TBI Myth #3: The Concept of Plateau

If only it were that simple

Here’s more discussion of The 10 Myths of Head-Injury

Closely related to Myth #2 – Recovery Occurs in a Year, this concept says that “recovery” starts after emergence from coma, continues at a gradual upward pace, then slows down, and levels off, so that no more improvement occurs. The visual analogy is a geographic one –a plateau. This myth leads families to despair when rate of change decreases and causes therapists to terminate services when clients stop progressing. There is a tendency to “write off” clients when a first “plateau” has been observed.

Nothing could be more true — that TBI recovery does NOT stick with a plateau paradigm. Actually, it would be more accurate to say that TBI recovery is like a whole landscape, filled with multiple plateaus, valleys, wash-outs, mountains, meadows, avalanches… you name it, if it’s in the natural world, there’s a TBI equivalent.

It is true that the most dramatic improvement does take place in the earliest stage and is followed by more gradual changes. However, the concept of plateau is dangerous for two reasons.

First, improvement following head injury is characterized by fits, starts, and bursts, often interspersed with periods of apparently little change, or even falling back. Head injured patients are notoriously inconsistent in their progress, at all stages. They may take one step forward, two back, do nothing for awhile, then unexpectedly make a series of gains. When one is preoccupied with watching for plateaus, it becomes easy to disengage from the client whose progress is sputtering.

This is important for everyone to keep in mind, even the folks who haven’t been in a coma. I think, especially for folks who haven’t had “severe” injuries (that were open-head injuries and/or caused them to lose consciousness for long periods of time). Even “mild” concussion (which is a really inaccurate description) can result in problems that stick around, despite your best efforts to deal with them. And you can be much better one day, then totally messed up the next. That’s one of the reasons that living with TBI survivors is such a challenge — we can be quite inconsistent, and we may look like we’re “all better” then BAM! we seem to be back where we started. That makes it really easy for the people around us to distance themselves and not want to bother with us. ‘Cause we don’t have that level of predictability and the consistency they expect, as much as we used to. And a lot of people can’t handle that.

Second, long “plateaus” can be interrupted years later by energizing environmental events. The appearance of a new, committed counselor, or the influx of social contacts that come from being “forced” to a support group, can uncover functional potential in head injured persons that has lain dormant for years.

This is where it becomes all the more important to keep engaged in life. Because you never know when you might find that next chance, that extra spark, that jump-start that gets you to a higher level. Even when things are looking really bad, it’s important to keep going. I went through a bunch of really tough circumstances around work, when I was first getting into addressing my TBI issues, and I can tell you, the people around me probably thought I was nuts, or a pretty hard-up case, bouncing from job to job. But I hung in there, and eventually I came out in a good position. That’s not the case anymore, unfortunately, but not because of anything I have done (which is a nice change), but at least I know that I have the ability to keep going and find better work as time goes on.

Of course, it’s rarely easy, and when it is, it tends to be a total surprise for me. And when I expect things to be easy, they turn out to have a whole bunch of very real issues I need to overcome. So, I have to back up and figure things out — yet again.

… Which is why it’s so important to stay flexible with regards to “the plateau thing” — maybe you’ll plateau, maybe you won’t. Maybe you’ll be at a certain level for a while, maybe you’ll “slide back” or “jump forward” without expecting it. And then a day later, you’ll find yourself back where you were, a week earlier. It’s all a bit of a roller coaster, at times, so it’s important to stay strong, stay flexible, and keep an open mind… at the same time that you’re being realistic about what your individual situation is about.

Getting hooked by the belief in a plateau is not only inaccurate, but also unproductive. It keeps you from focusing on what will move you forward — 100% involvement in your life, on ever level, and determined focus on your own well-being, no matter what the rest of the world has to say about it.

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8 thoughts on “TBI Myth #3: The Concept of Plateau

  1. I want to know something…. one minute I am making sense,well not 100%, i write comments on yahoo news, and I think that I am being smart and current… later When I wake up… all I do is sleep…. I can’t stay awake. I realize that I didn’t make sense like I thought I did.. it’s that plateaus?

  2. I think you’re thinking of something different. Plateaus are more long-term than your example. It’s like when people who have been recovering for a while improve to a certain point, and then they seem to “stop” improving. Like, if you have a brain injury, and after it you can’t remember anything, then you start to remember some things, then you remember more things… and eventually you can remember just about everything, except the time around the accident, and your short-term memory is not good. A plateau is when the progress you were making levels out and stops changing.

  3. I wonder if we are all talking about the same thing when saying “plateau”, even though what we refer to is what seems to be a stop in progress. We all have our own expectations of what we hope for in progress, and what the professionals treating us require. It once was that a “plateau” was reason for professional treatment to be terminated. I don’t know if that is still the case. When we feel stuck it could be the brain is doing its own thing internally to incorporate what we learned. I do remember more than a few times that I feared that I had gotten as far as I could. But in a short time, as if out of the blue, came a leap of improvement. I think it is important to try to separate out each deficit and make observations. I had delayed treatment for vestibular/visual deficits. My head movement and eye movement, which when normal are in sync, were no longer in sync. So I had motion sickness. When in treatment, I was given exercises to perform. I made progress with each of those exercises. I saw improvement in my ability to perform an exercise, then that improvement stopped, i.e. a “plateau”. Frustrated, I concentrated on another exercise. When I went back to the one I was stuck with a week or so later, it was easier, better, and seemed as if I had made a significant improvement that took me beyond that “plateau”. For me in some aspects of recovery more than others, a “plateau” was soon followed by another improvement. So many things can make progress slow including the fatigue. Treatment differences and whether or not we can apply ourselves consistently to some activity that fosters improvement in a particular deficit, make it hard to compare the progress of one person to another. With regard to attention, concentration, word finding problems that was a totally different experience,for me, more chaotic. There were times that I got worse but ultimately with effort got better. My progress continued over years, long past any prediction or expectation. I never stopped applying myself to some aspect I wanted to recover, to improve.
    Each individual’s injuries are so different. So many factors, restful sleep, the environment we are in, support or lack of it, stressors, the tasks we perform daily, treatment focus, and changes in these and more all have an impact on recovery. We are looking at such a complexity of symptoms and experiences, putting our best chosen words to label what we are each experiencing, or observing in another. Thank you for this blog posting Brilliant. Lynne

  4. Hi Brilliant! I included the URL to your blog entry in response to a parent with a question about plateaus. Then thought it might be worth posting my own experience on your blog. If you are willing, I would like ask if you would include the URL for stopconcussions.com Parent to Parent Forum on your blog in hope that more parents will go to the Forum and share ideas with each other. I am just the moderator. Thank you! Lynne
    http://www.stopconcussions.com/forum/?vasthtmlaction=viewtopic&t=17.0

  5. Hi BB, Thank you for this blog. We are all learning and are a vast network of information and experience. I am grateful to be able to be a part. Lynne

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