In the early stages of recovery following brain injury it is important to provide support and reassurance to the patient and their relatives, however, one should be careful to avoid the temptation to over-estimate the potential capacity for recovery or the likely duration of rehabilitation. It is advisable to refer to local rehabilitation experts instead who can advise about prognosis, treatment and management.
Providing statements that are intended to reduce anxiety or providing reassurance that the rehabilitation service will resolve all issues potentially will lead to unrealistic expectations which cannot be met. This may lead to frustration and potential for disillusionment when the unit does not live up to the expectation set. Alternatively, explain how rehabilitation will try to develop a way of getting the best possible outcome based on the patient’s impairments.
It is important to avoid giving any definitive view regarding a timescale for recovery. Statements to the effect that ‘patients continue to recover up to a year or two after injury’ can be misinterpreted as stating that inpatient rehabilitation needs to continue for that length of time (if goals are not achieved sooner) leading to difficulties in acceptance of the need for discharge planning. Alternatively explain that recovery can continue for several months or possibly years after injury, even following the period of in-patient rehabilitation.
In the absence of certainty, it is not unreasonable to defer an opinion on prognosis by explaining that a clearer prognosis will feasible at a later stage. When the patient has been medically stable for a period of weeks/months, ongoing assessment will yield information which will be helpful in providing a potentially more accurate prognosis.
