After a family learns and then accepts that the hemipsherectomy surgery is the only treatment to stop the intractable seizures plaguing their child, their focus is then shifted to what happens after the surgery. Following surgery, a hemi must relearn how to walk, make due in life as a one-handed individual, and cope with a severe vision cut. The physical rehabilitation after surgery is daunting, in many cases a multi-year project and, as a result, the physical aspect of the rehabilitation is the initial focus. What is typically left unsaid by the neurologists and the surgeons are the intellectual and cognitive struggles that lie ahead. As the years pass a certain level of physical recovery is achieved and the physical rehabilitation subsides. It is at this point, the cognitive and social issues associated with the surgery are then brought into sharper focus, especially as the child matures, enters high school, then young adulthood, and eventually faces the prospect of post secondary education. When considering the intellectual capabilities of a hemi, it can be quite challenging determining whether the individual is slow to learn or just missing the hard wiring of half the brain making it difficult to learn certain concepts.
The cognitive development of a hemi child similar to all children will involve the local school system which typically will not understand the issues facing a person that has had hemispheretomy surgery. In many cases parents will argue for physical and occupational services, but unfortunately will not focus on the curriculum and how it is taught. Standard teaching approaches in many cases do not work for the hemi as a combination of cues may be needed.
In the long term it is the cognitive ability of the individual that will most likely govern their ability to fit into life, hold down a job, exist independently and most likely find happiness. Complicating the issues after surgery is thee unpredictable nature of the outcome. For some diseases such as rasmussens the collective outcomes, in general, are better than other diseases, but that said there is no average outcome. Despite the fact one hemi student may be enrolled in college, another hemi may not make it despite countless hours of studying. In some ways, this is no different than whole brain individuals, but the unique challenge of raising the hemi child is to know how to do deal with the crucial difference of missing half the brain.