Our brain’s great capacity for recovery
Neuropsychologist Dr Katherine Dawson writes about what she sees as the cornerstone of rehabilitation by supporting brain injury survivors and their families to establish hope and trust in a future when you don’t yet know what that future holds.
Our brain is made up of 86 billion neurons….
Whilst this may be an overwhelming number to make sense of, imagine a massive network of connecting roads – all transmitting and receiving information, enabling different parts of our brain to communicate with each other.
Injury disrupts some of these networks and dependent on the severity of the injury, small to large areas of the brain can be affected.
We know however, that with challenges and new activities, the brain can rewire and grow new connections and that is the basis of neuro rehab.
When is the right time for rehab?
In terms of providing education regarding injury and establishing good routines, I am a firm believer that something can always be done to promote recovery following injury, at whatever stage of an individual’s rehabilitation journey.
In terms of priority goals, establishing ‘brain healthy’ routines and habits is crucial and this can be done at any time. If we look at how the pandemic has made us all stop and think about our own health, the key is picking one area to work on (sleep, drinking enough water, physical exercise, diet) and gradually building up good routines. A weekly planner is a must and whilst to some this might feel like living a bit of an artificial life, it is the cornerstone of good neuro rehab as it supports us to learn by doing and can also compensate for memory difficulties.
It is also crucial individuals and families have a clear understanding of what has happened in their brains in terms of the injury as this leads to greater motivation to self-manage and increased feelings of control. It is also important to increase the family’s understanding of the nature of their loved one’s injury so they are able to anchor the problems they see onto ‘hidden’ changes in the brain.
One of the biggest challenges after injury is getting the right ‘dosage’ of activity and rest. People either try to do too much too soon (sometimes because they desperately wish life would return to normal), and this leads to exhaustion, irritability and more fatigue.
Alternatively, for many people, when their mood is low and they are struggling with fatigue, a normal response can be to stop doing enjoyable activities, which can lead to feeling less motivated and energised and then fatigue can worsen.
It is important to spend time talking to individuals and their families about the resource-demand model. Basically, after an injury, the demands an individual is under significantly outweigh their resources and we need to work together to balance out the scales. Use of the weekly planner is crucial, as well as thinking about what makes life meaningful for individuals and their families as these values and roles are essentially the glue that holds us together.
With this in mind, it is important to think about identity. Following brain injury, in addition to physical difficulties, individuals and their families often experience a strong sense of loss around their identity, and trauma and injury often result in an individual’s world shrinking. Introducing activities that are linked to meaningful roles is therefore really important. It might be work around wanting to feel more like a parent again, or returning to physical exercise or learning a new skill. In a day, we recommend doing something that gives you a sense of achievement (so make a to do list and tick off several small tasks), do something in which you connect to someone else and also complete an enjoyable activity. When people are feeling really low, just doing something for 5 minutes can be a good rule of thumb and then it is up to you whether you stop or keep going. In addition, playing to strengths, setting small goals in which you experience a sense of success and gradually building up activities is key.
I have just written a book with 4 clients and their families and several members of the rehab team about adjusting to brain injury. One of the messages is that brain injury changes people yet doesn’t change people and there is always something of the person shining through. Supporting individuals and their families to establish hope and trust in a future when you don’t yet know what that future holds, in my opinion, is the cornerstone of rehab.
A proportion of sales of Katherine's book 'Adjusting to Brain Injury: Reflections from Survivors, Family Members and Clinicians' are being donated to SameYou.