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LES SUITES DES TRAUMATISMES CRANIENS SEVERES: ANALYSE PSYCHOPATHOLOGIQUE ET BILAN DE LA READAPTATION

par Crahay, Serge
Référence Annales de Medecine Physique, 18, 3, page (361-368)
Publication Publié, 1975

Article révisé par les pairs

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Résumé :

This study is based on a careful analysis of the somatic, psychological, and social abnormalities that the patient presents. It cannot be carried out until after the initial phase of recovery has taken place. It must be accurate and complete, otherwise treatment will be unsuccessful. The study is based on the examination of approximately 1500 cases of intracranial trauma encountered since 1955. The examination was performed in most cases between one and three years after injury. The entire group was studied from the aspects of age, the specific neurological damage that persisted after initial recovery, the psychological disturbances, the social and cultural situations, and finally, the degree of motivation for recovery and the status of compensation determination. Patients with severe intracranial injury may be expected to require the greatest investment in time and energy for their treatment and rehabilitation. Their recovery is divided into four stages: the phase recovery of basic physiological functions, recovery of intellectual and neurological functions, reeducation, making use of a program for social rehabilitation. This last phase is limited by the degree of mental impairment and personality change. Unfortunately, our progress in decreasing the mortality of severe brain injury has not been matched by improvement in preserving brain function. The clinical examination (neurological and psychiatric) plus a psychometric evaluation and a general history enables us to classify the intellectual deficits and the disturbances of specific cognitive functions into: (1) linguistic including the aphasias, dysarthrias, phonetic disturbances, and organic stuttering, (2) perceptive motor and psychomotor abnormalities, including agnosias and apraxias, (3) amnesias, Korsakoff's syndrome, (4) disturbance of visual association, (5) somatic agnosia and topoagnosias. Recovery from severe injury requires a physical, moral, social, and existential evaluation. It also requires the use of adequate techniques of individual and collective training.