Frequently asked questions about rehabilitation following brain injury include:

Will the brain recover?

Unlike other cells in the human body, brain cells do not regenerate when they are destroyed, however the brain does appear to recover quite spontaneously.  The pattern of recovery is usually one of rapid gains in the first six months, then a plateau, then further but less obvious gains in the following years.

Although it is believed that no more progress can be expected beyond two years, professionals currently working in the field of neuropsychological rehabilitation hotly dispute this assumption.  Certainly most of the progress appears to be made in the first two years but improvements can continue for very many years.  Families and individuals with direct experience of brain injury will confirm this.

It is not entirely understood how the brain recovers but research suggests that the brain, particularly the younger brain, is flexible (brain plasticity).  It does try to reorganise itself in an attempt to regain lost function.

We all have millions of ‘spare’ brain cells.  It is thought that the majority of recovery that is witnessed is due to functional areas of the brain taking over the activities of the damaged areas.  It does this by establishing new nerve pathways using these undamaged ‘spare’ cells.

These new pathways will only be established if the injured person repeatedly practices the skills/actions that have been disrupted.  Recovery depends on continuous targeted stimulation of the brain, whether this is sensory stimulation, exercising muscles and joints or re-training skills of everyday living.  In effect, recovery is a matter of learning and re-educating through a process of continuous rehabilitation.

Before moving on to discuss Rehabilitation, it is important to realise that no promises are made in relation to the amount of recovery that will be achieved.  Many families believe that rehabilitation is the ‘cure all’ but no matter how extensive it is, there will always be a limit to its effectiveness.  You will hear the phrase “every brain injury is different” – just as every person who suffers one is different.  The degree of recovery will be influenced by many factors including the nature and degree of the brain damage and the age and lifestyle of the injured person.  However, as you will discover in the following pages, amazing gains can be made even after the most severe brain injury.

Who is involved in the rehabilitation process?

Everyone is involved in the rehabilitation process (including, crucially, the injured person themselves).  All ‘concerned’ parties are involved in combining their efforts to help the injured person regain as much lost function as is possible, so enabling them to achieve their fullest potential and highest possible quality of life.

Some of the rehabilitation process will be structured and carried out by health and social care professionals but.... much of the rehabilitation takes place through family members and carers in the home and community extending beyond any formal rehabilitation programmes.

Research consistently shows the importance of the family in the rehabilitation process.  People who make the best recovery are those whose families actively work with the rehabilitation team and who continue learned processes at home.  This applies not only to the early stages of rehabilitation but also to vocational training programmes.  That is, those family members who actively support the endeavors of the rehabilitation programmes are more likely to realise sustained employment for their loved ones. 

Which professionals make up the rehabilitation team?

A number of clinicians make up the rehabilitation team (as well as doctors and nurses). Depending upon the nature of the injuries, the injured person may work with one, two or more of the team.  Family members and/or carers are considered to be a very important part of the team as they are the one's who know the injured person very well and can guide the team when looking at goals, motivators and life styles etc.  Family members and/or carers are also around when some team members are not and can consistently apply rehabilitation guidelines developed by the team.

Some of he members of the rehabilitation team are described in the Who's Who section

What factors influence a successful return to work?

A number of factors, including:-

Success in obtaining and/or sustaining employment depends on the person being able to do the job – that is they must have the cognitive and social skills that the job demands.  When considering a return to work it is very important to be realistic about this and to take advice from the rehabilitation team.  Unrealistic expectations due to reduced insight can present a formidable barrier to a successful return to work.

There is no doubt that from our own experience and from related research, the degree of self-awareness and adjustment to difficulties is a critical factor in recovery.  Those people who have reached a realistic acceptance of their difficulties will take on-board and practice compensatory strategies that will realise effective functioning.  They will open their minds to alternative suggestions for employment if a return to their pre-injury occupation is not feasible.  In short, a person must accept their new circumstances before they can learn to use alternative strategies and realise ‘ success’ again.

It is extremely important to learn social skills to initiate a good working relationship with work colleagues.  Research/evidence has consistently shown that poor interpersonal skills are the biggest barrier to a successful return to work.  Predictable but cognitive disability can lead to an inability to interact with work colleagues.

Characteristics in which this is displayed include impulsive behaviour, lowered tolerance, lack of insight and awareness, emotional liability, rigid and inflexible thinking.

Is it possible to go back to work too soon?

It is quite natural to want to go back to work as soon as possible.  However, people often make the mistake of thinking that because they are feeling physically able to return to work, they will be able to cope with the wider demands of the job.  Many jobs are lost because the person returns to work too soon.  Typically, they will overestimate their abilities and underestimate the effects of fatigue on performance.  Many expect to be able to work a full day straight away and finding out that this is not in fact possible for various reasons (already suggested in this Section) can be devastating to confidence and self-belief.  It is therefore an essential part of the work of any rehabilitation team to help the person identify the most suitable type of future job once all variants are taken into account.

How then can a return to work be ‘managed’?

A gradual return to work is important, as are easier working conditions and easier work tasks.  This will allow the person to build up their stamina and capabilities; a situation that may need to continue for quite an extended time.  Ideally, it should start with just a few hours per day, gradually building up time as stamina improves.  However, before a gradual return to work is considered, there should be evidence that the injured person can maintain concentration and have sufficient stamina to work safely and effectively for a specified period in the working day.

Easier working conditions may include a quieter working environment that is free from unnecessary distractions as filtering such distractions, is difficult for someone following a brain injury.  Consideration will also have to be shown for any physical difficulties; wheelchair access, adapted computers etc.  Such ‘special aids’ can be obtained from your Disability Employment Advisor (DEA) based at the local Job Centre, under the ‘Access to Work’ scheme.

Having someone to act in a mentoring capacity would be useful if such was required.  As an employer/line manager for example, you might not be able to find the time yourself to devote to special requirements.  Conscripting somebody to take-on this role might be dually beneficial.  None of us are the best judges of how we are ‘managing’ with new tasks in our work.  This is of particular relevance to somebody with brain injury, so the employer just has to use common sense in dealing with the situation.

 Remember JobCentre Plus can help with return to work

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