Rehabilitating Psychosocial Functioning
The rehabilitation of patients sustaining traumatic brain injury is aimed at restoring proper psychosocial functioning. The latter is variously defined, depending on national and cultural backgrounds. I have found that, in Western countries, the return of the patient to work at a job commensurate with his or her residual capacity constitutes an objective, integrative, and measurable index of outcome that is well correlated with the patient's subjective evaluation of the quality of life as determined by the Rehabilitation Need and Status Scale (RNSS). I have used this criterion in outcome studies of traumatic brain-injured patients at the Loewenstein Rehabilitation Hospital since 1974. In the last few years, it has gained a central place in the planning of the rehabilitation program.
Traumatic brain injury (TBI) has been recognized by the National Institutes of Health as a major problem of modern society. Among others, Goldstein ( 1990) described TBI as the "silent epidemic." Most TBI patients in developed countries are victims of road accidents. In the United States, road accidents take the lives of almost 100,000 people annually, and reduce an additional 70,000-90,000 people to a life-long debilitating loss of function. The estimated yearly cost to society is $25 billion ( Goldstein, 1990).
Israel is no exception. From 1964 to 1974, the death toll from automobile accidents in this country almost doubled, from 325 to 716 persons annually without significant changes in population. In