Insight into Mild Brain Injury from and Adlerian Perspective

By Haglin, Charlotte | The Journal of Rehabilitation, October-December 1996 | Go to article overview

Insight into Mild Brain Injury from and Adlerian Perspective


Haglin, Charlotte, The Journal of Rehabilitation


Brain injury causes a multitude of changes that affect an individual's ability to perform vocationally and socially. Changes may occur in cognitive, emotional and behavioral functioning. Although the functional impact for clients with moderate to severe brain injury is well documented in the literature (e.g., Lynch, 1986), many people with injury on the mild end of the continuum may be misdiagnosed and/or the functional impact of the injury may be underestimated (Kay, 1986; Mateer, 1992; Sorenson & Kraus, 1991). Due to the frequency of misdiagnosis and lack of needed support, many individuals sustaining brain injury remain either unemployed or underemployed. Few can return to, and maintain, their former vocational performance Kosciulek, 1994; Mateer, 1992). Rehabilitation of an individual with any degree of brain injury should include cognitive treatment strategies, psychosocial counseling, and vocational rehabilitation (Mateer, 1992). This paper will address how these functions interrelate in the well being of the client. The principal aspects of brain injury and how they contribute to the psychological well-being of the client will be described. The primary goal of this paper is to examine the psychological sequelae of a mild brain injury and the impact of the sequelae on the client's ability to function productively. Demonstration of how an Adlerian counseling approach can be used to lessen the functional limitations will be presented.

Prevalence estimates of injury in the United States are between 1,125,000 and 1,600,000 per year for mild brain injuries caused by trauma alone (Koch, Merz & Lynch, 1995; Ruff, Wylie, & Tennant, 1993). This figure does not include estimates for those caused by other events. The figure is sufficient, however, to recognize that this is a condition that affects a substantial population. The peak incidence rate for these injuries occurs in the late teens and early twenties (Sorenson & Kraus, 1991). During this period many individuals are in the midst of training or launching their careers; therefore, essential job-related skills are not yet well established.

Brain injury is a significant concern to rehabilitation in both direct loss of income and the indirect loss of time from the work force (Rimel, Giordani, Barth, Boll & Jane, 1981). Another issue that may affect rehabilitation is a premature attempt to return to work (Mateer, 1992). Individuals pursuing this strategy are likely to experience deterioration of their employment status. Individuals may encounter discouragement, employment termination and a damaged reputation that may prejudice future opportunities (Fowler, 1981). Many of these individuals are likely to present themselves to rehabilitation counseling for assistance in reestablishing work options.

Definition

Brain injury is described as an induced physiological disruption. The disruption can be caused by a variety of events. Examples of such events could include the head being struck, stroke, fall or drugs (Kay, 1986). The medical model criterion for diagnosing mild brain injury is that the patient may exhibit any of the following behaviors: alteration of consciousness, loss of memory for events immediately before or after an accident, confusion or disorientation, or perceptual deficits that may or may not be transient (Acimovic, Lemmon & Keatley, 1993; Kay, 1986; Mateer, 1992). Any one of these conditions may indicate that brain functioning has been disrupted. The severity of the injury should not exceed certain criteria to be considered "mild." The loss of consciousness should not exceed 30 minutes. At the end of a 30 minute observation period, the patient should be able to respond to the Glasgow Coma Scale well enough to obtain a score of 13-15. In addition, any existing anterograde or retrograde amnesia should not be greater than 24 hours (Mateer, 1992; Sorenson & Kraus, 1991). While this model is a starting point in the assessment of this problem, it does not address the impact that the injury has on normal functioning for the survivors (Kay, 1986). …

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