When a patient comes to Moody, often they ask our doctor or therapists a question such as “How long until I am able to walk on my own?” or “How much time until my memory will come back?” This focus on time is understandable. The healing process for a severe acquired brain injury can be quite long and patient’s want to know how much more time they will be on the road to recovery. However, this focus on time is not generally the best way of thinking about brain injury recovery.
Each patient is on their own recovery journey. Every person’s brain injury experience is a bit different so it is impossible to make guarantees on timelines for recovery. One person may return to walking normally in 6 months, another in a year and another may require help for the rest of their life. However, each therapist can outline the steps that a patient must achieve to reach the longer term goal. Aiming to reach each step on the pathway to the goal is much more useful and functional than trying to predict a time frame for the goal.
Every meaningful goal is accomplished one step at a time. For example, a patient may want to go from not eating at all by mouth to eating a regular diet. To reach the goal, there may be many steps that will need to be met. These steps may include being able to do a certain number of swallows on command, being able to do a certain number of throat muscle strengthening exercises and practicing swallowing small amounts of food without coughing. These and more steps will continue to add up to reach the goal of eating a regular diet. How long this will take will often be unclear and it is not particularly useful to focus on the time aspect. The most successful and functional way of approaching the goal is to understand the steps that need to be reached and to focus efforts on the steps that the patient is currently working on in therapy.
There are other dangers when focusing on time rather than steps. On rare occasions, a patient mistakes the idea of how much time it may take to get better for a guarantee that they will get better by that time frame. For example, a number of years ago, a patient with severe loss of movement in her left arm came to our facility 6 months post-injury but she was unwilling to work on improving her arm movement in her occupational therapy sessions. Upon questioning, it was learned that a doctor very early on in her brain injury recovery said that her arm should come back in 9 months. She took this as a guarantee that her arm would be back in 9 months, no matter whether she put in any effort or did not. This patient did not see a value in putting in effort in sessions. She thought that 9 months later, her arm would automatically start working normally. Of course, this is not how recovery works and it took considerable effort from staff and her family to help her understand the importance of working on her arm. Additionally, if a patient has in mind that a goal should be reached in a certain time period but their recovery toward that goal is taking longer, they tend to feel stressed and depressed about the goal. For instance, if a person believes that they should be able to dress themselves independently in 3 months, if they do not achieve that goal in 3 months they tend to get upset. They may focus their stress and anger on themselves, leading to depression. In reality, that person may have taken many steps forward in the process and is doing quite well but just needs a few more steps to reach the goal.
By knowing the steps to recovery a patient has a blueprint toward success. Step by step, achievement by achievement, patient can reach amazing, meaningful goals!