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In the wrong brain injury profession?



Over 90% of case managers in the brain injury field would recommend their career to others – and more than seven in 10 say they enjoy their job.

This is well above the UK national average and on par with the satisfaction levels found among the clergy, teachers and chief executives, says Nockolds Solicitors.

It is also in stark contrast to members of the legal profession, with whom case managers work closely, finds separate research.

Over half of personal injury solicitors say they would not recommend their line of work to others, reports Exchange Chambers.

Angela Kerr (pictured) is the chair of BABICM (British Association of Brain Injury Case Managers), which has over 700 members in the UK. She is also managing director at Nottingham-based AKA Case Management.

Being able to work closely with clients, and contributing positively to many difficult, individual situations can be life-affirming for case managers, she believes.

“Case managers support their clients to overcome life changing injuries, working individually with them to access services unique to that individual’s needs. The closeness of the relationship that develops over a long period of time allows case managers to see the value they can bring, to each and every person they work with.

“Generally, positive outcomes are achieved albeit over many years. Case managers ride the rapids of a client’s recovery through the highs and lows which enables them to connect closely and build trust with them.

“Support is also offered to families, allowing them to develop an in-depth understanding of the situation and adjust to the limitations of the client’s disability.”

Kerr said these relationships develop over a long period of time – as a case manager, she is still working with clients 15 years on from appointment – allowing a deep bond to develop between all parties.

“In many ways your aim is to work yourself out of a job, and that’s fine, as the aim is for your patient to regain as much independence and where possible, for them to get to a certain level requiring minimum help.

“Your role then becomes one of adding value to their lives as they overcome the challenges they face. It’s a very rewarding professional life,” she added.

The job satisfaction findings come in a Nockolds Solicitors paper; ‘The Challenges Case Managers Face in Order to Achieve the Best Possible Outcomes for their Clients’. Meanwhile Exchange Chambers finds 56% of solicitors would not recommend a career as a personal injury/medical negligence specialist to others.

Bill Braithwaite (pictured), QC, head of Exchange Chambers, said: “The reason so few personal injury solicitors would
recommend their career to someone else is that so many of them aren’t involved in really satisfying work.

“Much personal injury litigation is low value, high volume, which may produce lawyers’ profits, but certainly doesn’t look like a worthwhile career.

“Case managers, on the other hand, are undoubtedly setting out to achieve something of real value for people who need all the help they can get.

“In my world of catastrophic brain injury, which is where case managers started – I lectured at the first public meeting of BABICM in 1996 – the first thing a good lawyer will recommend, if money is available, is the appointment of a specialist brain injury
case manager.

“If the patient is lucky enough to have a good case manager, he or she will achieve an enormous improvement in condition and prognosis, and will help to make rehabilitation and later life a much more enjoyable experience for the patient and the family. “Why wouldn’t you recommend that career to someone else?”

Rachel Davis (pictured below), a serious injury specialist at Nockolds Solicitors, said: “I expect the big difference is down to the fact that case management is about assessing a client’s needs and improving their quality of life through care and rehabilitation, while personal injury lawyers deal with the litigation side, the defendants and the costs regime – it can be very frustrating at times.”

Stresses exposed; Further research required

Both pieces of research also highlight the stresses that surface in the relationships between care managers, clients, client’s families and personal injury solicitors. Exchange Chambers’ Case Management Process Survey found 56% of claimant solicitors have sacked and replaced the case manager during the course of their client’s recovery process. Also, over three-quarters of claimant solicitors say they have experienced a situation where the family has not acted in the best interests of their seriously injured relative.
Rachel Davis

In more positive findings, 73% of solicitors say case managers always act in the best interests of the client. However, the Nockolds Solicitors survey found that 81% of case managers have experienced a situation where a claimant solicitor has ‘clearly not acted in the best interests of the client’.

It reports the biggest headache for case managers is the rate at which funding is released; while also finding that over two- thirds of case managers have been verbally abused by their client or client’s family and 13% have been physically attacked.

Braithwaite said: “The themes emerging from this research can act as a catalyst to improve the whole claims and rehabilitation process. “An open dialogue between all parties needs to start now. Serious issues need addressing. Everyone must act in the best interests of the injured person, otherwise the whole system breaks down.”

Davis concluded: “There is clearly a perception that family members, solicitors and case managers are, on occasions, not acting in the best interests of the injured person.

“Whether this is intentional or not, there is simply no excuse for not putting the injured person first. It is particularly worrying because in serious injury cases, traumatic brain injury for example, survivors are likely to have complex long-term problems affecting their personality, their relationships and their ability to lead an independent life. They are extremely vulnerable and often dependent on the support of those around them.”

Commenting on the role case managers play, Braithwaite added: “I’ve always thought that a good case manager was the key to a successful outcome for the injured person, the family, and the compensation claim.

“If you appoint a good case manager early, and that person has the ability to get to know the family, gain their trust and confidence, and help to manage the stormy voyage through recovery and rehabilitation, that person will be an invaluable contact point for the solicitor, frequently helping him or her to avoid disturbing and distressing the family.

“So much of the litigation is bound up with the injured person and the family, and the plan for life, that it seems to me to be obvious that the case manager should be involved in some part of the litigation process.”
Kerr described the research as interesting, “having triggered many questions”.

She continued: “We have spoken to Exchange Chambers in acknowledgement of its research which is adding to the conversation between professionals.

“The survey is interesting, although we would not necessarily support its findings and would like to develop a more validated hypotheses in conjunction with BABICM’s research partners at Plymouth University.”

She went on to say members of the BABICM council had not been approached to participate in the research and felt further work was needed to more accurately quantify the value of case managers.

She also explained that BABICM was looking to establish a regulatory body in conjunction with the other professional bodies involved in case management work.

Braithwaite summarised that the surveys show there is room for improvement in managing the relationship between case managers and personal injury solicitors.

He continued: “Moving forward, the starting point for me would be to ensure that personal injury lawyers are truly expert in what they do. “Since time immemorial, personal injury has been an area of work that many or most lawyers think they can manage alongside their other areas.

“I’ve found, over more than a quarter of a century, that true specialisation really works; clients appreciate the knowledge that you bring to their problem, and the whole rehabilitation and litigation process is much better managed.

“That expertise in the lawyers would naturally lead them to appreciate good case managers and recognise bad ones. That would lead to more scrutiny of what case managers do, and so raise the standards.

“Equally, good case managers would – as they do now – help the family to identify the non-specialist or inappropriate solicitor or barrister and support them in finding a good alternative.

“Developing the relationship between the two professions, and enlarging their knowledge, would inevitably improve standards.”

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How can clothing help people affected by brain injury?



Inclusive fashion may seem obvious to those with a disability, but the fashion industry has a long way to go, argues Emma McClelland, founder of inclusive womenswear label Kintsugi Clothing.

It seems strange that, while the fashion industry is often experimental and boundary-pushing, designers are reluctant to relinquish conservative practices elsewhere.

Diversity on the runway is infamously poor. As you filter down to the high street, it improves slightly, with fractionally better representation of plus-size and disabled people.

But the looks you see in shop windows aren’t usually designed inclusively, regardless of whether the model wearing them has a difference.

As a matter of semantics, some of the people I’m referring to when I write the world ‘disabled’ don’t identify as disabled. I also use this phrase to mean people who are living with the physical effects of brain injury – effects like muscle weakness, for example – and people whose impairment is temporary, such as people who are recovering from surgery.

Emma McClelland

Clothing can add value for many people when it’s designed inclusively, not just for the size 8-10, white, non-disabled and tall, toned male ideals we’re used to. Don’t disabled people just wear “normal” clothes like everybody else?

Some can, and do. Likewise, some people need – or simply prefer – clothing that has been adapted specifically to solve challenges presented by certain impairments or health conditions.

This is why adaptive clothing is so important.

Take, for example, a woman whose brain injury has caused ataxia. The tremors in her hands make fastening small buttons a frustrating endeavour.

Adaptive clothing might come into play here with a blouse that appears outwardly to have buttons down the front but actually has concealed magnets that make dressing easier.

Or, say someone is using a wheelchair because their brain injury has caused hemiplegia. Trousers designed to be worn in the seated position – with a specific fit, longer leg length or higher back – are a specific solution.

They’ll probably also have pockets located further down the body (rather than at hip level) to make them more accessible when seated, and belt loops to help with pulling them up.

These are just some examples of the power of adaptive clothing design. ‘Adaptive’ and ‘inclusive’ design are often used interchangeably but there is a difference.

If adaptive design refers to clothing that has been designed specifically to meet certain needs, inclusive design refers to clothing that has been designed with some of those needs in mind.

Sadly, when it comes to fashion, that imagined customer is rarely disabled. Items are made without the company thinking about how their products will be used by people with disabilities.

This is where inclusive design comes into play.

Fashion brands should be creating clothing that anybody can wear, not just a specific person with specific needs. For the designer, it’s about thinking about how certain elements could add value to someone with a difference, whatever that difference may be.

For example, using certain fabric types and not using scratchy internal labels might make the world of difference to someone who experiences sensory irritation as a result of their condition.

For any other person, those features might be nice. They might not care about them at all. But they are still there for those who do. They are ‘inclusive’ features.

Inclusive design matters because we live in a world where 15 per cent of the population experience some form of disability. Any one of us can develop a disability – even if temporarily (after a leg or arm break, for example).

Brain injuries are an example of how someone’s world can change in an instant. If that happened to me, I wouldn’t want to be faced with a world so inaccessible that clothing is a struggle and dressing myself is exhausting.

Nor do I want to feel limited in terms of style. This is why I set up Kintsugi Clothing: to create beautiful, accessible apparel that is inclusive of a range of body types.

Fashion is something we should all be able to enjoy and it’s not as difficult as some brands might think to be inclusive about your design process. Ask disabled people what would make life easier for them and think about how you can work some features into your designs that will add value.

Inclusive design is a developing niche and I, for one, can’t wait to see where it goes in the future.

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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.



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 

Fitting COVID-19 guidelines into your routine

Keeping a check on your wellbeing

How to keep in touch with loved ones during the pandemic

How to keep a routine during the pandemic

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Brain injury in the new normal: How to keep a routine during the pandemic

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



Daily structure has changed for us all during the COVID-19 pandemic and this can feel very unsettling. A regular structure and routine is important for many reasons.

First, it increases feelings of normality and control, as well as meaning and purpose; all of which can help to push back against low mood. Second, it can reduce feelings of stress and anxiety through distraction.

Finally, a structured timetable can reduce the burden associated with some of the behavioural and cognition issues that can occur after brain injury. These include difficulties in starting an activity, planning, organising and making decisions.

So what can structure and routine look like during the pandemic?

A daily routine could include a mixture of self-care activities, such as having a bath, shower, or pampering yourself, completing some household chores and keeping active through exercise. Doing something fun that you enjoy, such as an online live music event, a quiz or watching a favourite film or TV programme, could also be included.

Try focusing on those activities that you find uplifting, positive or funny. Also some find it helpful to limit their watching of the news about COVID-19 as it can lower mood and increase their worries. There are lots of ideas for activities you can do at home in our resource pack which can be viewed via the ABIL website.

Having a daily timetable written down can help to ensure that structure and routine become the norm. It can also be reassuring to be busy and have things to do.

Checking off activities completed, can support you in feeling that you’ve achieved and accomplished things throughout the day.

Furthermore, a written timetable can help you to manage your time effectively, and support variety in your day. If you have difficulties getting started on something, or beginning an activity, you could share your timetable with someone else and ask them to help you get started, perhaps through a phone call or a text.

If you prefer to do this yourself, you can set up reminders on your phone or use other devices, such as Alexa.

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

Fitting COVID-19 guidelines into your routine

Keeping a check on your wellbeing

How to keep in touch with loved ones during the pandemic

How to get a good night’s sleep during the pandemic

Continue Reading
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