NeuroRehabilitation

Health care for multiple sclerosis has evolved over the past two decades from fragmented, sporadic, and crisis-oriented interventions to an organized system of services. The proliferation of comprehensive care centers and the development of a network of health care providers have provided a model for other chronic neurologic illnesses. In addition, concepts such as principal care and maintenance therapy may prove to be relevant to care in multiple sclerosis.

The first section of this article discusses the principal clinical components of a model system of care for traumatic brain injury (TBI) or spinal cord injury (SCI). The next section, “The Future of Model Systems”, addresses the advantages of such a system, as related to the changing health care climate and predicted future directions of health care in the United States. The need for innovative approaches to rehabilitation is upon us. In addressing this need, the last section, “Recommendations for Change”, outlines cost-effective measures for providing rehabilitation services to our clientele.

The Spinal Cord Injury Model Systems of Care have served a unique role in the provision of integrated and coordinated care for persons with spinal cord injuries (SCI), and in collaborative research efforts to advance available technologies. Although the basic mission of the model systems remains viable, contemporary issues and trends indicate that the model systems concept ought to be expanded in terms of roles and functions to meet current needs.

This article provides a short history of the hawing aspects of community integration in the United States for persons with permanent and/or long-term physical, affective, and cognitive disabilities. Included in this history are the philosophy behind the process, some pitfalls that have been found to be important to avoid, and some guidelines for developing community-integrating housing options for persons with disabilities. Also provided are names and addresses of organizations and agencies that might offer more detailed information.

Community integration is the assumption or resumption of culturally and developmentally appropriate social roles following disability. This article describes characteristics of a model system of professional and social services required to address the long-term, community integration of individuals who have experienced traumatic brain injury (TBI). Emphasis is given to defining the goals and values of a model system rather than the structure itself. Goals are defined from the point of view of the individual who has incurred a TBI, the professional providing rehabilitation services, and the society in which they both function. Optimal quality of life is described as the attainment of desirable outcomes from all three perspectives. Common barriers to optimal quality of life are discussed in relation to six salient dimensions of life activities. Values of a model system are drawn from recently delineated principles of community-based services. Implications for the structure of a model system built on these goals and values are suggested.

In this study, we investigated the relationship between coping strategy and long-term outcome from traumatic brain injury (TBI) in a sample of 72 female TBI patients an average of five years post-injury. Using cluster analytic techniques based on two subscale sets from the Ways of Coping Questionnaire-Revised (WOC—R), we derived clinically relevant cluster groups based on coping strategy and validated the groups on demographic, injury-related, and quality of life measures. Results suggested that coping strategies characterized by low overall coping and positive reappraisal were associated with relatively good outcome, while those characterized by high overall coping and a combination of self-blame and escape avoidance were associated with relatively poorer outcome. These results are similar to those obtained with male samples, but societally linked gender stereotypes may contribute to unique coping and restriction of coping strategy for female TBI patients.