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UKABIF report – shedding new light on a hidden epidemic

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The UK Acquired Brain Injury Forum (UKABIF) recently hosted a two-day virtual summit exploring the issues faced by the neuro-rehab community. The conference brought together academics, politicians and practitioners to discuss topics such as brain injury in sport, domestic abuse, training and education.

Two years after the launch of the All-Party Parliamentary Group (APPG) on Acquired Brain Injury’s report, ‘Time for Change’, UKABIF hosted a virtual conference to update on the group’s progress since. The two-part ‘Time for Change’ summit took place online in November.

Around 200 delegates were welcomed to the virtual event which featured speakers from the USA’s National Institutes of Health, The Walton Centre in Liverpool, St George’s Hospital in London, University College London and the Defence and National Rehabilitation Centre.

The first part of the summit explored new developments in the management of traumatic brain injury (TBI).

Dr Leighton Chan, chief of the Rehabilitation Medicine Department at the National Institutes of Health (NIH), spoke about the progress in developing biomarkers for TBI, including neurofilament light protein (NFL) which the NIH is currently developing.

A 2018 BMJ literature review called NFL “one of the most promising biomarkers to be used in clinical and research setting in the next future.”

The biomarker can measure neuro-axonal damage (a type of TBI) and distinguish between mild, moderate and severe brain injury up to one year after the injury occurred.

Chan said: “Our NFL findings need to be reproduced in larger groups, but we think it’s a commercially viable option”. COVID-19 was also a key talking point with a series of short presentations focused on the impact of the pandemic on neurorehabilitation and how services have adapted to deliver therapy online.

Speakers, including Nicky Ellis, director of Hobbs Rehabilitation, and Dr Margaret Phillips from Royal Derby Hospital, emphasised the need for flexibility and adaptability to ensure those in need of neuro-rehab continue to have access to the treatment they need.

University College London researchers spoke about the development of Neurorehabilitation Online (N-ROL), a telerehabilitation initiative launched this year at the National Hospital for Neurology and Neurosurgery at Queens Square.

The virtual neuro-rehab service was funded by Hollywood star Emilia Clarke’s charity, Same You.

The project at Queens Square concluded in November, however the organisation is now working with East Lancashire Hospitals NHS Trust to roll out ‘N-ROL@ELHT’. Meanwhile, Dr Mike Dilley, consultant neuropsychiatrist at St George’s Hospital, London, highlighted the barriers between physical and mental health.

“No health without mental health has to be the continuing focus going forward; integration is non-negotiable,” he said.

He also discussed the progress being made by Neurosciences Operational Delivery Networks and suggested that delegates identify their Integrated Care System Lead and lobby them.

An update was also provided on the progress of the National Rehabilitation Centre (NRC), which is part of the overall Defence and National Rehabilitation Centre (DNRC) at Stanford Hall in Nottinghamshire.

The original idea for the centre was proposed by the 6th Duke of Westminster in 2010, who wanted to ensure that seriously injured sailors, soldiers and members of the RAF could get the best possible care.

The DNRC’s defence facility opened and began treating patients in late 2018, transferring staff from the UK’s previous defence rehab centre at Headley Court in Surrey.

Since opening the defence arm of the facility, work has now begun on developing the ‘national’ element of the institution; a project led by the Nottingham University Hospitals Trust (NUH).

The first patients are expected to be admitted to the National Rehabilitation Centre in November 2024. Professor Mark Lewis, NRC board member, said: “The NRC is an opportunity for the
UK to continue to be a world leader in neurorehabilitation.”

The second part of the summit explored issues including domestic abuse, education and sport.

Kicking off the conference was MP for Rhondda, Chris Bryant, who referred to brain injury as a “hidden epidemic that is real”.

He argued that neurorehabilitation is one of the most cost-effective interventions currently available to the NHS.

This set the theme for the remainder of the event, which focused primarily on the progress of the APPG on Acquired Brain Injury’s report, titled ‘Acquired Brain Injury and Neurorehabilitation: Time for Change.’

Bryant, chair of the AAPG, also said that COVID-19 had created an opportunity to improve neurorehabilitation as more people require access to services, especially in the community.

He pointed out that rehabilitation prescription remains “patchy” with many not receiving a prescription when they are discharged from hospital.

A significant portion of Bryant’s Q&A was focused on the prevalence of brain injury
in UK prisons, which he said is “shockingly high”.

In a 2019 study of over 4,000 prisoners, hospitalised head injury was found in 24.7 per cent of participants.

Bryant said: “We need to work together to support the needs of people with brain injury and the criminal justice system needs to be led by public health approaches that keep people in the right place, with the right kind of support.”

In a first study of its kind, the Disabilities Trust set up a service at HMP Drake Hall to identify and rehabilitate female offenders with a history of brain injury.

The study revealed that 64 per cent of female offenders at the Staffordshire prison reported a history indicative of brain injury, and 62 per cent reported that they had sustained a traumatic brain injury due to domestic violence.

Alarmingly, research from the Prison Reform Trust has found that around half of female prisoners have experienced physical, sexual or domestic abuse. Speaking on behalf of the Disabilities Trust was head of the foundation, Jocelyn Gaynor.

She said: “We need to ensure the screening is sensitive and trauma-informed.

“We all need to work together to better support these individuals.”

The world of sport, especially football, came under fire from Bryant for its response to concussion and brain injury.

The Labour MP was critical of sports’ bodies, with the exception of the Rugby Union.

“The Football Association’s response [to concussion and head injury] has been shocking; they have been knowingly negligent,” said Bryant.

“If they don’t get it right, then we’ll have to legislate like the USA.”

With proven links between heading footballs and brain injury, the FA has come under scrutiny in recent years for continuing to allow players to direct the ball with their head.

In a 2018 interview with BBC 5 Live, Dr Bennet Omalu, who discovered the brain disease chronic traumatic encephalopathy (CTE), said heading a ball should be restricted in professional football and banned for those under the age of 18. Speaking to the BBC he said: “It does not make sense to control an object travelling at a high velocity with your head.

“I believe, eventually, at the professional level we need to restrict heading of the ball. It is dangerous.”
This notion was reinforced by Dr Michael Grey, reader in rehabilitation neuroscience at the University of East Anglia who, while speaking at the conference, said: “We need to reduce the risk in football, particularly for young children.

“We need to keep up the campaigns and awareness, as well as pressure on government in order to make change.”

Following the confirmation from the Department of Work and Pensions that assessors are being trained in brain injury, Bryant said he is “determined” to ensure that Michael Gove follows through with
his promise to bring together a cross- departmental ministerial committee to address the impact of ABI across government departments.

Bryant said: “It’s vital that assessors understand brain injury and how it affects life not only on a day-by- day basis, but also in the long-term.”

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Smoking linked to stroke in new study 

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Guido Falcone, assistant professor of neurology at Yale School of Medicine, was the senior author of the study

Adults who smoke, or are genetically predisposed to smoking behaviours, are more likely to experience a subarachnoid haemorrhage (SAH), new research has revealed.

The study found that while smokers are at a higher risk of SAH, that rises to over 60 per cent among those with genetic variants that predispose them to smoking.

The research, published in Stroke, a journal of the American Stroke Association, establishes a link between smoking and the risk of SAH for the first time.

While it has been proven in other types of stroke, this is pioneering research in its link with SAH – a type of stroke that occurs when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and the skull.

Results of the study show:

  • the relationship between smoking and SAH risk appeared to be linear, with those who smoked half a pack to 20 packs of cigarettes a year having a 27% increased risk;
  • heavier smokers, those who smoked more than 40 packs of cigarettes a year, were nearly three times more at risk for SAH than those who did not smoke; and,
  • people who were genetically predisposed to smoking behaviours were at a 63% greater risk for SAH.

Researchers also stated that while their findings suggest a more pronounced and harmful effect of smoking in women and adults with high blood pressure, they believe larger studies are needed to confirm these results.

“Previous studies have shown that smoking is associated with higher risks of SAH, yet it has been unclear if smoking or another confounding condition such as high blood pressure was a cause of the stroke,” says senior study author Guido Falcone, assistant professor of neurology at Yale School of Medicine.

“A definitive, causal relationship between smoking and the risk of SAH has not been previously established as it has been with other types of stroke.”

During the study, researchers analysed the genetic data of 408,609 people from the UK Biobank, aged 40 to 69 at time of recruitment (2006-2010).

Incidence of SAH was collected throughout the study, with a total of 904 SAHs occurring by the end of the study.

Researchers developed a genetic risk scoring system that included genetic markers associated with risk of smoking and tracked smoking behaviour data, which was collected at the time each participant was recruited.

“Our results provide justification for future studies to focus on evaluating whether information on genetic variants leading to smoking can be used to better identify people at high risk of having one of these types of brain haemorrhages,” said lead study author Julian N. Acosta, neurologist, postdoctoral research fellow at the Yale School of Medicine.

“These targeted populations might benefit from aggressive diagnostic interventions that could lead to early identification of the aneurysms that cause this serious type of bleeding stroke.”

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New campaign to reduce stroke risk launched on Stroke Prevention Day 

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Almost nine out of ten strokes are associated with modifiable risk factors

A 12-week campaign is being launched today – Stroke Prevention Day – to help raise awareness of how the risk of stroke can be reduced. 

The campaign encourages people to make one small positive change to their lifestyle to reduce the possibility of stroke, which is the fourth highest cause of death in the UK. 

According to the Stroke Association UK, 89 per cent – almost 9 in 10 – strokes are associated with modifiable risk factors in the Western countries, including lifestyle elements that can be changed to reduce risk, such as weight, diet and blood pressure. 

New research commissioned by the charity, which is leading the campaign, has also revealed: 

  •  Only 1 in 20 (6%) UK adults think they’re at high risk of a stroke, despite the fact that the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women
  • Almost half (47%) of the country don’t know that high blood pressure is a top risk factor for stroke 
  • 3 in 4 people (73%) said that they have had no information about stroke reduction recently, which rises to over 4 in 5 (85%) of over-65s, who are most at risk of having a stroke.

Blood pressure is the biggest cause of stroke, with 55 per cent of stroke patients having hypertension when they experience their stroke. Further, around 1 in 4 adults from 55 years of age will develop AFib. 

“While these numbers are concerning, they also demonstrate that with increased awareness, we can all take simple steps to reduce our risk,” says Charlie Fox, sales director of OMRON Healthcare, who are supporting the Stroke Association campaign alongside Patients Know Best. 

“As an incredibly important risk factor for stroke, having a healthy heart should be a top priority and remain front of mind.”

AFib can be asymptomatic and may not be present during a medical appointment as episodes can be occasional, which means it is often left undiagnosed. 

But given its seriousness, those who may be at risk should routinely record electrocardiogram (ECG) measurements, according to current medical guidelines. 

Through doing so at home will enable patients to become more in control of their health, with OMRON being one of the companies developing the technology to support them in doing so. 

“The public wants and needs to be more in control of its health, which is why we create products and services that are suitable for use at home as part of our Going for Zero strokes pledge,” adds Fox. 

“OMRON Complete, for example, is an upcoming, clinically validated home blood pressure monitor with a built-in ECG which can help detect AFib which we’re excited to launch in the coming months. 

“It is our hope that through this awareness programme and by equipping the public with the tools it needs, we can make having an empowered and informed lifestyle the new normal.”

People with a Patients Know Best (PKB) Personal Health Record can also log readings to get a more complete picture of their health journey. This allows them to look back with ease and share readings with clinical teams and caregivers in a safe, secure and meaningful way.

Fox concludes: “Your blood pressure provides important health insights. Monitoring it regularly alongside your ECG readings empowers you with knowledge, helps you act sooner, and can even save your life”.

More information about the campaign and how you can make your one small change can be found here: www.stroke.org.uk/PreventionDay

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What are the IDDSI Levels and why do they matter?

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Wiltshire Farm Foods takes you through the importance of the IDDSI Levels

Sponsored feature

Dysphagia, more commonly known as swallowing difficulties, can be prevalent amongst those in neuro rehabilitation. For those in recovery, understanding how their swallowing has been affected, what solutions are available and which nutritional, delicious and above all, safe, meals they should be eating, is of paramount importance.   

When someone starts to experience dysphagia, they are most commonly seen by a speech and language therapist (SLT) and a dietitian. Together, they will create a plan for the management of dysphagia. A speech and language therapist will explain in detail the importance of texture modified food and drinks and will work with you to carefully understand the right texture modification for you. 

What is IDDSI?

This is where IDDSI can help you understand your recommended texture modified diet in more detail.  IDDSI stands for International Dysphagia Diet Standardisation Initiative. This is a committee that have developed a framework of 8 levels which provide common terminology to describe food textures and the thickness of liquids for those living with dysphagia.

The purpose of IDDSI is to create standardised terminology and descriptors for texture modified foods and liquids that can be applied and understood globally – across all cultures and age spans.

Before the introduction of IDDSI, there were national descriptors in the UK which were formed by opinion rather than international standards. Having different terminology, categories and definitions in different countries caused some instances of food being of incorrect consistency. The IDDSI framework was fully adopted by food manufacturers and healthcare settings in the UK in March 2019.

The framework consists of levels for both drinks (liquids) and foods, some of which overlap as you can see in the image above. Here is a breakdown of each category in the IDDSI FOODS framework. 

Level 3 – Liquidised/Moderately Thick

  • Can be drunk from a cup
  • Does not retain its shape
  • Can be eaten with a spoon, not a fork
  • Smooth texture with no ‘bits’

Level 4 – Pureed/Extremely Thick

  • Usually eaten with a spoon (a fork is possible)
  • Does not flow easily
  • Does not require chewing
  • Retains its shape
  • No lumps
  • Not a sticky consistency

Level 5 – Minced

  • Can be eaten with either a fork or a spoon
  • Can be scooped and shaped
  • Small lumps are visible, but are easy to squash with tongue
  • Biting is not required
  • Minimal chewing required

Level 6 – Soft & Bite-Sized

  • Can be eaten with fork or spoon
  • Can be mashed/broken down with pressure
  • Chewing is required before swallowing

How can I check my meals are made to IDDSI standards?

You can check to see whether your food is compliant with the IDDSI Framework by watching these IDDSI Food Test videos.

To discover a Softer Foods range which is IDDSI compliant and created with your patients’ needs in mind, register here for the opportunity to try some complimentary meals from Wiltshire Farm Foods.

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