March 27, 2015
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.
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.
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.