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Brain injury rehabilitation - the fight for consistency of care

March 27, 2015 at 2:15 PM

Any brain injury, even cases involving relatively minor brain damage, can have a profound and lasting effect on the life of the brain injured survivor and their family.

In addition, due to the range and complexity of brain injuries, rehabilitation following an injury can vary greatly from patient to patient.

Therefore, in this blog I wanted to share some of the scenarios I've encountered when helping those who have suffered a brain injury, and how a focus on getting the right support early can have a profound impact.

Image of brain and skull

Importance of early Rehabilitation

The Royal College of Physicians defines rehabilitation as:

'the use of all means to minimise the impact of disabling conditions and to assist disabled people to achieve their desired level of autonomy and participation in society'

It is widely thought that neurological recovery (recovering from damage to the body's nervous system) is optimal for the first 6-12 months following an injury to the brain. Although some improvement may still continue for a further 1-2 years; little further recovery is expected beyond this point.

In light of this it is therefore clear that early effective rehabilitation for those who have suffered a brain injury is crucial, and may significantly improve the longer term outcome for both the brain injured patient and their families.

The brain injured patient may be left with a range of complex psychological, physical, emotional and functional issues that impair their ability to live independently, to establish and maintain relationships, and to fully function within society.

It is possible they will experience anxiety, depression, anger and irritability, as well as problems with memory and concentration and difficulties with speech. They may struggle to plan and make decisions and to communicate with those around them.

Serious brain injury can result in loss of motor control, problems with mobility and strength, or even paralysis, and can have a devastating impact on the individual.

Different people will need different types of rehabilitation depending on the type and severity of their injury and the stage of their recovery. Any rehabilitation programme should be tailored specifically for the individual patient, taking into account both their previous lifestyle and their needs and aims, and should set realistic, practical and attainable goals for them to work towards.

A multi disciplinary approach to neurological rehabilitation is required with the input of clinical psychologists; occupational therapists; specialist neuro-physiotherapists and speech and language therapists all working together to achieve the best result for the brain injured survivor.

Wider effects on the Family

In my experience of working with clients who have sustained a brain injury, following the initial shock and distress experienced when a family member sustains a brain injury; the family then have to come to terms with the longer term effects of the injury and the impact it has on their lives and relationships.

James Cracknell stood next to a bike

Families have to face the prospect of living with and caring for someone who they may no longer recognise as their husband, wife or child and to cope with their own conflicting emotions.

The dynamics of the family relationship can be thrown into disarray; particularly where there are children in the family. Their parent may become more distant, angry and less intolerant as a result of the brain injury and it can be hard for a child to understand and to come to terms with changes in their personality and relationship.

Beverley Turner; wife of the Olympic rower James Cracknell (who sustained a serious brain injury in 2010 through a cycling accident), describes this difficult situation eloquently:

"It sounds silly, but it's the trivial practicalities that make you feel really alone. He couldn't support me. He was the one person I wanted to talk to about how messed up the situation was, but he was the one person I couldn't discuss it with"

It is paramount that the families of those with brain injuries as well as the brain injured patient are provided with the education, support and advice to enable them to adapt to and accept the changes following the injury.

There needs to be effective and clear communication between the rehabilitation team and the families of those affected by brain injury. The rehabilitation team can then gain a valuable insight into how the injury is affecting the whole family and can provide more specific, focused and practical support tailored to their needs.

Availability of specialist support

Unfortunately some patients and their families are simply not offered the specialist rehabilitation support they need following an acquired brain injury, and recent cases in the press have highlighted the discrepancies in the quality and availability of rehabilitation services throughout the country.

A 2013 BBC Newsnight investigation identified that some NHS units described as specialist neurological rehabilitation centres were failing to deliver the services required by those affected by brain injury.

As a complex injury solicitor I've dealt with a number of clients who have suffered severe brain injuries and have on occasion witnessed these differences first hand. In some cases, clients are discharged from hospital with little or no support following a life-changing brain injury.

Discharged after only a week

One of our clients sustained a serious brain injury following an accident at work. He was working on a building site when a scaffolding pole hit him on the head; penetrating his skull. He was discharged home from hospital after only one week to be cared for by his family.

He was suffering from a range of significant symptoms including the loss of use of one of his limbs, cognitive impairment and psychological difficulties which manifested through memory problems and significant behavioural issues. He was unable to care for himself and needed help with basic, everyday tasks.

After being provided with some physiotherapy, his needs were assessed by an occupational therapist; however he had to wait long periods for any rehabilitation and there was little or no consistency in what little support was eventually provided.

Unsurprisingly, the injured person and his family experienced real difficulties in adjusting to his impairments and were put under extreme strain due the lack of support they received in the early stages.

Treatment by relaxation CD

More worrying was another of our clients who suffered a serious brain injury and was discharged from hospital with only a relaxation CD to listen to. Very little useful support was provided by his local hospital to the point where he and his family ended up moving home in order to access better services and support in another area.

The Consistency of Care

In my examples above, as the injuries were sustained through the negligence of another person; the injured people were in a position to obtain legal advice and support under the Rehabilitation Code, they could access the appropriate rehabilitation needed to maximise their recovery. However in cases where the individual sustains a brain injury where there is no fault on the part of anyone else; they are left to rely on the NHS provision in their area.

A dynamic and multi-layered approach to neurological rehabilitation is crucial but remains a major challenge. There is an obvious vital need for the various agencies and providers in both health and social care to communicate effectively with each other and with the patient to ensure that the required support and services are provided in a consistent and co-ordinated manner. Delays in the delivery of rehabilitation can cause significant setbacks in the patient's progress and considerable distress for both them and their family.

The availability of good, consistent neurological rehabilitation services is of paramount importance in improving the quality of life of people affected by brain injury. With the tireless work, support and campaigning of charities such as the Brain Injury Rehabilitation Trust, let's hope it's not too long before all those in need can access it.

About the author

Mary Kay PhotoMary Kay is an experienced lawyer who has worked at Spencers Solicitors for over fifteen years. After graduating from the University of Newcastle upon Tyne with a degree in English Literature, Mary qualified as a Solicitor in 2007 and has worked within the Complex Injury team for seven years dealing with catastrophic injury claims.

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Just a bad hair day

February 26, 2015 at 4:50 PM

The unregulated industry - would you know what to do if you were harmed through hair treatment?

The UK hairdressing industry employs nearly a quarter of a million people across 55,000 businesses and, as with any industry of that size, standards and safety procedures often widely vary. However the UK hairdressing industry is also totally unregulated, meaning that almost anyone can set up a business as a hairdresser without any formal qualifications or recognised training.

Hair on the floor

The influence of fashion coupled with a desire by many to look younger, has led to a steady increase in spending on cosmetic services such as hair and beauty, even in times of recession. Most of us enjoy a visit to the hairdresser and usually the salon and individual we go to is a skilled professional who we've used for years and came highly recommended.

Yet with the sheer number of hairdressers, procedures and techniques out there the potential for something to go wrong is never far away.

What's the worst that can happen?

When I talk about things going wrong, I don't mean just badly cut hair or a poor style choice. I'm referring to an act of negligence where someone's action has left a person seriously injured through no fault of their own.

These injuries can range from minor lacerations or dermatitis to serious scalp burns and complete hair loss.

Issues with appearance can also lead to psychological injuries, which as you imagine is more common in women than men, but no less traumatic for the sufferer.

Hairdressers (not to mention barbers) rarely just use a comb, brush and pair of scissors. They have a variety of tools, chemicals and styling equipment at their disposal. So injuries through the incorrect use of bleach, waving equipment or tinting chemicals are likely to cause more suffering than a simple cut.

Current standards and the campaigners for regulation

To try and help combat and reduce salon injuries there have been recent calls by Welsh MP Nia Griffiths for a compulsory register to be put in place which would amongst other things protect people from 'unscrupulous' and 'incompetent' traders. However the Work and Pensions Minister, Mark Harper, said the move could not guarantee the quality of hairdressers - and that those who were poor at their job would go out of business very quickly. It was also argued that the creation of a register would cost the industry £75 million.

Currently it is voluntary to belong to a UK register of qualified hairdressers. The Hairdressing Council is one such organisation which holds a register and was established through the Hairdressing Regulations Act 1964. The hairdressing Council believes in the professionalism and passion of hairdressing. It campaigns to raise standards, and believes every hairdresser should be registered, a move which would 'eliminate the cowboys who practice hairdressing with no qualification or experience whatsoever'.

Professional hair stylist curling hair

Habia (the Hair and Beauty Industry Authority) is also an organisation licensed by the UK government to create the standards that form the basis of all qualifications in the hair industry which include:

  • • NVQs and SVQs
  • • Apprenticeships
  • • Foundation Degrees
  • • Welsh Baccalaureate Qualification (WBQ)
  • • Principal Learning (previously part of the Diploma in Hair and Beauty Studies)

As well as setting qualification standards Habia have lobbied the government for compulsory state registration stating:

"Britain is internationally renowned for their high standards in hairdressing and has some of the best training in the world but we must protect the UK public from unscrupulous hairdressers opening businesses on the high street."

Finally there are independent review sites such as Good Salon Guide and SalonSpy which aim to share recommendations and ratings of a hairdresser from previous customers.

Top tips to finding, being happy and staying safe with your hairdresser or salon

Gain a recommendation - Ask family and friends who they've used or heard good things about

Search the Hairdressing Council to see if your hairdresser has voluntarily registered (or find one that has)

Confirm their reputation - Check out reviews on the Internet to see if other customers are happy with the service they have received

Ask about qualifications - Is it obvious how their staff are qualified and trained, do they have a Public Liability Insurance Certificate on display?

Get a consultation - most hairdressers offer a free consultation and you can ask what products and techniques he/she intends to use, giving you an idea of their experience

Advise them of any allergies or conditions - Have you ever encountered problems with certain cosmetic products or brands, do you have any known allergies (latex etc.)

If after all these precautions, you do suffer an injury it is important to seek medical attention straightaway. The salon should ideally be informed as well, especially if the procedure involved chemicals or dyes, as knowing the specific chemical ingredients used may help aid treatment and recovery.

It is also recommended to seek advice from a specialist legal professional, as the distress, pain, long term treatment and effects of a hairdressing injury should not be underestimated.

 

Protecting consumers and the hairdressing industry

Even though there are organisations that provide training, assessments, and voluntary registration, it remains that an industry which performs a multitude of physical and chemical procedures is still for the most part self-regulated.

The scenario that anyone could choose to call themselves a hairdresser, without any checks or qualifications, is mindboggling and scary to me. Regulation in some form needs to be mandatory to stop people being injured in this way, as well as protecting the reputation of the majority of qualified hair and beauty professionals.

 

Do you think all hairdressers should be regulated to comply with a set standard? Or is the current self-regulated system working just fine?

 

About the author

Lynne Urpeth  PhotoLynne Urpeth is a litigator at Spencers Solicitors and has nearly 10 years experience in dealing with personal injury claims. Lynne currently handles a mixed liability caseload dealing with accidents at work, occupier's liability, public liability and criminal injuries compensation claims.

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Has concussion in rugby doubled, or are we just better at diagnosing it?

February 17, 2015 at 10:50 AM

I have blogged previously about the issue of head injury in sport, and so when George North hit the headlines last weekend - after being concussed twice in the match against England - I was concerned that yet another player had suffered serious injury after concussion went seemingly unnoticed during play.

However this incident, along with the England Professional Rugby Injury Surveillance Report that recounted a staggering 59% rise in concussions from 2013-14 compared to the previous season, has sparked major debate. In fact, the matter of head injury in sport, and of course especially in rugby, has been under intense scrutiny this week.

Welsh Scrum

Back in July 2014 I wrote about the ways in which different sports deal with concussion and said the following about rugby:

The IRB [now World Rugby] have recently introduced the Pitch-side Concussion Assessment, or 'the five-minute test'. During a game, a test can be requested by a team doctor or referee if they suspect concussion.
Concussion Management - If in doubt sit them out

A substitute comes to the field whilst the injured player is taken off the field to a medical room to be assessed for head injury symptoms. The player is then asked a series of questions such as 'where are we' and 'who was the last person to score' etc. The player is also subjected to a balance test similar to that used to test drunk drivers.

[....]

If the player gets one question wrong, has four balance errors and the presence of one of more symptoms of concussion the player is removed from the game, otherwise he is allowed to return to play. The new rules have had a mixed reception with some suggesting that five minutes is nowhere near sufficient to assess the severity of a concussion, whilst others suggest that the new off pitch assessment has resulted in a significant reduction in the number of concussed players returning to the field by 25% so there is evidence that the new system is working.

 

Pitch Side Assessment in Action

I am pleased to say that in the Wales v England game this pitch-side assessment was put to use. During the first half, George North was removed from play in accordance with the Pitch-Side Assessment and he was off for eight minutes before being allowed to return to play after being hit in the face by the boot of England's Dave Attwood.

The assessment procedure was not followed when the next concussive incident occurred in the second half because the incident was not spotted by the Welsh team doctors, or the referee. Following the match further assessments have taken place and the Welsh team have announced that North will miss the game with Scotland on Sunday this week despite showing no signs of concussion during his return to play protocol. The decision has been made because it has transpired that North suffered an earlier concussion in November 2014 and therefore an extended recovery period is felt necessary.

It is a reassuring sign that following the incident steps have been taken over and above the current protocols to ensure North is fully rested before he is permitted to return to full match play, however lessons still need to be learned.

More instances of concussion, or simply more awareness?

I do accept the suggestion within the Surveillance Report mentioned above that, at least in part, the rise can be somewhat accounted for by a better understanding and higher instances of reporting head injuries.

It is alarming however that the huge increase suggests there has been potentially significant under reporting, and I suspect further measures will only increase the number of reported cases further. Greater awareness and a change in attitude from grass roots to professional level is required to ensure serious head injuries are avoided wherever possible.

Some argue that the current Pitch-Side Assessment protocol is insufficient; critics include Barry O'Driscoll, former IRB medical committee member, who when commenting on Saturday's events said he was of the view that "players are being experimented on", and that player safety was being put in jeopardy by a "refusal to adopt a 'going off and staying off' policy when concussion is suspected".

Continuously improving concussion detection in sport

Now that the issue is so brightly in the spotlight, I am hopeful for further improvements for player safety.

World Rugby have accepted that their protocols need to improve, and steps are being taken to introduce video replay for home and away matches in the Six Nations. Global intervention is also anticipated, and I suspect further changes will be made to protocols to make it easier for the referee and team doctors to be made aware of potential incidents of concussion.

Whilst I am encouraged by the fact that the governing bodies are now taking further steps to protect players at the very top of their game, I hope too that further steps are introduced to ensure that those playing at grass roots level are also afforded the best possible protection in the absence of such luxuries as instant video replay.

 

Have you noticed rugby players are receiving better protection from concussion? Or does the sport still have a long way to go in protecting players at all levels?


About the author

Louisa Chambers PhotoLouisa Chambers is a Chartered Legal Executive and Solicitor within Spencers catastrophic injury team. Louisa has a great deal of experience in acting for clients who have suffered serious and life changing injuries through sports related accidents.

Louisa's previous blog was Where we're going, we (do) need roads, but maybe not a driver.

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