Having had a career as an elite athlete abruptly ended through a freak accident, Drew Graham now dedicates himself to inspiring others through exercise.
Drew’s Pop Up Gym – a dedicated facility in the North of England for people with spinal and neurological injuries, alongside a number of outreach sessions across the region to bring the service closer to those who need it – illustrates his passionate advocacy of fitness as a means of rehabilitation.
Research has shown the benefits exercise can bring to people who have suffered brain injuries, with improved weight and stress management, emotional regulation, and increased strength, energy and attention all being directly linked to regular fitness sessions.
One report concluded that brain injury survivors, who engaged in exercise three times per week for 30 minute intervals, reported less depression, improved perception of physical abilities and increased community integration in comparison to those who did not exercise regularly.
And it is through Drew’s own experience that he has created a gym and associated sessions solely for people who have mobility or paralysis issues as a result of a brain or spinal injury, to increase the accessibility to fitness and avoid the feeling of being the ‘odd one out’ in mainstream gym facilities.
It was back in September 2014 that Drew, while training for a triathlon in the United States, jumped into a lake and broke his spine leaving him quadriplegic.
He spent three months in a US hospital and benefitted from its ultra-modern rehabilitation centre – but it was when he returned to the UK that he realised the absence of such specialist facilities for patients in this country.
“There are gyms that people with wheelchairs or disabilities can go to, but there is usually a very limited amount of equipment specifically for wheelchair users, if any at all. I often felt like the odd one out, like everyone is looking at me, and that can be very off-putting for people who could be getting the benefit of exercise as part of their recovery,” said Drew.
“The gyms that are most accessible charge anything from £60 to £100 a session and that is too much for most people. They may be able to go once or twice, but it can’t be a regular thing as costs mount up. I wanted to create something where people like me would feel comfortable, where I can exercise and get the benefit of that, and be able to socialise with other people too – statistics show that 20 per cent of wheelchair users are socially isolated, so that social aspect is hugely important.
“I thought that instead of whinging about the lack of these types of places, I’d create one myself – and the fact that we are pretty much at capacity for all of our sessions tells its own story about how much somewhere like this was needed.”
Since opening a year ago, Pop Up Gym, which operates on a not-for-profit basis, has proved a popular resource for people with brain injuries across the North of England, many of whom travel for miles to visit Drew’s site in Gateshead, Tyne and Wear.
Those who are recovering from strokes are among the most frequent users, and already there have been many examples of strong progress through using the gym in addition to their programmes of physio and other therapies.
Pop Up Gym, as well as offering gym equipment and tailored sessions, is keen to promote a holistic support system to its users, working closely with other professionals and organisations to give people the best possible chance of recovery through an effective rehabilitation programme.
Significant investment has been made in fitness equipment to aid recovery from paralysis and immobility with functional electrical stimulation (FES) bikes alongside a host of other equipment, including arm bikes, upright rowers and wheelchair accessible weights machines.
Its equipment is valued at over £100,000, making it one of the most advanced specialist fitness facilities of its kind with an array of state-of-the-art equipment. And at £10 a session, it has been priced to be accessible to anyone who needs it.
The nature of people’s injuries and medical needs will determine how much physical activity they can do. But experts have highlighted the benefits of cardiovascular workouts (through using machines like the bikes or rowers), strength training to challenge muscles (which can involve use of weights and resistance bands), and flexibility exercises, to help stimulate brain injury patients.
“We have a lot of regulars who have had strokes, and people who have other neurological injuries, and we have trainers here who can help and support them. Through my own experience I understand the road to recovery and the many challenges you face on a daily basis. It is so rewarding for the whole team to see the progress people make over the course of weeks and months,” said Drew.
“For example, we can use our machines to help people strengthen their weak side or weaker parts of their body, our team are able to help them regain and re-learn the strength and co-ordination they once had.
“There was one guy recently who had a stroke and he couldn’t drive, gradually he has been able to get to the point where he is driving again and it is such a great feeling that we have helped him with that.
“The fact we are also helping with the social isolation so many people feel is very important to me. This is something that is widespread among people with brain injuries or other disabilities, but here we have created a great community.
“Our youngest gym user is 18 – anyone from the age of 16 can come here – and the oldest is 79. There are all ages, all backgrounds, everyone is different but they have things in common too through their shared experience.
“We have lots of laughs and help people through the difficult times that of course arise. Exercise is so important and we are here to support and encourage all the way.”
Drew continually seeks to highlight the benefits of exercise as part of the rehabilitation process, and believes gyms which cater for people in wheelchairs should be much more commonplace.
With his own fundraising efforts prior to opening Pop Up Gym securing over £50,000, and additional support being received from the likes of the Matt Hampson Foundation – established to help support and inspire seriously injured people through the means of sport and physical exercise – Drew believes there is scope to develop the concept further across the UK.
“Things do have to change with regard to provision for people in wheelchairs, I think it is a great shame there are not more Pop Up Gyms out there. We would love to operate from places across the country, but that’s in the much longer term – there is a need for these type of centres now to help people with their recovery, and I would love to see greater numbers of gyms for people with disabilities in a developed country like ours,” he said.
“Exercise using the kinds of specialist equipment we have can be very important, and in this kind of environment too, it was hugely important for me and we see it with the people who come to us.
“The NHS does its best but there just isn’t the funding available for this sort of thing, and private sector gyms are often too expensive for people to access. Operating as a charity works well in this sector and gives the opportunity to everyone, not just those who can afford it.
“Hopefully we can inspire others to follow our lead and see the need to open gym access up to people in wheelchairs, as this can play a big role in recovering from brain and spinal injuries.
“It’s a great pleasure to be able to support people in the way we are and to see the benefit and enjoyment they get through coming into the gym, but I do hope that becomes much more widespread and common in the UK as it is certainly needed.”
Pop Up Gym was recently named as one of Irwin Mitchell Solicitors’ Charity of the Year for 2019 and will benefit from the firm’s annual fundraising drive. Read more here.
The couples therapist who rehabilitates love after brain injury
Trained couple’s therapist and neuropsychologist Giles Yeates helps support couples and families and their connection and intimacy after a brain injury. He talks to NR Times about how couples can resume their sex lives after brain injury.
“It’s about reconnecting that sense of closeness and connection, I’m trying to rehabilitate love,” he says.
“After a brain injury, the focus is on the injury and regaining independence, rather than interdependence, but many families ask for this.
“When people talk about personality changes, saying the person is different and the connection feels damaged or wrong, couples therapy is way to help them find their way back to each other.”
But it isn’t the standard to offer couples therapy in the care pathway following a brain injury, Yeates says.
Many couple’s therapists who don’t work with neurological conditions don’t have the skills or understanding of the impact of a brain injury on a couple’s relationship and the heartbreak, he says. This is why Yeates focuses on a specific type of therapy that prioritises emotion.
“Emotionally focused couple’s therapy ticks the boxes straight away. It works on slowing people down. It’s about what happens in the sessions between couples.
“It’s neuro-friendly from the beginning, getting people out of their heads, to notice and communicate their emotional needs of each other that doesn’t engender further conflict, in a way that supports connection. It’s not a panacea, but it’s given as an option for couples to try,” he says.
Research, Yeates says, shows that the mental health of the brain injury survivor and their partner, and the strains on their relationship, all worsens from two to five years after the injury.
“Someone had a life-changing event and is in hospital, they lived, and they start to make improvements. Then, it’s only when they’re back home and the dust is settled do couples realise it doesn’t feel the same anymore.
“Or maybe the partner has to do a lot of physical care that has challenged the intimacy between them, that shows the emotional connection isn’t the same.”
It’s at this point, Yeates says, couples often decide they need help. But services may have fallen away by the time they reach this point.
“Often, services have fallen away by the time these needs show themselves. It depends on the availability of the community team or third sector organisation as to what support they can offer, which varies on the postcode lottery.”
Some people might reach out to a general couple’s therapist, Yeates says, who has no experience of working with people with neurological conditions, or a neuropsychologist who isn’t trained as a couple’s therapist.
“There are unique challenges here to consider, but accessing the right type of support is difficult.”
Yeates has found, from general feedback, that people would like to be asked more often by clinicals about their sex and intimate live.
“In the services I work in, I always ask people, and most people are relieved to be asked about their sexuality after a brain injury. For a survivor, sex after a stroke can be affected in so many different ways, in the same way people’s memories can be affected.
“People describe the experience of their sexual identity changing, of what turns them on being different, now, a sense of what feels possible to express themselves sexually is different now.
Perhaps they have cognitive difficulties that mean sex can’t be spontaneous anymore, for example, Yeates adds.
“From a couple’s point of view, it’s complicated, because a breakdown in sexuality can often be reflective of an emotional breakdown between them.
“Having therapy on how to do things differently in the bedroom might not be a priority for them, they might not feel emotionally safe or supported with their partner right now, and maybe this needs addressing first.”
When the emotional side of the relationship is good, Yeates says, couples should find ways to be supported to resume intimacy together.
“If someone is paralysed on one side, it’s about finding new ways to explore different positions, for example, or using physical aids, discussing ideas of how to express themselves and enjoy sexual contact in different ways.”
Yeates is happy to have noticed the uprising of a disabled sexuality movement outside of the brain injury area.
“The movement is saying that people with disabilities have the right to an exciting sex life, as much as anyone else.”
But this conversation is important for brain injury survivors, too, he says, as it’s important to think creatively and challenging norms to think outside the box of what sex is, Yeates says.
“This part of life after a brain injury gets overlooked and doesn’t get the attention it deserves. But for a survivor or a couple, it has loads of payoffs with mental health, wellbeing and connection.”
Yeates says there isn’t enough awareness among doctors, either. For example, he says, a person with a brain injury might experience side-effects of medication including loss of libido or erectile dysfunction, which can then lead to depression or low mood, but they often can get passed from a neurologist to a urologist, and no one speaks about things from the perspective of the person’s sexuality.
Yeates also works with brain injury survivors who aren’t in relationships, who want to develop the sexual component in their lives.
“I support people to use escorts a lot in my work, which is a contentious issue. There’s a lot of discomfort on the part of professionals, which is leaving service users high and dry to that dimension of their lives.”
But for those going to see escorts, the pandemic, particularly the lockdown, made it more difficult.
“In the lockdown, people can’t access sexual services in the same way. One client was able to resume going to a massage parlour and get intimate care, but the massage therapist was wearing a facemask and nothing else – if it wasn’t complicated enough already, this has added to it.”
Yeates has co-written a series of leaflets with Headway on relationships and sexuality, and a series of videos for Different Strokes on sex after a stroke, which can be viewed here.
The light and shade of brain injury recovery
When comic artist Wallis Eates saw an ad from Headway East London looking for an artist in residence for the charity’s art studio, she knew she had to apply…
Headway’s East London studio provides a place for members, who all have acquired brain injuries, to create artwork.
Eates’ own line of work leading up to this included autobiographical comics, and digital storytelling with prisoners.
“I’d been looking for ways to help others share their stories or collaborate on story-sharing,” she tells NR Times.
Eates applied for the artist in residency, outlining in her application that she’d like to do comics of Headway members and incorporate their work into them. Eates’s application was successful, and she spent six weeks going into the studio three times a week.
“I was allowed to mill about, sit at the desk and ask what they were up to. They’d share their work with me, and I’d tell them about my project,” she says.
“They’d share experiences with me that I’d remember when I was looking at their work online, later, to see how I could combine it all.”
Eates says the experience made her feel inspired, and she came away with a strong feeling of the sense of community she saw in the studio.
“It was such a vibrant atmosphere,” she says. “I knew everyone was managing all kinds of stuff in their lives, stuff connected with their brain injury, and they were coming to the studio and creating incredible pieces of artwork.
“It reminded me of when I was in school when we did art and I wasn’t precious with it, I was doing it for the love of it. That’s what they were doing in the studio.”
The experience made Eates think about the individual and the collective, and she wanted to explore the dynamic between the two via shared experience.
Eates was taken up by Unbound, a publishing platform that supports people to crowdfund the funds to publish books. She’s currently halfway through her crowdfunding, before her finished book, Like an Orange, is published.
She says the name of the book came from several inspirations.
“One of the members I spoke with, who’d fallen down the stairs, said the brain surgeon he worked with said that the head is like an orange. That’s all he told me, but I assume he meant the elasticity, the texture.
“I later spoke to someone else who said the surgeon told her her brain was growing tumours like Saville grows oranges.”
Eates didn’t know anything about brain injuries before going into the project – and she’s learnt several lessons she hopes to pass on to readers of Like an Orange.
“I kind of knew brain injuries would affect everyone differently, and I went in with that agenda, ensuring the uniqueness of each member comes through.
“The biggest lesson I learnt was when we went on a daytrip to the Tate museum and I saw how invisible disabilities can be. Some of the members had nothing visible about them that suggested they were having a challenge walking down the road, but I knew they were,” she said.
“That really brought home to me how, when we go out onto the streets, we don’t know who we’ll be sharing that space with, we don’t know what’s going on with anyone who’s around us.”
“One chap kept going in front of the road or walking in front of people. At any time, we could be walking down the street and passing someone with a brain injury.”
Eates was also surprised to see such a positive atmosphere in Headway’s studio.
“Two members said they wouldn’t go back to life before their bran injuries,” she says, “because the lessons they’ve learnt have been more valuable since before then. It was extraordinary – I want to share these things in the book.”
Eates is looking forward to the members seeing their work in the final book.
“Most of them didn’t work autobiographically, they did artwork for the pleasure it, for escapism, focused concentration, and the joy of applying colour,” she says.
“It will be interesting for them to see how their artwork and their stories have inspired others.”
Scottish MP talks rehab, criminal justice and out-of-work assessments
NR Times speaks with SNP MP, Lisa Cameron, about her background as a clinical psychologist and how long-term issues related to brain injuries are often overlooked.
Lisa Cameron’s attention is on countless important issues in her role as SNP MP for East Kilbride, Strathaven and Lesmahagow in Scotland, but she tells NR Times why she is particularly interested in policies relating to brain injuries. Before becoming an MP, she previously worked as a consultant clinical psychologist and is chair of the All-Party Parliamentary Group on Disability.
“When I was working as a psychologist, I was undertaking assessments of people with brain injury in relation to memory, executive function and language,” she tells NR Times.
“I’d routinely do assessments in practice, working with people on the front-line with brain injuries.”
Cameron also has second-hand experience, as her husband acquired a brain injury when he was serving in the Armed Forces. Thankfully, he received fast rehab, but the experience only highlighted to Cameron the importance of rehab and ongoing support for brain injury patients.
“I became aware from a personal point of view that these issues are often overlooked,” she says.
“Although someone might have treatment initially, often there are long-term consequences that go unnoticed, or support isn’t there over the long term and I feel it should be, particularly for veterans.”
Cameron often hears about the same pattern unfolding among her constituents, as well as problems accessing financial state support.
She has previously raised the issue of ‘inadequate’ personal independent payments (PIP) and employment and support allowance (ESA) assessments for people with brain injuries in the House of Commons.
“Someone with a physical disability has assessments with the Department for Work and Pensions to be assessed for financial support, where there’s often an underlying brain injury that may be historic on their medical records.
“But assessors don’t realise or understand that their functioning may not return to pre-morbid levels, and that there will be a residual impact on the person’s memory, potentially their language, their ability to plan and their executive functioning, and often these things aren’t picked up with benefits assessments.”
Unless someone has a really traumatic brain injury, Cameron says, they’re often not tested, despite the fact that much less severe brain injuries can often still have a massive impact on someone.
The coronavirus pandemic is exacerbating these issues, says Cameron, who is seeing diagnosis and assessments being delayed even more than usual in her constituency.
“That’s having an impact on constituents in terms of the support they have, and their access to appropriate welfare support,” she says.
Cameron has seen that, unless someone is admitted to hospital at the time of their brain injury, and undergoes extensive testing, there can be years of delay before the person is referred for assessments.
In Cameron’s constituency, there has been such a delay that a specialist service has been running outside of the NHS to alleviate pressure on the NHS for a number of years. She sees the positive and negative impacts this is having on the community.
“It’s preferable if services are conducted within the NHS, but the practicalities of things being the way they are currently mean that’s not happened, the NHS isn’t really able to manage this within the timeframe.
“For people who have been able to access it, it’s had positive benefits for them in terms of getting diagnoses, but the specialist service creates barriers where people can’t afford it, which creates inequality in the system.”
However, the service does get some referrals from the NHS to reduce patients’ waiting times.
“It’s good if people can access it from all backgrounds and it doesn’t undermine services the NHS is providing,” she says.
Away from her constituency and in Westminster, Cameron has found that, in her role as chair of the All-Party Parliamentary Group on Disability, there’s also a lack of understanding of brain injuries.
“People get confused between brain injuries and developmental disorders, spectrum disorders and mental health issues in parliament,” she says.
But Cameron has found this isn’t unique to parliament.
“When I worked in the prison service and going in to do assessments on people, there was a lot of underlying brain injuries that were unassessed. They were demonstrated in terms of impulsivity, lack of planning and poor executive functioning.
“This is a huge issue that needs to be addressed within criminal justice.”
Cameron says there should be basic training for prison officers around spotting brain injuries, and routine testing and assessments for brain injury when people are placed on remand.
When Cameron visited prisoners, she’d hear about prisoners who’d had three or four brain injuries, but no one linked it to difficulties they were having until she asked about their memory or executive functioning.
“Awareness training for prison officers and police officers would be helpful, and assessments for people on remand or in the system already, to ensure they get adequate support and any particular issues linked to their medical condition can be flagged up. This would definitely help recidivism rates.”
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