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Sleep disturbance linked to slower progress in rehab

New evidence that post-brain injury sleep problems can slow the pace of recovery has emerged from an obervational study.

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Researchers analysed the sleeping patterns of 59 people with brain injury staying in a rehabilitation unit in Oxford, and 55 people who didn’t have a brain injury and were at home.

Participants were asked about their quality of sleep over a month and wore a monitor on their wrists that recorded movement, which would suggest sleep disruption.

Those with brain injuries reported having lower quality sleep, and the monitors recorded more disrupted sleep compared to the control group.

People with brain injury who had less disrupted sleep recovered quicker than those who had more disrupted sleep. They scored higher on arm/hand function tests, showed less overall movement impairment in their affected arm and legs and were more mobile.

This is because disrupted sleep can impair learning, says Melanie Fleming, researcher at the Wellcome Centre for Integrative Neuroimaging at the University of Oxford, who led the study, which was published this month in the ‘Neurorehabilitation and neural repair’ journal.

“Our main hypothesis is the idea that if you don’t sleep well, you don’t consolidate what you learnt from your physio session that day, and don’t make improvements day to day as quickly as you might if you consolidate what you learnt better,” Fleming says.

“There’s a lot of research showing that if you learn a sequence of movements then sleep overnight, you learn it better in the morning than if you were to stay awake during the night and try again it in the morning.”

Fleming didn’t directly measure how much patients engaged with rehabilitation, although she did measure how much time people were sedentary and active, but didn’t see any patterns.

“Some studies have looked at staff from rehabilitation units who say they feel people don’t engage as well when they’re reporting having bad sleep, which is easy to see – if you’re exhausted in the morning after a terrible sleep it’s very hard to then go to a physiotherapy session,” Fleming says.

Between 30 and 70 percent of patients experience sleep disturbances after a brain injury and have at least one sleep disorder, research has found.

This can partly be attributed to the noises and other disturbances ongoing throughout the night in hospital environments, but it’s not the sole cause.

Fleming says brain injuries themselves can also impact sleep quality due to damage to parts of the brain that control sleep, as well as low mood, which occurs more often in people with brain injuries, and is associated with difficulty sleeping.

Fleming’s study was observational, which means it couldn’t prove a cause-and-effect relationship between sleep quality and recovery. The most effective way to find this out would be to do an interventional study where researchers try to improve people’s sleep in hospital and see if it effects recovery. Fleming is currently in the process of applying for funding to carry out research of this nature.

“This study can’t say if people are sleeping poorly, but it’s common sense,” she says. “Low mood and poor sleep are really linked. Quality of life is better if you can improve a person’s sleep, and they engage better in rehabilitation.

“The main takeaway from this study is that when people say they’re sleeping badly, they really are – we need to be thinking about this when we think about the rehabilitation environment.”

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Two major neuro events postponed due to COVID-19

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The Neuro Convention and The National Paediatric Brain Injury Conference have both been postponed

Two significant events in neuro practitioners’ calendars have been delayed until later in the year, as the effects of the COVID-19 pandemic continue to be felt.

The National Paediatric Brain Injury Conference, which was already revised from an in-person to online event, will now not go ahead as planned in February due to the continuing demands on frontline healthcare professionals as COVID-19 cases continue to rise and the country is plunged back into lockdown.

The event, organised by The Children’s Trust, is now earmarked for May 13, although that is subject to further developments in the pandemic.

The ‘Connections and Collaborations’ conference is set to attract an international audience and will hear from an array of speakers from around the world, many of whom are global leaders in the field of paediatric neuro care.

Explaining the postponement, Dalton Leong, chief executive of The Children’s Trust, says: “Over the years, a high number of attendees are from the NHS, including consultants, doctors, surgeons, nurses, and therapists.

“We know that many of these staff are being redeployed to support the Covid pandemic.

“To run a conference at this time, taking them away from delivering vital frontline services, does not seem a sensible option. We look forward to holding the conference later in the year when, hopefully, these pressures have reduced.”

As well as the conference, the Neuro Convention too has been postponed, moving from March until September to enable delegates to attend in person.

The event, held at the Birmingham NEC, typically attracts around 3,000 people from across the country, and organisers hope that by delaying the date, it will give the best chance of lockdown and social distancing measures being lifted to allow them to go ahead.

In addition to the event planned for September 15 and 16 – although that too may be subject to change – an additional digital version of Neuro Convention is set to go ahead in March, enabling neuro professionals to still receive the insight and analysis planned for the NEC event in an online format.

Neuro Convention is hailed as being Europe’s only specialist trade event for brain and spine experts, and boasts an array of internationally-respected speakers and leaders in their field.

“We have been in consultation with various Government departments and whilst the rollout of the vaccine has given the country much needed optimism, we have been advised that we will be unable to host the Neuro Convention event in the spring,” say event organisers Roar B2B.

“The safety of our visitors, customers, partners and staff is paramount. We are confident that moving the event to September will enable us to run the safe, successful event the industry demands.

“To support our exhibitors, partners and the wider industry we are delighted to announce an additional digital version of Neuro Convention. This will provide a digital meeting place, world-class speaking sessions and access to the latest products and services.”

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Arm and hand function could be regained following spinal cord injury through new pioneering research

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Treatment could be developed for arm and hand dysfunction in people living with spinal cord injury through a pioneering new research project.

A pilot study of new therapy for improving upper extremity function is now underway, following funding from BrainQ Technologies – an Israel-based startup which is working widely in precision medicine to reduce disability following neurodisorders – to the Kessler Foundation.

The study is titled ‘The safety and effectiveness of the use of a brain-computer interface-based electromagnetic field treatment in the management of patients with chronic spinal cord injury: A pilot study’ and is seen as a potentially significant breakthrough in researching possible treatment.

It will be led by Dr Ghaith Androwis, a research scientist in the Centre for Mobility and Rehabilitation Engineering Research at Kessler Foundation, and Dr Steven Kirshblum, senior medical officer and director of the Spinal Cord Injury Program for Kessler Institute for Rehabilitation, who received the grant to further their work in the field.

Thousands of new traumatic spinal cord injuries occur each year, with statistics showing around 17,500 of those are from the United States alone, and more than half of those people experience loss of motor function of the upper extremities which limits their independence and adversely affects their quality of life.

“To achieve the best outcomes after spinal cord injury, restoring arm and hand function must be a priority in rehabilitative care,” says Dr Kirshblum.

“This study is an important first step towards increasing the ability of individuals to function more independently at home, in their communities, and the workplace.”

During the study – which will be conducted in the US and Israel – researchers will test the safety and efficacy of noninvasive low frequency electromagnetic field stimulation delivered via the BQ System.

Individuals with spinal cord injury (duration 18-30 months) will participate in the 34-week study. Functional status will be measured at baseline and compared with status following the experimental treatment.

By quantifying gains in motor function, motor control and activities of daily living, this pilot study will provide preliminary information on the potential application of BrainQ’s therapy in rehabilitation programs for individuals with disability.

“We are very interested in testing the effectiveness of this novel and non-invasive approach in persons with spinal cord injury,” adds Dr. Androwis.

“Such interventions may improve participants’ performance of activities of daily living leading to gains in their overall quality of life. This particularly is important when an intervention can be provided simultaneously with conventional therapy.”

This multi-site study is being conducted at Kessler Foundation, The Miami Project to Cure Paralysis, Miami, and Sheba Medical Center, Israel.

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‘My brain is slipping into my spine’

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Karl Johnston suffers from a rare condition called Chiari Malformation Type 1

After years spent in pain and struggling for a diagnosis, Karl Johnston felt relief when he was confirmed as having a little-known condition where the brain effectively slips into the spine. Here, he shares his story.

“Some dads get to put their children on their shoulders, but I’ve never got to do that.”

That is just one of the day-to-day realities facing Karl Johnston, whose condition, Chiari Malformation Type 1, means his brain is effectively slipping into his spine.

For eight years, Karl had experienced a catalogue of symptoms, including intense and debilitating neck pain, light-headedness, fatigue and numbness in his arms, but without securing a diagnosis of his condition.

But now, the 35-year-old admits he feels some relief at the knowledge he has Chiari Malformation Type 1, as devastating as the diagnosis was to receive.

“A lot of people felt sorry for me when I finally got a diagnosis, but it was a relief because I’d been telling people that I was suffering for years and they hadn’t believed me,” says Karl, from Wallasey, on Merseyside.

“You start to question yourself about things. Just knowing takes a lot of the weight off you.

“Some days the pain is so much that it’s difficult to move around and all I want to do is lie down.”

The biggest difficulty emotionally, says Karl, is the impact it has on his ability to play with his daughter Seren.

“It’s devastating when she wants to play and I’m not up to it,” he says.

“Some dads get to put their children on their shoulders, but I’ve never got to do that.”

While Chiari Malformation Type 1 is most commonly diagnosed in adults, it is believed to often be present from birth.

Many people with the condition are asymptomatic, meaning it is only found if they have an MRI scan.

Karl had symptoms from when he was a teenager, but getting a diagnosis was difficult due to the lack of awareness around the condition.

He is now determined to help raise awareness of Chiari Malformation Type 1, in the hope that others may be able to secure a diagnosis quicker than his.

“There needs to be a way to make doctors and people in general more aware of these rarer conditions because otherwise people just fall through the cracks,” says Karl.

The dad-of-one has been supported by The Brain Charity, a national charity based in Liverpool that supports people with all forms of neurological conditions. Statistics show that 1 in 6 people in the UK is currently living with such a condition.

The charity recently told NR Times that demand for its services had soared by over 70 per cent since the start of lockdown in March, with predictions that the numbers of people needing support with issues including mental health, Long Covid and employment rights would grow further still.

Having turned to the charity last year, Karl is now getting the practical and emotional support he needs to get on with his life.

“The Brain Charity helped me get a better understanding of what was going on with my condition,” he says.

“It has felt like so many people haven’t taken me seriously but The Brain Charity has.

“They didn’t pity me but tried to understand what I was going through.”

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