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Brain injury in the new normal: How to get a good night’s sleep during the pandemic

Consultant clinical neuropsychologist Dr Keith G Jenkins and Dr Jenny Brooks, consultant clinical psychologist on how to sleep well during the pandemic.

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Getting a good night’s sleep is important all of the time, as we know from our work with people with brain injury, but some people have seen their sleep pattern alter during the pandemic.

This change to the normal time people go to bed and fall asleep and/or wake up in the night, may be due to several factors, including changes to the way the person spends their day in terms of education, work, meeting up with family and friends, seeing support workers and / or attending rehabilitation sessions. Also they are perhaps exercising, playing sport or doing other activities less.

Lower mood, such as feeling sad, having worries or feelings of uncertainty, can also impact on your ability to get to and stay asleep.

Changes to our sleeping habits can lead to a poor sleep-wake cycle, otherwise known as our body clock. Not getting enough sleep, or good quality sleep, can cause fatigue and tiredness throughout the day. You might feel unwell as a result, and this can increase anxiety and worries further, making getting through the day more difficult. It might also mean that relaxing to sleep becomes harder, and a vicious downward spiral can follow.

Fortunately, there are some very simple things we can all do to support a good night’s sleep. These include going to bed and getting up at the same time each day to support your body clock, exercising during the day if you can safely do so and trying not to exercise too close to bedtime. Avoiding caffeine or nicotine close to bedtime – or reducing them if you can’t stop completely – can also help.

Be aware that alcohol might mean that you fall asleep faster, but it can disrupt the second stage of sleep, meaning that the quality of your sleep may be reduced, which can then lead to you feeling tired the next day.

It’s generally best to avoid things that may cause you upset or stress before your usual bedtime, like a difficult phone call or a scary TV programme. It is also important to reduce your exposure to blue light, for example from smartphones and laptops, before bedtime.

Blue light tricks your brain’s body clock into thinking it’s daytime and suppresses the production of melatonin. This is the hormone you need to feel sleepy.

Try to have a bedtime routine that supports you in winding down, whether that means a bath, listening to music or a relaxation CD. It’s also really important to ensure that your bedroom supports your sleep, so consider things such as lighting and temperature. Most people tend to find that a tidy bedroom can help the room feel more relaxing too.

Of course, many people with an acquired brain injury tend to experience fatigue and often find having a nap in the day can help them to manage this. But an afternoon nap should end before half past three in the afternoon at the latest, with your next sleep being in bed for the night. Headway has a very helpful section on its website regarding managing fatigue.

While bedrooms should predominantly be for sleeping, some people have been spending more time in them during the pandemic doing other things – perhaps using them as a quiet space to complete education or work.

For those in hospitals or care homes, increased bedroom time may be due to isolation procedures. If this is the case, perhaps consider having a chair or a beanbag to sit on, rather than lying on your bed during the day. Where possible, try to come out of your room for meals.

If you find it is taking a long time to get to sleep, try getting out of bed and doing something else, like reading a book or a magazine, and then return to bed when you are feeling sleepy.

The advice we have given here is in line with the recommendations on the NHS website.

A good night’s sleep is crucial to thinking at our best, which is especially important if you are working or being educated at home; and there are some other simple things that you can do to boost your productivity in these scenarios.

Firstly, make sure you have a shower and get dressed rather than working in pyjamas or dressing down. Getting dressed helps you to psychologically get into work mode. Have a designated workspace and, if possible, keep the area tidy.

Have a timetable of when you’re going to work and try to stick to it. As we’ve mentioned, writing a timetable down and ticking off jobs completed supports feelings of achievement. Make sure you schedule regular breaks during which you move away from the workspace. You might go into your garden or make a drink, for example.

Try to minimise distractions. That might mean moving your mobile phone out of reach, turning off the TV and considering where the quietest places are. If you live with other people, you might want to consider how to ensure they don’t disturb you. This might just mean letting them know what your work timetable is.

One distraction that can’t be ignored, however, is the need to wash our hands to prevent the spread of the virus.

We hope you have found this guide useful and wish you a safe and happy summer as we all continue to rise to the challenges presented by COVID-19.

This is one of five blogs in a series on living in the new ‘normal’ with a brain injury, based on a webinar produced for ABI London (ABIL). See below for links to other articles in the series. Dr Keith G Jenkins is consultant clinical neuropsychologist at St Andrew’s Healthcare and chair of Headway East Northants. Dr Jenny Brooks is a consultant clinical psychologist working independently and a director of The ABI Team. For any questions about this topic email update@standrew.co.uk. 

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Impact during TBI can have effects years later – study

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Researchers from Imperial College London helped lead the study

The force exerted on the brain during traumatic injury is linked to damage years after the initial event, research has revealed.

Findings of the new study have been hailed as having the potential to predict the severity of brain injuries and help influence new approaches going forward, particularly in the field of sport.

TBI has a number of immediate impacts, including physical effects like unconsciousness and bleeding, alongside the ‘hidden’ symptoms of memory loss, mood and personality changes, which may take much longer to develop.

However, the link between the mechanical forces that act on the brain during TBI and the resulting long-term changes is poorly understood.

Now, researchers from Imperial College London have shown a clear link between the forces acting on the brain during TBI and its associated long-term changes.

The study – ‘From biomechanics to pathology: predicting axonal injury from patterns of strain after traumatic brain injury’, which is published in Brain – combined a computational model of brain injury with experimental studies on rat brains.

“The initial damage during a traumatic brain injury takes only milliseconds to occur, but it triggers many changes that result in ongoing effects which can be felt years later,” says Dr Mazdak Ghajari, from the Dyson School of Design Engineering.

“Understanding the link between the two is crucial for predicting who is at risk for long-term damage, and how protection may be better designed to prevent this damage.”

The findings have the potential to make positive impacts in protective equipment, such as in the design of helmets.

Professor David Sharp, from the Department of Brain Sciences, says: “We are also looking at how the type of impacts experienced by American football players affects whether they lose consciousness, and whether new helmet designs might protect soldiers from the effects of blast waves following explosions.

“These types of studies can also help explain whether repeated small impacts, such as heading the ball in football, could lead to similar long-term brain injury.”

Previously, the team had built a human computer model to predict the location of long-term brain damage following TBI, focusing on the ‘white matter’ of the brain, which contains nerve fibres called axons which play a large role in the brain networks that are altered in long-term brain damage.

Now, they have tested this modelling approach to see if it can accurately predict the pattern of white matter damage in rats given mild or moderate TBI.

They simulated the rats’ brains during injury, revealing the location and duration of mechanical forces linked to damage. Using a precise experimental model, this damage was induced in the rat brain and followed up after several weeks, which correlates to years of changes in a human brain.

They found that the effect of shear stresses on the white matter helped to predict the location of long-term damage. Shear stresses push two parts of the same object, in this case the brain, in different directions.

The intensity of the shear at different locations caused by different impacts, for example what angle they come from, predicts where the most severe white matter damage will occur. This could potentially help doctors predict the likely long-term effects in patients who have suffered a TBI.

“Different types of injuries will cause different kinds of shear. With this new model we can now more accurately predict which injuries will cause severe, long-term damage, and potentially avert it,” continues Dr Ghajari.

“For example, motorbike accidents involve a lot of rotational movement, which causes lots of shear. We are studying dozens of bike helmets to see which best protect against excess rotation.”

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First-of-its-kind post-Polio service created

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PhysioFunction are leading this unique rehab project

A specialist neurophysio service to support people with Post Polio Syndrome (PPS), believed to be the only programme of its kind in the country, has been created.

PhysioFunction has established a dedicated offering for people who have had polio earlier in life, but for whom some effects have returned years later with the onset of PPS.

The programme, which incorporates aquatic and land-based physiotherapy, has attracted a number of people from around PhysioFunction’s base in Northampton, but through the addition of telerehab during lockdown, has involved participants from a much wider area.

PhysioFunction engages members of the British Polio Fellowship in its programme and has also secured funding from Rotary International in recognition of its innovation.

Led by neurophysiotherapist Kirsten Good, the specialist service was created in response to the needs of one client initially, but expanded once the demand for such bespoke therapy was realised.

PPS is estimated to affect up to 50 per cent of those who have had polio in younger years, and its symptoms can include decreasing muscular function or acute weakness, pain and fatigue.

“Initially, it started with one client who had a hip replacement after a fall, but wasn’t recovering as expected, he went to St Thomas’ Hospital in London and was diagnosed with PPS. He had polio as a child, but the effects of the fall, combined with the operation and the recovery process, had triggered PPS,” says Kirsten.

“Having developed something very specific in response to his needs, involving our hydrotherapy pool for aquatic physiotherapy, as well as land-based physio which includes the use of our Alter-G treadmill, we saw how well this approach worked.

“I had never worked with anyone with polio or PPS previously, but it has many symptoms in common with neurological conditions I regularly treat, and working with this client inspired me to develop an interest in this area.”

From there, PhysioFunction devised a programme built to the exact needs of people with PPS, incorporating sessions of up to 30 minutes involving hydrotherapy and equipment-based exercise.

“We have a number of polio survivors attending our groups every week, and the funding we have had to subsidise the programme has made it very affordable for them,” says Kirsten, who was named a Paul Harris Fellow by the Rotary Foundation of Rotary International for her work in developing the initiative.

“It has been very warmly received and our participants have such a fantastic ‘get up and go’ attitude. Perhaps because many had polio in childhood , they have always grown up with the long lasting effects and have learned to get on with their lives – but when we say ‘Have you tried this?’ they’re really keen to give things a go. It’s a very positive group.

“Some people initially aren’t confident in getting in and out of the pool, and the adversity to temperature changes is another big factor caused by polio, so we can vary it between land and water-based as is required.

“We also have some fitness and endurance sessions, which we offer more widely at PhysioFunction, but overexertion in exercise can exacerbate PPS symptoms, so again, this has been tailored and developed to the requirements of this condition.”

The addition of telerehab to the PPS programme during lockdown was initially greeted with some scepticism, but has now been embraced.

“I’m not sure everyone was 100 per cent keen on it initially, but it has worked well. We are able to involve new participants from some distance away, who may not have travelled to our sessions, and it has continued to build our community,” adds Kirsten.

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STEPS makes great strides in its growth

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STEPS was set up by sisters Toria Chan and Jules Leahy

A residential rehabilitation centre has increased staff numbers by 300 per cent after securing investment to boost its development in the three years since its opening.

STEPS Rehabilitation was established by sisters Toria Chan and Jules Leahy to address the lack of facilities for younger patients in need of intensive neurorehabilitation.

Since opening in 2017, the Sheffield-based centre has now become a national centre of excellence for people with neurological conditions, stroke, spinal cord injuries, acquired brain injuries and other complex trauma injuries.

To date, the centre, which also offers day services, has supported over 200 people with their rehabilitation.

The 23-bedroom centre has a range of facilities to enable it to deliver specialist therapy to its clients, including a therapy gym, hydrotherapy pool, alongside social space to facilitate social interaction.

Through securing a £250,000 loan, STEPS has been able to vastly develop its offering to clients, as well as develop its operational processes behind the scenes, and staff numbers have increased from 35 to to 140 in tandem.

After an initial investment of over £1.6 million in the creation of the specialist centre, on the site of a former Sheffield engineering works, the three-year loan enabled STEPS to get to its next level of development.

The investment, from NPIF – Mercia Debt Finance, managed by Mercia and part of the Northern Powerhouse Investment Fund, has now been fully repaid.

“We have been on an incredible journey since we launched in 2017 and we are thrilled to have been able to make such a huge impact on our clients’ lives,” says business development and founder Jules.

“NPIF has been an important part in helping our dream come to fruition, with its funding helping to facilitate considerable operational improvements to help get us to where we are today.”

Pete Sorsby, investment director at Mercia, said: “STEPS is a unique business.

“Toria, Jules and the management team have put in many years of hard work and investment to make the centre what it is today – a nationally recognised rehabilitation facility.

“With future expansion plans in the pipeline, I have no doubt that STEPS will continue to go from strength-to-strength, and we are pleased to have been on that journey with them.”

“NPIF was launched in 2017 and STEPS was one of our earliest investments, so it has been excellent to watch it grow and excel over the last few years,” adds Sean Hutchinson at British Business Bank.”

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