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.