Contradictions and conflicts in brain injury rehabilitation. A systematic inquiry into models of rehabilitation

The approach of addressing biology as the sole process to recovery after a brain injury has been criticized since the 1980s. Based on the bio-psycho-social model (BPSM), new national guidelines stipulate that brain injury rehabilitation should be based on dynamic approaches and interactive principles. Proceeding from a Systematic Inquiry into Models for Rehabilitation (SIMREB) and Institutional Ethnography approach, we identify possible contradictions, barriers and conflicts hampering the implementation of the BPSM with reference to basic discourse conflicts within the field of acquired brain injury rehabilitation. We find four main barriers within practice that may hamper the implementation of the new paradigm: institutional premises that sustain biological discourses, difficulty of predicting recovery, lack of interdisciplinary collaboration and a general ignorance regarding the life-world of people with ABI. The analysis is based on fieldwork in a Danish Neuro-Rehabilitation Centre.