Life-changing injuries
Rehabilitation after injury or acquired disability
After leaving hospital treatment for traumatic injury, people we interviewed typically went on to receive various kinds of rehabilitation (rehab) treatment, including physiotherapy, occupational therapy, speech and language therapy, neuropsychology, and counselling.
These rehabilitation therapies aimed to enable people to get back to living as independently as possible after traumatic injury by encouraging them to become experts in their own injury, helping them regain mobility (either by walking or using mobility aids), regain speech ability, take care of themselves, come to terms with their injuries, and deal with mental impairments such as memory problems.
Experiences with rehabilitation therapy for traumatic injury or disability
People sometimes felt they had to re-learn everything (see interview 23). They said it was 'like being reborn' or 'like going back to primary school'.
When people felt depressed and sorry for themselves, rehab sometimes gave them hope that they could get their lives back on track.
Initially, Bill felt 'buoyant', but worried about starting rehabilitation. Staff motivated him by introducing him to other people whose injuries were more extensive than his.
Initially, Bill felt 'buoyant', but worried about starting rehabilitation. Staff motivated him by introducing him to other people whose injuries were more extensive than his.
Bill: Yeah, I was, but I was also beginning to feel the disability. So the first mind game that they played on me was they sat me in a in with other amputees and the guy next to me wasn’t even English. I don’t know what nationality he was, but he couldn’t speak English and he’d flung himself in front of the train and he’d lost both his legs above the knee, very high above the knee. He’d lost an arm and he’d lost part of his – I’m not sure which hand it was, right or left hand – but he’d lost part of his hands, his fingers. And all he had left was a leg like this. I’m sure it was deliberate, because even though I was feeling buoyant, it was like trepidation to move forward. What am I going to do now? You know, but it had the beneficial effect of actually saying, well I’ve only lost, I’ve only lost my leg. This guy’s lost two legs. And an arm. And you think, how is he going to cope? And it’s like you know, thankful for small mercies, you know, I’ve only lost a leg. Bad enough isn’t it?
For the most part, rehabilitation took place in rehab centres, hospitals, or units. Sometimes people were admitted as inpatients, but others attended outpatient rehab or were treated in their own homes.
Family members were often involved in organising and finding the most appropriate rehabilitation therapies. Others took control of organising their own rehab and incorporated alternative therapies like electric acupuncture and reflexology into their therapy.
Marina phoned and visited the rehabilitation centre until she secured a place for her son to attend after his brain injury.
Marina phoned and visited the rehabilitation centre until she secured a place for her son to attend after his brain injury.
After her brain injury, Amy contacted brain injury experts and for advice. She tailored her rehab to suit her needs and now helps others to do the same.
After her brain injury, Amy contacted brain injury experts and for advice. She tailored her rehab to suit her needs and now helps others to do the same.
I emailed people because they told me that there was nothing that could be done. So I actually started emailing neuro-scientists, anyone that had something where it; it seemed they actually knew what they were doing and I found out what they were saying that worked and then what I did was I found programmes that seemed to be able to carry some of that out and I matched them to the areas of my brain that were injured because I figured that it would; it's almost like going to a gym in that if you've injured a shoulder then you might not necessarily be able to directly exercise that shoulder but you can exercise all the muscles and the ligaments and everything around that shoulder and strengthen it and protect it and then eventually get to the shoulder and make the difference. So I took all the areas like attention, processing speed, memory, executive function and I found out where I could work and kind of tailor made a plan for me and I do that a lot for people now. I do a lot of consulting in that field. And what people don't realise many times is they think that they can buy a computer programme off the shelf and if they're doing crossword puzzles or if they're doing something that says its brain training that it's going to make a difference and many times it's not. It really needs to be targeted to that person's specific deficits and those deficits need to be built for it to make like a long lasting difference because otherwise what we find is people get good at the games but they don't get any better at life which, you know isn't so helpful. Maybe they get a little bit of self-esteem but if, if those strategies are used correctly they can make, they can make massive gains.
Rehabilitation was made more difficult by fatigue and weakness that people experienced after injury, but they often felt determined to work hard on their recovery outside of their sessions with rehabilitation professionals.
People went to the gym, walked, and swam; exercise helped people gain strength after injury and increased their self-confidence.
Since Simon A was being financially supported by his employer he decided to treat rehab as his job.
Physiotherapists usually focused on helping people regain mobility and strength after injury through exercise and massage.
Simon B joked that at his rehabilitation hospital physiotherapists were nicknamed ‘physioterrorists because they always pushed you'.
Learning and re-learning with rehabilitation therapy
People who were able to walk again after their injury went to ‘walking school’ and re-learned by using parallel bars. Those who needed mobility aids (e.g., wheelchairs and prosthetic limbs) were taught how to use these effectively by rehabilitation staff.
Dave describes the first time he sat in a wheelchair after his spinal cord injury.
Dave describes the first time he sat in a wheelchair after his spinal cord injury.
Yes, I think I was probably in bed for eight weeks before I sat in a wheelchair for the first time. Getting up for the first time, you’re warned that it will be very difficult and you’ll feel nauseous and you might well pass out. You are prepared for going into a wheelchair by taking some ephedrine, which raises your blood pressure, keep your blood pressure up, because having been horizontal, to go vertical your blood pressure drops enormously. And I certainly remember taking that. I also had a binder round my stomach and abdomen to also try and keep my blood pressure up. And I think getting up for the first time I was able to do 15, 20 minutes, something like that, before you have to go back to bed and, and lie down. And you feel exhausted after that. And then obviously, you know, it was extended over the course of time and, you know, after a few weeks you’re up to a couple of hours. And then at, at a certain point you sort of reach the, the situation where you can be up all day. And then, you know, in conjunction with that was various physiotherapy sessions that you attend, occupational therapy
Occupational therapists helped people learn or re-learn skills that would help them live independently, such as cooking, cleaning, shopping, and using public transport. They also made sure people had the aids and equipment they needed and that their homes were appropriate for their new needs (see ‘Mobility aids for physical disability’ and ‘Making homes accessible for acquired disability’).
Going out in public was difficult for some people who feared they could be injured again (see 'Being in public').
In occupational therapy, Adrian learned how to cook, which was something he didn't do before his injury.
In occupational therapy, Adrian learned how to cook, which was something he didn't do before his injury.
I’ve had psychologists and therapists going through to help me recover again walking again, talking again, having a lifestyle again, cooking and cleaning. What made me laugh in rehab, we’d, I was actually under BIRT, Brain Injury Neurorehab Trust, [place]. They asked me to schedule to cook and clean. I was in my Transitional Living Unit in [place], and we had a schedule for cooking and cleaning. I’m like hang on, I said, “Look you said to me, rehab is about relearning old skills that you had before. I never cooked or cleaned in my life.” They were like, “What?” I said, “Well I worked for [investment bank] the bank. I was doing long hours. I’d get in from work having got in from work say in the evening. My dinner was done for me by my girlfriend. We had a cleaner to clean the house because we were both working full time. So, I never cooked or cleaned in all my life, and you ask me to do it now.” And the answer to that was, “Tough, get on with it.” And that is fair, and that is fair, because that’s true, because I did need to get on with it and learn it for my own good. Not, not for their good, but for my good. So I know what they were going on about now, but I’d say, “Say you say me to relearn, this is new to me, I’ve done it before in my life.” I could it, but I never had to do it. Yeah.
Initially, Julie's son was 'mortified' by some of the things he had to do in rehab. At that stage he hadn't grasped the extent of his problems.
Initially, Julie's son was 'mortified' by some of the things he had to do in rehab. At that stage he hadn't grasped the extent of his problems.
People learned to talk again with the support of speech and language therapists.
Learning to talk again could take time and practice. One man (Interview 7) thought the way he spoke made him sound 'drunk and stupid'. Jamie said after his injury his voice sounded 'childish'.
In speech and language therapy, people were taught physical exercises to help strengthen their facial muscles. To help them pronounce words, they used tongue twisters such as 'Wee Willy wept wildly as his wicked uncle whipped him'.
They learned to breathe and to speak slowly and clearly with volume. Interview 7 had a palatal lift for several months to stop air escaping from his upper palate when he spoke.
The speech and language therapist gave Daniel exercises to strengthen his muscles, and learn to talk again.
The speech and language therapist gave Daniel exercises to strengthen his muscles, and learn to talk again.
Like again, like that, it was all to do with the muscles. That was all it was. Like obviously there was other stages I needed, like think about, like obviously like the facial like expressions and stuff like that. I had to, it was like the same as walking, I had to just train it all back again. Like, my, especially my lips and my mouth that was the hardest bit, than the walking again. It was more I can’t explain it, but it was so, I was trying so much, but it never clicked, if that makes sense, whereas the talking and the walking did. I just, that spurred me on so much, and then when I couldn’t talk and stuff like that I just, well I’m not going to be able to talk again well, as much as I did, but yeah. It all, it all came through, thanks to the obviously the speech therapist and stuff like that.
Neuropsychological rehabilitation and mental health after traumatic injury
After brain injury, people were assessed by neuropsychologists to understand the extent of their impairments. Memory problems were one of the most commonly discussed issues.
Psychologists helped people devise strategies to deal with the new challenges they faced, and some helped people return to work or find a new role.
Jane describes the tests psychologists did with her to find out how her injury had affected her.
Jane describes the tests psychologists did with her to find out how her injury had affected her.
People we interviewed who experienced mental health issues after injury were referred to psychiatrists or psychologists and/or were admitted to mental health units. They had cognitive behavioural therapy (CBT) to help them 'rewrite the soundtrack' in their head, as Jane put it, and to manage the thoughts they fixated on.
Part of one man’s therapy (Interview 23) involved gardening, which also gave him skills he could use to find employment.
Some, but not all of the people we spoke with were offered counselling to deal with the trauma of their injuries. Those who declined it said they preferred practical help.
Amy was offered psychological help but rejected it because she wanted to 'learn practical skills' to help 'fix' her brain.
Views of and approaches to rehabilitation therapy
It was important for people that the rehabilitation therapists they worked with had specialist knowledge of their type of injury, but therapists had not usually experienced a life-changing injury.
Through rehabilitation people got to meet others with similar injuries who sometimes became friends. People often felt 'lucky' because they realised there were others with more serious problems than them.
Some met ‘expert patients’ who had similar injuries and told them about struggles and pitfalls they may face and how to avoid them.
Meeting other people with spinal injury was encouraging for Simon B. They gave a personal insight into post-injury life that his able-bodied therapists could not.
Meeting other people with spinal injury was encouraging for Simon B. They gave a personal insight into post-injury life that his able-bodied therapists could not.
Those who were rehabilitated in hospital described both the physical environment and the culture as ‘disabled friendly’ (Nick Z), but going home was often quite a difficult experience, especially if people required more support and their homes had not been modified to suit their new needs.
Simon B said 'rehabilitation really starts when you are discharged'.
Hospital is an unrealistic environment and Dave said his rehab continued when he left it.
Hospital is an unrealistic environment and Dave said his rehab continued when he left it.
And the whole rehabilitation process is gearing you up to leave hospital and resume as normal and healthy life as, as you can outside hospital. And I would say that your rehabilitation continues really way beyond hospital, because hospital is quite an unrealistic environment. It’s, it’s a flat area with nurses and, you know, hospital equipment everywhere. And out into the real world is quite different. So I think, yes, your rehabilitation starts in hospital, but it, but it also carries on when you go home.
People said it was important to practice rehabilitation exercises in their own time in addition to their sessions because therapists could only help so much and the rest was up to them.
People were usually determined to do their best in rehabilitation and felt that the difficult time and the effort they put in during the initial stages after their injuries would pay off in the long-term.
People often lost their self-confidence after injury and said that undergoing rehab helped them regain it.
Rehabilitation is hard work, requires perseverance, and can be a frustrating time, but people were encouraged by the progress they made.
Rehabilitation provided many benefits for Simon A. Most importantly he felt he was contributing to his progress.
Rehabilitation provided many benefits for Simon A. Most importantly he felt he was contributing to his progress.
And also it gave me self-confidence which I’d lost completely. And it gave me a sense of, contributing towards my recovery and I was actually actively doing something to, or I could see, I could see each day that I was making progress. I was getting fitter. And it was helping me relax as well afterwards I would say.
At the time of their interviews, some were still in rehab and they hoped they would continue to improve.
People still faced challenges but continued to learn new ways of dealing with them, although they didn’t want to have to do rehab forever. They were grateful they were able to access rehab on the NHS, but worried about the lack of funding for rehabilitation units.
People were often supported in their rehabilitation by their family and friends, and paid carers sometimes took on a physiotherapy role to help people with their exercises.
See also ‘Making homes accessible for aquired disability’, ‘Mobility aids for physical disability’, ‘Challenges and strategies after injury or aquired disability’
Last reviewed: August 2025.
Last updated: October 2015.
Copyright © 2024 University of Oxford. All rights reserved.