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Update: Spinal cord injury research

Research into spinal cord injury (SCI) has continues at pace, with several exciting new findings in recent months, summarised here.

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Neural interface restores touch sensation after spinal cord injury 

A sensorimotor neural interface successfully restored touch sensation in a patient with quadriplegia resulting from a spinal cord injury, researchers report.

Dr Patrick D. Ganzer of Battelle Memorial Institute in Colombus, Ohio, said: “Neurotechnology and brain-computer interfaces are becoming an effective way to leverage residual neural signals for functional benefit following SCI, stroke, and several other dysfunctional states.”

An estimated 50% of patients with a clinically complete SCI have a “sensory discomplete” SCI, where tactile stimuli evoke changes in cortical activity, despite the patient not being able to feel them. Brain-computer interfaces (BCIs) can reanimate paralysed muscles after SCI, but whether they can restore touch is unknown.

Dr. Ganzer and colleagues used a BCI to simultaneously reanimate both motor function and touch sensation in a chronically paralysed patient with a clinically complete SCI who could already use a BCI to move the hand.

While the patient was unable to perceive mechanical sensory stimuli below spinal level C6, sensory stimuli to the hand robustly modulated neural activity in the contralateral primary motor cortex (M1). This residual sensory neural activity was reliably decoded from M1 using a support vector machine (SVM), and a vibrotactile array on the affected bicep enabled sensory feedback that restored conscious touch perception to a detection rate over 90%.

A modified grasp and release test demonstrated real-time sensorimotor demultiplexing where the participant was able to perform the task using the system but not without using the system, the team reports.

Discussing the study’s findings, Dr Ganzer said: “It was initially surprising when we first discovered the subperceptual touch signal.

“These results demonstrate that even a small contingent of spared spinal fibres can be leveraged for functional benefit.

“The study’s overall results are interesting because the brain implant was not originally intended to record both touch and movement neural signals.

“Participants that have a ‘clinically complete’ SCI may have a small contingent of spared fibres remaining that are still transmitting a neural signal. Therefore, a very small quantity of spared fibres can potentially be leveraged for benefit, even though they might only be transmitting a faint signal.

“Additionally, the study’s findings can potentially inform future neural implant locations. Future neural interfaces can be placed in areas that encode a multitude of mixed neural signals that might be of value for the given technology. Regardless, information from neural interfaces should be maximized to enable new functional benefits in patients, even in new and unintended ways.

“The NeuroLife team at Battelle is currently working with our collaborators to develop a take-home BCI system. This would allow for the BCI to be used during activities of daily living outside of the laboratory setting.

“One of our recent achievements in this domain was a demonstration in the participant’s home using a portable miniatured version of the ‘muscle stimulation system.’ A computer tablet was able to control muscle stimulation to elicit hand movements during home activities.”

Dr Andrew Jackson, professor of neural interfaces at Newcastle University, Newcastle-upon-Tyne told Reuters Health: “The study rests on a surprising finding: touch stimuli that are imperceptible to a spinal cord-injured participant can nevertheless be ‘decoded’ from brain activity in the motor cortex. Previous brain imaging studies have suggested such signals can reach the brain even after injury, but this is the first study to reveal them in the activity of individual brain cells.

“There are two ways this could work in practice. First, the decoded sensory signals could be used to trigger some kind of sensory substitute, in this case a vibrotactile cuff acting on a part of the body that the patient can consciously feel.

“Second, the sensory signals could directly influence the electrical muscle stimulation, thereby implementing a sensorimotor feedback loop similar to the unconscious reflexes that allow us to maintain our grip on an object without having to think about it.

“While there are other ways to achieve this in principle, the nice thing about the current approach is that it only requires a single surgical implant to achieve both motor and sensory restoration.

“These approaches are still at an early stage of development. I anticipate seeing more studies like this one that find clever ways of exploiting and enhancing these surviving connections to restore function.”

Scientists regenerate neurons in mice with spinal cord injury and optic nerve damage

New research by scientists at the Lewis Katz School of Medicine Temple University (LKSOM) shows that gains in functional recovery from SCI injuries may be possible, thanks to a molecule known as Lin28, which regulates cell growth. In a study published online in the journal Molecular Therapy, the Temple researchers describe the ability of Lin28 – when expressed above its usual levels – to fuel axon regrowth in mice with SCI or optic nerve injury (ONI), enabling repair of the body’s communication grid.

Shuxin Li, senior investigator on the new study, explained: “Our findings show that Lin28 is a major regulator of axon regeneration and a promising therapeutic target for central nervous system injuries.

“We became interested in Lin28 as a target for neuron regeneration because it acts as a gatekeeper of stem cell activity. It controls the switch that maintains stem cells or allows them to differentiate and potentially contribute to activities such as axon regeneration.”

To explore the effects of Lin28 on axon regrowth, Dr Li and colleagues developed a mouse model in which animals expressed extra Lin28 in some of their tissues. When full-grown, the animals were divided into groups that sustained spinal cord injury or injury to the optic nerve tracts that connect to the retina in the eye.

Another set of adult mice, with normal Lin28 expression and similar injuries, were given injections of a viral vector (a type of carrier) for Lin28 to examine the molecule’s direct effects on tissue repair.

Extra Lin28 stimulated long-distance axon regeneration in all instances, though the most dramatic effects were observed following post-injury injection of Lin28. In mice with spinal cord injury, Lin28 injection resulted in the growth of axons to more than three millimetres beyond the area of axon damage, while in animals with optic nerve injury, axons regrew the entire length of the optic nerve tract. Evaluation of walking and sensory abilities after Lin28 treatment revealed significant improvements in coordination and sensation.

“We observed a lot of axon regrowth, which could be very significant clinically, since there currently are no regenerative treatments for spinal cord injury or optic nerve injury,” said Dr Li.

One of his goals in the near-term is to identify a safe and effective way of getting Lin28 to injured tissues in human patients. To do so, his team of researchers will need to develop a vector, or carrier system for Lin28, that can be injected systemically and then hone in on injured axons to deliver the therapy directly to multiple populations of damaged neurons.

Dr Li also wants to decipher the molecular details of the Lin28 signalling pathway. He said: “Lin28 associates closely with other growth signaling molecules, and we suspect it uses multiple pathways to regulate cell growth.”

‘Cell pores’ discovery gives hope to millions of brain and spinal cord injury patients

Brain and spinal cord injuries affect all age groups. Older people are more at risk of sustaining them from strokes or falls, while for younger age groups, major causes include road traffic accidents and injuries from sports.

The high-profile example of Formula 1 racing driver Michael Schumacher demonstrates the difficulties physicians currently face in treating such injuries. After falling and hitting his head on a rock while skiing in Switzerland in 2013, Schumacher developed a swelling on his brain from water rushing into the affected cells. He spent six months in a medically induced coma and underwent complex surgery, but his rehabilitation continues to this day.

The new treatment, developed by an international team of scientists working at universities in the UK, US, Canada, Sweden and Denmark, features in the latest edition of the scientific journal Cell.

Researchers used an already-licensed anti-psychotic medicine – trifluoperazine (TFP) – to alter the behaviour of tiny water channel ‘pores’ in cells known as aquaporins.

Testing the treatment on injured rats, they found those animals given a single dose of the drug at the trauma site recovered full movement and sensitivity in as little as two weeks, compared to an untreated group that continued to show motor and sensory impairment beyond six weeks after the injury.

The treatment works by counteracting the cells’ normal reaction to a loss of oxygen in the CNS – the brain and spinal cord – caused by trauma. Under such conditions, cells quickly become ‘saltier’ because of a build-up of ions, causing a rush of water through the aquaporins which makes the cells swell and exerts pressure on the skull and spine. This build-up of pressure damages fragile brain and spinal cord tissues, disrupting the flow of electrical signals from the brain to the body and vice versa.

However, the scientists discovered that TFP can stop this from happening. Focusing their efforts on important star-shaped brain and spinal cord cells called astrocytes, they found TFP prevents a protein called calmodulin from binding with the aquaporins. Normally, this binding effect sends the aquaporins shooting to the surface of the cell, letting in more water. By halting this action, the permeability of the cells is reduced.

Traditionally, TFP has been used to treat patients with schizophrenia and other mental health conditions. Its long-term use is associated with adverse side effects, but the researchers said their experiments suggested that just a single dose could have a significant long-lasting impact for CNS patients.

Since TFP is already licensed for use in humans by the US Federal Drug Administration (FDA) and UK National Institute for Health and Care Excellence (NICE) it could be rapidly deployed as a treatment for brain injuries. But the researchers stressed that further work would allow them to develop new, even better medicines based on their understanding of TFP’s properties.

According to the World Health Organisation (WHO), each year around 60 million people sustain a traumatic brain or spinal cord injury and a further 15 million people suffer a stroke. These injuries can be fatal or lead to long-term disability, psychiatric disorders, substance abuse or self-harm.

Professor Roslyn Bill of the Biosciences Research Group at Aston University said: “Every year, millions of people of all ages suffer brain and spinal injuries, whether from falls, accidents, road traffic collisions, sports injuries or stroke. To date, their treatment options have been very limited and, in many cases, very risky.

“This discovery, based on a new understanding of how our cells work at the molecular level, gives injury victims and their doctors hope. By using a drug already licensed for human use, we have shown how it is possible to stop the swelling and pressure build-up in the CNS that is responsible for long-term harm.

“While further research will help us to refine our understanding, the exciting thing is that doctors could soon have an effective, non-invasive way of helping brain and spinal cord injury patients at their disposal.”

Dr Zubair Ahmed of the University of Birmingham’s Institute of Inflammation and Ageing continued: “This is a significant advance from current therapies, which only treat the symptoms of brain and spinal injuries but do nothing to prevent the neurological deficits that usually occur as a result of swelling. The re-purposed drug offers a real solution to these patients and can be fast-tracked to the clinic.”

Dr Alex Conner of the University of Birmingham’s Institute of Clinical Sciences said: “It is amazing that our work studying tiny water channels in the brain can tell us something about traumatic brain swelling that affects millions of people every year.”

Dr Mootaz Salman, Research Fellow in Cell Biology at Harvard Medical School, said: “This novel treatment offers new hope for patients with CNS injuries and has huge therapeutic potential. Our findings suggest it could be ready for clinical application at a low cost in the very near future”.

Brain-computer interface lets man with complete spinal cord injury feel and move his hand

In an exciting development, researchers from Battelle and The Ohio State University Wexner Medical Center are reporting that a man with clinically complete spinal cord injury can now move his paralysed hand and feel what he’s touching.

The man had a brain-computer interface chip implanted into the motor cortex of his brain six years ago and it was assumed that his injury was too severe to ever be able to tap the nerve signals related to touch.

However, the latest update reports an unfelt signal that was detected by the researchers, which does reach the brain via unexpected pathways, and which they can detect using the brain-computer interface. In turn, the signal is translated and directed to a haptic device that creates a vibration that produces a sense of touch. The development is reported in a published study in journal Cell.

The team that developed the technology is working on turning it into a system that can be used at home, as it is currently tethered to power supplies and computers.

“The authors have leveraged on a rarely appreciated aspect of spinal cord injury to provide a novel and important advancement in neurological functioning using a brain-computer interface,” said Dr Keith Tansey, Professor of Neurosurgery and Neurobiology at the University of Mississippi Medical Center.

“The notion that clinical completeness in spinal cord injury is very often neurophysiologically ‘discomplete’ acknowledges that activity in residual neural circuitry can be detected and utilised to both augment motor function but also to restore sensory perception from below the level of injury.”

Adults with traumatic spinal cord injury at increased risk for psychological morbidities, study suggests

Adults with traumatic spinal cord injuries (SCI) exhibited increased incidence of psychological morbidities and multimorbidity compared with those without such injuries, according to results of a study published in Mayo Clinic Proceedings.

Mark D Peterson of the department of physical medicine and rehabilitation at University of Michigan said: “Clinicians caring for adults with SCI need to be aware of the increased risk of developing mental health disorders in this patient population.

“This may be particularly important during social distancing due to Covid-19, as these patients often already experience social isolation.”

Although prior studies have established a relationship between age-related noncommunicable diseases, cognitive dysfunction and depression among populations without SCI, researchers have yet to study the extent to which psychological conditions are comorbid with age-related chronic diseases following SCI.

Further research is sparse regarding the natural history or incidence of psychological morbidities and chronic diseases among adults with SCI.

In the current study, the investigators sought to compare the longitudinal incidence of psychological morbidities and multimorbidity and chronic disease estimates among adults with vs. without SCI. They examined insurance claims of 6,847 privately insured beneficiaries with an ICD-9, Clinical Modification diagnostic code for a traumatic spinal cord injury who had medical coverage at any time between January 2001 and December 2017.

Results showed that compared with adults without a traumatic SCI, those with one had a higher incidence of adjustment reaction, anxiety disorders, depressive disorders, alcohol dependence, drug dependence, psychogenic pain, dementia, insomnia and psychological multimorbidity.

For example, incidence for those with vs. without a traumatic SCI was 19.3% vs. 14.1% for anxiety disorders, 29.3% vs. 9.3% for depressive disorders and 37.4% vs. 23.9% for psychological multimorbidity. The researchers reported significantly higher adjusted HRs of each psychological outcome for individuals with spinal cord injury, and these ranged from 1.18 (95% CI, 1.08-1.29) for anxiety disorders to 3.32 (95% CI, 1.93-5.71) for psychogenic pain.

Those with spinal cord injuries also had a significantly higher prevalence of all chronic diseases and chronic disease multimorbidity, except HIV infection/AIDS. The researcher’s propensity matched adults for age, education, race, sex and chronic diseases and still reported a significantly higher incidence of most psychological disorders and psychological multimorbidity among those with spinal cord injuries.

Of the findings, Peterson and colleagues said: “Future research and clinical efforts are needed to better understand the health care burden associated with these conditions in the traumatic [spinal cord injury] population.

“These findings should be used to inform the development of appropriate clinical screening algorithms and design of early behavioural interventions to reduce the risk for disease onset/progression in this higher risk population.”

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Brain injury case study: Simon’s story

Simon’s story demonstrates that consistent support from a small, specialist team can maximize quality of life and reduce barriers to discharge home.

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In August 2019, Simon was admitted to the Coach House in Northampton, a specialist residential care home for adults with acquired brain injury. He was the first service user in a brand new service from experienced care provider, Richardson Care.

He had sustained a hypoxic brain injury in 2015 following cardiac arrest, and had resided in a number of care environments following his discharge from acute rehabilitation.

He was referred to Richardson Care due to an increase in unsettled and challenging behaviours and as his current placement was no longer best-placed to meet his needs.

Simon had been increasingly isolating himself from the rest of the care home and would only engage in very limited activity with 1:1 support. He would frequently make complaints about his placement.

Goal for Placement

On admission to the Coach House, the overarching goal was to enable a safe discharge home for Simon. To enable this, further exposure to more independence would be required to appropriately risk assess and inform future care provision once at home.

This would provide information as to whether his previous environmental restrictions within care homes were preventing his progression or whether his needs were more enduring.

Intervention and Support

Following an initial assessment of his needs it was evident that Simon struggled with flexibility of thinking and that unsettled behaviours would present when his expectations were not met.  This could then manifest itself in paranoid behaviours, which he would then perseverate and allow to dictate his day.

Simon was provided with a structured programme to assist him in managing his expectations: a programme which he devised with the support of his Keyworker, Gareth.

By adopting a person-centred approach to the formulation of his programme, Simon felt in control of his day and less reliant on others to initiate activity for him. Simon was able to manage his own expectations of how his day would look.

He became increasingly able to manage deviations from this if he was informed of the purpose of these changes. Whilst Simon still presented with some agitation on such occasions, the structure and the relationship he had built with his key staff enabled him to become more receptive to feedback.

Simon became more flexible in other ways and was more willing to take on new challenges. His initial engagement in food preparation was short lived, but his willingness to at least ‘have a go’ was a marked difference from his previous compliance. He started to eat different meals at lunch time and take interest in his nutritional intake.

He joined the gym and set goals around his personal fitness. Whilst Simon was still largely dependent on others for some activities of daily living, he had developed new interests which significantly and positively impacted on his quality of life and mood.

Whilst Simon remained resistive to face-to-face therapy, he benefitted from oversight from the clinical team who would assess and inform future interventions and support. Simon gained some insight into the limitations imposed on him by his brain injury and focused on realistic goals, rather than shutting down at the suggestion of anything new. In brief, Simon started to enjoy his life.

Discharge Planning

Simon’s placement, in part, was to assess whether plans for future independent living were a viable option. During the year of his placement, on-going risk assessments were completed and observations made to inform future care needs on discharge home.

Close liaison with his case manager enabled remote planning during the Covid-19 pandemic, using technology to ensure that Simon could make decisions and choices regarding his future adaptations and environment. An occupational therapist from the team assessed Simon’s future home and made recommendations.

The team at Richardson Care also made recommendations on how a care package should look and Simon was involved in drawing up a person specification for the role of his personal assistant. In August 2020, almost a year since his admission, Simon discharged to his own home.

What did Simon say about the Coach House?

He felt that the staff treated him with dignity and respect and listened to him.

Simon said: “I like the room at the Coach House, I can’t complain.”

“I was only disappointed once during my stay.”

What did his case manager say about the Coach House?

Five weeks after admission:

“It was really lovely to visit yesterday and to see how well Simon is doing at the Coach House. It was particularly encouraging to hear that he is engaging with eating at the Coach House and not spending fortunes on going to a restaurant every day anymore! It was genuinely heart-warming to see the enthusiasm and satisfaction on his face, describing the steak lunch he had just bought, helped prepare and eaten.

Simon seems a great deal more relaxed in his new surroundings and it is abundantly clear that he has a great team around him, who understand his needs and are pro-active with him. He has not experienced that before, so it is all very pleasing! Many thanks.

After Simon’s discharge

“Could not have managed yesterday (or the past year!) without yours and especially Gareth’s support. He was an absolute legend yesterday – he really is a credit to himself and the Coach House. He did not relent in his efforts to help Simon settle in. He even put a ton of DVDs away on shelves after driving down and unloading the van in that heat. The man is a tank!

“I will make sure our paths cross again the next time I have a suitable candidate – I’ve really enjoyed working with you and your team too. You helped transform Simon’s life!

Chris Dindar RGN, Associate Case Manager at Brain Injury Services Ltd

Richardson Care is an independent family business and has a proven track record over more than 30 years. It has six specialist residential care homes in Northampton, three of which provide care for adults with acquired brain injury. The remaining specialise in supporting adults with learning disabilities. Its focus is on providing an inclusive family environment in which service users develop daily living skills, increasing their independence and well-being.

www.richardsoncares.co.uk.

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Expanding the horizon of neuro patients

With AlterG Anti-Gravity Treadmills.

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A wide range of patients are now benefiting from the use of AlterG Anti-Gravity Treadmills throughout clinics across the UK.

Patients with a wide range of neurological conditions are gaining confidence within a fall-safe environment which allows for high intensity repetitions along with increasing motor learning early on in the rehabilitation stage.

Originally designed for NASA, the AlterG uses patented Differential Air Pressure Technology to unweight patients from 100% down to 20% of their bodyweight in precise 1% increments.

AlterG started in Professional Sport assisting with rehabilitation from ACL and Ankle injuries, moving onto MSK Physiotherapy Clinics. However multiple research papers and case studies have now been carried out to show the benefits of use with multiple neurological conditions including Stroke, Multiple Sclerosis, Parkinson’s, Functional neurological disorder, Brain Injuries & Incomplete Spinal Cord Injuries.

Developing the technology further, along with a precise partial weight bearing environment, AlterG has liaised with multiple Neurological Physiotherapists and Surgeons and added new features to enhance the experience on the machine and enable patients to gain as much as possible from each session.

The machines are now available with basic Gait Analytics (Stance Time, Step Length and Weight Bearing Symmetries and Cadence), Pain scales, pre- programmed exercises and camera for live video monitoring allowing patients to see their feet whilst walking.

Multiple case studies have been carried out, one of which is Brainstem Cerebrovascular Accidents (CVA) or Strokes. In conjunction with AlterG, Kate Haugen from Great Moves Physical Therapy (Colorado, USA) wrote a great case study with regards to a 42-year-old runner and university tennis coach. The individual presented two strokes resulting in right sided weakness and significant balance deficits from the first stroke and almost complete paralysis on his left side for 8 days following a second CVA.

“Weightbearing exercises caused medial tibiofemoral joint line pain and swelling. The patient was unsuccessful with a stationary bike and elliptical trainer. AlterG allowed for more controlled loading progression for returning to Full Weight Bearing.”

After multiple weeks of rehabilitation, the patient can now step over objects and change direction quickly. In addition, there are no limitations with the distance the patient is able to walk, and they are not limited by fatigue.

Along with a range of case studies, various research papers are available online showing how the treadmill can be an effective intervention for those who have experienced a stroke or other neurological conditions.

“The AlterG enables Neuro patients to experience what they thought they could never do again – be it walking, jogging or running. We have had some very encouraging results – even with clients who had trialled some of others rehabilitation technologies, including a conventional partial-weightbearing treadmill. Any neuro patient who can achieve an assisted step to transfer into the AlterG can benefit.

The AlterG allows a physio to challenge neurological patients in a safe manner and in a cost-efficient manner without the need for an additional therapist or assistant”.
– Jon Graham, Physiofunction.

Trevor Donald, Managing Director of SportsMed Products Ltd (the UK distributor) stated “it is great to see research coming through about the huge benefits the AlterG can have for individuals suffering with neurological conditions. The patient stories emerging from our customers at neurological physiotherapy clinics has been incredible”

Not only does the AlterG aid walking but it can be used simply in a partial weight bearing environment to carry out exercises such as single hand throwing and catching, squats and hopping.

If you would like further information on the papers and case studies carried out along with clinical protocols please feel free to contact AlterG’s UK distributor, SportsMed Products Ltd.

https://sports-medical.co.uk/case-studies/

sales@sports-medical.co.uk

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The family experience of brain injury

After a person acquires a brain injury, the impact on the whole family can often be life changing as they adjust to a new reality and relationships come under intense pressure…

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Karen Ledger (KL): When brain injury occurs, it’s like a bomb going off in the family. Life will never be the same again for any of the members of that family.

People will be shocked, bewildered and overwhelmed, and they then have to go through a complicated process of adjustment, and people reach that adjustment at different stages.

The person with the brain injury will generally have a neuropsychologist assigned to support them. Most will pay attention to people’s feelings and emotions, but the rest of the family may not have any psychological support.

This situation doesn’t get better of itself without professional input, it can get worse and people’s mental health can and often does spiral down.

Louise Jenkins (LJ): It’s a particular challenge if you’ve got someone with little or no insight. They often won’t recognise the need for or be willing to engage with neuropsychological treatment until much further down the line, by which stage, the family may have entered a more advanced stage of crisis and their whole family unit may be at risk of breakdown. There are complex emotions involved in the adjustment process following trauma which include shock, guilt and loss.

KL: That’s a scenario we see a lot. The client’s relationships may get to an advanced stage of deterioration and as Louise says, crisis, before they’re able to accept help. This is often because there is an immense amount to absorb from their new world of injury, rehabilitation and the medico-legal process and clients do not have the psychological space to consider how they are, never mind undertake the rehabilitation.

LJ: That’s where some of the challenges come in from the legal perspective. The compensation claim process is quite rigid in that generally speaking, only the injured person can claim for financial losses and for professional support, but we maintain that as the underpinning principle for compensation claims is to restore someone to their former lifestyle, you have to consider them both as an individual and as part of the family unit. We try to build into the claim some therapy sessions not only for the injured person but also for their spouse and their children.

Some defendants (compensators) say they’re happy to support that because, if the family unit breaks down and the uninjured spouse has been providing a lot of the day-to-day support, prompting and encouragement that the injured person needs, the cost of commercial care to replace that support is significantly more expensive than the amounts you can recover in a claim for support provided by a family member. It is also about embracing the spirit of the Rehabilitation Code and Serious Injury Guide in looking at the wider family need.

KL: Often, people can’t work anymore; they feel their work is taken away from them. People get their sense of identity out of work, as well as from being a spouse or a partner, a father or a mother. And if they lose their ability to earn and their relationships start to deteriorate these are often perceived as more failure and thereby serve to reduce a client’s confidence and self-worth.

LJ: It is akin to a bereavement process for the uninjured partner, yet the person is still there with you.

KL: People don’t have to have a death to experience loss, and loss can activate a bereavement process. So they’re grieving for the person they once knew, and now they’ve got this new person which makes adjustment to the injury complicated. And the thing about brain injuries is they’re hidden. The person looks the same but behaves differently to how they did before. It understandably takes a long time for clients and family members to really grasp the effects of brain injury, because they’re often traumatised, angry, discombobulated and distressed.

The family that includes somebody with a brain injury goes through a process of understanding, just as the client hopefully does.  It’s a complex situation trying to comprehend what a brain injury means whilst feeling bereaved.

Family and children’s therapy is relevant too. Children often get missed because they deal with loss and trauma in different ways to adults. Children tend to get on with their lives, as if it’s not happening, so they need particular attention. They won’t be talking about it so much, but they’ll be experiencing it. The sooner that’s managed by specialists, the better it will be for children in the longer term, giving children the best chance of allowing normal development to take place.

LJ: It’s difficult because there’s a significant investment of time and energy put into implementing a rehabilitation programme and support around the injured person. This is integral to the claims process. The spouse can feel as if all the focus is on the injured person and they’ve been left out.

From a legal perspective, we try to involve the uninjured spouse as much as possible in discussing what we’re doing and why we’re doing it. We try to weave in that therapy support for the uninjured spouse so they come along the journey with us rather than becoming a disrupter to the rehabilitation programme because they feel excluded and unsupported. If securing interim payments through the claim to fund support is challenging at an early stage, our in-house team of client liaison managers, all of whom have a healthcare background, can provide time and input in discussing the challenges and in signposting for support both for the uninjured spouse and children as well as for the injured client. There are some really valuable resources for children, for example, which explain some of the problems that can arise in a parent who has sustained a brain injury to help them to understand and come to terms with changes in the family dynamics.

KL: People affected by brain injury can feel deserted by their partner and like a single parent.  This is because they’ve lost their partner’s contribution to childcare and work in the home. The complexity and challenges of living in these circumstances should never be underestimated.

LJ: At the point of injury, they are in shock and just want to be there for the person who’s injured.  I’ve worked with a number of people where the grief and adjustment process is very substantially delayed. These delays extend to weeks, months or even years.

They’re in a fight/flight/freeze situation. They’re managing a situation that’s about life and death initially in the most serious cases. When the acute stage is over and they have some space to start thinking about themselves, rather than the person who’s injured, they can start reflecting. It’s an emerging awareness that it’s never going to be the same again, that some degree of permanence will remain with the injuries, that this is how it will be in the longer term and a realisation that you need support to adjust to the new normal.

KL: It takes a while for that realisation to come in. I am often working with partners who are in that process of adjustment and what initially attracted them to the person pre-injury has been lost post injury, for example agile thinking and intelligence.  Moreover they now find themselves in a caring role and one where many strangers are entering their home and talking to them in alien language!  It’s not surprising that for many people this is often too challenging for them to manage and why therapy is needed as soon as possible for clients to regain their own personal power as soon as possible. They will have a private listening, respectful and tender place for them when the rest of their lives are so exposed.

LJ: They don’t know where that injured person is going to land with their recovery in the longer term. There’s a natural recovery process of a minimum of two years following brain injury, often longer, and they don’t know how much recovery the person’s going to make. They’re living with that uncertainty for a long time before being able to understand and adjust to what the long term will look like, often with significant physical, cognitive and behavioural changes which place great strain on sustaining relationships. Independent family law and financial advice is often essential to protect both parties in the event that the relationship does break down.

KL: I believe that acquired head injury is usually devastating to the person and those around them.  However, in my experience, people are often amazing in how they find the strength to establish new ways of being and making their life work for them.  Therapy can often speed up that process because clients feel heard, respected and understood, a powerful combination for a restorative process particularly when they are so often feeling powerless.  This process can help families stay together or decide to go their separate ways and with support they are more likely to do this without acrimony and additional trauma.  Observing and supporting clients and their loved ones to dig deep to find the strength and commitment to establish a new life is such an amazing privilege and honour for me.

LJ : When the claims process is managed by expert serious injury lawyers, early access to specialist rehabilitation and support will enable an injured claimant to restore their life to the best possible position and allow them to maximise their potential for the long term, restoring a sense of control and positivity for the future. Working together with therapists like Karen is essential to ensure that a multi-disciplinary network of support can be put in place in order to support an injured person to achieve their goals and rebuild their life as an individual and as part of a family unit after a life changing injury.

Louise Jenkins is a partner at Irwin Mitchell and leads the serious injury team at the firm’s Sheffield office. Karen Ledger is managing director of KSL Consulting and a therapist, counsellor and supervisor with over 30 years of experience.

 

 

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