Impairments in daily life after SAH
Contemporary social medicine differentiates three levels of effects of bodily illnesses: 1. “impairment” as the injured organ system, 2. “disability” as the resulting impaired function and 3. “handicap” as the individual psychosocial consequences (World Health Organization, 1980). Next to the level of neuropsychological impairments which should correspond to disability, the psychosocial impairments are to be mentioned on the handicap level. Although an illness such as SAH often leads to permanent disturbances of brain function, visible bodily impairments are rare. Therefore, it could be termed a “hidden” illness. The consequences of the illness cannot be observed directly by outsiders since no visible impairments or other abnormalities show in the outer appearance of the patient. Six months after the acute event only 20% of all patients exhibit deficits noticeable for outsiders such as pareses or mental impairments as severe aphasias (Gilsbach and Harders, 1989). Nevertheless, the patients are substantially handicapped in their daily functional capacity. Therefore, also in patients after SAH also questions about problems in daily life are of great importance. Based on the brain organic limitation to perceive the own deficits and because of the fact that assessments by the life-companion are in general more reliable, also the patients’ partners should be questioned about complaints and functional impairments (Hiitter and Gilsbach, 1995a). For this reason it is sensible, also in scientific studies, to take the assessment of the state of the patient by the life-companion (proxy-rating) into account (Hiitter and Gilsbach, 1996b; 1995a;b; Hiitter, Gilsbach and Kreitschmann, 1995).
KeywordsNeuropsychological Impairment Psychosocial Impairment Outer Appearance Critical Life Event Severe Aphasia
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