Timescales for Rehabilitation after Brain Injury

20 May 2019

Following a brain injury it is very difficult to predict the length of time recovery can take and its outcome. Usually the rates of recovery are slow after the initial improvement.

With the initial six months following the injury there can be a vast improvement and further improvement up to two years but after the two year period then any further improvement tends to be very slow.

With a mild Traumatic Brain Injury (TBI) 15% of those have symptoms up to a year.

However 10% of mild TBIs will be permanent 66% moderate TBIs would be permanent. 100% of severe TBIs will be permanent.

In order to categorise the TBI the following can be an indication:

Mild – No loss of consciousness or brief loss of consciousness, confusion, disorientation, memory loss and headache.

Moderate – Loss of consciousness 20 minutes to 6 hours, lethargy, brain swelling/bleeding.

Severe – Loss of consciousness more than 6 hours.

Initially after an accident there will be acute stage in relation to a severe brain injury where the patient will be admitted to an intensive care unit until they stabilise. Once stabilised they can then be transferred to a sub acute unit in the hospital or be transferred to an independent rehabilitation hospital.

Every single brain is unique and the diagnosis and treatment will therefore be different in most cases. The individual rehabilitation programme devised will be based on the level of physical and mental capabilities. The programme will need to be modified and adapted with continual assessment during the period of rehabilitation and it is likely that a multidisciplinary team of different specialisms will be involved.These could include:

  1. Neurophysiotherapy – to rebuild and maintain physical strength, balance and coordination

  2. Occupational Therapy – to help patients perform activities of daily living such as dressin g, feeding, bathing, toileting and transferring themselves from one place to another. This may also require use of adapted equipment and technology aids.

  3. Speech & Language Therapy – to monitor the patients ability to safely swallow food and assist with communication and assist with communication and cognition.

  4. Neuropsychology/psychiatry – to help patients relearn cognitive functions and develop compensation skills to cope with memory, thinking and emotional needs and interaction with friends, family and members of the public.

  5. Vocational Therapy – to assist the patient in their return to work or to retrain to obtain employment.

  6. Housing – if necessary to ensure adaptations to patients house or assist a patient and/or family to move to a more appropriate accommodation.

Depending upon the type and location of the injury to the brain the person’s symptoms may include:

  • Loss of consciousness
  • Confusion and disorientation
  • Memory loss/amnesia
  • Fatigue
  • Headaches
  • Visual problems
  • Poor attention/concentration
  • Sleep disturbances
  • Dizziness/loss of balance
  • Irritability
  • Emotional disturbances
  • Depression
  • Seizures
  • Vomiting

Most patients are discharged from hospital once their situation has stabilised and they no longer require intensive care. Some patients will be ready to return home but others will need to transfer to long-term care or rehabilitation centres. A long-term acute care facility will usually be required for someone who requires a ventilator or frequent nursing care. Once they are weened off the ventilator they can be moved to a rehabilitation or skilled nursing facility.

A rehabilitation facility is appropriate for a patient who still requires help with basic daily activities and a physiotherapist and occupational therapist will then work with the patient to help them achieve their maximum potential for recovery.

Following is a list of some brain injury centres in the South of England:

    UK Brain Injury Rehabilitation

There are many Case Managers who support TBI patients in returning home to continue independent living who will organise various therapies to continue the rehabilitation process. BABICM (British Association of Brain Injury Case Managers) is the professional body for Case Managers working with individuals who have a brain injury and complex needs.

Case Management companies who have specialist brain injury case managers include, HCML, Bush & Co, Brownbill Associates Limited, Anglia Case Management, Rehabilitation Without Walls, Tania Brown (to name a few).

By Caroline Flashman, Partner, Personal Injury & Clinical Negligence

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For further advice on the above topics, please call us on 01483 464222 or alternatively email