This book examines the effects of brain injury and stroke on a person's life, and demonstrates how the skills and talents of people with brain injury and stroke can be fostered.
Roger Rees's focus is on how a person's skills and talents might be nurtured, irrespective of his or her disability. The factors that best contribute to a person's rehabilitation and learning, including careful planning, errorless learning, and the generation of convoys of social support, are identified. Adjustment of attention, memory and language skills, with case examples drawn from clinic, classroom, and the scientific literature, is advocated. Strategies for coping with post-trauma personality change and emotional difficulties are demonstrated. Transition back to school and work is linked to principles of errorless learning and the generation of support networks. The role of the arts, post-trauma, is emphasised, as is the importance of sustained communication and activities with known and trusted mentors. A neuroscientific view of rehabilitation is presented. In each chapter, the relationship between a person's participation and learning and his or her basic nervous system is illustrated, with the neurological foundations of recommended activities outlined. But the neuroscientific approach to the subject is overlayed with the author's advocacy of the supreme worth of each individual. Many case studies, based on the author's clinical work, running a community-based rehabilitation program in Adelaide, demonstrate how a person participates, learns, and adjusts, and how skills and talents can be nurtured by well-chosen interventions.
The book is written for rehabilitation program practitioners, and families and activity groups, who facilitate the learning and wellbeing of people with physical and psychological difficulties following brain injury or stroke. Tertiary-level students of rehabilitation will find it invaluable. The book can also be used for models of recovery from behaviours as diverse as attention and memory difficulties, social skills acquisition, language and personality disorders, planning and problem-solving difficulties, and return to employment.
CHAPTER 1: CONCEPTS AND OBJECTIVES: DEVELOPING UNDERSTANDING AND SUPPORT
Introduction. The beginning: coma and brain injury. Awareness stimulation. Recovery and plasticity. Severity of injury: post-traumatic amnesia. Concussion and minor brain injury. Interventions and assessment. Dynamic assessment. Conclusion.
CHAPTER 2: NEUROLOGICAL FOUNDATIONS AND FUNCTIONAL SYSTEMS: 'IT'S NOT ALL OR NOTHING'
Introduction. Professional and lay perceptions. Development and redistribution of skills. Neuroimaging and observations. The brain and nervous system. Bridging the gap. Brain complexity and versatility. The first functional unit: the brain stem. The second functional unit. The third functional unit. Frontal lobe function. Primary, secondary and tertiary zones. Connections within and between zones and functional units. Communities and cortical zones. Diaschisis. Conclusion.
CHAPTER 3: STRUCTURE AND ERRORLESS LEARNING: THE BASIS FOR REHABILITATION
Introduction. Fundamental questions. Processing information. Mastery learning. Phases of learning. Structure of learning. Evidence of behaviour. Manageable levels and sequencing. General and specific objectives. Types of learning. Conclusion.
CHAPTER 4: ORIENTATION: SETTING THE SCENE
Introduction. Definitions. Orientation difficulties. Strength of stimuli. Signalling systems and orientation. Conclusion.
CHAPTER 5: ATTENTION: ENGAGING THE BRAIN
Introduction. Active and passive attending. Sequences. Cueing. Mechanisms of attending. Binding and attending. Controlled and automatic attending. Activation and attending. Hierarchical attending processes. Localisation of damage. Brain damage and attending difficulties. Attention and reaction times. Distractions. Interests and needs. Attention and rehabilitation. Conclusion.
CHAPTER 6: MEMORY SYSTEMS: THE GLUE OF MENTAL LIFE
Introduction. Learning, remembering and forgetting. Amnesia and redeveloping memory. Short-term memory and long-term memory. Sensory input. Cueing and retrieval. Temporal stages of memory. Memory and awareness. Verbal and non-verbal memory. Functional memory difficulties. Assessment of memory. Rehabilitation of memory. Factors influencing memory loss. Summary of strategies for developing memory. Conclusion.
CHAPTER 7: LANGUAGE: THE BUSINESS OF COMMUNICATING
Introduction. Language components of the brain. Visual and auditory building blocks. Auditory processing. Lateralisation of language. Spatial abilities and language. Physical and social activities. Voice and music. Language and speech representation. Personnel. Language and thinking. Language maintenance. Categorisation of language difficulties and interventions. Exchanging information and reducing confusion. Symbolic and nonsymbolic confusion. Selecting forms of communication. Sequencing and language routines. Total communication. Psychological adjustment and language. Potential and difficulties. Effective communication. Conclusion.
CHAPTER 8: EXECUTIVE FUNCTIONS: CREATING oPPORTUNTIES
Introduction. Phineas Gage. Frontal lobes and cognition. Planning and consciousness. Communities within the community. Learning following frontal lobe damage. Commenting on one's own activity. Frontal lobe damage. Conclusion.
CHAPTER 9: EMOTIONS AND PERSONALITY: SIGNIFICANT ISSUES
Introduction. Emotion networks. Personality change and emotional difficulties. Wellbeing. Temperament and character. Pathways and emotions. Learning from experience. Pre-existing traits and post-trauma behaviours. Variations in mood. Consciousness and emotion. Motivation and emotion. Conscious awareness. Depression and personality change. Interventions. Conclusion.
CHAPTER 10: PROBLEM SOLVING: TAPPING THE RESERVOIR
Introduction. Physical, emotional, and cognitive components. Physical guidance and broad tuning. Emotions and motivation. Input and output systems. Introspection and support. Awareness and cognition. Getting started. Familiar and novel experiences. Connections and awareness. Phases of problem solving. Difficulties in problem solving. Written programs. Brain damage location and problem-solving difficulties. Reasoning and concept formation. Types of thinking and problem solving. Conclusion.
CHAPTER 11: TRANSITION TO EMPLOYMENT: REGAINING STATUS
Introduction. Rationale. Sample and Transition process. Key issues in transition to employment. Training and job placement. Evaluation of skills. Conclusion.
CHAPTER 12: COMMUNITY REHABILITATION: HAVING A VISION
Introduction. Protection. Making contact. Family love. Positive identity. Full inclusion: determining factors. Community rehabilitation. Rebuilding the personal self. Building bridges. Signs and symbols. Mentors. Coping and learning. Humanness and rehabilitation. Action: preparation and needs. Outcomes.
About the Author:
Roger J. Rees, BSc. (Hons), MEd, PhD, MAPS, is Emeritus Professor of Disability Studies, School of Medicine, Flinders University.