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Once the medical team is satisfied that the person’s measurements are stable, they will be allowed to start breathing for themselves and then
slowly come to rely less on the ventilator. This process may take several days. The doctors in the intensive care unit will eventually remove the tube from the lungs, and the person should then soon be in a position to leave the intensive care unit and go to the neurosurgical ward. They may stay in the neurosurgical ward for some time, or they may be transferred back to their local hospital or to a rehabilitation centre once their condition is stable. This will make it easier for family and friends to visit, which is an important part of the rehabilitation process after a severe head injury.

How long will they take to recover?
This is impossible to predict and it depends on the severity of the injury. The neurosurgeon should be able to give you an idea of timescale, but everyone is different, so it is impossible to be exact. As a general rule, recovery after a severe head injury takes many months and the degree of recovery will ultimately depend on the injury itself. Some degree of recovery may continue for several years, especially in younger patients.

What will they be like during recovery?
Again it is difficult to predict, but often recovery from a severe head injury follows a similar pattern to the development of a child. Initially the person is uncommunicative, acts inappropriately and behaves in a baby-like manner. Thereafter there may be temper tantrums, swearing or shouting and child-like behaviour. Eventually the behavioural patterns may become more normal, although there may initially be some degree of loss of self-control. Progress during the recovery phase is seldom smooth. It may become slow or even stop completely at any stage - a feature that is again very difficult to predict and which is a cause of great concern for family and friends.

Can anything be done to help recovery?
If the brain can recover it will. Measures aimed at improving recovery generally speed it up, but do not necessarily affect the final outcome. People are generally best looked after at home, when circumstances allow, as this brings them back to reality and surrounds them with familiar objects and voices. However, looking after someone in this condition is no easy task and assistance from the GP, social services and community nursing may be essential.

Specific problems may be improved by therapy, such as speech therapy where there are problems with impaired speech, and these may be performed either at home or at a clinic, health centre or hospital. Physical problems, such as weakness, stiffness or poor co-ordination may be considerably helped by regular physiotherapy. This is initially done at the hospital, but can then be continued at home by the family to maintain a set level of exercise. Some people may need to be looked after in a specialist rehabilitation unit, and a few will require institutional care indefinitely.

What is the risk of having fits after a head injury?
The terms “fit”, “seizure” and “convulsion” mean the same thing. Epilepsy is when a person continues to have seizures (i.e., has more than one). The risk of developing epilepsy following a head injury depends on several factors, such as the severity of the head injury, whether the skull is fractured (in particular if the fracture causes a tear in the covering of the brain) and whether there is any bruising to the brain (a brain contusion).

Sometimes a person may have a fit soon after suffering a head injury and this puts them at greater risk of developing epilepsy. If the doctor feels there is a high risk of a person developing epilepsy he or she may prescribe drugs (anticonvulsants) to try to prevent this from happening. These drugs should not be stopped unless advised to do so by your doctor and they must not be stopped suddenly but gradually over a period of time.

What are the restrictions on driving after a head injury?
In many cases people are able to return to driving as soon as they have made a full recovery. However, if there has been a severe head injury, if a person has had surgery or if they have had one or more fits, it is essential that they contact the medical officer at the DVLA (see the address at the back of this booklet), who will tell them when they can drive again. If a person has a fit they will have to remain free of further fits for at least a year before they can drive again, and after an operation on the brain they will usually be banned for a minimum of six months.

The restrictions on PSV and HGV drivers are much more rigorous. If in any doubt, consult your doctor before driving. This is very important as you have a legal requirement to inform the DVLA of any medical condition that may interfere with your ability to drive. Failure to do so carries a maximum penalty of £1,000 and will invalidate your insurance.

Sport
After a head injury causing significant concussion, a skull fracture or after surgery to the head, contact sports (rugby, football, boxing, etc.) should be avoided for a period of time. Your doctor will advise you when it is safe to resume these activities.