Brain injury rehab: an introduction
The degree of recovery after a brain injury
is strongly influenced by rehabilitation - the process of restoring
as much ability and quality of life as possible after an
injury has occurred.
The brain does have a limited ability to heal itself with
usually the biggest improvements seen in the first year.
Rehabilitation seeks to make the most of this period when the brain
is recovering using a variety of techniques. It also relies on
neural plasticity - the brain's ability to 'rewire' itself to some
extent and begin using other parts of the brain to bypass the
Why rehab is so important
This ability of the brain to rewire itself is
very important because it means that our experiences after a brain
injury have a strong effect on our recovery, because:
- Lack of use and stimulation of the brain will limit
- Inactivity and withdrawal can lead to various social, cognitive
and behavioural disabilities
- Depression and other emotional disorders can lead to poor
motivation and less use of helpful coping strategies.
The rehabilitation team
Formal rehabilitation will start at some point
after the person has been medically stabilized and emerged from any
post-traumatic amnesia. This could be as an inpatient or outpatient
depending on the degree of injury. There is usually a team-based
approach due to the wide-ranging effects of a brain injury, and a
case manager who will liaise with family members.
The most common rehabilitation technique is
developing compensatory strategies - ways to compensate for lost
abilities and skills. There are five common forms of recovery and
adjustment following a brain injury. To explain these forms of
recovery and adjustment, the following sections use speech problems
as the example.
relearning how to perform tasks and skills in a similar way to
before the brain injury e.g. investing time and effort to practice
speech therapy exercises in order to relearn and master language
compensation involves using previously
acquired skills or learning new skills to perform tasks in a
different way e.g. if talking is too difficult, using alternatives
like writing messages, using a communication board or sign
adjusting personal goals and expectations to suit the changed level
in abilities e.g. if communication problems will be a long-term
issue, it may mean finding a different job or a change in social
Assimilation is modifying the
environment or adjusting the expectations of other people e.g.
educating other people on how to use alternative means of
communicating with the person.
Decompensation is often more
problematic than it is beneficial so it is not a widely used
technique. It involves reducing the need to use a skill, e.g.
avoiding or withdrawing from social interaction to reduce the need
Behavioural issues can emerge after the return home. Identify
the issues as early as possible, and create a positive behaviour
support plan for the whole family to apply consistently. See our
fact sheets about challenging behaviour, and contact your Brain
Injury Association for information.
Family involvement in rehab
The family is a very important part of the rehab process.
A good rehab team will include the family where possible, as
it is the family who will continue the rehab process once the
'official' part is over. In a sense rehabilitation is never
finished and the family can often help to achieve progress even
years after the injury. It is useful to record everything in
writing throughout the rehab process - keep copies of letters, take
notes and date your phone calls. Ask for permission to record phone
calls if you think this is required.
Information, education and support are the three most important
aspects of rebuilding life after brain injury. Add to that an equal
measure of love, and it can be a win-win situation for