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Brain injury

ABI to be recognised in new domestic abuse legislation

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Specialist advisors could be assigned to victims of domestic violence

New statutory guidance will recognise that survivors of domestic abuse may have sustained an acquired brain injury (ABI) for the first time, it has been revealed.

Consideration of brain injury will be made as part of the Domestic Abuse Bill, currently being debated by the House of Lords.

Domestic abuse protection orders – designed to protect victims from all forms of domestic abuse – will now consider ABI as part of the range of needs any survivor may have.

Where police are attending a call out to a domestic incident in the community, they could be accompanied with, or shortly after visited by, an Independent Domestic Violence and Abuse Advisor who would be able to offer expert support to the survivor, including in relation to ABI.

This commitment from the Government will also introduce new standard questions to ensure all prisoners in England will be screened for ABI sustained through domestic abuse from April 2021.

Both initiatives – which will have impact in terms of protection and support – are the translation of five years of research highlighting the link between domestic abuse and brain injury among female offenders, culminating in lengthy discussions with the Government, NHS and Criminal Justice Acquired Brain Injury Interest Group.

The research, from The Disabilities Trust – who have campaigned on this issue alongside UKABIF and Chris Bryant MP – found that nearly two-thirds of women (64%) at HMP Drake Hall had a history of traumatic brain injury (TBI).

From the women identified through the brain injury service at HMP Drake Hall, 62% reported they had sustained their brain injury through domestic violence.

Research has shown there is a clear link between life trauma, offending and poor health outcomes for women in prison, and this was reflected in the histories of women with TBI involved, with The Disabilities Trust reporting many were subject to prolonged periods of intense violence that was often directed towards their head while they were unconscious.

Furthermore, a third of the women reported sustaining their brain injury before their first offence with the average age of first brain injury reported at 25. Statistics show that incidence of female head injury has increased by 24% since 2005/6.

Whilst the physical symptoms may be obvious, brain injuries can also result in behavioural, cognitive and emotional consequences, which can be considered hidden, but can affect someone for the rest of their lives.

These symptoms include poor memory, lack of concentration or difficulties multi-tasking, poor impulsive control, aggression, irritability, but also mental health difficulties such as anxiety and depression.

The new statutory guidance was welcomed by those who campaigned for its introduction.

Chris Bryant MP said: “This is a journey that started with research from The Disabilities Trust and I’ve been delighted to work with them and a range of individuals and organisations including the UK Acquired Brain Injury Forum to ensure these important initiatives change practice and improve the support survivors receive both in the community and in prisons.”

“This is a very successful outcome following many months of discussions with the minister and NHSE,” said Chloe Hayward, executive director of UKABIF.

“We are delighted that those with brain injuries caused by domestic violence are highlighted in the revised guidance.

“The work of the Criminal Justice Acquired Brain Injury Interest Group was able to give co-ordinated, evidence-based input to meetings ensuring they were attended by those with expertise and experience in this field.”

Irene Sobowale, chief executive of The Disabilities Trust, added: “As a leading charity actively providing neurorehabilitation within prisons in England and Wales, we are delighted to have succeeded in campaigning to ensure that brain injury sustained through domestic abuse is highlighted for survivors in the community and in the criminal justice system.

“We hope that this change will ensure that survivors with a brain injury can be provided with effective support to address all of their needs including the often-hidden disability of a brain injury. This result builds on research from the Disabilities Trust working with partners and Government to achieve this.”

Brain injury

‘I’m sorry for handling the steering wheel with buttered fingers’

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As he continues to come to terms with the loss of his ‘ex life’ and learns to celebrate the 21st birthday of his new self, The Brain Damaged Baron reflects on the comfort blanket of support from those close to him, while struggling with the loss of vanishing friends

 

Let’s get straight down to business.  The salient truth is that one day, the life I once knew came to an end. Yep, gone, cheerio, toodle pip.

It is an ex-life. It has ceased to be, I trotted off this mortal coil in order to push up some buttercups. Is it buttercups? I forget. 

It was so very difficult, sometimes impossible, to comprehend that all I knew had gone. That sentiment only increased over the years and there have been 21 of them. Twenty-one long years.  My new life has matured and is now old enough…

To vote – when it remembers to.

To drive – it can’t, partial blindness caused by the brain injury would make driving an absolute lottery.  That and the complete lack of spatial awareness. After all, I can’t walk down the street without colliding with lampposts. I wouldn’t be safe in a bubble wrapped bumper car. I’m not sure the roads of the UK are ready for me just yet.

To drink alcohol – it can’t, epilepsy denied that pleasure. Due to medication, I feel half-drunk most of the time anyway. Without alcohol, I have the memory of a goldfish with Alzheimer’s disease. I hardly need the odd libation to wipe what recall I do have. 

To have sex – if I can stay awake long enough. I’ll say no more. It was all I could do to prevent myself typing ‘stay up’ long enough. Ooh-er, Mrs!

And it’s now old enough to know what the hell happened to me.  And is still happening right up to this very day.

That’s the nature of a bang on the bonce; confusion.  

Massive disorder in my mind, incomprehension shadows me like the gloomiest raincloud preparing to unleash a deluge of perplexity. I know it’s there, it’s always there. The monkey on my back, the albatross overhead, the angry weasel with a chip on its shoulder.   learnt to live with it. 

That and the ability to invent nonsensical idioms. It’s a gift.

However.

Back in the day, long before I became 21 again, it began.  The curtains were closed, slammed shut. Well, to be fair, they were curtains, not so much ‘slammed’, but more ‘flopped’.  They needed opening, I had to let the day begin.  And commence it did, as the flaccid curtains were swept aside and the hard graft started.

While I was hurting, while I was struggling, while I was learning, there were other people around. There still are, every day. It’s just a question of tenses really.  

Watching, witnessing, feeling my pain. Either on the side-lines or directly involved, family, friends, all observing the effects. Mostly it was no spectator sport, it was grim viewing, if I am honest. And still they remained, standing by with a collective arm outstretched.  

Twenty-one years later and it’s still there. A comfort blanket, a safety net cushioning the unavoidable falls.

It’s a whole new world out there, and that world has a habit of biting back. Sometimes it is just a nip, although occasionally, it’s like a bite from a hungry shark. And those nibbles come thick and fast. Each bite eroded away my former self and ate away, no pun intended, at the life that had sadly departed.  All the while…

Watching, witnessing, feeling my pain…

There are so many bites that they all seem to merge into one. Remembering can be exhausting beyond belief. I had never thought it possible to get so drained, so shattered simply from attempting to recall what the day is.  

Another aspect of my life that my previous self had taken for granted. There was never any reason not to. I was a 25-year-old man and it didn’t seem a lot to ask to remember where I kept my keys. It was never a conundrum.  

However, after the injury, I could then forget where I kept my pants and socks, let alone my keys. Not when I was wearing them, obviously; my pants and socks that is, not my keys.  

And with the exertion of something as basic to a human being as ‘thought’ came the inevitable headaches. The first to strike shook me to my very core. It smarted, just a tad.  They continue to this day, bless ‘em. 

Almost a year after the old brain took its battering and continued to fight the good fight, epilepsy was thrust into my life. The unwanted gate crasher causing havoc with every appearance. A lightning bolt from the deepest blue. Body spasms, unconsciousness, confusion, memory lapses, post seizure headaches that make the usual head pains seem like old friends.  Well, it keeps me on my toes.  And still…

Watching, witnessing, still feeling my pain. The outstretched arm remained, absorbing the anger and feeling my frustration. 

Fatigue and apathy soon entered the fray. More undesirable visitors cluttering an already overloaded brain. They pushed aside my old friends ‘eagerness’ and ‘concentration’ as ‘alertness’ looked on with all the subtlety of a slightly annoyed bricklayer wielding a sledgehammer. Oh, he had anger issues too.

The passage of time was a cruel mistress. Particularly when my addled brain was struggling to establish some form of normality… whatever that may be.  

My life in its entirety had altered beyond recognition. Epilepsy could now strike without warning at any given moment, throwing the day into chaos. Fatigue that plagued almost every aspect of my life began to throw up barricades.  

It was hard to live with what I had become.  To live in the present and not rely on the past.

And still they watched, witnessed, felt my pain. And for some, it was too much, too difficult, too much like hard work. 

Relationships ended and friendships broke down. Ultimately, people vanished. They had their reasons, I was never told what they were, but I’m sure they had them. Occasionally I had the courtesy of an invented tissue of lies that possibly salved their own conscience, but only served to batter my own into submission.

Relationships with everyone in my life, friends, new acquaintances, and even the odd member of my family, seem to be based on the flip of a coin. 

Should a ‘Head’ land on terra firma and whatever my brain throws into the mix, they’ll hang around. Should a ‘Tail’ drop gracefully to the ground and they’ll turn that tail and run for the hills.  And that’s how it’s been since the day I landed on my cranium with one hell of a thud.  But wait a moment here…

I like to think I’m not a stupid man, I pride myself on it in fact. I’m 46-years-old now, time is marching on relentlessly like a runaway train with only one destination.  

I’m married to my best friend, a couple of children have their place in my life and I’m still learning more about my own limitations and abilities. Only one thing has remained constant throughout the journey that became my second shot at this rollercoaster we call ‘Life’. That damn scar on my brain still throws its weight around whenever it fancies a bit of a giggle. And thus…

I still forget things with frightening regularity.

I can’t control my emotions like I should.

Background noise irritates me to the point of exasperation.

I still invent idioms like a ferocious aardvark with a knuckleduster.

I may have a seizure with varying degrees of severity at any given moment.

Fatigue is a pest that simply won’t leave me be. And sleep is my panacea.

I can’t socialise like I once could.

I can’t drink, I can’t drive.

I am no longer the ‘me’ I once was. And do you know what? I no longer care. I wouldn’t change one God damned thing.

I throw out these statements with gay abandon, almost on a whim.  The fact remains that while I was coming to terms with the throwaway facts, those people close to me WERE watching, they WERE witnessing and they WERE feeling my pain.  

For instance, let’s start at the very beginning. I was in a coma in hospital. Essentially, I was asleep, just for a smidgeon longer than usual. I always was a lazy sod. While I slept, my family and friends sat at my hospital bedside wondering whether I would live or die. I had it easy, I really did. I still do.

The first epileptic seizure and every single one since sees my good self disappear into another world for however long, while whoever is there can only watch, wait, and worry.  Again, I repeat, I have it easy.

I have a wife I adore. The lady who came along and turned out to be the missing piece in my jigsaw. Who knew? The rock to my roll, the milk on my cornflakes. Much like my friends and family who were there long before that missing piece arrived, she tolerates the moods and the headaches.  She lives with the forgetfulness, the now thankfully muted anger, the annoyances, etc. They’re all part of just another day.

Twenty years of watching and worry. Good grief, I’m so sorry for putting you all through this journey, none of you asked to be passengers, you really didn’t. You still don’t, you never so much as complain. I certainly didn’t want to be the driver and I’m sorry for handling the steering wheel with buttered fingers…

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Brain injury

Sleep problems ‘can be worse with mild TBI’

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Sleep disorders are more prevalent among people with mild traumatic brain injuries (TBI) in comparison to those with more a severe diagnosis, new research has revealed. 

In the study, the links between TBI and sleep problems were strengthened further, with people with TBI shown to be up to 50 per cent more likely to develop insomnia, sleep apnea and other sleep disorders than people who have not been injured. 

And in a significant outcome, the association with sleep disorders was stronger amongst those with mild TBI than in the case of serious injury. 

The research also showed that the risk for sleep disorders increased for up to 14 years after a brain injury – showing the need for the impact of TBI to be assessed in the long-term, said the research team from the University of California. 

“Clinicians should ask TBI patients about their sleep and they should follow that up,” says study investigator Yue Leng, assistant professor in the university’s Department of Psychiatry and Behavioral Sciences.

Data was analysed from 98,709 Veterans Health Administration patients diagnosed with TBI, alongside an age-matched group of the same number of veterans who had not received such a diagnosis. The mean age of the participants was 49 years at baseline, and 11.7 per cent were women. Of the TBI cases, 49.6 per cent were mild.

Researchers assessed a number of sleep disorders, including insomnia, hypersomnia disorders, narcolepsy, sleep-related breathing disorders, and sleep-related movement disorders.

During a follow-up period that averaged five years but ranged as high as 14 years, 23.4 per cent of veterans with TBI and 15.8 per cent of those without TBI developed a sleep disorder.

After adjusting for age, sex, race, education and income, those who had suffered a TBI were 50 per cent more likely to develop any sleep disorder compared to those who had not had a TBI. 

The association with sleep disorders was also found to be stronger for mild TBI than for moderate to severe TBI which, say the research time, might be due to differences in the brain injury mechanism.

While the study was conducted with veterans, the research team expected to find an increase in probability of sleep problems in those with PTSD. 

“But actually we found the association was pretty similar in those with, and without, PTSD, so that was contrary to our hypothesis,” says Leng.

The researchers could not examine the trajectory of sleep problems, so it could not be concluded whether sleep problems worsen or get better over time, she adds.

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Brain injury

Women ‘more likely to have long-term issues after concussion’

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Women may be at increased risk of long-term physical and mental issues after a concussion, a new study has revealed. 

In analysis of 2,000 people who sustained a head injury, women were found to be more likely than men to still have some symptoms a year later. 

These included memory and concentration problems, alongside headaches, dizziness or fatigue. 

Women between the ages of 35 and 49 typically had worse symptoms than both younger and older women, the research found. 

The study revealed that in other traumatic injuries, men and women’s recovery times were similar – the main area of disparity was in brain injuries.

While this research cannot answer the question as to why this happens, says lead researcher Professor Harvey Levin, from Baylor College of Medicine in Houston – it is possible, he says, that chronic inflammation in the brain tissue or hormonal influences play a role.

The brain has receptors for oestrogen, and previous research has indicated that women who sustain concussion at certain times in the menstrual cycle tend to have a slower recovery.

It also builds on previous research which has also pointed to sex differences in concussion recovery. 

Writing an accompanying piece to the study, which was published in JAMA Network Open, Martina Anto-Ocrah, an assistant professor of emergency medicine and neurology at the University of Rochester Medical Center, says it strengthens the case that women’s slower recovery is related to concussion. 

“We expect most patients to recover within weeks,” Anto-Ocrah says, adding that about 90 per cent have largely recovered within three months.

But in the study, women did have higher rates of depression and anxiety diagnoses before the concussion, compared to men. And those are risk factors for prolonged concussion symptoms, Anto-Ocrah adds.

However, the researchers accounted for depression and anxiety, and those diagnoses did not seem to explain women’s more persistent symptoms.

Some women, Anto-Ocrah says, encounter scepticism when they tell their doctor they are still having concussion symptoms many months after the injury.

“This is additional proof that it’s not all in your head,” she adds.

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