Traumatic brain injury: a view from the inside

Information about the outcomes after traumatic brain injury comes from observational studies and, increasingly, subjective sources. Narrative analysis provides an avenue to explore life after the trauma, and a perspective that may illuminate critical aspects of the relationship between the health professional and health consumer. Language use by health professionals in their interactions with health consumers may profoundly bias expectations and outcomes. Terms such as 'recovery', for example, may be inappropriate, as severe traumatic brain injury may not be an injury that one is able to 'recover' from. If the brain is seen as the basis of the personality and is altered by the trauma, then, philosophically, it is difficult to argue that the person is the same as before. Concepts of rehabilitation after severe traumatic brain injury should, therefore, take into account the expectation of the health consumer in shaping the outcomes and the possibility that new and adaptive patterns of behaviour need to be developed rather than focusing on returning to the pre-injured person. This introduces the notion of rehabilitation as assisting the injured person to re-orientate or rebuild their life using a new set of 'maps' with which to navigate through life. The paradigm of 'new maps' is positive, challenging, and honest as far as expectations are concerned, and encompasses the idea of actively exploring new and unknown territory.