Rehabilitation Unit Liverpool Hospital
Rehabilitation Directorate (BIRD) NSW Agency for
Recognise the process of recovery
ii) Stages of recovery
iii) Brainstorm Q
from a traumatic brain injury usually occus in several stages.
Typically, at the point
of injury, one of the immediate effects is that a person exhibits
a depressed or altered state of
consciousness. This may include a period of coma (a loss of
consciousness). The length of unconsciousness can be measured on the
Glasgow Coma Scale.
However, not everyone
experiences a loss of consciousness (LOC) as the result of a TBI.
who are injured will be confused
(i.e. in PTA) but without ever losing consciousness. One example
of this is a football player, who is concussed as the result of
tackle. The person may not lose consciousness, but may be
confused and disoriented for a few minutes, not knowing that they are
on a football field (this would be classified as a mild TBI).
Post-traumatic amnesia (PTA)
As people emerge
from a coma, they go through a period of post-traumatic amnesia
(PTA), during which the person is not orientated to time, place,
person, and is unable to learn, and may display disinhibition, irritable
or agitated behaviour. This is in contrast to the many misleading
media portraits, in which a person emerges from a comatose state,
as if waking from sleep,
fully lucid and oriented.
The period of coma
and/or PTA, can range from a matter of minutes, through to days,
even months. The duration of PTA is
measured until continuous memory is restored. Duration of PTA, as a
measure of initial injury severity, is the best predictor of long
after a TBI.
PTA less than
one hour = a mild injury
PTA of 1 - 24 hours = a moderate injury
PTA of 1 - 7 days = a severe injury
PTA 1 - 4 weeks = a very severe injury
PTA more than 4 weeks = an extremely severe injury
Lucidity and recovery
As people emerge from coma
and PTA and become more lucid, they also make rapid recovery of functioning
more generally, including
physical recovery, language, and functional abilities.
rapid recovery is in the first 6–9 months post-injury, but
after two years most of the natural recovery has plateaued. After
this time, the person can still make improvement, but this will be
through a process of adjustment, making optimum use of intact
abilities or developing strategies to compensate for remaining
People who sustain
a TBI will also characteristically lose some memories of the events
the injury. Once again, this memory
loss may only last a few minutes, but in more severe cases,
they may lose their memories for events that happened hours,
days, weeks or even
months before the injury. The loss of memory for events occurring
prior to the injury is called retrograde amnesia.