after traumatic brain injury: generic or specific tool ? QOLBI, about 95 cases Acta Neuropsychologica,  in press

     

  4. YOURCENAR M. Mémoires d’Hadrien, Plon ed., Paris,1951