When Will I Get Better - Fact Sheet
Predictions of recovery are difficult in the
months following a brain injury, with individuals and their
families often frustrated by the lack of knowledge about the
This uncertainty is common along the spectrum of brain injury.
With a severe injury, doctors can make vague guesses on the degree
of recovery expected, yet they will have seen exceptions to the
rule, with some never emerging from a coma despite good prospects,
and others who defied all odds and returned to work, albeit with
cognitive problems to deal with.
Doctors also realise that in very mild traumatic brain injuries
and concussions, they can once again make general statements about
expected recovery yet some individuals with a brain injury may have
lifelong problems that result in a major disability.
Why Predictions are Difficult
Physical injuries do not give an accurate picture of the degree
of brain injury sustained. The victim of a terrible 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. It is only recently that a technique called
diffusion tensor imaging has been shown to be effective at finding
these injuries. Unfortunately, the cost of the scan is a big
handicap to its usage in public hospitals.
The brain does have a limited ability to heal itself. This process
tends to occur over two years, with the most rapid improvement in
the first six months as swelling and bruising of the brain subside.
This pace of healing usually tapers off to the two year mark. This
is only a guideline as some will find improvement stops after a
year, others may find gradual improvements two years afterwards.
Generally, a slow rate of initial improvement is associated with a
greater chance of permanent disability.
Proper rehabilitation is very important once a patient has emerged
from coma and post-traumatic amnesia, and has a significant effect
on the final outcome. It should be noted that discharge from
rehabilitation does not mean that recovery has finished. The
individual with a brain injury has hopefully learned the tools to
continue with their own recovery.
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. Those
who had drinking or drug problems before the brain injury do not do
as well in recovery, particularly if they continue their habit
after the injury. Other personal factors that contribute to a good
outcome are a tendency to be 'giving' and think of others, an
optimistic and humorous approach to life, and religious faith.
How Predictions are Made
Physicians look at several indicators to predict the level of a
patient's recovery during the first few weeks and months after
- Duration of coma
- Severity of coma in the first few hours after the injury (as
measured by the Glasgow Coma Score)
- Duration of post-traumatic amnesia (PTA)
- Location and size of contusions and haemorrhages in the
Severity of injuries to other body systems sustained at the time
of the TBIPrecise predictions are difficult with TBI, but some
generalizations can be made:
- The more severe the injury, the longer the recovery period, and
the more impairment a survivor will have once recovery has
- Recovery from diffuse axonal injury takes longer than recovery
from focal contusions.
- Recovery from TBI with hypoxic (lack of oxygen) injury (e.g.
near drowning, strangulation or carbon monoxide poisoning) is less
complete than without significant hypoxic injury.
- The need for surgery does not necessarily indicate a worse
outcome. For example, a patient requiring the removal of a blood
clot may recover as completely as one who never needs surgery.The
Glasgow Coma Scale is used to determine the depth of coma.
The length of time a patient spends in a coma correlates to both
post-traumatic amnesia (PTA) and recovery times:
- Coma lasting seconds to minutes results in PTA that lasts hours
to days; recovery plateau occurs over days to weeks.
- Coma that lasts hours to days results in PTA lasting days to
weeks; recovery plateau occurs over months.
- Coma lasting weeks results in PTA that lasts months; recovery
plateau occurs over months to years. Post Traumatic Amnesia (PTA)
is the gradual process of regaining consciousness after coma.
- Individuals in PTA are partially or fully awake, but are
confused about the day and time, where they are, what is happening,
possibly who they are and they will have problems with memory.
Length of PTA is frequently used as a guide to the severity of
brain injury. A commonly used interpretation of the scale involves
Duration of PTA
< 24 hours
> 4 weeks
A general finding is that if the PTA stage lasts for more than
one week, ongoing cognitive problems can be expected.
It is important for the person and the family to be optimistic but
realistic about recovery and to develop a better understanding of
what is or isn't possible. Some families with a loved one in
hospital have likened this to hoping for the best while preparing
for the worst.
Factors Influencing Long Term Outcome
An injury to the brain results in a number of impairments that
may create serious problems for the injured person. The ability of
an individual to cope with these effects is influenced by four
- Personal assets and limitations of the person before the
- 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 acquired brain injury that is
recognised as the one that can most likely be changed to improve
future enjoyment and success in life. Self-awareness, motivation,
goal setting, coping strategies (use of memory aids etc.) and
management of emotions are important reactions which influence
long-term outcome following an acquired brain injury.
Hard Work and Hope
A brain injury is very different from other conditions where
full recovery is the norm. The reality is that even a mild brain
injury will usually leave lifelong cognitive effects.
The brain is the most highly organised system in the universe and
the bad news is that a complete recovery is usually not possible.
The good news is that faith, hope, hard work and a systematic
approach can dramatically impact upon the recovery process and life
afterwards. Like a marathon, you have to pace yourself for the long
race and keep a positive attitude on the way.
References and further information