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Why are survivors told that they’ll improve only for 6 months after their injury? I’ve also heard two years and one year.

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Answer transcribed from the Brightway Answers interview with recreation therapist Holly Auth:

I once heard a great therapist say, “If I had a crystal ball, I would pull it out and tell you exactly how long it would take for you to recover.”  Everyone's injury is so different - it really depends on the person, the severity of their injury, their support system, and their motivation. I personally don't like to give time frames because of this. When someone says, “if you're not better in six months then you know you're not going to get better”, I think that's unreasonable.  I think injury or no injury, everyone has the opportunity to get better. So I never give time frames.

Sometimes we see huge milestones like relearning how to walk, talk, dress themselves, eat on their own, etc, but as a therapist i think like any success is huge. The visual or physical things are easier to notice, whereas cognition, memory, planning and organizing, or paying bills - those things people don't typically notice as much.  But I find that organizing your cupboard, or getting your driver's license back - which can happen five, ten, or even more years down the road - is still fantastic progress. I see people making progress every day and a lot of times they don't see it themselves. But I see it and it's important to point that out, and to celebrate the little successes that you’ll have along the way.

Senior physical therapist

Answer transcribed from Brightway's interview with Dr. Cristen Gordon (pt.2):


I hear that a lot in all patients that I've treated with any form of brain injury, whether it was traumatic brain injury or stroke. That was a sort of an older way of thinking before research and evidence-based practice was as important as it is now. It was like you make the most gains during your first year and then after that, you're kind of stuck with whatever you got. Well, they've done so much research that shows that progress continues and into the decades 10 years or 20 years out, so the reason a lot of people are told that is again just the old way of thinking. It’s one of those things that sticks now. What's important to note is that the majority of the gains quickly will happen in the first year, so that means you'll see the most dramatic and drastic improvements. Then following that, gains continue to move slowly. 


Part of it is that the rate that our nerves heal themselves is very slow. It's something like an eighth of an inch per year last time I read about that in research. Then the other thing is the easier things come quickly. The big things are like standing up, that's a big action that our body has been used to doing for years and really, the majority of our life and can’t return too quickly. You think about something else like somebody returning to work and being able to type quickly, that's a very fine detailed activity that would take longer for your brain to figure out how to do. This all goes back to neuroplasticity, as we talked about last week, which is the brain's ability to recreate pathways that were damaged. The brain and the body are always trying to heal themselves but if there is nerve damage and brain tissue damage, that can't be repaired. That happens but neuroplasticity is where the brain can create new pathways around the damaged area and figure out new ways to get the signal from the brain to muscle in order to perform a function. 


I always tell people that with therapy, one of the most challenging parts can be patience and getting through the process. It's not always easy because you don't always see big gains right away, but again, the research shows. I encourage all of my patients that as you're going through therapy, you may not get a perfect 100 on your first round of therapy, and in fact, in a severe injury like a brain injury, oftentimes people will come to the therapy then leave therapy and then come back to therapy. It's really a process and some of those things just require repetition and diligence to make gains. Unfortunately, especially here in the states we are very governed by what our insurance companies tell us we can and can't do unless you just have unlimited pockets of money and they'll probably come a time where insurance says you have to stop coming to therapy. What you and your therapist should do is plan to discuss it. Oftentimes, we know upfront the limitations of insurance, so we may make a goal to work towards a specific task, and then when you can reach that task, we'll take a break from therapy. I will give you all sorts of exercises, homework, and things to work on. It's up to you to stay diligent and then when it's time to come back for therapy, we can pick up where we left off and take the next steps.