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Brain injury

‘Don’t count the days, make the days count’

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In our latest interview with the Brain Injury team at St Andrew’s Healthcare, we meet Dr Lorraine Childs, a Consultant Clinical Psychologist on Rose ward, one of only three secure neurobehavioural units in the country.

Dr Childs and the team on Rose use a neurobehavioural approach that supports people who have a forensic background to re-learn skills that have been impacted by their brain injury.

As she explains: “Unfortunately, brain injury can result in an increase in aggression, so we do a lot of work to identify what a patient’s goals are and help them to achieve their aspirations in pro-social ways that preclude the use of aggression.”

Co-production between patients and the clinical team has led to the development of programmes such as ‘Better Lives’, used to encourage people to take an active role in decisions about their care. These type of approaches are transferable across all settings where people are receiving support and rehabilitation following a brain injury.

We spoke to Lorraine to find out more.

What is your experience in mental health? 

I have worked in mental health for over 25 years. I have worked across the UK including St Andrew’s, Broadmoor, Rampton and in New Zealand.

I specialise in Forensic Brain Injury. I used to specialise in LD but became very interested in the etiology of learning disabilities and people who had ABI from an early age.

Dr Lorraine Childs

What are the challenges in your role? 

People who have a brain injury and require secure care tend to benefit from consistent, structured treatment.

Many of our patients are negatively affected by change and inconsistency. Working with large groups of staff can make it difficult to keep things consistent and this has been especially pronounced during the pandemic. I try to counter this by keeping things simple and comprehensive.

What do you most enjoy about your role? 

Working with a team of staff and patients. Creating things together, that are meaningful and purposeful. 

On Rose we have a really good structured neurobehavioral programme, developed by staff and patients, which works at both a group and individual level.

Describe the service you work in and some of the approaches that you use.

Rose is a medium secure neurobehavioral ward for people who have forensic backgrounds. Unfortunately, aggression is one of the things which can accompany brain injury and this is why some people need secure care to keep them safe.

We work with a neurobehavioural paradigm, helping people to learn new skills or relearn skills that have been affected by brain injury. We give patients opportunities through extensive vocational options and a range of therapies. 

Our ‘Better Lives’ programme provides people with opportunities to learn life skills. Patients really understand that they are here as part of their journey to achieve a better life.

In fact, our ward icon and motto is Muhammad Ali and his quote; ‘Don’t count the days, Make the days count’. In other words, the patients can influence their own future every day.

Co-production is key to this programme. For example, as a result of ‘Better Lives’ sessions we have co-produced a ward clinical treatment philosophy, a healthy-living programme and an information leaflet for newcomers. Patients requested for this to include information about timetables, events, contacting family and there is a poem written by a patient about their experience of moving here. Feedback about this is positive, one new patient said “it is informative and puts the mind at ease”. 

We encourage patients to take an active role in decisions about their own care, especially via Positive Behavioural Support Plans and utilising feedback. Increasing involvement encourages ownership and responsibility, even within a necessarily restrictive setting, and can help equip patients for their future in settings of lower security and community.

Describe a typical patient presentation.

There is a very diverse group of patients on Rose ward. Ages range from late teens to 60s. If I had to describe a ‘typical’ patient it would be a male in his 40s who had a brain injury in his 20s, usually because of a road traffic accident or substance related, leading to a loss of functioning, cognition, social and physical abilities. 

Most people who come to Rose have spent up to 10 years in standard psychiatric inpatient units and often well over a year in prisons. In fact, 100 per cent have been in psychiatric units and 70 per cent in prisons but only 16 per cent have had any psychological or neurorehabilitation.

So for many, St Andrew’s is the first time they have had some treatment support for their brain injury needs. 

What is the difference between Rose ward and a general neurorehabilitation ward: 

Rose is very unique due to the forensic aspect of the ward. Rose specialises in working with people with high levels of aggression and working with people to help them to find alternative ways to express themselves and achieve goals.

What are the main interventions used: 

Our key intervention is the neurorehabilitation programme. This aims to assist patients in compensating for the deficits they have in communication, volition and motivation, by providing a scaffold structure where they can safely develop skills required for daily life that are lost because of their brain injury or lack of opportunities in early life.

We also do a lot of health promotion and healthy living work on Rose and have presented at conferences and won awards for our work. I think lockdown had a negative impact on most of our waistlines and so we have an opportunity for staff and patients to work together to improve our diet and wellbeing.

What sets St Andrew’s apart:

St Andrew’s provides a clear and structured pathway for neurorehabilitation patients, with evidence-based success for patient outcomes.

This shows how patients progress in terms of increased levels of cognition, social skills, reduced levels of aggression, and increased levels of leave within the community.

Most importantly however, the patients have the opportunity to move towards their life goals. 50 per cent of patients from our Medium Secure Unit go straight to community rehabilitation. Most others advance to low secure. All go closer to home. This is what we are here to do. We do it well and help to shape Better Lives.

St Andrew’s Neuropsychiatric service provides specialist pathways for brain injury, dementia and Huntington’s disease across secure, non-secure and step-down settings. To find out more visit the website HERE

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Brain injury

Expert panel to assess future of brain injury rehab

The webinar on Wednesday will examine the challenges and opportunities in neurorehab now and into the future

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Experts from across the world of brain injury rehab are coming together to assess the future of the sector at an event this week. 

The webinar – What does the future of brain injury rehabilitation look like? – brings together leaders in their field of assess what challenges and opportunities lie ahead. 

Scores of people have already signed up for the hour-long live online event, on Wednesday at 4.30pm, with places still available and questions can be submitted in advance. 

The expert panel comprises:

The event marks the second webinar held by NRC Medical Experts, in association with NR Times, following a successful debate about the Rehabilitation Prescription earlier in the year. 

The upcoming webinar will focus on brain injury rehab, and the advances made in innovation to better meet the needs of people living with life-changing injuries. 

Through changes in technology, developments in medicine and the advances in neurorehabilitation, brain injury patients should face an outlook which is better than ever before. 

However, the lack of resource within health services, exacerbated by the ongoing impact of COVID-19 and mounting pressures on the NHS, mean that progress and change is not being seen at the rate many would hope for. 

“We are very much looking forward to addressing the very pertinent topic of brain injury rehabilitation with our stellar panel, all of whom have a vital role to play in supporting people living with brain injuries and their families,” says Deborah Johnson, editor of NR Times. 

“Innovation and technology is a hugely exciting area, but the impact of COVID on already stretched resources is of great concern. 

“Our webinar will look at the challenges and opportunities that lie ahead, and what more can be done to improve the lives of patients and their families.”

To attend the webinar, registration is required in advance. To sign up, visit here 

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Brain injury

ABI strategy confirmed by Government

Huge breakthrough in support for people with brain injuries comes after Chris Bryant MP introduced the ABI Bill

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The Government has today committed to producing a strategy to deliver better support to people living with acquired brain injury (ABI), following efforts from MP Chris Bryant and an array of charities and leading figures to force them into action. 

In a statement, it was confirmed a strategy will be drafted with a call for evidence being launched early in the new year to help shape its development. 

Gillian Keegan MP, Minister for Care and Mental Health, said the development of the strategy would be co-chaired by herself and Mr Bryant, with senior officials in all relevant Government departments invited to join the board. 

“Following publication, the strategy will be kept under review and may be revised periodically to ensure that it continues to reflect the priority areas and actions needed to best support people living with ABI and their families,” the statement said. 

The move by the Government marks a huge step forward in ABI provision, following years of campaigning from charities and survivors for more support. Mr Bryant recently introduced a Private Members Bill with the aim of forcing the creation of such a strategy, which was due to have its second reading in Parliament tomorrow. 

Mr Bryant – chair of the All Party Parliamentary Group (APPG) on ABI and a tireless campaigner for the cause – had called on the Government to take action to ensure a more joined up approach from Government departments in supporting individuals and families affected by brain injury. 

Last month, he delivered a letter signed by over 200 MPs, charities, brain injury survivors and other providers to 10 Downing Street, calling on the Prime Minister to take action. Following that, Boris Johnson confirmed in Parliament that the Department for Health and Social Care would be looking at the development of such a strategy. 

It has also been supported widely by the public and via social media.

But today’s confirmation is a huge step forward and will ensure the development of an appropriate strategy, with input from families and professionals across the world of ABI. 

Announcing the development on Twitter, Mr Bryant said: “ The Government has just announced it will draft a strategy on Acquired Brain Injury, set up an ABI programme board which will be co-chaired by Gillian Keegan and me, and will call for evidence very soon. 

“So my ABI Bill won’t be needed. Many thanks to all who’ve helped!”

Charities who have been vocal in their support of Mr Bryant’s Bill were keen to celebrate the move, which comes after years of campaigning. 

UKABIF hailed the announcement as “a gift” and the Disabilities Trust said it was “just amazing”. 

The Child Brain Injury Trust added: “Fantastic news to hear. A strategy for ABI has been needed for so long. We are thrilled!”

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Brain injury

UEFA concussion charter urges protection and education

The importance of educating players, coaches, referees, doctors and the public about dangers of concussion in football is highlighted

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A European-wide football concussion charter has been launched, stepping up efforts to safeguard players and urging the education of those involved in the game around the dangers of impacts to the head. 

UEFA has launched its concussion charter, which will apply to all teams taking part in men’s and women’s club and national team competitions across Europe. 

The charter aims to reinforce the importance of good practice in concussion management and highlights the concussion procedures that should be followed. 

It also promotes the education of players, coaches and staff about the concussion procedures in force at UEFA games. Team doctors are being asked to organise specific education sessions to brief players, coaches and staff about the concussion procedure to be followed at UEFA matches.

Furthermore, its 55 member associations are ‘strongly encouraged’ to deploy where possible, a medical video review system at their stadiums to enable immediate and informed injury assessments.

UEFA will facilitate the installation of the system with the host broadcaster. Home teams using a medical review system should offer the visiting team the same system.

Club and national teams are being urged to sign the charter to underline their commitment to safeguarding the health of their players.

In doing so, the signatories pledge their full support for UEFA’s guidance on how to recognise and manage a head injury from the time of injury through to the safe return to football.

“Everyone should know how to react and what to do,” said Tim Meyer, UEFA Medical Committee chairman. 

“Concussion is undoubtedly a serious injury which needs to be managed and treated properly. 

“The health and safety of any players taking part in Europe’s club and national team competitions is of paramount importance not only to UEFA, but also to national associations across the continent.

“Although research studies report a low incidence in football, everyone should know how to react and what to do in the event of a concussion on the pitch.

“By signing this charter, clubs and national teams will demonstrate their support for UEFA’s concussion awareness activities – and take a considerable step forward in helping to protect their players.”

The measure is the latest stage in efforts to safeguard players, following steps including UEFA’s implementation of a keynote concussion awareness campaign in 2019 and the Premier League becoming the first competitive league in the world to introduce concussion substitutes. 

UEFA’s head injury procedure is:

• In the event of a suspected concussion, the referee will stop the game to allow the injured player to be assessed by the team doctor. Players should remain calm during the situation and not interfere with the assessment.

• The assessment should in principle not take more than three minutes, unless a serious incident requires the player to be treated on the field of play or immobilised on the field for immediate transfer to hospital.

• If the assessment cannot be made after the three minutes and/or a suspicion for a concussion arises, the player should not be allowed to continue playing.

• A player suffering a head injury that requires assessment for a potential concussion will only be allowed to continue playing after the assessment, on specific confirmation by the team doctor to the referee of the players fitness to do so.

The decision remains entirely with the team doctor. Coaches, referees and players are not allowed to interfere in the assessment and decision of the doctor.

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