Recovering From Head Injuries: a Family Primer

When 20th century medicine matured sufficiently to allow people to survive serious brain injuries, it was thought that a sort of “spontaneous recovery” would happen naturally over a period of one to two years. If the family and the physicians could not rehabilitate the patient in that time frame, they often concluded there would be no further recovery.

It became evident over time, however, that the physical effects of the trauma – tissue and bone damage – were more readily addressed than the problems of impacted behavior and impaired cognition. Negative effects on memory, impulse control, value judgment and the appropriateness of social behavior frequently surfaced. The problem, then, was obviously multidimensional and required the application of multiple treatment modalities.

Many individuals who have sustained serious head injuries still retain the ability to change their behavior, learn (and re-learn) both factual knowledge and personality traits and once again lead productive, meaningful lives.

Family members of brain-injured patients need to educate themselves about head injuries, recovery methods and the ways in which treatment can be optimized. The following key points will help in this important task.

Different, not worse – Injuries that affect the brain will make the patient different, not necessarily “worse.” The first responsibility of rehabilitation planning is to assess the patient’s strengths and weaknesses. The CT scans, X-rays, neurological tests and other medical evaluations are, of course, a necessary step, but it is crucial to ascertain how the patient’s family deals with the behavioral problems.

Maintaining hope – Despite pessimistic prognoses that predict no recovery, the family should maintain hope, especially the sort that is based on new medical findings and leading edge research. Family, friends, nursing staff and physicians should all pay close attention to the patient’s personal interactions, as more data assessed in the treatment plan can mean better medical decisions.

Treating the whole person – Head injury patients often have trouble generalizing the lessons from one environment to another, so any speech or mobility therapy should take place in the variety of settings the patient would encounter in a “normal” life. Two days per week of speech therapy, done in an office setting, would have less remedial value that just a few hours done daily in various settings.

Control comes first – Brain-damaged people can exhibit a range of negative traits, from frustration and anger to depression and confusion. Although understandable, emotional reactions cannot be tolerated when they begin to lead to embarrassment and inhibit social “reconnection.” Before cognitive or even physical rehabilitation can succeed, the patient must re-learn self-control.

Harm reduction – Those who have suffered head injuries should avoid environments with high concentrations of paint and chemical fumes, as well as steer clear of alcohol, non-prescription drugs and other mind- and mood-altering substances. In addition, megavitamin therapy should not be attempted with brain injury patients, as a damaged brain may metabolize these compounds differently. Balanced diets are more than adequate for the delivery of the patient’s nutritional needs. Finally, all medications should be taken only as directed.

Clearly, recovering from a head injury is time consuming, expensive, physically tiring (on patients and family alike) and emotionally demanding. Some patients will improve just enough to decide that the work required for restoration of their pre-injury condition is no longer worth it.

However, temporarily halting the rehabilitation plan does not necessarily translate to “giving up,” nor does it have to lead to skills degradation. Remember, patient attitude is a key to an effective recovery, so be supportive, positive and compassionate at all times, in both medical and family settings.