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By GORDON MUIR GILES AND JO CLARK-WILSON
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Extra resources for Brain Injury Rehabilitation: A neurofunctional approach
Here assessment is discussed briefly to provide a context for the discussion of predictors of outcome which follows. The rapid assessment of trauma severity is important for a number of reasons. Severity of injury influences early management and is an indicator of prognosis. , 1988). It is now widely accepted that all patients with severe brain injury should have a CT scan. Diffuse axonal shearing may not be distinguishable, necessitating estimation of the severity of this type of injury on other indicators.
More recently, Damasio and Hoesen (1985) have argued persuasively for a special affinity between the herpes simplex type 1 virus and the limbic cortices. These structures have a particular neurological structure less complex than that of the neocortex. The destructive action of the virus follows the brain's architecture very closely. During the onset of acute viral encephalitis, the patient becomes pyrexial and may have headache, seizures and olfactory, gustatory or auditory hallucinations. The patient's level of consciousness gradually deteriorates until they lapse into coma.
In the acute stage, coma stimulation is viewed as an essential component of treatment by many therapists. In later stages of acute recovery occupational therapists have attempted to stimulate patients by the use of tasks of graded difficulty. Hierarchies in various cognitive, behavioural and physical domains have been constructed and therapists attempt to 'move' patients through these. It has been suggested _that the earlier patients can be exposed to this type of acute rehabilitation the greater the recovery (Cope and Hall, 1982).