Brain injury rehabilitation: an introduction

Rehabilitation refers to a variety of therapies and support services available to people following the acute phase of recovery, once a person is medically stable. Rehabilitation therapies usually begin in hospital, and often continue after returning home. They can continue up to two years post injury. A neuropsychological test will explain the ways the brain injury is affecting the injured person. This is then used to guide the rehabilitation process, and assess areas of impairment.

A brain injury can affect almost every aspect of a person’s life, including mobility, thinking and emotional processes, personality and behaviour, relationships, vocational abilities and leisure activities. A good rehabilitation program is vital to optimise recovery following brain injury. It will be tailored to the specific needs of the individual.

People work with a variety of health professionals to regain lost function, adapt to the injury, and set goals for the future. Depending on the nature of a person’s injuries, they may undertake therapies to improve physical or cognitive function, speech therapy, anger or behaviour management, and later occupational therapy and vocational rehabilitation may be appropriate.

The most common rehabilitation technique is developing compensatory strategies. This is 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:

• Remediation  involves relearning how to perform tasks and skills in a similar way to before the brain injury. For example investing time and effort to practice speech therapy exercises in order to relearn and master language skills again.
• Substitution or compensation involves using previously acquired skills or learning new skills to perform tasks in a different way. For example if talking is too difficult, using alternatives like writing messages, using a communication board or sign language.
• Accommodation involves 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 life.
• Assimilation is modifying the environment or adjusting the expectations of other people. An example of this is 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 to communicate.

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.

Read more about challenging behaviours

Family involvement is very important.  A good rehabilitation team will include the family where possible. This is because it is the family who will continue the rehabilitation 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 rehabilitation 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. It is important for the injured person and the family to be optimistic yet realistic about recovery, and to understand what is possible.

The three most important aspects of rebuilding life after brain injury are information, education and support. Add to that an equal measure of love, and it can be a win-win situation for everyone.