Why predictions are difficult

Predictions of recovery are difficult in the months following a brain injury, with the person and their family often frustrated by a lack of knowledge about the future.

This uncertainty is common along the spectrum of brain injury, and the long-term effects of the injury may not be evident for some time. With a severe injury, doctors can make their best estimates, yet these are only ever a guide, and the degree of recovery will not be known for months or even years after the injury.

Physical injuries do not give an accurate picture of the degree of brain injury sustained. The victim of a serious car accident may have numerous fractures, yet there can be less brain trauma than someone who fell over in the bathtub.

The CT and MRI scans used to detect brain injury are good at detecting bleeding in the brain, yet fail to accurately show trauma at the microscopic level. Brain trauma can sever the connections between brain neurons over areas of the brain, yet this will not show in many tests.

Long-term outcomes may not be evident until the completion of a program of formal rehabilitation, which can continue for up to two years after the injury. Rehabilitation is crucial for optimising recovery following brain injury, and the level of engagement of the injured person and their family in the rehabilitation process influences the long-term outcome.

Rehabilitation should ideally commence while the injured person is still in the hospital and continue as an outpatient service once they have returned home. It should be noted that discharge from rehabilitation does not mean that recovery has finished. Equipped with the tools and strategies learned through rehabilitation, many people continue with their own recovery long after formal support have finished.

Recovery will continue for years after the injury. Neurons can take up to 5 years to heal, and there is no reason to stop teaching the brain new ways to do tasks that have been effected by the injury. The rate of improvement, will slow down over time, but there is no need for it to stop.

Long-term outcomes are influenced by many factors, including:

• Personal assets and limitations before the injury
• The nature and severity of the injury
• The person’s reaction to the injury
• The support of significant others.