‘From Surviving to Thriving with Acquired Brain Injury’ was the theme of UKABIF’s Annual Conference, held at the Royal Society of Medicine in London last week.
Advances in the treatment of brain injury over the past decade have resulted in increased survival, but there are long-term consequences for survivors. Speakers at this year’s Conference looked the rehabilitation challenges following the re-organisation of trauma care, the status of predicting outcomes, and discussed new approaches to rehabilitation management.
Professor Michael Barnes, UKABIF Chair, welcomed 250 delegates from all fields of brain injury including the interdisciplinary rehabilitation team, commissioners, case managers, personal injury lawyers, social care workers, voluntary organisations, care providers and also individuals and their families living with a brain injury.
UKABIF would like to thank delegates, the sponsors – Christchurch Group, Irwin Mitchell, Leigh Day and The Royal Buckinghamshire Hospital, as well as all the exhibitors for all their support.
Trauma initiative and the implications for rehabilitation
Dr Andy Eynon is the Director of Major Trauma at the University Hospital, Southampton NHS Foundation Trust. He provided an update of the review and reorganisation of emergency medicine which has resulted in the establishment of 26 Major Trauma Centres (MTCs) in England providing specialised trauma care and rehabilitation; they function 24/7 and work closely with local trauma units.
Dr Eynon said: “The chances of surviving trauma have improved by 60% in three years – it’s definitely been a success”.
Many patients will also need a personalised rehabilitation programme involving an interdisciplinary team to help them return to an independent life. However, in the re-organisation of trauma care rehabilitation services have not faired very well. These services lack coordination, bed blockage continues to be an issue, and the demand and timeliness for rehabilitation is an increasing problem.
Dr Eynon said: “We need rehabilitation consultants involved at the MTC. Rehabilitation needs to be integrated into the acute aspects of trauma care otherwise decisions are left to consultants who don’t know anything about rehabilitation. Rehabilitation prescriptions are a necessity and increasingly rehabilitation will take place in people’s homes, so a working relationship is required between the NHS, third sector and the private sector to ensure a seamless and holistic service is provided.”
Predicting outcomes for people with Traumatic Brain Injury
Professor David Menon is Head of the Department of Anaesthesia and Principal Investigator at the Wolfson Brain Imaging Centre. He is also Co-Chair of the Acute Brain Injury Programme at the University of Cambridge.
“Neurotrauma is a major cause of neurodisability globally but the prognostic indicators for rehabilitation are not well-defined” said David Menon, “Prognosis in Traumatic Brain Injury is difficult but important, because it guides appropriate treatment, tries to limit the proportion of patients left in a persistent vegetative state, helps the family come to terms with their loved one’s condition and assists with future planning. Clinical and physiological variables, radiological predictors and biological markers all exist but are more useful for prediction at the population level than for guiding decisions concerning individual patients.”
Professor Menon discussed some of the models available and the prognostic calculators, he concluded: “We’ve come a long way but much more work is required”.
A life-world approach to Rehabilitation
Dr Caroline Ellis-Hill is Senior Lecturer in Qualitative Research at Bournemouth University.
Edmund Husserl, the German philosopher, created a theory of knowledge called ‘phenomenology’. He defined the lifeworld as a place distinct from, and different to, the more systematic observation and considered reflection that characterises science. Dr Caroline Ellis-Hill discussed two examples of the lifeworld approach to rehabilitation, the HeART of stroke project and the humanisation care project.
The HeART of Stroke is a feasibility study of a randomised controlled trial of an Arts for Health (AfH) group intervention, to support self-confidence and psychological wellbeing following a stroke. Health services currently focus on the practical and visible aspects of life and ignoring the emotional challenges. Through the use of the imagination, AfH practices offer the opportunity for self-development. Within a group setting, a collective sense of identification and belonging facilitates the process of self-development and acceptance, and instils a sense of self-confidence.
The humanisation care project involved working with staff and patients in two hospitals with the aim of humanising stroke services by applying a deep philosophical theory to everyday practice. The project was very successful and resulted in humanising stroke champions on wards.
“The lifeworld approach is not an ‘instead of’, it’s an ‘as well as’ and it’s a very different logic to traditional rehabilitation” said Dr Ellis-Hill. “It’s early days, but we’re very enthusiastic about this developing approach”.
Peer mentoring in Traumatic Brain Injury
Professor Paula Kersten is Head of the School of Health Sciences and Professor of Rehabilitation at Brighton University
The aim of peer mentoring is to provide support by those who have successfully faced a similar experience, and can provide good counsel and empathetic understanding because of their comparable experience. A randomised controlled trial compared a novel peer mentoring approach in six people with moderate to severe TBI. Meeting and talking to mentors provided a sense of hope and built self-confidence, however, there were tensions for mentors in terms of the expectations of the role and they too needed a lot of support.
“Although it was a small study, peer mentoring undoubtedly had a positive impact” said Professor Kersten.
Bridges – a self-management programme for Brain Injury
Sam Shephard, a UKABIF Trustee, who lives with an ABI, talked about his relationship with rehabilitation. Engaging with the world post-injury proved to be an enormous challenge, but a necessary requirement to managing his rehabilitation long-term.
Self-management programmes are not new but they are rare in brain injury and stroke. The aim is to achieve small successes that influence an individual’s confidence in their recovery, to find a way of identifying what is meaningful and to provide ways of navigating the challenges.
Professor Fiona Jones, Reader in Rehabilitation, School of Rehabilitation Science, Faculty of Health, Social Care and Education , St George’s University, London, and Kingston University described ‘Bridges’ self-management programme which comprises a package of support to address self-management in people with complex conditions such as brain injury. Founded in 2013 Bridges is used by more than 120 healthcare teams and 1800 clinicians and support workers across acute and community settings.
Bridges trains teams of healthcare professionals and support workers to integrate key self-management support strategies and principles into their everyday practice and organisational context. Practitioners utilise key Bridges principles supported by co-produced self management tools given to patients and families.
Dr Petra Makela, Consultant Rehabilitation Medicine at Imperial College Healthcare NHS Trust discussed the successful implementation of Bridges at Kings College, London Major Trauma Centre (MTC). The plan is to disseminate Bridges across the other three MTCs in London and to introduce a short teaching/dissemination film to share the learning of whole of this project.
Mixed Diagnoses and Acquired Brain Injury
Jill Greenfield is a Partner at Field Fisher in London. She spoke about two of her clients; Phil aged 64 with dementia who subsequently had a head injury, and Nathan aged 18 who was thought to have ADHD. Both these individuals were ‘labelled’ incorrectly and following intervention by Jill and further clinical tests were found to require long-term rehabilitation.
“Every case is different but authorities don’t always look at the individual. Don’t take things at face value” she concluded.