Rééducation et Réadaptation

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Brain injury is a life-altering event

Brain injury is a life-altering event which affects every area of a person’s life — including his or her relationship with family members and others close to him or her. The effects of brain injury often change roles and responsibilities within the family. Family members and others close to a person with brain injury may struggle to cope with behavioral changes caused by the brain injury. The injured person also may struggle to adjust. Family members and others close to the person may feel stressed, burdened, even depressed by the major changes in activities, responsibilities, daily schedules, leisure and support that are required to adjust to the consequences of acquired brain injury.

Often, major adjustments are best made in small steps. Simple changes may help the person with brain injury, family and friends to find more enjoyment in their relationships and activities.  By taking each stressful situation one step at a time, the person with brain injury and family may feel that life is becoming a little more “normal” again.

This part of our website contains information on the recovery process and common thinking changes, perceptual, behavioural, emotional and communication changes as well as physical changes that can occur after a brain injury.  It also outlines examples of stressful behaviors and situations that people with brain injury may experience. Possible solutions follow each example.  A solution that works well for one person may not work for another. For this reason, the best way to use this information is to try one solution for two or three weeks. If that solution does not work, try another.

Sometimes, the ideas on this website stimulate families to develop unique solutions to challenges. If, after trying several solutions to a problem, nothing seems to work, seeking advice from a professional may help. A brain injury psychologist (neuropsychologist), clinical social worker or other behavior specialist can help analyze and develop an approach that considers the special features of the patient’s situation.

Adjustments are best made in small steps. Recovery from brain injury is a process that takes time.


Prepare for a marathon, not for a sprint

Recovery following a brain injury may be measured in weeks, months or years, and slows with the passage of time.  Some of the effects of brain injury can be long-lasting and recovery may be incomplete.  Although some people with severe brain injuries experience only mild long-term difficulties, others may require care or special services for the rest of their lives.

In the days and weeks immediately following brain injury, the function of surviving brain tissue is often affected by swelling, bleeding and/or  changes in the brain’s complex chemistry.  Sometimes blood accumulation must be removed surgically to reduce swelling and pressure within the brain. Controlling swelling and allowing time for the brain’s blood flow and chemical systems to recover usually lead to improved function.

Exactly what happens in the brain during the later stages of recovery is not clear, but some parts in the process are becoming clearer.  New research is shedding light on brain tissue and its capacity to repair itself. Many things can occur that help restore surviving brain tissue to maximize function.  For example, although the total number of brain cells may not change, it is thought that surviving brain tissue has the capacity gradually to learn how to perform some functions of destroyed cells.

In cases of traumatic brain injury, trauma often occurs to other parts of the body, with associated bleeding, swelling and changes in function.  The effects of these other injuries can prolong overall recovery and maybe even further damage the brain.  For instance, excessive bleeding may deprive the brain of needed blood and oxygen.  Prompt treatment of associated injuries may help limit brain damage.

The medical community is gradually realizing how a damaged brain recovers. Current treatment methods are based on a growing understanding of the brain’s recovery processes.

Recovery from a brain injury is a process that takes time. Various treatment options and coping strategies can help life gradually feel “normal” again.


Stages of recovery

Researchers do not understand exactly what happens to the brain during recovery.   Factors such as age and the severity and location of a brain injury can affect, but do not entirely predict, the outcome of recovery.  For example, some people with significant brain injuries experience only mild long-term difficulties, while others need lifelong, special care.

In the first few weeks after a brain injury, swelling, bleeding or changes in brain chemistry often affect the function of healthy brain tissue.  The injured person’s eyes may remain closed, and the person may not show signs of awareness.

As swelling decreases and blood flow and brain chemistry improve, brain function usually improves.  With time, the person’s eyes may open, sleep-wake cycles may begin, and the injured person may follow commands, respond to family members, and speak.

A period of confusion and disorientation often follows, during which the person’s ability to pay attention and learn stops and agitation, nervousness, restlessness or frustration may appear.  Sleeping patterns may be disrupted. Overreaction to stimulation and physically aggression may result.  This stage can be disturbing for family because the person behaves so uncharacteristically.

Inconsistent behaviour also is common.  Some days are better than others. For example, a person may begin to follow a command (lift your leg, squeeze my finger) and then not demonstrate this behaviour again for a time.  This stage of recovery may last days or even weeks for some.  However, once demonstrated, a behaviour usually appears again.  In this stage of recovery, try not to become anxious about inconsistent signs of progress. Ups and downs are normal.

Later stages of recovery can bring increased brain function.  The person’s ability to respond may improve gradually.  New research is investigating the body’s ability to replace damaged brain tissue.  Other parts of the brain, however, may slowly learn to assume functions of the damaged tissue.

Most adults with a brain injury progress through common recovery stages, the length and outcome of each stage cannot be predicted. During recovery, a person may shift back and forth between stages. Inconsistency is common.



Treatment of Brain Injury

A broad range of therapy, testing and other treatment options are available to help people after a brain injury. Treatment for brain injury is tailored to meet individual needs. Depending on the nature of the brain injury, some people need only regular follow-up appointments with a health care provider.  Others receive therapy, tests and monitoring on an outpatient basis.  Still others begin treatment in an intensive care unit (ICU) or a general hospital unit, and may be transferred later to a rehabilitation unit.  After they leave the hospital, therapy as an outpatient may continue.

During the early weeks after injury, treatment focuses on stabilizing the person’s  physical condition, preventing complications such as pneumonia and blood clots, and addressing medical issues that arise (for example, removing blood or other fluid build-up to reduce swelling and pressure in the brain).

When the health care team determines that the person with brain injury is ready, the rehabilitation process can begin.  Rehabilitation encourages the body’s natural healing process through:

  • Stimulating and enhancing physical and thinking abilities.
  • Teaching new techniques to compensate for lost physical, thinking (cognitive) and behavioural skills.

Early on, therapy strives to keep the person safe and increase awareness of his or her surroundings.  For example, the health care team may need to help the person relearn date, time and location and understand what happened with the injury.

As cognitive and physical abilities progress, the focus shifts to improving attention span and mobility, coping with memory and thinking problems and increasing independence in self-care skills.  The person may participate in stretching, strengthening, balance and range of motion exercises.  Community outings to practice skills learned in the hospital may be included.

How much and what rehabilitation therapy the person with brain injury will need and be able to receive depends on factors such as level of awareness, other injuries such as fractures, the need for rest, and the ability to participate in therapy.