Connect with us
  • Elysium

Brain injury

New guidance for teachers on ABI children returning to school

UKABIF and the N-ABLES programme have joined forces to show education staff how to help children when they return to school after a brain injury.

Published

on

ABI

Teachers and support staff already play an essential role in a child’s development, but their importance is increased tenfold when dealing with a child who has endured a brain injury.

Their return to school is one of the biggest steps of the rehabilitation process, so it is crucial this is done properly.

To make sure all education staff are properly trained in how to do this, the National Acquired Brain Injury in Learning and Education Syndicate (N-ABLES) have launched a new set of resources.

Created in partnership with The United Kingdom Acquired Brain Injury Forum (UKABIF), the information will be used to help children from ages four to 18.

From inclusion to understanding, the resources highlights a number of steps teachers can take to make sure these children are not left behind.

Dr Emily Bennett, consultant clinical psychologist at Nottingham Children’s Hospital, spoke on behalf of N-ABLES about why this information is so needed.

“A lot of the work that we’ve been doing is thinking about how we can upskill teachers,” she said. “They don’t have that background with ABI and what that leads to is a child coming back into school and the impact of that brain injury being missed.

“We also find that over time what happens is behaviours that might come as a result of the injury become misinterpreted or misattributed, so people are forgetting about the brain injury.

“I think the other reason that it matters is that there is this lack of pathways and there’s a lack of joined up thinking across health and education.

“What we found clinically is that it means the teachers feel that they’re left with a situation that they don’t believe they’ve got any expertise in.

“So the guidance really spells out who should be involved, what can they do to help and it’s aiming to get everybody working together and sharing this expertise

Through a set of posters, booklets and educational materials N-ABLED and UKABIF are looking to make sure the unique needs of children affected by ABI are met.

Their younger years are then most crucial for their development, which is why both groups feel this training for school staff is vital.

“Returning to school is absolutely crucial, there’s no doubt,” Dr Bennett said. “For many children schools are actually the biggest rehab provider that they have any contact with.

“We think that probably around 70 per cent of most children’s rehab will happen in school and it’s a place where they’re in this natural, experience rich environment.

“It’s somewhere that they relearn a lot of the skills that they may have lost, particularly with regards to things like cognition and social skills.

“But it’s also somewhere that they can learn to compensate for those acquired difficulties, they can learn new ways of trying to do things and with the right support around them that can be really successful.”

The resources are off the back of an independent inquiry from 2018 which outlined a number of recommendations for the government to undertake to better care around brain injury.

The Time to Change report also displayed some alarming statistics, such as traumatic brain injuries costing the NHS around £15 billion a year.

Furthermore it led to the formation of N-ABLES, which includes professionals from a range of backgrounds including head teachers and both educational and clinical psychologists.

The All-Party Parliamentary Group on Acquired Brain Injury (APPG on ABI) discussed the improvements, including allowing ABI to be classed as a special educational need.

However where UKABIF and N-ABLE’s are currently concerned is around making sure all education professionals have a minimum awareness and understanding of the condition.

The Department of Education has been heavily involved with this, but all organisations are aware that every child’s needs are different and they need to be empowered from this.

“The guidance was made off the back of that Time to Change report,” Dr Bennett said. “One of the recommendations in the education section was that we needed a clear pathway and support for returning to school after ABI.

“What we’re faced with is a situation where there’s a handful of pathways and processes around the country, but in most areas there’s a real lack of any coordinated or collaborative learning around this.

“We discussed clinical experience and thought about how we could produce a set of core principles to provide this effective support around a return to school.

“What we wanted to do was to make sure that the guidance was really focused on the child and young person, but then encouraged professionals to work together around a set of shared principles.”

More recently the UK has undergone some huge changes to its educational practices brought on by the pandemic, leading to a large-scale return to school effort after lockdown.

Dr Bennett says this has been a tough time for those affected by ABI.

“I think clinically our experience has been really mixed. From a rehab perspective, you lose a lot with home schooling, especially that experience rich environment.

“For those who have had an injury during COVID, it’s been really complicated as we’ve wanted to get them back into school and get them that natural rehab that they need.

“It has been more challenging and I think COVID hasn’t helped any of us, but it’s certainly not made life easy for young people with an acquired brain injury.”

Dr Bennett also said there has been a real positive reaction to this new approach from educational staff, with the resources set to be sent out to more schools in the coming weeks.

The guidelines were first announced at The Children’s Trust National Paediatric Brain Injury virtual conference, with that particular charity also recently publishing its own set of recommendations in this area.

Brain injury

High-res computer modelling to shed new light on TBI impact

Published

on

Researchers have created a traumatic brain injury (TBI) computer model that maps blood vessels in a rat brain in the highest resolution yet.

The team at Imperial College London say the models could help improve understanding of how blood vessels are affected by TBI, as well as its effects on the protective layer encasing them known as the blood-brain barrier (BBB), which protects the brain from harmful circulating molecules and pathogens.

If the methods translate well onto human brains, Imperial say they could also help improve understanding of how TBIs develop and how best to treat and protect against them.

The simulations could even help to replace animal models of TBI, potentially reducing the use of animals in brain research.

TBIs are the most common cause of chronic disability in under 40-year-olds and result from severe blows or jolts to the head. 

Beginning at the site of impact, mechanical forces travel in waves through the brain, twisting, stretching, and shearing brain structures as the injury cascades. These forces are known to affect blood vessels, but the finer details of the relationship between mechanical forces and vascular injury are yet to be established.

Now, researchers at Imperial have created a computer model of TBI which maps the network of vessels in the brain – called the vasculature – in the highest resolution yet, incorporating rat brain vessels just 10 microns in diameter.

Using the models, they found that adjacent blood vessels sustain profoundly different levels of stress depending on their alignment with neighbouring ones.

Blood vessels at 90 degree angles to others were less likely to be damaged, and vessels could be stretched to up to 14 per cent of their original length without injury, while stretching by more than this amount would result in injury.

Lead author Dr Siamak Khosroshahi, who conducted the work while at Imperial’s Dyson School of Design Engineering, says: “Our unique approach explains the unrecognised role of the vascular anatomy and shear stresses in how large forces cascade through the brain. This new understanding could contribute to improving TBI diagnosis and prevention.”

The degree to which the BBB lets molecules into the brain is known as permeability. The barrier can become more permeable after injury, making it more likely to let pro-inflammatory molecules reach the brain and usher in further injury.

By using rat models of TBI, the authors demonstrated that greater BBB permeability occurs in TBI as a result of disruption of the vasculature, and that this is most evident soon after injury.

From this information they created brain models digitally in high enough resolution to highlight the vasculature. They found that the computer models allowed them to accurately predict the distribution of stress in the small blood vessels of the rat brains. The models also allowed them to slow down time to look at the details of TBI more closely.

Senior author Dr Mazdak Ghajari, also of Imperial’s Dyson School of Design Engineering, says: “Injury happens in a fraction of a second, making it hard to observe exactly what goes on. By slowing down the process, we can pinpoint exactly which brain areas sustain the most damage and go some way to understanding why.”

The new, high resolution computer simulations could provide a blueprint for studying TBIs using more computers and fewer animal models, in line with the principles of Replacement, Reduction and Refinement (the 3Rs) in animal research.

The researchers say their models could also provide a more objective way to assess protection systems like helmets. Future studies on humans that include detailed reconstructions of the biomechanics of TBI are also needed to confirm the findings before using them to predict injury risk in humans.

The improved understanding of the BBB could also help further research into drug delivery of brain-specific medicines.

Continue Reading

Brain injury

Head injuries in rugby players linked to brain structure changes

A study of 44 rugby players, almost half of which had sustained a mild head injury while playing has revealed a significant proportion had signs of abnormalities to the white matter.

Published

on

A study of 44 rugby players, almost half of which had sustained a mild head injury while playing, has revealed a significant proportion had signs of white matter abnormalities.

It is the first study to assess long term changes in MRI images of professional rugby players. It also revealed abnormal changes in white matter volume over time.

The researchers say that more work is needed to determine the long term effects of rugby on player’s brain health.

The research is part of the Drake Rugby Biomarker Study. It was led by Imperial College London and published in the journal Brain Communications.

The research

The study took 44 players of which 21 were assessed after sustaining a mild head injury called a mild traumatic brain injury.

These are one of the most commonly reported match injuries accounting for one in five injuries. The rugby players were compared to other athletes in non-collusion sports and people who do not play sport.

Participants in the study underwent two MRI brain scans a year apart during 2017 and 2019.

The study used two advanced types of MRI called susceptibility weighted imaging and diffusion tensor imaging.

This reveals the structure of blood vessels and white matter. The white matter helps the brain cells to communicate with each other.

The players were also asked to complete memory tests to assess brain function.

Scientists analysed the brain scans for changes.

The scans revealed that 23 per cent of all the players showed abnormalities to their cell axons or small blood vessel tears. These tears cause small leaks in the brain called microbleeds.

The changes were seen in the players with and without a head injury.

Read more: Same You, a catalyst for change

rugby players in a scrum with their heads and shoulders down

Further research needed

Senior author from Imperial’s Department of Brain Science, Professor David Sharp said: “Despite relatively high rates of head injury and an increasing focus on prevention, there has been relatively little research investigating the long-term effects of rugby participation. More objective measures of the effects of sporting head injuries on the brain are needed to assist with the assessment and management of individual players.

“Our research using advanced magnetic resonance imaging suggests that professional rugby participation can be associated with structural changes in the brain that may be missed using conventional brain scans.  What is not clear at this stage is the long-term clinical impact of these changes.

“Further research is needed to understand the long-term implications of repeated head injuries experienced during a rugby career and to provide more accurate ways to assess risk for an individual.”

Clinical services

The research was funded by the Drake Foundation. A not-for-profit organisation focused on understanding and improving the health and welfare of people impacted by head injuries.

It was supported by National Institute for Health Imperial Biomedical Research Centre, the UK Dementia Research Institute and the Rugby Football Union (RFU).

Dr Simon Kemp, medical services director at the RFU, added that a specialist clinical service for the assessment and management of retired elite players will be provided. It aims to assess the brain health of players.

“We welcome any research that helps to advance our knowledge which is why we actively collaborated with the academic institutions on the Drake Foundation Rugby Biomarker Study from its inception, particularly to promote the recruitment of players.

“While it is unclear from that research what the individual long-term implications are regarding the brain changes seen in these advanced imaging techniques, it is clearly a priority to investigate this further.”

Read more: Seven devices that are revolutionising dementia care

Continue Reading

Brain injury

Community rehab programme saved by brain injury charity

Published

on

A vocational rehabilitation programme in the North East aimed at getting those living with a brain injury back into working life has been resurrected by a community charity.

Headway Tyneside worked closely with the NHS and fellow charities, Headway County Durham and Headway Darlington & District, to ensure the programme could continue following last year’s closure of Newcastle-based providers, Momentum Skills.

‘Headway to Work’ is the newly-branded service which will support around 14 people per year living in Durham and Darlington. Each participant will be individually assessed by therapists to gain an understanding of their difficulties, enabling the team to offer personalised support throughout the programme.

The training focuses on improving self-management skills such as self-care, goal setting, productivity, sleep and fatigue management, as well as technical skills such as IT and literacy. The final phase of the programme will involve voluntary placements for participants to ensure they feel comfortable, confident and have the relevant vocational skills before seeking paid employment.

In the future, the group hopes to deliver the ‘Headway to Work’ programme across more parts of the North East, within Gateshead, Newcastle, South and North Tyneside.

Alistair McDonald, chairman at Headway Tyneside, explains: “We all know how incredibly difficult the past 18 months have been. Those with disabilities or long-term health conditions have been especially vulnerable. The Momentum programme was well received and helped lots of individuals with a brain injury plan a route into employment, education or training and it’s fantastic that we can continue to deliver this type of service.

“The service will now be delivered closer to where participants live rather than having to travel to Tyneside. Less travel and being in a more familiar place should help people feel less fatigued and provide an opportunity to socialise and development friendships with other learners local to them.

“Currently, we have around 10 staff, including Julie Meighan our clinical service development manager, who will oversee training sessions run by a neuropsychologist and job coach. Julie worked as a specialist brain injury occupational therapist for many years so has the clinical knowledge and experience this programme needs.

“Our fantastic team of committed volunteers will support the delivery of this vital work to those who want to prepare for a return to work or plan a route into employment, training or education.”

Headway Tyneside is an independent charity providing support services to brain injury survivors and their families. In recent years, the board of trustees has developed a strategy to grow the scale and scope of services to provide more diverse and specialist services to their members.

Continue Reading

Newsletter



Get the NR Times update

Trending