Traumatic Brain Injury
What to expect
From the records arriving to the home programme starting — including the phase nobody warns families about.
Before you travel
Send the imaging, the acute hospital discharge summary, any record of how long the person was unconscious and how long post-traumatic amnesia lasted, and a description of current function. A rehabilitation physician replies within 48 hours with what is realistic, which programme and how long.
If the person is still in post-traumatic amnesia, that is not a reason to wait — but it does change what the first weeks are for, and the reply will say so.
Week one: measuring, not treating
Daily post-traumatic amnesia assessment where it is still present, cognitive screening, communication and swallowing assessment, and physical measures. Goals are set from those numbers at the end of the week.
This is the week families find least impressive and it is the week that makes the rest of the stay accountable.
The middle weeks, and the phase that frightens people
Full intensity, with fatigue managed rather than pushed through. If the person is still emerging from post-traumatic amnesia this is also when agitation is most likely: repetitive questions, restlessness, sometimes aggression directed at the people closest to them.
It is a stage. It is managed with a quiet room, a consistent routine and familiar faces. We tell you it may happen before it happens, because being warned changes how a family experiences it.
The last weeks: handover and honesty about the horizon
Companion training moves to unsupervised practice. Memory aids and the structure of the day are set up in a form that survives the flight home. Equipment is specified and, where possible, sourced before discharge.
You also get a realistic statement of the next twelve months. Recovery continues well past the end of the stay, and a plan for that period is part of what you are paying for.
Sources
- INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part I: Posttraumatic Amnesia — Journal of Head Trauma Rehabilitation (2023)
- Practice Guideline Update: Disorders of Consciousness — American Academy of Neurology (2018)
- The misdiagnosis of prolonged disorders of consciousness by clinical consensus compared with repeated Coma Recovery Scale–Revised assessment — BMC Neurology (2020)
- Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment — BMC Neurology (2009)
- Utility of post-traumatic amnesia in predicting 1-year productivity following traumatic brain injury: comparison of the Russell and Mississippi PTA classification intervals — Journal of Neurology, Neurosurgery & Psychiatry (2011)
- Patterns of Functional Change Five to Ten Years after Moderate-Severe Traumatic Brain Injury — Journal of Neurotrauma (2021)
- Natural history of recovery and long-term outcome in critically ill patients with brain injury. — Current Opinion in Critical Care (2025)
