Abstract
This chapter discusses some basic facts about the neuropsychological and social consequences of severe brain injury and the implications of these facts for successful post-acute management and treatment. The typical pathological changes induced by severe traumatic brain injury include diffuse hemorrhages and microscopic injury to the cerebral white matter on which may be superimposed contusions and other focal lesions. Ignoring the characteristic pathophysiology of traumatic brain injury also affects the treatment of cognitive and behavioral sequelae. Patients with severe brain injuries tend not to transfer spontaneously across settings the skills they learn in therapy, yet the generalization of training is one of the most important goals of rehabilitation. For most patients, rehabilitation should involve many different skills important to ultimate success. Fragmented services are particularly detrimental to the ultimate success of brain-injured patients. The rehabilitation community has gained much knowledge about the effects of severe traumatic brain injury on quality of life.
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