Complete recovery of all brain functions following brain injury is rarely accomplished. Still, if recovery is defined as a reduction in impairments in behavioural and physiological functions over time then changes do occur so that, typically, there is recovery of function together with a fair amount of substitution of function. Mechanisms include resolution of brain swelling (oedema), resolution of damage to other brain regions damaged through shock (diaschisis), changes in the structure of the nervous system (plasticity), and regrowth of neural tissue (regeneration). The extent of recovery depends on the severity of the injury, the number of times injured, the age at the time of injury, premorbid cognitive status, extent to which loss functions can be subsumed under other systems, integrity of other parts of the brain, individual brain structures, motivation, emotional considerations, and the quality of rehabilitation programme. (4 55)
Although children and adolescents tend to have a better outcome after severe traumatic brain injury than those over the age of 21, (46> the adult brain has greater plasticity than previously considered.(49,) Despite this general rule, children who are younger than 7 years may have a worse outcome since they may be at increased risk of child abuse, which may be particularly traumatic. Furthermore, younger children may have a worse outcome based on the global effects of trauma on the developing brain. The duration of recovery of significant neuropsychological, behavioural, and emotional deficits may last several years following injury. These higher cognitive deficits lead to the major disability observed with traumatic brain injury.
Partial recovery of function can and does occur over time, not only in children but also in adults. (49> Intervention through retraining and the use of cognitive memory aids can lead to improvements in cognitive functioning such as memory, attention, language, and perception. (5°) Even though partial recovery does occur after various types of brain injury, there is variability in the extent of recovery.
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