TBI Case Studies: A Vygotskyan Approach to Rehabilitation After TBI: A Case Illustration The case illustration presented in this article is taken from Collaborative Brain Injury Intervention: Positive Everyday Routines, by Mark Ylvisaker and Timothy Feeney, published in 1998. The article is used with permission of the publisher, Singular Publishing Group of San Diego. Successful behavior outside of the context of well ... Article
Article  |   May 01, 1998
TBI Case Studies: A Vygotskyan Approach to Rehabilitation After TBI: A Case Illustration
Author Affiliations & Notes
  • Mark Ylvisaker
    Department of Communication Disorders, College of Saint Rose
  • Timothy Feeney
    School of Education, The Sage Colleges and Sage Statewide TBI Neurobehavioral Support Project
Article Information
TBI Case Studies
Article   |   May 01, 1998
TBI Case Studies: A Vygotskyan Approach to Rehabilitation After TBI: A Case Illustration
SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, May 1998, Vol. 8, 14-19. doi:10.1044/nnsld8.2.14
SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, May 1998, Vol. 8, 14-19. doi:10.1044/nnsld8.2.14
The case illustration presented in this article is taken from Collaborative Brain Injury Intervention: Positive Everyday Routines, by Mark Ylvisaker and Timothy Feeney, published in 1998. The article is used with permission of the publisher, Singular Publishing Group of San Diego.
Successful behavior outside of the context of well rehearsed routines typically requires some mix of clear-headed reasoning and learning from the consequences of previous behavior in similar circumstances (Damasio, 1994). Unfortunately, prefrontal and limbic system injuries, common in closed head injury, threaten both routes to successful action. High reason presupposes the ability to make logical decisions and implement effective plans based on consideration of many relevant factors and to deliberately call on past experiences in making strategic decisions. Prefrontal injury is associated with the following types of disability that can wreak havoc with such reasoning: a curious dissociation between thinking and acting (Teuber, 1964), concrete thinking, difficulty planning and organizing, impulsiveness/disinhibition, impaired initiation, weak social perception, difficulty transferring, and impaired working memory. Combined injury to prefrontal and limbic structures, particularly the hippocampus, impairs explicit, declarative memory and strategic retrieval.
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