Affiliations: [a] Department of Psychiatry and Behavioral Medicine, Wake Forest Baptist Health Center, Winston-Salem, NC, USA | [b] Center for Neurorehabilitation Services, Richmond, VA, USA | [c] Brain Injury Association of America, Vienna, VA, USA
Correspondence:
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Address for correspondence: Gregory J. O'Shanick, MD, 7401 Beaufont Springs Drive, Suite 205, Richmond, VA 23235, USA. Tel.: +1 804 272 0114; E-mail: Gregory.oshanick@centerforneurorehabservices.org
Abstract: Background:While acute rehabilitation following neurotrauma has evolved over the past 30 years to include the common use of pharmacologic agents to promote synaptogenesis and improve recovery potential, little guidance exists for a similar strategy in the post-acute or community re-entry phases of injury. Drawing upon the existing scientific literature, models of pharmacologic intervention in promoting stability in other disease states and the authors' collective clinical experience, this article provides a potential structure by which to implement methods to create a stable physiologic platform to facilitate behavioral intervention. Objectives:This article reviews basic foundations for physiologic optimization, pharmacologic strategies for facilitation, and dyscompliance after neurotrauma. Methods:Literature review, case analysis, clinical experience. Results:Guidelines for facilitation of behavioral intervention with physiologic stabilization and with pharmacologic agents are presented with clinical rationale for their utilization. Conclusions:Improving physiologic readiness for behavioral intervention in the post-acute and community re-entry phases following neurotrauma has potential to improve both the efficiency and durability of these efforts.
Keywords: Neurotrauma, pharmacology, interventions, behavioral facilitation, post-acute, community re-entry
