Overview of the Traumatic Brain Injury Recovery Process

by Steve Holder on June 28, 2008

The time required to recover from a traumatic brain injury (”TBI”) varies widely for many reasons. To make sense of the TBI recovery process, we need to differentiate between mild, moderate and severe injury. The majority of people who receive a mild TBI fully recover within three to four weeks with no specific course of treatment. Others with moderate injuries may recover significantly, if not completely, within 6 to 12 months, while those with severe injuries may never fully recover despite extensive rehabilitation.

Mild, Moderate, or Severe?

Doctors have no reliable ways to predict the outcome of seemingly minor head trauma. As a testament to the complexity of traumatic brain injuries and recovery, you won’t know for certain whether your injury is mild or moderate until three to four weeks have passed. If you feel pretty much back to normal in a few weeks, then it was a mild TBI. If you don’t, then it was more serious.

The same can be true with moderate and severe injuries. In these cases, evidence of brain lesions may be visible in CT scans or MRIs, but these images are not great for predicting recovery time or the degree to which rehabilitation will be successful. Much of that is dependent on the individual.

The recovery process for moderate to severe injuries has several stages that will typically overlap:

And though this is a recovery process, not everyone will complete it, and not everyone will make a full recovery.

Physical Rehabilitation

In mild and moderate cases, there may be no external injury, or nothing worse than a cut, bump, or bruise. A full medical recovery is often quick.

In cases of extreme physical trauma, however, injuries to the body and to the brain’s motor-control areas, combined with lengthy confinement can make extensive physical therapy necessary.

In a successful scenario, the patient regains substantial or complete recovery of physical abilities within a few months to a year. A moderately successful outcome has the patient continuing to make progress in regaining motor function though never returning to pre-injury capabilities. A poor outcome finds the patient’s mobility and physical functioning severely and permanently limited.

Behavioral Rehabilitation and Emotional Recovery

Behavioral problems following brain injury have been well documented and include:

  • Aggression
  • Cursing
  • Extreme temper
  • Self-centeredness
  • Manipulative behavior
  • Inappropriate sexual behavior

Emotional problems are also very common, including:

  • Irritability
  • Anxiety and depression
  • Mood swings
  • Apathy or lack of emotional response

Not everyone will suffer from these conditions. Sometimes some of these issues arise as a direct result of the injury’s location in the brain, while other times they arise as a psychological or emotional response to being injured.

From a therapeutic standpoint, behavioral problems and emotional problems are considered together because they are psychological issues often treated using typical psychotherapy techniques and medications.

From a recovery standpoint, on-going behavioral and emotional problems will make it impossible to achieve cognitive and occupational rehabilitation. The severity of these problems must be brought under control before recovery can proceed.

For some TBI survivors, one or more of these psychological problems may remain lifelong issues.

Cognitive Rehabilitation

When thinking ability is compromised by a brain injury, patients can often regain some or all of their previous mental skills through relearning and practice. In other cases, they can learn alternate ways to perform tasks that minimize the importance of their particular deficit. For example, people with short-term memory issues learn to compensate by keeping a notebook and writing everything down in it.

Cognitive rehabilitation programs are obviously tailored to the TBI survivor’s specific deficits and needs. The individual typically makes steady gains in capabilities for the first 18 to 24 months and then reaches a plateau where further progress seems to be made slowly. Most therapists agree that such plateaus are only temporary, and do not represent the limit of the individual’s ability to continue recovering cognitive function.

Occupational Rehabilitation

The TBI survivor who makes it to occupational therapy has come a long way. It means that behavioral and emotional problems have been addressed adequately to allow functioning in the workplace, and the individual has achieved a positive outlook and the desire to be productive. Also, the significance of cognitive impairments has been suitably overcome by adaptive techniques, so the individual has a meaningful opportunity to fulfill a job role.

For the survivor of a serious traumatic brain injury, returning to work, even in the presence of significant and permanent performance limitations, has to be considered a successful recovery.

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