Brain injury, whether from TBI or stroke, is a complex condition with a wide range of injury severity and and variable outcomes. So, when a patient or caregiver asks, “How long will recovery take?” the answer really depends on cause of the injury, location, severity and the general health of the patient. The one thing the answer will not be is “six months” or “one year” “and at that point that’s as good as it gets.” These answers are what many medical providers used to give in the past, but published research has since proven that brain injury and stroke survivors can push past a supposed “progress plateau” and improve with effective and continuous brain rehabilitation—even years after the initial event. This post addresses the myth of the brain injury plateau and provides tips for getting past it, because…you can!
Some years ago, it was believed that recovery peaked six months after brain injury. Due to cognitive bias (looking for evidence of what you believe even if it isn't true), this often lead to termination of therapy by providers when patients stop progressing at the first “plateau.”
But research has since shown that that first “plateau” is typically temporary. In fact, the true progression of recovery is characterized by fits and starts and bursts often interspersed with periods of seemingly little change, or even falling back. But with the right stimulation and therapy, recovery can keep moving forward. That’s why it's important to keep going, even when it feels like progress has stopped.
What Is a Plateau?
Right after the initial injury, recovery tends to happen a lot faster, and may not necessarily require as much effort. This is due to something called spontaneous recovery, where the brain is healing from the trauma of the injury, and as a result, physical, cognitive, and language difficulties may improve very quickly. This is especially true in the first days, weeks, and even months after brain injury.
What happens when the brain has done its initial healing? That’s when neuroplasticity comes in. We know that our brain has the capability of reconfiguring its network—in other words, our brains can learn to work around damaged areas and begin to compensate. Or as Daniel Laskowitz, well-known professor of neurology at Duke University explains it:
The central nervous system retains an innovative ability to recover and adapt secondary compensatory mechanisms to injury. The basis of recovery stems from neuroplasticity, defined as the ability for neurons in your brain to make adaptive changes on both a structural and functional level, resulting in recovery of functions thought to be lost.
So when frustration sets in when it seems like recovery had stalled, keep up the hope! It’s normal. And things will change.
How To Get Past the Plateau
Multiple published reports and studies now show that patients can regain cognitive function years after a stroke or brain injury—and what can help to keep recovery going is access to targeted, evidence-based therapy even after leaving traditional rehabilitation. For example, a study published in Frontiers in Human Neuroscience proved that patients using the Constant Therapy mobile app improved on cognitive and language tasks post-initial-therapy—and that even patients who were 15 years post-stroke still made improvements.
So keep going, even if it feels frustrating. If you need some help staying motivated, try these great tips:
Try Something New: Change up your routine, try a new therapy or pick a skill you'd like to learn and practice it.
Build In Rewards: Identify a fun activity that you can enjoy after finishing your practice—watch a TV show, take a walk, read a book or grab a cup of coffee, for example.
Join a Support Group—Either In Person Or Online: Support groups can provide motivation and camaraderie, and you’ll get extra therapy to boot.
Make Sure To Look At How Far You've Come: Talk about your goals and accomplishments. Review a chart of your skill progression if you have one. Ask loved ones to provide examples of daily activities you weren’t previously able to do on their own. Be kind to yourself! You’ve worked hard.
When you hit a plateau, don’t stay focused on it. Know that you will move past it, and instead keep focused on what will move you forward—staying healthy, staying motivated, and remaining involved in your recovery.
Des Roches, C. and Kiran, S. (2015). Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform, Frontiers in Human Neuroscience, 05 January 2015 | https://doi.org/10.3389/fnhum.2014.01015.
Frasca, D., and Tomaszczyk, (2013). Traumatic brain injury and post-acute decline: what role does environmental enrichment play? A scoping review, Frontiers in Human Neuroscience, published online 2013 Apr 17. doi: 10.3389/fnhum.2013.00031a
Center for Disease Control and Prevention (2017). Traumatic Brain Injury in the United States: Fact Sheet.
Laskowitz, D. and Grant, G. (2016). Translational Research in Traumatic Brain Injury. CRC Press/Taylor and Francis Group; 2016.
Teasell R. and Mehta S. (2012). Time to rethink long-term rehabilitation management of stroke patients, Top Stroke Rehabil,(6):457-62. doi: 10.1310/tsr1906-457.
Soros, P. and Teasell. R. (2017). Motor recovery beginning 23 years after ischemic stroke, Journal of Neurophysiology, 01 Aug 2017 https://doi.org/10.1152/jn.00868.2016
Moroz, A., (2017). Rehabilitation After a Brain Injury, Merck Manual, Alex Moroz, M.D., Associate Professor of Rehabilitation Medicine, Vice Chair of Education, and Residency Program Director, New York University School of Medicine.