Zaburzenia psychiczne po urazach czaszkowo-mózgowych – wybrane problemy rehabilitacji i orzecznictwa

Head-brain injuries are a complicated and multidimensional problem, which include acute and chronic therapy as well as varied aspects of rehabilitation. Patient treatment after head-brain injury requires co-operation between physicians of various specialties, as well as psychologists and physiotherapists. A patient’s treatment outcome depends on many factors, with some enhancing and others impeding the rehabilitation process. A knowledge of these factors helps one to optimize the whole therapy process as well as to prevent its unfavorable course. The paper describes several neuro-psychiatric aspects of head injuries – connected particularly with diagnostics as well as disability benefit rulings. Every patient to undergo rehabilitation requires diagnostic verification – particularly a ‘difficult’ patient with complex dysfunctions including neurogenic ones. The revision requires sometimes even the fact of the occurrence of a head-brain injury or its primary intensity. The absence of a head injury or mild concussion in principle cannot result in future in a severe psychoorganic brain syndrome. The diagnostic incoherencies relating to the results of additional investigations (psychological tests, MRI and CT of the brain) in outcome states and their influence on disability benefit rulings were discussed. The size of the structural changes of nerve brain tissue at times does not correspond with the intensity of clinical symptoms. For example, the valuation of possible intellectual deficits seems to be more important than a confirming of the organic substrate. The value of patient motivation that influences positively the processes of rehabilitation and healing, or that at times determines merely those activities for the obtainment of disability benefits, for example, were emphasised