Entwicklungsmöglichkeiten nach schweren Hirnverletzungen mit frontalen Läsionen

Abstract

Developmental opportunities after severe brain injuries with frontal lesions Brain injuries with frontal lesions are an extraordinary challenge from both a theoretical and clinical perspective. The focus of more cognitivist perspectives on this problem area is on disturbances of executive functions, primarily in terms of action and future planning, with simultaneous preservation of memory and intelligence. However, at the same time significant personality changes in affective and emotional levels are being reported, without this aspect having previously been the subject of in-depth analysis. Newer perspectives supported by modern imaging techniques are approaching the emotional aspects of brain injuries (e.g. Damasio), but this has also led to a kind of neurosciences monopoly of interpretation. The present thesis stresses this approach and, based on qualitative research and theoretical analysis, arrives at a much more complex and dynamic description of potential development after TBI. Through concrete case-related descriptions, and by theoretically reworking them, the essay reveals the interlinking of biological, psychological, and social factors in development after severe TBI. In this respect the author is focused explicitly on Vygotsky's concept of the 'zone of proximal development', as well as on considerations closely related to this tradition, those of Anochin regarding the theory of functional systems, of Lurija for neuropsychological syndrome analysis, and those of Jantzen, which refer back to the modern neuroscience and developmental psychology debate that further developed the interdependence of emotional, motivational, and cognitive processes. As a consequence of the thesis results, the author specifically speaks out against the misuse of neuropsychology as mere 'psychological testing', and advances relationship and dialogue as a central element of psychotherapeutic neuropsychology. It is only through adaptive dialogue that the mediation of bottom-up and top-down processes can be improved after severe TBI. Only this triadic structure of a developmental matrix (emotion-cognition-dialogue), in conjunction with the notion of the transitional subject, enables us to conceive of dynamic development after TBI.