Neuro-rehab has an image problem. It is evident in the highest quarters of the NHS, at Westminster and on hospital wards.
The fact is, as a healthcare field, there is a widespread lack of awareness about exactly who we are and what we do. This identity crisis manifests itself in many ways.
Our field is often lumped in with distant cousins of healthcare when auditors come to town. In the data vaults of many clinical commissioning groups, neuro-rehab is not even categorised.
Meanwhile, we are shamefully underrepresented at the top table of the NHS, despite the prevalence of brain injuries, stroke and other neurological disorders.
Blatant examples of our misunderstood status are also regular occurrences in the legal world.
Even among legal professionals who have been embroiled in serious injury cases for many years, the value of our expertise is often overlooked.
In brain injury cases, when expert witness testimony is required, it surprisingly common for lawyers to initially call on general neurologists.
The court needs a detailed projection of the individual’s likely challenges for the rest of their life and how they can be managed.
A long-term picture is required of probable cognitive, emotional and behavioural problems. Specifics on daily tasks, like eating, walking and washing, also contribute vitally to the claimant’s case.
Given that few neurologists work directly with brain injured patients beyond the bedside, their expertise is less relevant to these longer-term cases. Even if they have seen people with brain injuries in hospital, they are usually concerned with the patient’s acute situation, not the long-term outlook.
Even more mismatched to quantum in brain injury court cases are neurosurgeons – which judges and lawyers have been known to call upon regularly.
Their involvement in brain injuries is restricted to the 48 hours or so immediately following the trauma. Managing that pressurised situation is their primary focus, rather than the long-term permutations of the injury.
When a head injury has been sustained among broken bones and other injuries, orthopaedic surgeons are sometimes enlisted as experts.
Such requests from lawyers are not uncommon, but thankfully a few words of advice from neuro-rehab experts can often put them straight before the court case begins.
They do underline how poorly recognised the neuro-rehab field is, however. All of the big questions the court needs to know about how a brain injury will impact on a person’s life can be answered within the neuro-rehab community.
What is their life expectancy? How have their employment prospects changed? What are their immediate and future care needs?
Are there issues around their capacity to make decisions? To what extent are they at risk from the myriad of other problems that often come with brain injury, like depression and speech difficulties?
Neuro-rehab physicians are clearly best placed to answer all of these questions. Furthermore, I believe the many other professions that work with brain injuries should also play a part in certain court cases.
Whether relayed by the physician, or directly by the professionals themselves, speech and language specialists, neuro-rehab physios and occupational therapists, neuropsychiatrists and neuropsychologists all have valuable expertise to share.
Their input will give the court the clearest possible picture of the life-time fallout of a brain injury.
In turn, compensation packages will be as accurate and fair as possible. In recent years, the firm I co-direct, National Neurological Rehabilitation Chambers, has added a wider range of neuro-rehab professionals to our books.
We believe their involvement in courts will become more prevalent in coming years, as compelling evidence for the many ways brain injuries affect lives grows.
A good neuro-rehab expert, from the correct professional background, can give the most relevant and accurate view of the claimant’s problems and will be of value not only to claimant lawyers but to defendant lawyers as well.
After all, a good rehab programme will reduce costs in the long term. People will improve more effectively after a period of good quality rehab and thus need less care overall. Ultimately, they will also stand a greater chance of returning to some form of employment.
For now, neuro-rehab sector bodies, charities and collectives, such as the soon-to-be- launched brain injury parliamentary group, have a job to do in better defining and promoting our field.
Mike Barnes is a consultant neurologist, a rehabilitation physician and managing partner of the National Neurological Rehabilitation Chambers. www.nnrc.org.uk