Restitution and substitution: Two theories of recovery with application to neurobehavioral treatment

This article reviews two theories regarding recovery from brain damage in adulthood. The notion of restitution of function assumes that behavioral improvement results from the increasing integrity of the injured functional system. In contrast, the theory of substitution of function assumes that improvement results from system reorganization or compensation. Both these processes take place during the course of neurologic recovery. The ability of the clinical neuropsychologist to maximize behavioral changes in the brain-damaged patient during the recovery period requires an appreciation for these recovery mechanisms. Treatment decisions can be enhanced by knowledge of the time course, degree of recovery potential, and behavioral constraints of these complementary recovery processes.