創傷性腦損傷後的復原：第一年的情況可能如何

Traumatic brain injury recovery rarely follows a straight line. The first year often brings a mix of steady progress, setbacks and adjustments, for the injured person and for the people around them.

No two brain injuries are the same, so no guide can tell you exactly what will happen. What follows is a general picture of what the first year can involve, the changes to look out for, and where to find help along the way.

What is a traumatic brain injury?

A traumatic brain injury (TBI) is caused by a blow to the head, or by the head being forced to move rapidly forwards or backwards, as can happen in a car crash, fall, assault or sports accident. It is one type of acquired brain injury, which healthdirect defines as damage to the brain that occurs at any time after birth.

Brain injuries range from mild to severe. Synapse, Australia’s brain injury organisation, explains that doctors use the Glasgow Coma Scale, a score from 3 to 15, to rate severity soon after injury. Scores of 13 or more indicate a mild injury, 9 to 12 moderate, and 8 or below severe. How long a person is in post-traumatic amnesia is another important guide to severity.

This article focuses mainly on moderate and severe injuries. Many people with a mild injury (concussion) recover well within days to weeks, but anyone with ongoing symptoms should see their GP.

The early weeks: hospital and post-traumatic amnesia

After a moderate or severe injury, a person may spend time in intensive care, then on a hospital ward. Many go through a period of post-traumatic amnesia (PTA), a state of confusion where they cannot form new day-to-day memories. They may not know where they are, may repeat questions, and may be restless or agitated.

PTA can be distressing for families. It helps to know that it is a recognised stage of recovery. Hospital staff usually track it with daily questions. Keeping the environment calm, limiting visitors and gently reorienting the person can help.

Once out of PTA, many people move to an inpatient rehabilitation unit, where a team works on physical skills, communication, thinking and daily living tasks.

Months 1 to 3: coming home

Returning home is a big step. It is often when the effects of the injury become clearer, because daily life is more demanding than a hospital ward. healthdirect lists common effects of acquired brain injury, including:

• Thinking: problems with memory, concentration, planning, organisation and communication, and confusion
• Physical: tiredness, sleep changes, weakness, poor balance, headaches and seizures
• Emotions and behaviour: mood swings, irritability, feeling on edge and personality changes

Fatigue

Synapse describes fatigue after brain injury as common and highly disabling. The brain has to work harder to do things that used to be automatic, so tasks like a conversation in a noisy café or reading an email can be draining. Planning rest breaks, breaking tasks into smaller steps, and doing demanding things at the time of day when energy is highest can help.

Thinking changes in daily life

Changes in thinking often show up in ordinary moments. For example, a person might:

• lose track halfway through a task, such as making a cup of tea
• forget what was said in a conversation earlier that day
• find it hard to follow a group conversation or a TV plot
• take much longer to reply to messages or make decisions
• struggle to plan a shopping trip or keep track of appointments

Simple supports help a lot at this stage: one shared calendar, phone reminders, a whiteboard for the day’s plan, and keeping keys, wallet and phone in the same place.

Lack of awareness

Some people are not fully aware of the changes in themselves after a brain injury. This is caused by the injury, not by stubbornness. Gentle, specific feedback and a good rehabilitation team can help.

Months 3 to 12: rehabilitation and getting back to life

healthdirect notes that the biggest improvements happen in the first few months after an injury, but recovery can continue for years afterwards. In this stage, rehabilitation often shifts towards real-world goals, such as cooking a meal, catching public transport, managing money or returning to work.

Rehabilitation

Community rehabilitation may involve occupational therapists, physiotherapists, speech pathologists, psychologists, neuropsychologists and case managers. International guidelines for thinking problems after TBI, called INCOG 2.0, recommend first checking for factors that make attention worse, such as hearing, vision, fatigue, sleep, pain, anxiety, depression, substance use and medicines. They also support strategy training focused on everyday activities.

Work and study

Returning to work or study is an important goal for many people. A gradual, planned return usually works better than going back full time straight away. This might mean shorter hours, fewer tasks, written instructions, regular breaks and a quiet space to work.

Driving

Driving draws on attention, speed of thinking, vision and judgement. Under the national Assessing Fitness to Drive standards, a head injury affects licensing if it leads to ongoing impairment or seizures. The standards note that clinical, neuropsychological or practical driving assessments can help decide fitness to drive. Drivers have a legal obligation to tell their licensing authority when a condition is likely to affect driving.

Alcohol and other drugs

Alcohol and other drugs can affect thinking, balance, sleep and mood, and may interact with medicines. Synapse suggests limiting alcohol as part of managing fatigue after brain injury. Talk with your doctor about what is safe for you.

Emotional changes and mental health

Adjusting to life after a brain injury is hard. Low mood, anxiety, frustration and grief for the life you had before are common, for the injured person and their family. Some changes come directly from the injury to the brain, and some are a natural reaction to what has happened.

Psychological support can help with adjustment, mood and relationships. If you are in danger, call 000. For 24-hour crisis support, call Lifeline on 13 11 14.

Support for families and carers

Family members often take on new roles, from driving to appointments to managing finances. It is common to feel exhausted and unsure. Synapse and Brain Injury Australia provide information and support for people with brain injury and their families, and the healthdirect helpline (1800 022 222) can guide you to local services.

Invictus Health 能提供哪些協助

A neuropsychology assessment can describe changes in memory, attention, speed and planning, and guide rehabilitation, work and study plans. Where an injury involves a TAC, WorkCover or other claim, we provide 法醫鑑定. We also prepare NDIS 評估與報告, and offer counselling for people with brain injury and their families.

This article is general information only. Please speak with your treating team or another qualified professional about your own situation.