title: Facilitation of functional independence after neurotrauma: strategies for increasing physiologic readiness.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Psychiatry and Behavioral Medicine, Wake Forest Baptist Health Center, Winston-Salem, NC, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: McQueen
authors.affiliation: Center for Neurorehabilitation Services, Richmond, VA, USA Brain Injury Association of America, Vienna, VA, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: O'Shanick
mesh_terms: D000547:Amantadine / Q000627:therapeutic use; D000698:Analgesia / Q000379:methods; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation / Q000628:therapy*; D003681:Dehydration / Q000628:therapy; D019587:Dietary Supplements; D015259:Dopamine Agents / Q000627:therapeutic use; D005625:Frontal Lobe / Q000293:injuries; D006801:Humans; D044342:Malnutrition / Q000628:therapy; D010349:Patient Compliance; D020127:Recovery of Function / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000209:etiology / Q000628:therapy
chemical_list: D015259:Dopamine Agents; D000547:Amantadine
keywords: Neurotrauma; behavioral facilitation; community re-entry; interventions; pharmacology; post-acute