Rehabilitation for brain injury
The brain is different to most other areas of the body, in that damaged cells cannot repair themselves. In order for recovery to occur, the brain must ‘reorganise’ itself through a process known as ‘plasticity’. This means that new neural pathways are created so that undamaged areas of the brain will take over from the damaged areas.
The aim of brain injury rehabilitation is to aid the growth and development of these new neural pathways so that the brain can learn to operate in a new way, minimising the long-term impact of a brain injury.
It is a long process, because it often involves re-learning how to do everyday tasks from scratch. For any remaining effects or disabilities, rehabilitation aims to develop coping strategies so that the person can learn to live with them and regain control of their life
It is important to manage the expectations of rehabilitation after a brain injury. It is often a long process where those injured must ‘re-learn’ to do all the things that they now have trouble with.
The brain must re-wire itself. This can only be done through long-term repetition and it may take months or years.
1-6 months post-injury
Understanding recovery from a brain injury is still a relatively new area of medical science. It is very difficult for medical professionals to predict how much a person will be able to recover within the first few months after their injury. This is because it can take several weeks for the full extent of the injury to manifest itself, and only once the injury is fully understood can an accurate picture be given. It tends to be the case that the more severe the injury, the longer recovery will take.
6-12 months post-injury
It used to be the case that doctors would tell patients that whatever recovery will take place is going to happen within the first 12 months. It is true that the largest and quickest improvements tend to take place within the first year, and that improvements after the first year will be slower, and less noticeable. However, it is now understood that the brain continues to recover many years into the future.
1 year+ post-injury
Over a year after a brain injury, patients may reach a ‘plateau’ where they do not show significant signs of any further improvement. Unfortunately, because dramatic and noticeable improvements are usually made over the first year, when the first plateau is reached there is a tendency for this to cause people to become demoralised.
Recovery from a brain injury occurs in quick bursts involving ‘in-between periods’ of little to no change. It is sometimes the case that the person will get worse, before improving by taking one step back and two steps forward.
Very long plateaus are sometimes overcome many years after the injury by environmental events. Changing to a new counsellor, joining a new support group, or even something as simple as starting a new hobby can cause new functional gains to be made.
The key to long-term functional improvement is to push towards new goals. Always take small steps towards a new goal or improvement, and do not have a time frame in mind. Instead of thinking, “I want to be better in six months’ time”, try thinking along the lines of, “I want to keep doing this until it is no longer difficult”.
Where it takes place
‘In-hospital’ naturally refers to first stage of rehabilitation which takes place while the patient is in hospital. It should be noted that rehabilitation from a brain injury can start as soon as possible, even in the acute stages of intensive care in hospital.
Rehabilitation specialists are on staff to evaluate the effects of the injury and therefore the immediate needs of a patient post-injury or post-surgery. Ideally, therapy will be on a one-to-one basis, although this will be determined by hospital resources unless private help can be arranged.
If a patient is discharged from hospital but cannot live unassisted, they will be sent to an in-patient rehabilitation facility. These facilities exist solely for the purpose of rehabilitation, and their offering can be much more intense than their hospital equivalent.
In-patient rehabilitation is more like a gym atmosphere (especially in the case of physical rehabilitation), with patients wearing their own clothes and attending both group and private sessions every day. The focus is to restore the patient to as normal a level of operation as possible so that they can return home.
Outpatient rehabilitation (available both on the NHS and privately) is where the person has sufficiently recovered to be able to live at home, but still requires further rehabilitation.
They will travel to a rehabilitation facility or be treated at home, depending on individual needs such as equipment required, their ability to travel, and so on.
Towards the end of a scheduled rehabilitation programme, patients will be given exercises and routines to undertake by themselves, and this will often signal the end of NHS involvement.
Those who suffer brain injury benefit greatly from continuing care and assistance from rehabilitation professionals, long after the end of the NHS scheduled programme.
Types of therapy
Every brain injury is different and its rehabilitation must be considered on a case-by-case basis by medical and rehabilitation professionals. For in-depth advice into the nuances of the required types of therapy, it is important to seek advice from medical professionals familiar with your exact needs and requirements. As serious injury experts, we are able to direct you to the best brain injury rehabilitation experts in the country. To learn more, please visit About us.
Neurological physical therapy
Physical therapy is a branch of treatments that focus on overcoming impairments and disabilities that make everyday tasks difficult. Examples of this include balance, coordination and movement.
Neurological physical therapy is a specialist subsection of physical therapy that involves the evaluation and treatment of people with mobility difficulties resulting from damage to their nervous system. After a brain injury, it is very likely that the injured person will require this type of treatment. Common difficulties that are caused by nerve damage include problems with balance, movement, muscle strength and vision.
A neurological physical therapist will help their patients to undertake physical exercises that are designed to aid nerve regeneration. This will reduce the long-term functional impairment of an injury as much as possible.
Occupational therapy is a branch of treatment that focuses on ensuring that an individual has the daily living and working skills to lead a healthy and fulfilling life. At least one of the following approaches are undertaken to do this: adapting the environment; modifying the task; teaching the skill, and educating the client.
Examples of the types of everyday skills that an occupational therapist can help with include taking a shower, preparing food and getting dressed.
There is a significant overlap between occupational therapy and physical therapy because their respective goals are similar; namely, improving their functional abilities and allowing them to regain control of their everyday life.
Head and brain injuries can have a significant impact on the emotional, psychological and behavioural aspects of people’s lives. As it is a wide-ranging field with many varying effects, this section discusses three examples of psychotherapies that have the potential to help people throughout their rehabilitation:
Cognitive therapy (CT) is a branch of treatment that focuses on helping an individual overcome any difficulties they are experiencing by highlighting and repairing dysfunctional behaviours, thought processes and emotional responses.
The therapy is based on the principle that health issues such as anxiety, depression and irrational fears are the result of the way people perceive events in a negative light.
Therefore, the aim of cognitive therapy is to improve the ways in which people think, act and feel through a collaborative ‘talking therapy’ programme between the therapist and the patient.
The therapist will help the patient to identify the existence of such thought patterns, they will help them recognise the thoughts when they occur, and help them understand how they develop into their specific health problems. By changing these thought patterns, they can reduce their health problems and develop a more realistic way of thinking.
An example of where cognitive therapy would be needed is when someone has such negative thoughts, that they manifest themselves as a ‘downward spiral’. If a person thinks “I am useless at this task, everything I do is always wrong” then their mood will worsen. Then the person may avoid completing the task at all costs in future, thus their behaviour is confirming their belief of being “useless”. Cognitive therapy then works to amend these negative thought patterns by introducing alternative ways of responding to similar situations, thereby enabling negative thoughts to recede.
Another form of cognitive therapy is a therapeutic treatment called rational-emotive therapy (RET). It is distinctive from cognitive therapy through the way it bases its theory on irrational thought itself.
The principle of the theory is that people do not get upset by the adverse events that affect them, but rather they upset themselves with the sometimes harsh and irrational demands that they place on their lives. People can display a reliance on three core beliefs:
- That the individual should be loved unconditionally by others and have outstanding achievements
- That other people are giving, liberal and fair
- That the world is a generous and easy place to navigate and cope with
RET is used as a treatment for people that suffer from the anxiety, stress and depression that result from such views, so the aim of the therapy is to reduce irrational emotional pain and encourage the individual to focus on the positive things that occur in life such as their healthy relationships and personal creativity.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) and is the most widely practiced of these psychotherapeutic therapies. It combines cognitive therapy (CT) with behavioural therapy, as most therapists believe that combining the two provides a more rounded and complete therapy for those with anxiety, depression and so forth.
Simplified, this is usually a type of talking therapy where the individuals discuss how they think and feel about themselves, the world and other people (the ‘cognitive’ element); and they also discuss how their actions affect these thought processes (the ‘behavioural’ element).
It is based on the idea that adverse events do not upset the individual, but rather the meaning that people place on those events upsets them. The aim of cognitive behavioural therapy is to help the individual move away from such heavily polarised thought processes as amplifying negativity and minimising positivity, with the goal of creating a more realistic way of thinking and thus reducing stress.
Placing such negative meanings on events and situations can cause a ‘downward spiral’ or a ‘vicious cycle’ that is difficult to escape; however, through cognitive restructuring (assessing the beliefs and assumptions behind the patient’s thought patterns), many people who suffer from post-injury anxiety may experience psychological improvements.
How to access rehabilitation
Once someone injured has been medically stabilised after their serious injury, the rehabilitation process should begin as soon as possible.
However, there are various factors that determine the setting in which rehabilitation should take place.
In order to choose the most appropriate venue, a decision must be made via thorough consultations between the patient, their family and medical professionals.
There are numerous head and brain injury rehabilitation centres across the country, with some operated by the NHS whilst others are private facilities. Different hospitals may specialise in different areas of head and brain injury rehabilitation, so it is important to take such factors into consideration.
As with any required appointment at a medical institution, spaces within the rehabilitation hospitals are subject to availability. For this reason, it’s common for the most geographically convenient venue to be unavailable, making it necessary for the patient to access rehabilitation in an unfamiliar area.
Admission to a particular hospital may be determined by the way in which the rehabilitation programme is funded. As an example, there could be an instance where there may not be any available space at an NHS facility so a private hospital may accept the referral from the NHS, who will in turn still fund the programme.
Alternative methods for funding also exist, such as from a local authority, through health insurance or simply by self-funding. Once a referral is made, it is imperative that the fund-providing service is be informed, otherwise payment will not be made and admission to the hospital will not be granted.
Some regions of the UK offer regular drop-in centres for people who have suffered from acquired brain injuries (without charge through the NHS), and their goal-based rehabilitation methods may be useful to those who may wish to incorporate them into their programme.
It is recommended that different facilities be visited by those involved in the rehabilitation process prior to making a decision.
Asking questions helps to build up a wider understanding of each place: Does the hospital provide all the necessary rehabilitation methods as part of its programme? Does it achieve the required levels of cleanliness? Are other patients content with their treatment? What is the staff-to-patient ratio at any given time?
The rehabilitation process for a brain injury can be lengthy and complex, so it requires a high level of commitment from everybody involved and choosing the right setting will help to improve the whole process.
Other important issues
Head and brain injury rehabilitation requires an incredible amount of hard work. Due to the varied nature of such injuries, precise predictions cannot be made for the extent of the patient’s recovery nor how long it will take, but it is very likely that rehabilitation will be a long and demanding process.
Physical and psychological demands
The physical and psychological demands placed on the recovering individual are considerable, especially once they have been through major surgery, so it is important to keep sight of the ultimate goal of rehabilitation and the benefits that it will bring. Studies have shown that people who show the most improvement after injury are those with a strong and positive mental attitude.
During challenging exercises, the injured person may become much more physically tired than they were previously used to, though in due course their stamina will return. The mental strain of their new circumstances cannot be underestimated either, and mental fatigue can often be a major issue.
For the injured person, the support of their family and friends is of vital importance during the recovery period. In the same way, it is recommended that emotional support be provided for the family through such trying times, for example through specialist brain injury support groups.
It is important for all involved to treat every improvement and progression as a victory, no matter how minor. Be positive. It is a clear sign that you are moving closer to your goal.
Visiting the hospital
When visiting someone who is recovering from a serious head and brain injury, it is important to be mindful of how much of a demanding experience that it can be for them.
Of course, wanting to be close to a loved one as often as possible through such a difficult and serious event is a completely natural and understandable reaction – in fact, support from the patient’s family and friends is emphatically and wholeheartedly encouraged.
However, the uncertainty that surrounds recovery from a brain injury means that during the rehabilitation period, family and friends should approach the patient with care; enough to offer comfort and support, but not enough to physically and emotionally drain the strength from the patient, preventing them from achieving optimal results in recuperation exercises.
This can be a difficult period of adjustment in many different ways, both for the injured person and their family. It is key to be composed and attempt to find the right balance.
We’re committed to putting in place complete rehabilitation services for our brain injured clients. Read more in our client stories.