This is the most common question asked of head injury professionals. Unfortunately, the best answer to "How long it takes to get better?" is, "I don't know." In the first six months following a head injury, professionals tend to be poor at long range predictions. I put this chapter at the end of this book because it is the least useful bit of information. If you want to know why this is a problem or have symptoms that go beyond six months, read on.
Let's talk a little about why we can't predict results and some general statistics about recovering from a head injury. In the very early stages of a head injury, it is impossible to predict the long road ahead. Obvious physical injuries (ones that we can see) are an unreliable predictor of the future. For example, some people have "minor" medical problems and are discharged from a hospital within hours of the car accident. In the long run, however, they may never be the same. On the other hand, I've had people who were in a lengthy coma and had multiple physical injuries. These people not only got out of the coma, but are doing extremely well.
Let's look at it from a wider perspective. If we can't predict individuals, can we predict groups? I may not be able to predict the behavior of one person at a football game, but I can reliably predict the behavior of a large group of people (especially when someone scores a touchdown!).
Let's start looking at some of the things that make a head injury prediction complicated. First of all, a positive CT Scan or MRI (machines that take pictures of the brain) doesn't always predict how severe an injury is. (Remember, "positive" means they found something abnormal in the brain; Positive doesn't always mean "good".) CT's or MRI's are very good at picking up bleeding in the brain. There are people who have significant bleeding in the brain (requiring neurosurgery), yet have a very good recovery. At the same time, I have seen people with negative CT Scans and MRI's who are in a deep coma. This highlights the problem that medical tests are not always the best predictors of long-range outcome.
People bring different strengths and weaknesses to the recovery process. One way of looking at differences in people is to look at their ability to solve problems. Psychologists use IQ tests to measure this ability. A 100 score is an average score. What happens if I drop 15 IQ points following a head injury? If someone has a 130 IQ score (smarter than 99 out of 100 people), then drops to an IQ of 115 (smarter than 85 out of 100 people), that's still pretty good. But if I have a 100 IQ (smarter than 50 out of 100 people) and I drop the same 15 points, I'm now smarter than only 16 out of 100. In general, having a higher IQ tends to help. However, there is a common problem that I have found with people who have a high IQ who get a head injury. They realize they're "different" and often have a harder time dealing with it emotionally. They're used to thinking quickly, having answers come to them quickly, and doing things easily. This is true for anyone with a head injury, but can be a greater problem for very bright people.
Another positive factor is how people do in the school system. In general, good performance in the educational system is a good predictor. A college diploma is great. A high school diploma is also great, particularly if someone has done well. Now, here is a common problem. Many people were not motivated when they went to high school. They were lazy, found school boring, or they just never applied their skills. Some of these people did poorly in the education system, but became very successful later in life. In other words, they worked hard and were able to get ahead. Academic skills can be, but are not always, a predictor of recovery.
A lot of studies have found that use of drugs and alcohol is a negative predictor. If you've been abusing alcohol for many years (10 to 20 years), you have already killed off large numbers of brain cells. Alcohol is one of the most deadly drugs (yes--alcohol is a drug) that we have. Alcohol kills more than any other drug. Of the 50,000 traffic deaths per year in America, half are alcohol-related It is clearly important to stop using alcohol and drugs following the injury. Alcohol especially tends to attack areas of the brain dealing with short-term memory. Those who continue to use drugs following a head injury have a poor outcome.
HOW LONG DOES IT TAKE TO RECOVER?
Each doctor you talk to is likely to give a different estimate of how long it takes to recover. Some physicians may say that recovery from head injury is 6 to 9 months. This may stem from a "medical" point of view, as they commonly look at how long it takes to relearn to walk or use parts of the body. As a neuropsychologist, I look at complex thinking and very subtle changes in behavior. I use psychological tests that look for changes in thinking or memory. Research on these tests indicate that for two years following a head injury, there is evidence of improving scores. After this two year period in time, I can no longer see large changes in scores. Does that mean people stop getting better at two years? No. I have many patients in a long-term support group that I run who continue to report progress. However, these changes tend to be very subtle. For example, fatigue tends to be a long-term problem. From the second to the third year following the injury, they report that their fatigue has decreased.
Some people want to know, "How long will I be in treatment?" Once you leave the hospital, you may be lucky enough to be in a head injury program (I would estimate that only 25% of head-injured people have insurance coverage for this type of programming). Using the Neuro-Recovery head injury program as an estimator, the average individual will be in the program between 3 and 6 months (normal variation). Depending upon the services provided and the type of injury you have, the length of treatment will vary.
Does this mean you will be "all better" when you are discharged from a head injury program? Unfortunately, no. When people leave the Neuro-Recovery program, it is my expectation that they will continue to improve on their own. A lot of what a head injury program will do is improve what skills they can and teach you coping approaches for what can't be improved. This may include memory techniques and organizational strategies. Basically, no one ever really "graduates." They learn the tools to continue with their own recovery.
Is it better to get therapy early on? Yes. There were some studies that compared individuals who had a stroke and got treatment with individuals who didn't get treatment. Those who did not receive treatment did improve on their own. The brain will spontaneously heal on its own. But individuals who did get treatment healed faster and did better on tests. What if there is a delay in getting treatment? Sometimes is takes a while to get into a head injury program. I've had people enter a program after a year and still make large gains. On test scores, people have sometimes improved 5 or 6 years in terms of their academic abilities (e.g., reading abilities, comprehension abilities, etc.) in just a few months. However, not everyone makes this level of gain.
WILL I EVER BE "100 PERCENT" AGAIN?
Am I ever going to be "100 percent" following my head injury? In working with patients over a long periods of time, I find that they almost universally say "no". People will report being at 99% or 98 or 95% of their former abilities; I've never really met anybody who's claimed to have recovered 100 %. I've had people who've had significant head injuries, yet returned to work, regained a normal family life, and seemed to be doing great. They appeared to be doing well socially, got promotions, and made money. Yet they still say, "I just feel different." Often family members will argue, saying that the head-injured person is fine ("You just want sympathy"). It is very hard for family members to deal with this type of change.
Change is a hard part of life. But in reality, we are always changing. If you have your appendix out, the scar from surgery never completely goes away. It's going to be there forever. It's become part of you. As we get older, some of our skills diminish over time. We know that we're not as strong or as quick; our stamina is not as good as when we were younger. If you ask, "Am I 100% of what I was at 18?", no one is. The aging process is gradual and happens over time. We learn to accept this as part of life. The unfairness of the head injury is that change happens so suddenly.
HEY, THIS PREDICTION STUFF IS DEPRESSING!
For most people who hear this information, it can be very depressing. In the hospital, medical recovery seems so quick. You can have major heart surgery and be out of the hospital in a week. With some surgeries, you are in and out of the hospital in one day. If I have a broken leg, I'm going to be in a cast for a month or two. Why does this head injury take so long? The brain is the most complex machine in the world. Fixing it is not easy. That's the bad news. The good news is that people do get better. I think you have to keep in mind that, "With time, I will get better." You have to keep having faith. You have to keep working hard. Keep using the memory and organizational strategies. Head injury is like running a marathon. A marathon is 26 miles; you can't sprint 26 miles. You have to pace yourself for the long race and keep as positive an attitude as you can along the way.
By Dr. Glen Johnson, Clinical Neuropsychologist
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