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Recovery from Acquired Brain Injury - Fact Sheet
 After acquiring a brain injury the most important issue is usually the degree of recovery expected.
Recovery is usually rapid at first with improvements occurring as swelling and bruising of the brain subside. Improvements continue as damaged cells heal, but healing can be slow. The most significant improvements usually occur in the first six months, but good gains can continue for at least two years. Generally, a slow rate of initial improvement is associated with a greater chance of permanent disability.
Of every 1,000 people who survive a severe brain injury:
- 64% are expected to experience good recovery but may experience ongoing
 Cognitive and/or behavioural problems
- 25% are expected to have a moderate disability
- 10% are expected to have a severe disability
- 1% are expected to remain in a permanent Coma-like state.
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.
STAGES OF RECOVERY
There are three broad stages of recovery following an acquired brain injury:
Acute medical stage
This involves intensive medical treatment that may be needed for survival and preventing further complications.
Rehabilitation stage (secondary stage)
This involves intensive therapy aimed at helping the natural process of recovery and reducing the likelihood of long-term disability. Emphasis is placed on the person regaining previous skills and learning strategies to overcome or compensate for ongoing problems.
Community re-entry or Tertiary rehabilitation
This focuses on the issues of everyday living and returning to previous community activities such as work, study and leisure. It aims to help the person and family find ways to adapt to, and compensate for, any long-term problems or disabilities.
MANAGING RECOVERY
Family members may need to make important decisions when they feel least in control. This will require them to be clear headed and well informed. Many will find it useful to keep a diary in which they record:
Medical information
- names of the doctors and areas of responsibility
- dates and times of assessments
- key medical terms
- diagnosis and test results.
Social information
- person’s achievements
- visitors’ messages
- milestones (physical and cognitive recovery)
A diary and a visitors’ book can be helpful in retelling the history of what has happened.
Financial information
To assist with future claims for compensation, it is important to keep all receipts associated with caring for the injured person. It is also recommended that a diary is kept showing the time people have devoted to the personal care and rehabilitation of the injured person.
FURTHER SUPPORT AND COMPENSATION
At some stage it will be necessary to think about the financial impact of the injury including loss of earnings, hospital expenses, rehabilitation costs and long-term care expenses. Regardless of the situation it is recommended that legal advice be sought by a solicitor who is familiar with the issues and effects of acquired brain injury. The local Brain Injury Association can assist with the provision of educational information for legal advisors.
RECOVERY AND REHABILITATION
Recent research indicates that the adult brain can show experience-dependent recovery of neural circuits. This finding has three important implications, as follows:
- A lack of use and lack of stimulation of the brain, such as the absence of rehabilitation opportunities or inactivity, may prevent experience-dependent recovery.
- If people reduce their activity and participation in their world because of the effects of brain injury, they may develop secondary or additional social, cognitive and behavioural disabilities.
- Depression and other emotional disorders, such as anxiety and post-traumatic stress, can lead to poor motivation and may lower a person’s use of helpful coping strategies.
There are five common forms of recovery and adjustment following an acquired brain injury. To explain these forms of recovery and adjustment, the following sections use speech impairment as the example.
Remediation
Remediation involves relearning how to perform tasks and skills in a similar way to pre-injury performance, e.g. investing time and effort to practice speech therapy exercises in order to relearn and master language skills.
Substitution or compensation
This form of recovery involves using previously acquired skills or learning new skills to perform tasks in a different way, e.g. learning alternative means of communication such as writing messages, using a communication board, sign language or maximising non-verbal communication skills.
Accommodation
Accommodation involves the adjustment of personal goals, expectations and priorities to reflect the changed level of abilities, e.g. accepting that the speech deficit is a long-term effect of the injury and adjusting self-expectations about speech abilities.
Assimilation
Assimilation involves modifying the environment or adjusting the expectations of other people, e.g. selecting supportive environments or tasks that match the person’s level of communication skills or educating other people to use alternative means of communicating with the injured person.
Decompensation
Decompensation is often more problematic than it is beneficial. It involves reducing the need to use a skill, e.g. avoiding or withdrawing from social interaction to reduce the need to communicate.
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 factors:
- Personal assets and limitations of the person before the injury
- 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 situation 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.
Self-awareness
The ability to recognise personal strengths and limitations is particularly important during rehabilitation when the person has the most opportunity for specialised support. There are three different levels of self-awareness. Intellectual awareness is the ability to understand that a particular skill or ability has changed following the injury. Emergent awareness is the ability to recognise and understand when a problem is actually occurring such as noticing that concentration is poor when reading a book. Anticipatory awareness is the ability to anticipate that a problem is likely to occur in future situations such as knowing a shopping list will be needed at the supermarket.
Research suggests that the development of intellectual awareness can take up to twelve months following the injury although some people will not develop a full awareness of their problems due to neurological or psychological reasons. However, specialised rehabilitation programmes can assist the development of self-awareness at each level.
A SUMMARY OF LONG-TERM EFFECTS
People with an acquired brain injury and their families often observe the following long-term effects:
- Poor attention and concentration
- Memory problems
- Low motivation and poor initiation
- Difficulty carrying out plans
- Reduced ability to behave appropriately in social situations
- Rapid changes in mood and difficulty controlling anger
- Decreased ability to cope with stress and multiple demands
- Depression and anxiety
- Reduced number and quality of relationships
- Social withdrawal and loneliness.
The long-term implications of acquired brain injury are difficult to determine during the early stages of recovery as they may be disguised by the impact of grief and loss.
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Recovery from acquired brain injury 
