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Why does this occur?

The main reason for the slump is psychological. During rehabilitation, people are able to focus on recovery goals and progress is more apparent. Although the recovery process continues after the initial rehabilitation phase, progress can slow down. Some may feel disappointed if they leave rehabilitation without the level of function that they hoped for. It is important to remember that someone with brain injury will continue to make gains with the right support.

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Who is this stranger?

The life changes experienced by people after brain injury take time to accept. Physical and cognitive impairments, changed relationships and family roles, altered friendship networks, and limits on employment opportunities and leisure activities can all mean that people no longer feel like themselves. Some describe the new self as a ‘stranger living in their skin’. It is common to feel angry, depressed or under stress as a result. Extra support may be needed given that these feelings are harder to manage with a brain injury.

Accepting the new self

With support, a person with brain injury can learn to accept that life as they knew it is unlikely to return. It is time, instead, to build a new life, taking into consideration what is and isn’t possible.

A desire to work again and stay socially active might be possible if the person is flexible about how this can be achieved. For example, working again may involve changing careers or volunteering. A person might not go out to socialise often, but invite friends to visit instead.

Accepting a new self, and even learning to appreciate it, can be seen as the final, and often hardest stage of recovery. For some people, being able to re-frame their experience into a more positive light can be helpful. For example, a person might discover new strengths as a result of working to overcome cognitive impairments.

Being unable to work gives people an opportunity to develop new skills and hobbies such as art or gardening, and a lack of energy might be seen as having time to ‘smell the roses’. Some survivors make sense of their experience by helping people in similar situations. For example, wrestling with depression gives an insight into the pain and suffering of others.

Joining or starting a support group is a way to share hard-won lessons. Paid work supporting others with a brain injury may also be an option. For others, a spiritual approach or commitment to self-improvement may be the key. In other words, each difficulty can be seen as an opportunity for self- growth and development.

People often find gradual improvement in some areas for years after their injury when they use this approach. Some even come to appreciate how a brain injury has made them a more thoughtful, stronger person because of the many challenges they have faced and worked through.

What can the family do?

Families can help by putting strategies in place to avoid or lessen the post-rehabilitation slump. They can work together to develop new goals and activities before formal rehabilitation ends. Counsellors are available to help people with brain injury accept their new identity. As one survivor put it: ‘for survival, we must let go of what was, in order to become what we will be.’