However, the brain has a unique capacity (not shared to the same extent by the other organs of the body, except perhaps the muscular system) to upgrade its level of function by practice. Doing this is how we all learn new information, skills, and social behaviour – not only while we are growing up (during which time natural ‘maturation’ of the nervous system is going on at the same time and helping us learn things with remarkable speed) – but also as adults when we learn to do a new job, or develop a new hobby or sporting skill. Such activities stimulates the formation of new connections in the brain, and can also re-establish some of the connections lost in an injury.

As we all know, learning is speeded up by wanting to learn, being in the right environment for learning, being healthy and well fed, having expert tuition, having a happy home life and practising regularly. These are the same basic principles that underlie rehabilitation after a brain injury. There are also risks, of course. Not all learning is beneficial. After brain injury, as in life, we need to avoid learning to walk clumsily, behave disfuctionally, or to lose our hope and expectations for the future.

The timescale over which a person can continue to improve their performance by learning new skills and getting physically fitter is much longer (by several years) than the period of natural recovery after an injury. But this element of recovery will only happen if the individual spends time and effort on the necessary practice. This is quite different from the body’s response to drugs, which occurs automatically without a person having to do much more than take the tablets regularly.  Rehabilitation is not a process ‘done to’ someone – it is a process achieved through ones own effort.

Once you have learned a skill, you need to keep using it regularly not to lose it again. From time to time a ‘refresher course’ may be needed to help you keep up to the mark. The same is often true after a severe brain injury.