Mediating the relationship between injury,impairment and disability: a vulnerability,stress and coping model of adaptation following brain injury

The World Health Organization (1980) started the process of classifying consequences of disease and structuring a comprehensive model of illness by publishing its International Classification of Impairments, Disabilities, and Handicaps (ICIDH). Since that time, the field of brain injury rehabilitation has witnessed an evolution from biomedical to biopsychosocial conceptualizations of adaptation and outcome. In the current paper a vulnerability, stress and coping model is presented which incorporates psychological, social and cultural factors with biological factors to offer a schema for increasing understanding of variability in functional outcomes following brain injury. A procedural methodology with preliminary instruments for identifying important vulnerability and stress and coping factors is presented, along with preliminary data which supports the utility of this approach, and suggestions regarding useful applications to clinical rehabilitation interventions. The importance of better understanding the variables that mediate the relationship between impairments, disability and handicap cannot be underestimated, and continued investigation of vulnerability and stress and coping formulations of adaptation following brain injury are clearly indicated.