Reader Question: My nephew suffered a traumatic brain injury recently and he was put in a medically induced coma for almost a week. He is alert now, but there are obvious signs of cognitive impairments, including memory loss and he is showing signs of depression. Is it possible that he will regain his full memory and overcome the other deficits that are noticeable?
Dr. Barry Jordan: Seeing a loved one sustain a traumatic brain injury and then watching him rehabilitate can be very difficult because so much is left unknown. Some of the biggest questions asked by family members during this time is exactly what you’re asking—how long will recovery take and how much function will come back?
Unfortunately, there is no set answer. No two people heal the same way and there are multiple factors that can affect the patient’s recuperation. The best people who can provide the most accurate estimates for recovery would be his medical team, but here are some thoughts to keep in mind.
Much of the recovery happens in the first six months, but again, the rate will vary between people. However, experts agree that you can expect to see continued improvement for up to one year and perhaps some more improvement thereafter, albeit at a slower pace. Cognitive impairments like memory loss as well as muscle weakness may not change much more after a year but the patient can continue to learn to compensate and increase functionality that way.
Other factors that can affect recovery include:
- Medical history, including previous brain injuries or neurological problems;
- Type and location of injury;
- Depth and duration of coma;
- Low blood pressure or oxygen levels after injury; and
- Findings from post-injury physical exams, brain scans and other tests.
The Rancho Los Amigos Levels of Cognitive Functioning (RLCF) is a widely-used scale for describing brain injury recovery and studies have shown that the speed that a person goes through the levels can help determine how much the patient can improve. Not all patients will pass through each level and some may stop at one and not move on to the level above. (See Fig. 1 for an abridged version of the RLCF scale. Click on image to view full size.)
Cooperation with the medical team as well as support from friends and family can also impact the extent and pace of recovery. One may even consider seeing a neuropsychologist to help with depression, which can sometimes affect those who have had a brain injury.
People can get better after a brain injury but how much and how soon they can recover is very difficult to predict. The family should continue to have open communication with the medical rehabilitation team throughout his treatment to discuss his progress, get a better understanding of his road to recovery and how you can help.
—Barry Jordan, M.D., MPH
Assistant Medical Director and
Director, Brain Injury Rehabilitation