- "Strength" vs. "deficit" approaches: Early rehab efforts must focus on a person's deficits and on how to remediate them. In fact, the list is often so long that it's difficult to prioritize and even decide where to start. Later, however, as a person begins to regain abilities, it can be very challenging from an emotional or psychological standpoint to continue to just think about deficits -- "What I CAN'T do." As soon as possible after the emergency or trauma phases have passed, it's time to begin shifting that focus to a person's strengths -- "What I CAN do."
For some, remaining in a "rehabilitation center" -- where programs are almost entirely deficit-based -- can become a very depressing and counter-productive situation. Switching to activities that build on a person's strengths can both be more productive AND provide someone with a much more positive view of life!
- Treating a patient vs. treating symptoms: The "medical model" is designed to have the best available experts treat the conditions or symptoms with which they are most familiar. Unfortunately, the fact that these symptoms or conditions belong to a patient -- a person -- can be overlooked. For a person with a TBI -- who already may have lost a grasp on "self" -- this can become just one more negative. On the other hand, involving the "whole person" can be a good step on the road to regaining an image of self-worth.
- Community re-entry vs. isolation: A rehabilitation center -- even one used on an outpatient basis -- is an artificial world. As soon as possible, work towards getting back into the community -- taking walks, shopping, returning to favorite activities. Many families have spoken of their loved ones "passing rehab" but "failing life". Obviously, there's merit in practicing in a safe environment -- but it can also be very uplifting to be back out in the "real world".
- Actual rehab "team" vs. lip-service: You may even find that your therapists or physicians speak of a "team" effort -- including family and loved ones -- but then act totally differently, as if you could not possibly be able to help your loved one get better. If that is occurring in your case, then RUN -- don't walk -- to the nearest exit. Seek new solutions, new alternatives, as soon as humanly possible!
- Slower progress or "plateaus": Let's face it, the rate of improvement from any approach can gradually decline, no matter how good it may have been at the start. Ultimately, certain skills or abilities may even "plateau" -- improvements may halt. Don't give up! Find a new alternative, a different way to succeed.
- "Spiral learning" curve: It is also important to remember that skill acquisition is not a linear process. There is a need for skills to be assimilated and used before moving forward. Educators call this a "spiral learning" curve. When a person is on the flat side of the spiral, it can appear as a "plateau". However, this is often simply the point in which the person is consolidating the new learning. After lots of practice in many different situations, then the person may be ready to move "upward" on the spiral again. We all must strive to keep learning fresh and new, not stop working on it!