Skills, Routines, and Activity Patterns of Daily Living: A Functional Nested Approach

Abstract

Traumatic brain injury is best characterized as a diffuse injury to white matter of the brain, one of whose functions is to transmit coordinating information from one area of brain to another. A diffuse injury of this sort results not only in a breakdown of individual skills but more importantly in the deterioration of linkages across skills which are ordinarily grouped into the routines and activity patterns of daily life. Predilection for damage to the frontal and temporal lobes causes deficits in planning, organization, and problem-solving skills, deficits in selecting from an array of alternatives, impaired new learning and critical evaluation of self-performance, deficits in self-awareness, social behavior, and interpersonal skills. In short, a diffusely injured brain with preferential damage to the frontal and temporal lobes produces diffuse disturbances in physical, social, cognitive, and emotional capacities. The result is disintegrated behavior of multifactorial origin. This chapter will stress the reintegration of skills into the adaptive routines and activity patterns of daily life by means of a nested skills approach which is specific to the needs of the social context. For brain-injured individuals, we think that adaptive behavior is more important to achieve than independence.