How Well Will My Survivor Recover?

One of the unsettling realities of brain injury is the uncertainty. No one knows how well your survivor will recover. The brain is a complex, wondrous organ that remains much of a mystery to doctors and scientists. Many variables — biological, chemical, physiological, genetic, psychological, cultural, social, academic, financial, familial, vocational, and community — impact how well someone recovers from a brain injury. This uncertainty places a heavy burden on physicians who face families desperate for a glimpse of the future.

Some doctors offer a pessimistic perspective. Their reasoning: the family should prepare for the worst and be pleased with anything that exceeds a catastrophic outcome. They also may fear a lawsuit if the patient fails to meet expectations. Plenty of survivors surpass these bleak prognoses, and their families are pleased. But this strategy can crush the hope a caregiver needs to inspire and encourage her survivor to achieve the best possible outcome.

For just this reason, other doctors offer a more optimistic picture. Their aim is to support the family through the trying months ahead. As one mother on the panel told me, “False hope is better than no hope.”

This strategy also has its downside. A second mother, after being assured her son would be able to return to college, was devastated when his persistent cognitive impairments burst her unrealistic view of his academic future.

I just as easily could have been distraught if I took to heart the well-intended comment by Dr. Thomas that Jessica may be able to resume her career.

A third group of doctors stick to the Litany of Uncertainty and refuse to offer any prognosis. This works for certain families. They prefer to live day to day, concentrating on the care and comfort of their survivor. One father told me, “In my case, ignorance was bliss. I didn’t want to know how bad it might be. Nor did I want to develop any false hopes.”

While some folks do okay not knowing, many of us can’t help but imagine the future. We yearn for something realistic — and a bit optimistic — to cling to. We research the possibilities and the probabilities, the worst case and the best case, expecting our survivor’s outcome to fall somewhere in between.

While it’s impossible to predict the future for any single patient, the science of brain injury has advanced so that doctors now can discuss probable outcomes with some confidence. Researchers have identified the factors that influence the success of a patient’s recovery. Reviewing these factors with your doctor can provide at least a hazy picture of the future.

Bearing in mind that every brain injury is unique and unpredictable, you may want to reflect on the following list.

Factors that Impact the Success of Recovery from a Brain Injury

• The nature, location, and gravity of the injury
• How soon the injury is diagnosed
• The quality and speed of acute care
• The depth and duration of the coma
• The length of post-traumatic amnesia
• How rapidly the patient proceeds through the stages of the Glasgow Coma Scale and the Rancho Los Amigos Scale of Cognitive Functioning
• The patient’s age
• How quickly the patient begins rehabilitation
• The quality and quantity of rehabilitative care
• The nature and extent of other injuries
• The quality and quantity of the involvement of family and friends
• The extent to which the patient and caregiver use easily available resources, such as support groups, educational materials, and community programs
• The patient’s pre-injury physical and mental health
• The degree of the patient’s education
• The individual’s history of alcohol and/or substance abuse
• The ability of the survivor and his/her caregiver to recognize and adapt to the reality that the individual will not return to his/her pre-injury condition
• The spiritual comfort of the survivor and his/her caregiver
• The individual’s personality, including his/her:
  • Ability to cope with adversity
  • Self-control and patience
  • Flexibility
  • Determination
  • Intelligence and intellectual curiosity
  • Motivation to succeed
  • Engagement in life

The maxim “Use it or lose it” applies well to brain injury. A survivor who has lived an active, challenging, and full pre-injury life has conditioned his/her brain to be well-prepared for the rigorous reworking necessary to recover well. A patient who perseveres in his/her rehabilitation, in the challenges of daily life, and in the pursuit of an active and productive lifestyle will give his/her brain the exercise it needs to heal.