Rehabilitation and return to work after brain injury

Rehabilitation may be divided into three phases: acute, postacute and reintegration into family and work. In acute rehabilitation there is a lack of consensus on terms as permanent vegetative status (PVS). The effectivity of coma-stimulation programs remains equivocal. in the postacute phase the focus is on the neuropsychological rehabilitation with special reference to metacognitive disorders due to frontal lobe lesions. A hierarchical model of cognitive functions facilitates the understanding of the consequences of severe brain injury and of the concept of ''holistic rehabilitation''. In a study on outcome of a program aiming at social and vocational rehabilitation based at our institution we found a reduction in the rate of unemployment from 91% before the program to 28% following at least 1/2 year later. New approaches to vocational rehabilitation combining elements such as supported employment and case management are reported.