Tuesday 10 March 2009

THE BRAIN




STARTING ASSUMPTIONS


1. There is no cure for brain injury. At present, brain surgery and drugs are used to prevent damage, or lessen its impact. There is no putting back lost tissue. Some regrowth can occur naturally, but this isn't extensive. (More: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=neurosci.section.1740)

2. The concept of 'recovery' can be confusing in the context of brain injury. The changes caused, whether small or large, usually persist. In the case of smaller changes that either don't dramatically affect the person or can be more easily compensated for, the person may appear to have 'recovered'. In the case of more severe injury, changes often remain noticable for good or ill and the person appears not to 'recover' in the same way. But in both cases the changes are not reversed. Injuries have a persistent impact on the persons involved, being simply more noticable in some cases than in others. But this does not mean a person cannot be well, happy and successful after injury. Because in all cases also, the surviving nervous system continues to change and reorganise. The damaged tissue forms part of the context for ongoing change, but does not make future changes inevitably or exclusively bad.

3. The brain is an organ designed to alter its stucture over time - it organises itself in response to the environment (the one inside the body and the one outside, experienced with the eyes and ears and skin and so on). This self-organisation is called learning. Learning is the result of (the same thing as) the strengthening and weakening of connections between cells in the brain and this is a process that continues throughout life. Memories are formed, skills are acquired and improved, habits are hard to shake, useless (and useful) things are forgotten. Without this, none of us would be able to do anything new. After an injury (particularly one caused by trauma, by impact) there is a period when the brain can't form new connections, and so nothing is remembered or learned. But once the brain, and the person it's in, have returned to health, once they have recovered from the trauma, the process of connecting, learning and remembering returns - in all the tissue that is undamaged, still present and functioning. Different parts of the brain play different roles in this process of change, and in the other tasks of the nervous system (seeing, feeling, thinking, imagining, behaving, wanting, believing...). Injuries to different parts of the brain have different effects on the process of learning and remembering. As a rule of thumb, the more significant (the more dense, the more wide spread) the injury is, the more difficult learning and remembering will be. But all living nervous systems remain capable of responsive structural reorganisation becuase they are made up of cells that have no other way of being. (More: http://en.wikipedia.org/wiki/Donald_Olding_Hebb)


4. All living people, therefore, even those with significant brain injury, are capable of learning, changing, responding and reorganising themselves to a greater or lesser degree.

5. Cognitive Rehabilitation is the process of helping someone with a brain injury learn things that are useful to them (reorganise for the better). This is similar to teaching. Just like in schools, in rehabilitation settings the approach to teaching and learning can take different forms. It can be approached according to a model of what works best, based either on research or presumptions or received wisdom. It can also happen without a model, or with multiple, perhaps competing models in play. It can be delivered in a one-way transaction, from master to pupil, with the roles of teacher and learner fixed, or it can be discovered in a responsive manner, through negotiation, where the roles may be flexible, reciprocal to some degree, as where two equals are concerned.

6. After brain injury, people don't become categorically different. They remain human and therefore will share common needs with other humans. They still want the same things other people want. These are: occupation, contact with other people, care, reciprocity (the chance to give as well as receive), and to be valued (by them selves and others). (More: http://www.hgi.org.uk/archive/human-givens.htm; http://www.faculty.ucr.edu/~sonja/papers/LSS2005.pdf)

7. Some recent research shows that, in the long term, the lives of people with brain injury are affected less by the original severity of their injury, or by the nature of any impairments they have to their function, than they are by the person's mood and their self esteem. (More: http://jnnp.bmj.com/cgi/content/abstract/77/5/640). Neither the injury, nor any measure of its original impact, necessarily predict good or bad outcome for the person. A person's situation at any given time is dependent primarily on the question of whether their environment (both social and physical) meets their needs. This is true of people with and without brain injuries, of people who are well or unwell, of people of all abilities. The fittest, most able person relies continually on the support of others to live successfully, they just don't tend to notice because the support they receive is viewed as typical or normal. People who need more or different support in order to participate and succeed are often viewed as burdensome, but this is often due to a tendency to focus on what they cannot do and on the provision of 'care', rather than capitalising on the talents people have retained or on encouraging them to develop new ones. (More: http://www.accessmylibrary.com/coms2/summary_0286-14406817_ITM)

8. Successful rehabilitation practices are likely to be those that improve the mood and self esteem of their participants, those that enable them, somehow or other, to find occupation, contact with other people, care, reciprocity and value. Successful rehabilitation practices are likely to be those that help people compensate for things they find difficult, while encouraging them to do things they are good at.

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