Rehabilitation Counseling Term Paper

Pages: 6 (1992 words)  ·  Style: APA  ·  Bibliography Sources: 5  ·  File: .docx  ·  Topic: Disease

¶ … Head Injuries and Resultant Deafness

John Q. is a twenty-five-year-old male who suffered head injuries as the result of a roadside bomb in Iraq. Until this injury, John was a healthy young man with a wife, a child, and on a career path in the United States Army. The incident not only altered John's life plan for himself and his family, but left him physically disabled and, now, facing the post surgical prospect of neurological rehabilitation. Worsening the situation, the proximity of the explosion to John was such that he sustained injuries to both ears, and is now hearing impaired with a complete loss of hearing in either ear. His hearing impairment is not such that it can be repaired with cochlear implants, and, in addition to neurological rehabilitation, John Q. must now begin learning a new means by which to communicate without the benefit of hearing. John's traumatic brain injury (TBI), resulted in intra-parenchymal hemorrhaging, followed by a coma. The hemorrhaging was surgically repaired, and John Q. awoke from coma experiencing the post-surgical effects of fatigue, attentional deficits, and mood swings and frustration from the combined injuries and his inability to hear and communicate (Uzzell, 1996, p. 8).

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Magnetic resonance imaging (MRI) indicate that John Q.'s surgical procedure was successful, and that with time and proper therapy John Q. will most likely regain his full range of physical ability, that is, movement, but that he may suffer some long-term memory loss. John Q.'s speech is dually impacted by his acquired deafness and normal post surgical condition impacting his ability to speak. John Q.'s speech, like his movement, with proper rehabilitation should return, though that level of ability is sure to be impacted by his acquired hearing impairment. A plan of rehabilitation and training, and a plan for education to teach John Q. The art of sign language will be implemented, and John Q.'s progress will be monitored and evaluated over the upcoming months.

Rehabilitation

Term Paper on Rehabilitation Counseling Assignment

For patients suffering TBI, Anne-Lise Christensen and Barbara P. Uzzell (1994) say research has shown "Along with the increase and diversity of procedures, there is a reemphasis on psychological constructs related to ego psychology such as awareness and self-efficacy as relevant modulating variables in facilitating response to treatment (p. 1)." It therefore becomes necessary to understand everything there is to know about the patient, and that means that close family support, interaction and participation in the patient's neurological rehabilitation is essential to the patient's recovery and success in regaining as much of the mental capacity and physical functioning that the patient had prior to the TBI.

Treatment combinations for John Q's TBI will reflect the learning of contemporary therapies and exercise, combined with appropriately included pharmacology. Leonard Diller (1994) discusses the progress made in the rehabilitation of patients suffering TBI, and summarizes contemporary rehabilitation this way:

Progress toward finding the right treatment combinations has advanced along a number of fronts in the past 5 years. These include developments in identifying behavioral characteristics at both ends of severity in the recovery from traumatic brain injury. At the most severe end is the application of newer assessment devices, and at the opposite end is the clarification of the definition of minor traumatic brain injury. In the middle range there have been two major developments. First, there has been a proliferation of therapeutic modalities to establish competence in functional settings. Among them are the increase of group methods, the applications of the family coach model as a tool, the use of supported employment, and the introduction of computers for orthotic devices or cognitive aids. Second, there has been a large number of reports on varieties of cognitive remediation. These reports are reviewed with regard to the nature of outcomes that are achieved and their experimental designs. Along with the increase and diversity of procedures, there is a reemphasis on psychological constructs related to ego psychology such as awareness and self-efficacy as relevant modulating variables in facilitating response to treatment (p. l)."

The combination of pharmacology and rehabilitation and exercise has lead to a number of success stories in neurological rehabilitation. John Q's assessment has involved the combined efforts of the team of therapeutic disciplines, including the pharmacologist. Discussing the role of pharmacology in neurological rehabilitation, Donald G. Stein, Marylou M.Glasier and Stuart W. Hoffman (1994) jointly conclude:

It has been only within the last 10 years that research on treatment for central nervous system (CNS) recovery after injury has become more focused on the complexities involved in promoting recovery from brain injury when the CNS is viewed as an integrated and dynamic system. There have been major advances in research in recovery over the last decade, including new information on the mechanics and genetics of metabolism and chemical activity, Including the definition of excitotoxic effects and the discovery that the brain secretes complex proteins, peptides, and hormones that are capable of directly stimulating the repair of damaged neurons or blocking some of the degenerative processes caused by the injury cascade. Many of these agents, plus other nontoxic, naturally occurring substances, are being tested as treatment for brain injury. Further work is needed to determine appropriate combinations of treatments and optimum times of administration with respect to the time course of the CNS disorder. Understanding the mechanisms underlying traumatic brain injury and repair must eventually come from a merging of the findings of neurochemical alterations in the whole brain with data from intensive behavioral testing, which will determine the meaning of these findings. For optimum treatment strategies, we also need testing procedures and definitions used in connection with treatment for brain injury (p. 17)."

Learning to Live with Deafness

John Q. has a great deal of work to accomplish, not the least of which is re-learning the ways in which he communicates with others, and especially his family members. John Q's ability to communicate will be further impacted by his TBI, and aphasia, and there will be a need to bring together the modalities of neurological therapists with the sign instructor to help John Q. overcome the difficulties that this combination of injury means to him.

Charles Goodwin (2003) advises:

In aphasiology it is commonly the case that aphasic language structures, such as lexical and grammatical forms, are analyzed and "treated" in relative isolation from, or in parallel to, other, more "functional" aspects of the condition such as the ability to communicate or psychosocial issues. For example, while assessments of aphasic language (e.g., Goodglass & Kaplan, 1983; Kay, Lesser, & Coltheart, 1992) typically focus on lexical, grammatical, or other linguistic structures in relative isolation from their communicative use and psychosocial effects, others focus on communicative abilities (Holland, 1980; Wirz, Skinner, & Dean, 1990) or on psychosocial consequences of aphasia (Code & Muller, 1992) with little or no analysis of the linguistic forms used by the speaker with aphasia under investigation. Within this framework, aphasic language has predominantly been investigated (and treated) using units of analysis such as "word" and "sentence, " and assessments of aphasic language have typically adopted methods of data collection that facilitate analysis using these units, such as naming (of objects or pictures), describing (of pictures), or the production of narratives (such as well-known stories) in the form of a monologue (p. 59)."

Unfortunately, John Q. is at a disadvantage, because he is an acquired deafness, and thusly will not feel acclimated to the deaf community of which he will become a part of. Much research has been done in the study of the deaf culture (Glickman and Harvey, 1996); and it is a society unto itself, and is in fact hostile to attempt to surgically modify children born with the condition of deafness (Poitras Tucker, 1998). Whether or not John Q. will be accepted into this social order remains to be seen, and his is certainly a case that merits attention to understand the implications acquired deafness has for a person over that of a person born with the disability.

Family and Social

There cannot be enough emphasis placed on the importance of John Q's family and friends in support of rehabilitation and coming to terms with what will be his permanent hearing impairment. The more readily the family accepts these consequences and permanent changes in John Q's life, the more readily they can move forward as a family, and the more quickly they can make these permanent adjustments. Every effort must be made to help John Q. regain as much independence in his life as possible, as this will greatly reduce the anxiety and range of adverse emotions that he will experience along the way to regaining his independence.

There are other therapeutic considerations that should be made to assist John Q. In accomplishing his independence: a specially trained dog can, for instance, relieve the family of the burden of worry and concern about leaving John Q. alone in his state of diminished functioning as a result of his loss of hearing and, hopefully temporary, ability to speak. A trained dog can… [END OF PREVIEW] . . . READ MORE

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