What is Getting Better? It depends on who you ask.
When someone is injured and arrives in the Emergency Department the physicians, nurses and staff are focused on saving the life of the individual and preventing further complications. Once stabilized, further acute hospitalization, acute rehabilitation or other follow up care may be needed, but to the Emergency Department physicians and staff, once the person has moved on, they are better.
Following the Emergency Department, if surgery is required, the surgeon’s focus is primarily on “fixing” what has been determined to be “broken" so that the individual can move forward and begin to heal. So, for example, if a neurosurgeon has removed a blood clot which was pressing on the brain, and the individual is “medically stable” following this procedure, then, in the eyes of the neurosurgeon, the individual has gotten better. And, so it goes for each level of hospitalization. However, getting better after a traumatic brain injury includes more than the acute needs of the injured person.
Rehabilitation from a brain injury can be a life-long process. Rehabilitation is a multi phased process and can occur in many environments and over the course of many years. Therapists define getting better as evaluating and defining goals by the setting the individual is in. Each therapy discipline has an area of focus related to evaluation and goals. However, getting better in rehabilitation is best demonstrated when people are able to take on more and more independence in less and less sheltered environments. For each individual this is vastly different. For those with severe behavioral issues that are prohibiting participation in traditional programming, improvements in coping, emotional control, behavioral stability and overall awareness, which allow a transfer to a less restrictive setting, like outpatient services, suggest to the behavioral therapist, that the individual has gotten better. But this may not be the whole story
An individual, who might have a vestibular disorder, may work with their therapists on establishing compensation strategies, relaxation techniques, schedule adaptations and environmental changes that will allow them to have a higher quality of life and participate more fully in activities that are personally rewarding. But again they may still not be the same person they were before the injury.
For some people, assistance is necessary to help them maintain a consistent and productive activity pattern. This might include some continued therapy, sheltered or volunteer work, competitive employment, day programming, as well as a leisure lifestyle that is meaningful to them. This is typically referred to as “supported living”. In other words, the person is “well enough” to have developed some of the above skills but they are not entirely independent. This is also a period in which an individual is beginning to develop or save their social network. Their family and friends are re-establishing relationships. Sometimes people are able to reestablish their independence entirely and sometimes supports are required for the long term.
Following a brain injury, recovery depends upon a number of things including, the severity of the injury, the length of time the individual was in a coma, the physical issues, how well attention and memory are working and how quickly they are responding to treatment. Of course, recovery is largely dependent upon what an individual is doing to “get better”. The earlier an individual is able to access rehabilitation and the type of rehabilitation that is available to them, makes a difference. Families can expect their loved one to get better than they are, but how much better is an entirely different matter. Recovery can happen and improvements can be made over long periods of time following a brain injury so “getting better” is not a single point. How soon and how much improvement can be greatly affected by the amount and type of rehabilitation and it is important to note that there is a limit to how much recovery can occur based upon the type of injury, the amount of damage and the type of treatment the individual receives.
What “getting better” means following a brain injury is a complicated question and has a different answer depending upon your relation to the situation.