Mapping Cognitive Rehabilitation in Diffuse Axonal Injury (DAI): A Case Study

There has been no report on detailed temporal mapping of traumatic brain injury (TBI), especially diffuse axonal injury (DAI), rehabilitation process. A case study is presented here on four-year tracking of a 24-year old male adolescent with severe DAI. The study aimed to develop a theoretical visual model of TBI (DAI) cognitive rehabilitation, and to validate this model by mapping out the sequence of significant behaviour events. The ensuing spiral cone model concurs with two well-known TBI rehabilitation sequels. The sequence of cognitive rehabilitation should aid in planning interventions in other similar or comparable TBI (DAI) patients. Introduction Brain injury is a major societal and health concern worldwide. Traumatic brain injury (TBI), also called intracranial injury or head injury, results from a sudden trauma which causes brain damage. The injury can be focused or diffuse i.e. involving more than one area of the brain, hence the term diffuse axonal injury (DAI). At least half of all TBI is known to be caused by transportation accidents. It is widely held as a significant health epidemic (Levine, 2006). In the USA, each year, up to 2 million new cases of TBI, incurring a total cost of US $56 billion, have been reported (National Institutes of Neurological Disorders and Stroke, 2002; Tiersky, 2001). In Malaysia, in 2006, there were 341, 252 motor vehicle accidents (MVA), with 5719 fatalities, 7373 seriously injured, and 15, 596 slightly injured (Royal Malaysian Police, 2008). There are no data available on numbers of consequent brain injury-rehabilitating patients. Moreover, in Malaysia, to date, except for Hassan et al. (2006), no report is available on rehabilitation of TBI patient. This is in great contrast to the proliferating research and reports on brain injury rehabilitation, and on the concomitant cognitive functions deficits and impairments, in developed countries (e.g. Anderson et al., 2003; Anonymous, 2007; Burtscher & Szczyrba, 2007; Crothers et al., 2007; de Guise et al., 2005; Donahue, 2004; Donnelly et al., 2005; Glasino & Zasler, 1995; John-Steiner, 1997; Klonoff et al., 2006; Lundin et al. , 2006; Petrella et al., 2005; Ponsford, 2004; Osborn, 1999; Rees & Storry, 1996; Sherer et al., 2006; Snodgrass & Knott, 2006; Sohlberg & Mateer, 2001; Spanos et al., 2007; and Wongvatunyu & Porter, 2005). Even single case studies of TBI homebased rehabilitation have been reported (e.g. Wilson & Robertson, 1992). Most reported researches on brain injury rehabilitation used quantitative approaches. Nevertheless some studies and reviews using the qualitative approach have been published (e.g. Carson, 1993; Chamberlain, 2006; Dye, 2000; Figueiredo, 1998; Jumisco et al., 2007; Karpman et al., 1985; Man, 2002; Orto & Power, 2000; Smith & Smith, 2000; Willer et al., 1990; and Wongvatunyu & Porter, 2005). These studies articulated mostly on experiences and practices on caring, coping and living with TBI, on available and expected health service and infrastructure provision, as well as on different meanings it had for persons suffering from TBI. Analysis of their data revealed differential perception and acceptance, in terms of personal and family traits and commitments, and personal and family well-being of the respondents involved. Problems, disabilities and deficits of TBI survivors comprise physical, physiological, psychological, emotional, behavioural, social, cognitive, and motor functions and processes (Donahue, 2004; Mayfield & Homack, 2005; Orto & Power, 2000; Osborn, 1999; Sohlberg & Mateer, 2001; and Wongvatunyu & Porter, 2005). Carers and family members are challenged traumatically in caring for TBI patients (Jumisco et al., 2007; Katz et al., 2005). The outcome of TBI rehabilitation is always confounded by many latent factors (Corrigan & Bogner, 2004; Greiner, 2006). The traumatic experience has been best articulated by the survivors themselves (Meyers, 2003; Osborne, 1999). The majority continues to bear multiple long functional disorders and deficits (Kreber, 2005).