Rehabilitation After Brain Injury

The reality of brain injury is nothing like is portrayed on TV! You don’t just “wake up” from a brain injury and carry on with life where you left off. The forward course of is slow, inconsistent, and at best, unpredictable. When the brain heals, it does so very differently than a cut, burn, or broken limb. And, recovery is different for every injury, and for every person. Many factors are involved in brain injury rehabilitation: the type of injury, location, severity, personality before injury, coping methods used, support systems available, and so on.

There are two processes involved: recovery, which is the physical healing of neurons in the brain, and rehabilitation, which involves problem solving to work around the effects of the injury. These new ways of doing things are called “Coping”, or “Compensatory” Strategies.

1) Recovery – Physical Healing Of Neurons

In the past, it was believed that the brain was “hardwired” like a machine, and that repair or regeneration was not possible. It is still true that many neurons will die from the injury, and will not be replaced, and that there is no medication or surgery that can “fix” the brain. However, there is increasing evidence in the study of neuroplasticity that the brain can regenerate and re-designate neurons in order to change itself.

Research shows that neurons can sometimes repair themselves by growing new branches and make new connections. Nearby neurons may take over part of the function of the dead or damaged neurons, and eventually take over their space. However, neuroplasticity is a slow process, and it may take many months for a neuron to grow only a short distance. The new neuron pathways also may not work as well as the original, and may not be consistent from day to day. It is currently impossible to predict the final outcome of healing after a brain injury, but overall improvement in brain function can be expected over time.

During the healing process there will be bursts of dramatic recovery, and then plateaus where it seems to level off. Most ‘physical’ recovery occurs over the first six to eighteen months, and during this time, the focus is usually on re-learning to walk, talk, eat, etc.

The cognitive (thinking) and psychosocial (emotional) functions generally take much longer to recover, and can frequently take five to ten years, or more. The process will be inconsistent, with good days and discouraging days. When tired, stressed or ill, the recovering brain will become overloaded, and will not work as well.

How To Promote Recovery:

Here are guidelines and methods to assist brain injury rehabilitation:

Ensure overall good health

• Nutrition – the brain needs lots of fuel, especially after injury

• Exercise – promotes the wiring together of neurons and improves thinking

• Sleep – promotes neuron growth, solidifies learning and memory

• Positive attitude – helps brain and body function better overall

Stimulate and challenge the brain to increase neural growth

• Learn new things

• Do exciting or important things to you

• Give things your full attention

• Mimic others (uses many cognitive abilities)

• Use humor, it releases good hormones and uses many cognitive abilities

• Crying is also good, as it relieves stress

Practice skills over and over

• Repetition makes neurons stronger, faster and sharper

– Neurons that “fire together, wire together”

– Neurons “out of sync, will fail to link”

– Neurons not used will wither and die, so “Use them or lose them”

• Learn, or relearn things from the beginning, and work up in small steps

• Practice regularly and frequently – preferably every day

• Make it part of your everyday life

Avoid things that may slow recovery

• Stress – promotes the death of neurons in Hippocampus

• Getting overtired – shuts down some brain functions, especially those in the frontal lobe

• Alcohol and drugs – negatively increases the effects of injury

2) Rehabilitation – Use problem solving to work around injury

The goal of brain injury rehabilitation is to find new ways of doing things, working around the brain injury to move forward. These are called coping, or compensatory strategies. Typically, it is best to start developing coping strategies immediately after injury. They are concrete things that the survivor can do to be successful and meet their goals. At the same time, they can also stimulate their neurons, with the knowledge and hope that they will see improved brain function over time.

How to get started and take charge of rehabilitation

Most people seeking help many months, or even years after their injury. In the beginning their brain was fuzzy, but they figured everything would get back to normal soon. They kept trying, but things just did not work. Their emotions were all over the place. They could not trust their brain. Things did not make sense. They may have feel frustrated with their doctor for not giving them the “right” treatment.

This is a very typical sequence of events after injury. It can leave them feeling depressed, frustrated and dependent, like they have no control over their own life anymore. By taking charge of their own rehabilitation, they will gain control over their life again. To do this, they first need to learn all that they can about their injury, and work through any denial to accept the changes in their abilities.

• They need to find out what their strengths are.

• They need to try new things.

• They need to experience success and feel proud.

• They need to make mistakes and learn from them.

• They need to sort out who they are are now.

Northern Brain Injury Association educational materials are dedicated to assist this very process, helping survivors along the road to recovery, one tiny step at a time, and families by providing the tools they will need to give them help. Yes, the process of brain injury rehabilitation and recovery is slow and frustrating, and may make people feel like giving up. But, urge patience and persistence, for in the end it will be well worth all the hard work and dogged determination.