Chapter 11: Prognosis and Treatment Planning
Prognosis: the ability to forecast or predict the longterm pattern of recovery following
injury or disease.
Treatment plan: involves all of the services, which will be provided for the client
successful treatment begins with an appropriate evaluation.
The assessment tools must answer questions related to the possibilities success in
treatment and returning to one’s previous situation, hence, it implies prognosis.
Often a treatment plan is administered by a case manager, whose role is to
coordinate services delivered by multiple disciplines.
Social workers are familiar with the multitude of services that a patient may need
and the types of programs available to finance these various services.
Premorbid Patient Factors:
Premorbid functioning: the level of functioning of any ability of the individual
that was present prior to the injury and that now may have been lost or changed.
Crystallized intelligence: acquired skills and the use of the knowledge in activities
such as work or hobbies; it has the advantage of practices.
Using Wechsler scales, it appears that crystallized intelligence declines very little
as individual ages.
Fluid intelligence tends to reflect a decline with aging. (Wechsler’s Digit Symbol
and block design)
Brain size as measured by MRI correlates modestly (r=.35 approx.) with summed
Hence, brain size contributes to ability level which is also related to academic
Satz postulates that the amount of brain reserve capacity (BRC) represents
structural or physiological brain advantages or disadvantages.
Advantages: higher educational levels, higher test scores both premorbidly and
postmorbidly and a better level of functioning of the brain after disease or injury.
Individuals who have attained a more advanced level of education score better on
neuropsychological tests even with brain impairment.
Important age for CNS: 5 & 65
Using fMRI, it shows that in 20s, CNS is continuing to develop (structural
1 major changes is thickening of the corpus callosum which causes improved
However, the Cerebral cortex does not finish maturing until 1825 years, whereas
Amygdala matures earlier.
There is influence of the environment as a factor in brain changes, such as a
recent study in which the corpus callosum thickened and more brain connections
were formed when adolescents resisted peerpressure.
Hence, nature nurture always interacts with age in brain impairment.
Plasticity is the behavioral or neural ability which the brain exhibits to reorganize
after brain injury. 1524 age group sustains more closed headed injuries than any other age group,
followed by young children and the elderly.
1524 age group tends to engage in more risky behaviours than any other age
group which could put them at risk for numerous types of difficulties.
The following changes all occur during normal aging: decline in brain volume,
cortical atrophy evidenced by wider sulci, narrowed gyri, thinning of the cortical
mantle, increasing dilation of the ventricles, and changes in the temporal lobes
and in the basilarsubcortical regions.
Males are better at: targeting throwing and catching. (motor skills)
Females are better at fine motor skills.
Males are better at directions and spatial rotation.
Males have more grey matter than females.
Male brains have larger asymmetry in the Sylvian fissure than female brains.
Diffuse damage: affects many areas of the brain but usually the damage is not
Diffuse brain damage usually occurs due to a circumstance that causes