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Get The Facts

Brain injury rehab: an introduction

Information Services


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 damaged area. 


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 recovery
  • 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. 


Rehabilitation techniques

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.


Remediation involves 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 skills again. 


Substitution or 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 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 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 to communicate.   


Challenging behaviours

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 everyone. 



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