Brain Injury and Neuropsychological Rehabilitation: International Perspectives

be necessary to combine agents to produce maximum beneficial effects. Additionally, as more is learned about the continuum of changes that occur after an initial insult to the CNS, we will be better able to alter treatment to coincide with a "window of efficacy." These fields of research have yet to be adequately developed.

Although it is true that a long course of medical and psychosocial therapy may be expensive, it may nonetheless be necessary if true functional recovery is the goal. Such therapy must be conducted in a positive, caring, and enriched environment. Close cooperation and coordination of treatments among neurologists, physiatrists, and rehabilitation psychologists should be the norm and the standard in the field of restorative neurology. Based on what we know from experiments in laboratory animals ( Finger, 1978; Finger & Stein, 1982; Held, Gordon, & Gentile, 1985; Kelche, Dalrymple-Alford & Will, 1988; Will, Rosenzweig, Bennett, Hebert, & Morimoto, 1977), environmental enrichment, coupled with appropriate pharmacological treatments, may hold out the best hope for functional recovery in severely brain-injured patients, but only if one is prepared to invest the necessary time and effort to accomplish this goal.

In conclusion, there is no doubt that those concerned with basic research in restorative neuroscience have made great progress in opening new lines of inquiry and developing a better understanding of the injury and recovery process. Following the great strides in molecular biology, many research laboratories and pharmaceutical companies are identifying or developing new agents capable of protecting the nervous system. To paraphrase a famous Dane, we are closer than ever before to protecting brain-injured patients from "the slings and arrows of outrageous fortune" to which they are often heir.

Attella M. J., Hoffman S. W., Pilotte M. P., & Stein D. G. ( 1992). Effects of BIM-22015, an analog of ACTH4-10, on functional recovery after frontal cortex Injury. Behavioral and Neural Biology, 57, 157-166.

Attella M. J., Hoffman S. W., Stasio M. J., & Stein D. G. ( 1989). "Ginkgo biloba extract facilitates recovery from penetrating brain injury in adult male rats". Experimental Neurology, 105, 62-71.

Attella M. J., Nattinville A., & Stein D. G. ( 1987). "Hormonal state affects recovery from frontal cortex lesions in adult female rats". Behavioral and Neural Biology, 48, 352-367.

Auburger G. R., Heumann R., Hellweg S., Korsching S., & Thoenen H. ( 1987). "Developmental changes of nerve growth factor and its mRNA in the rat hippocampus: Comparison with choline acetyltransferase". Developmental Biology, 120, 322-328.

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