Predictions of recovery are difficult in the months following a brain injury, with the person and their family often frustrated by 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 may not be known for months or even years after the injury.
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Why aren’t there accurate predictions?
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 bath tub.
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.
Importance of rehabilitation
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 may commence while the injured person is still in hospital, and typically continues 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 supports have finished.
Personal factors make a significant difference to the degree of recovery expected. For example, people who did well in the educational system and those with very determined, motivated personalities usually perform very well in rehabilitation.
Recovery typically slows down at some point, however it need not stop when formal rehabilitation finishes.
The ability of a person to cope with these effects is 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
Of these four factors, it is the person’s reaction to his or her situation that is recognised as the key factor in relation to future enjoyment and success in life.
Self-awareness, motivation, goal setting, coping strategies (use of memory aids etc.) and management of emotions also are important factors which influence long-term outcome following an acquired brain injury.
Tests and scans
Some of these tests may be done very soon after admission to hospital as the doctors need to rapidly assess the danger of the brain injury worsening.