Watts, A., Psychological Society of South Africa, South Africa
Clinical neuropsychological rehabilitation is a specialised and unique discipline which aims to get the brain-injured back to as productive a life as possible by improving the cognitive, emotional and psychosocial problems flowing from their brain injury, enhancing their independence, and returning them to work wherever possible. As brain injury is a family affair, it also aims to reduce stress on family and careers. As such, neuropsychological rehabilitation forms an integral component of the treatment protocol of brain-injured individuals in developed countries. This is not the case in developing countries such as South Africa, despite the fact that the country has one of the highest rates of head injury in the world due to road traffic accidents and violence related trauma such as gunshot and stab wounds. Furthermore, the World Health Organisation's 2001 report on mental health noted that in Africa neuropsychiatric disorders account for 17,6% of all years lost due to disability. A review of the literature reveals that whilst progress within the cross-cultural domain has been made in the assessment sphere, there is a dearth of work within the rehabilitation field. Furthermore, it appears that no such work has been done in Africa. Existing Eurocentric approaches to neuropsychological rehabilitation will be discussed in terms of their problems for a multicultural and rapidly evolving society such as that in South Africa. Thereafter, a model will be presented which takes cognisance of sociocultural factors, such as different conceptualisations of illness and the sick role, as well as the need to deliver such services within a primary health care framework, given that the bulk of the South African population (i.e., some 57%) reside in rural areas.