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Using art to help manage the life long effects of a brain injury

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Natalie Mackenzie, of BIS Services, has worked with ‘James’ since 2002. In fact, he was one of her earlier clients in her career. She is immensely proud of the challenges he has overcome; not all of the effects of the accident have been surmounted, but none the less he has exceeded many expectations of medical professionals, with a will of iron and an exceptional talent that is finally being acknowledged. Here she shares the experience.

James is not defined by his brain injury, but his experiences and the challenges of his TBI have moulded his work and the individual we now see. As we are all aware, living with a severe TBI is a lifelong journey, and I still support Jim in the community, and have continued to do so whilst he has travelled around the world, through the now ‘normal’ virtual rehabilitation.

I have watched his art bring meaning and focus to his daily life, encouraging a motivation and structure that is always needed for individuals like James managing their cognition. Although there remain issues with some areas of function, James has learnt, consolidated and implemented a toolbox of strategies that support him to pursue his passion and bring joy to others.

It has been a pleasure to work with someone as driven as James, and I have seen him take a turbulent journey through his recovery, which I am sure many professionals in the field can relate with.

His need for increased rehabilitation through life challenges is always available and those of us that work with him remain committed to supporting him as he continues to develop his artwork further, wherever that may take him. There may even be a few of you reading this today who have been part of his journey.

Some of his artwork now hangs proudly in the BIS Services office with room for more to come.

Here in his own words, is his story.

James Cyril Gardiner was born in Woking, Surrey in 1967. Parents Margaret, a cleaner, and ‘Jock’, a hospital porter, subsequently brought him up in the village of Englefield Green, Surrey.

Despite a troubled and turbulent early life James did well in most subjects at school, excelling at Art and English. His O-level mark in Art which gave him grade A was, according to his teacher at the time, ‘the highest recorded in the borough for over 10 years’.

After gaining an A-level grade B at the local sixth form college and being offered a place at Chelsea School of Art, he was faced with a difficult choice. Either go away to London to develop his Art education, or stay and work in order to look after his older, autistic brother, following his parents’ divorce and subsequent loss of the family home.

He chose the latter, and so began the next 17 years of warehouse, stock control, purchasing and accounting roles. Beginning at a fledgling Thorpe Park, and ending at China House on Piccadilly (now ‘The Wolseley’) via 7 years at the uber-trendy Halkin Hotel in Belgravia – his aptitude for detail, mathematical exactitude and forecasting meant he had developed a successful career, although a world away from anything exploiting his early artistic talent.

Maybe this was shown in other ways, however, as he was also developing a sideline career as a talented songwriter and guitarist in indie pop, with a modicum of success, but with great hopes for the future.

Life was good, and was only going to get better. Now living in London’s Olympia, with a steady, reasonable income, an active social life, and daily gym sessions meaning any excesses from the weekend were negated, all meant life was pretty much as good as it gets for an early thirty something man in the capital…

Then, one night in early September 2001, everything changed.

That evening he visited a friends’ nightclub- the infamous ‘Uncle Bob’s Wedding Reception’- to witness the first London performance of a mutual friend’s band, The Darkness.

Earlier that day, England had beaten Germany 5-1 during the qualifying stages of the 2002 World Cup, and it was a hot, heady, boozy and celebratory evening, which spilled over into the early hours of the following morning.

Eventually, he and a friend were driving home (the pal being the sober driver) when, at about 4.30 am, ‘joyriders’ were ironically the reason for James eventually being painfully aware of the word ‘Anhedonia’.

Teenage car thieves, being pursued by the Police, were travelling on the wrong side of the road with lights off at a speed of over 80mph. The head-on collision saw James’ car being bounced off some railings and then into a traffic light, therefore involving three collisions with devastating results.

The crushed pelvis, broken arm bones, eye damage and two collapsed lungs were the immediate, obvious results, a GCS of 3 on admission to hospital meaning the medical team were less than optimistic as regards the chances of survival.

Any Traumatic Brain Injury was not obvious, even after being eventually roused from the 12 day induced coma, and the long, slow process of rehabilitation commencing.

After over a year of appointments, hard physical work and bewilderment, other professionals ‘in the trade’ suggested that there was possibly another subtle, yet massively important result of the accident which would have a permanent effect on his cognition, mood and subsequent PTSD.

After eventually accepting that the previous working life was now gone forever, James was happy to see that although his hemiparesis meant his guitar playing was also a thing of the past, he could still draw – a long dormant avenue of expression was gleefully available to be explored again.

Although fatigue, scar tissue, recurring eye issues (a lens replacement and detached retina being just two) all hampered progress, the relief from the Anhedonia -with which he was now all-too familiar – was only felt when successfully completing a drawing.

The next five years were spent exploring differing media, instruction, approaches, ideas and styles, and probably meant the Foundation Course and Degree missed in the Eighties was now complete. A particular favourite was the drawing of cities around the world,

Though London was a readily available source of material. The idea of just replicating what was there in front of the artist always seemed unsatisfying, however, ‘I had done many still life works during my teens. I knew the ability to reproduce things I see accurately was still intact… but there had to be something more to be explored…’

Eventually a theme was developing in the artworks – one of recording the space occupied by people, questioning when a person REALLY exists.

‘ I think this came about as a result of thinking about my friends and family coming to visit me in hospital, when I was comatose.I was there, lying in that bed, alive. But I wasn’t there. I was occupying the space. We had an experience there, together. In that space, at the same time.

‘But, although my body was there, my personality wasn’t. And I have no memory of that time.’ This idea soon started seeping through into the artworks. Thin, black outlines of people were drawn ‘over’ a background of monochrome cityscapes, sometimes with a minimum of primary colour to provide relief.

‘I would often sit in a place, drawing the background of the city structures. And, during this time, I would take many, many pictures with my iPhone of the passers-by in my view. I would therefore record the people that had also been in that space with me, during that time.

‘Later, I would choose the stances and shapes that appealed to me from the photos, and make a composition that I felt recorded that time I was there. But all I recorded were the outside shapes of the people. Not really them, themselves , with their personalities, and thoughts and feelings…’.

The U.K. lockdown during 2020 meant the artworks suddenly had an increased level of pertinence, and this prompted a series of new works entitled ‘The City Missing The People’, showing London landmarks – this time drawn in colour – empty but with the now familiar trademark ‘Outline people’ drawn with white lines, suggesting an almost ghostly feel…

‘I wanted to show the city with a personality, but mourning the sudden absence of the multitudes of people that normally give the city it’s life, it’s feeling… it’s personality… as if it was therefore missing that part of itself’.

These drawings were included within BBC Radio London’s ‘Make A Difference’ feature, the proceeds from selling online and original purchases being donated to ‘The Big Issue’.

This work has prompted further developments – ‘ I liked the idea of looking further back – other people have also been in the same space, perhaps themselves looking back – perhaps looking forward, imagining us – a future they could not comprehend. But they WERE there then. They DID occupy that space…’

So another series of drawings has been made, redoing the ‘The City Missing The People’ works, but with the addition of Edwardian and Victorian characters posing, as if for the camera, in those same spaces, the juxtaposition of the white outline contemporary figures with the more solid, yet partially drawn grey antique poses raising all kinds of questions…

‘I look forward to continuing to develop this – and other -styles. I think I am a person with a chequered history first – and an artist second. Maybe the injury to my brain has enabled me to see things in a different way. Maybe I would never have thrown myself into Art again – there’s just no way of knowing. I hope there is still enough of the pre-accident ‘me’ to inform my Art accordingly, as the last thing I want to create is needy, ‘damaged’ pieces asking for sympathy. I hope I am now exploiting the unique approach my experience has given me…’

James’ work can be viewed and purchased on www.jamescyrilgardiner.com

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Magnetic sensor could detect early signs of TBI

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Signs of traumatic brain injury, dementia and schizophrenia could be detected at an earlier stage as a result of the development of a new sensor which measures weak magnetic signals in the brain.

Through the development of the new Optically Pumped Magnetometer (OPM) sensor, scientists are hopeful of enabling a greater understanding of connectivity in the brain, which could have significant benefits in the chances of early diagnosis.

The device, developed by teams of scientists at the University of Birmingham, is currently in trail stage and clinicians at the Queen Elizabeth Hospital Birmingham are involved in its use in pinpointing the site of TBIs.

Its potential to increase diagnostics for neurological injury, neurological disorders such as dementia, and psychiatric disorders such as schizophrenia, has been widely recognised, and the team are now seeking commercial and research partnerships to help advance its development further.

The new sensor has enabled advances in detecting brain signals and distinguishing them from background magnetic noise, when compared to commercially available sensors. By using polarised light, the device can detect changes in the orientation of spin atoms when exposed to a magnetic field.

The team was also able to reduce the sensor size by removing the laser from the sensor head, and made further adjustments to decrease the number of electronic components, in a move that will reduce interference between sensors.

Benchmarking tests have taken place at the University’s Centre for Human Brain Health, and has reported “good” performance in environmental conditions where other sensors do not work.

Specifically, the researchers showed that the new sensor is able to detect brain signals against background magnetic noise, raising the possibility of magnetoencephalography (MEG) testing outside a specialised unit or in a hospital ward.

The research – published in the ‘Detection of human auditory evoked brain signals with a resilient non linear optically pumped magnetometer’ report, Kowalczyk et al (2020) – was led by physicist Dr Anna Kowalczyk.

“Existing MEG sensors need to be at a constant, cool temperature and this requires a bulky helium-cooling system, which means they have to be arranged in a rigid helmet that will not fit every head size and shape,” she says.

“They also require a zero-magnetic field environment to pick up the brain signals. The testing demonstrated that our stand-alone sensor does not require these conditions.

“Its performance surpasses existing sensors, and it can discriminate between background magnetic fields and brain activity.”

The researchers expect these more robust sensors will extend the use of MEG for diagnosis and treatment, and they are working with other institutes at the University to determine which therapeutic areas will benefit most from this new approach.

Neuroscientist Professor Ole Jensen, who is co-director of the Centre for Human Brain Health (CHBH), highlighted the potential of the sensor.

“We know that early diagnosis improves outcomes and this technology could provide the sensitivity to detect the earliest changes in brain activity in conditions like schizophrenia, dementia and ADHD,” he says.

“It also has immediate clinical relevance, and we are already working with clinicians at the Queen Elizabeth Hospital to investigate its use in pinpointing the site of traumatic brain injuries.”

The team at the CHBH has also recently been awarded Partnership Resource Funding from the UK Quantum Technology Hub Sensors and Timing to further develop new OPM sensors.

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Management during a pandemic: what we’ve learned

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As the country faces the second wave of the coronavirus pandemic, the management team at Richardson Care reflect on their experiences so far. Richardson Care has six specialist residential care homes – three for adults with acquired brain injury and three for adults with learning disabilities. Caring for up to 78 people, many of whom are vulnerable brings added responsibilities and pressures, as well as additional skills.

Our experience in supporting people who are rebuilding their lives after brain injury or living with learning disabilities means that we are problem solvers. We support people to overcome challenges every day. Never has this been more important and we’re proud of the way that our management team and staff have responded.

We asked our Homes Managers for their personal views and experiences of the pandemic – from their initial reactions to plans for the future. We discover what we’ve learnt, and how we can change things for the better.

Resilience
‘The capacity to recover quickly from difficulties; toughness’ has been demonstrated by our team throughout the pandemic. Jane Payne, Operational & Clinical Officer at Richardson Care, takes us back to the beginning of the year: “On February 18th 2020 we informed staff that there was a new virus, and preventative measures were put into place; including hourly touch point cleaning, increase in hand washing and an increase in awareness. Ahead of government guidance on March 12th 2020, we took the very tough, necessary decision to close our doors to family and friends to protect service users. We made sure that all staff worked only in one home, so in the event of an infection, it would not be transferred from one home to another by our staff.”

“The management team have become incredibly solid; working as one in supporting each other, as and when each has needed, as we live and work through the rollercoaster that is Covid-19. I am proud to lead; and be part of such a strong group of individuals displaying a sole purpose of ensuring the care, welfare, safety and security of our service users and staff. Richardson Care has shown we are more than resilient, we have become stronger through experience. Care: it’s in our DNA.”

Jacky Johnson, Registered Manager at our Boughton Green Road home for adults with acquired brain injury talks about the realities of dealing with something that no one had ever experienced before. She says: “We were dealing with real disease: a real virus, in real time with real people…The guidance received from various governing and public bodies changed before the ink could dry…The initial fear demonstrated by some staff left others having to broaden their shoulders… taking on extra activities within their daily routines…The expectation on myself as a Manager weighed heavily, it felt like I should know all the answers to the questions they asked… I was clear of my expectations from my team and them of me… Resilience: it’s not about how many times you fall… it’s about how many times you stand up and face another day.”

Teamwork
It was important to create a positive spirit as we knew our response would impact our service users. Central staff were redeployed so each home had enough admin and maintenance support in their team. This means they have been able to form closer relationships with the service users, some have been helping out with maintenance jobs – developing their skills and feeling valued while completing meaningful activities.

The teams within each home became closer, bonding more as they faced challenges together. No job was too big.

Weekly management meetings moved online in February. The Managers have worked more closely together while being socially distanced. Helen Petrie, Manager at The Richardson Mews adds: “No-one has ever been in this position before. We’re all learning together and supporting each other. We’re there to boost morale when it’s needed, sharing experiences and insight to keep our service users and staff happy and safe.”

Resourceful
We’ve found more efficient ways of operating – reducing risk while continuing to help our service users develop their daily living skills. For example, instead of going out to the shops several times a day, there’s just one trip per day. This means planning ahead, so service users have been helping to plan the menus, write shopping lists and prepare for their daily needs. These all require cognitive skills.

We have all become much more tech-savvy, using the internet, apps, photos and video calls as well as phone calls and letters to keep in touch with service users’ family and friends. We’ve also been checking in with each other more too.

Wendy Coleman, Registered Manager at our Duston Road home adds: “For service users, routine is a major part of their life. When their usual activities are no longer possible – no home visits, day services, community activities – staff have shown how well they have supported service users, reassuring them throughout all this. They have also been dealing with more challenging behaviours due to service users’ complex needs and lack of understanding of what is happening. We have created different routines and activities, promoting health and exercise.”

At The Richardson Mews (inspired by Joe Wicks) the day now starts with ‘Morning Motivation’ – exercising to music every day to improve fitness, flexibility and well-being. We’re also making more use of our in-house gym equipment. One service user who has a brain injury thrived during lockdown: he was in a wheelchair in February and now he can walk 70 lengths of the parallel bars.

Although the service users have missed going out, we have had plenty of scope and opportunity to develop in-house activities. Our large gardens and outdoor spaces have been used for gardening, ‘coffee shops’, sports and games, trampolining and treasure hunts. Our indoor communal spaces have hosted quizzes, craft activities, music and karaoke sessions. We’ve celebrated birthdays with gifts, parties and barbecues. We’ve maintained structure when needed, providing mental stimulation, social interaction and fun, while supporting well-being and skills development.

Appreciating each other
“The new normal is valuing and appreciating the simple things in life and each other, focusing on the positives,” adds Wendy Coleman. As we have gone through the months, we’ve noticed positive changes in service users – improved bonding with staff due to them having much more 1-1 time. Individual service user’s communication skills have also improved.

“Staff have done all this whilst dealing with the impact on their own lives. I feel through all this we all have changed our priorities, we have learnt different coping skills, adapted to change, and have gained new skills.

“It is important to show how we value, support and appreciate each other, talk more, respect and most importantly listen to each other. Learning that showing praise and valuing people is so important in these difficult times.”

Never has the responsibility of managing specialist care services been so great. As we prepare for the next phase of the Coronavirus pandemic, we know that we have the experience, skills and resilience to face the challenges ahead.

Richardson Care provides specialist residential care and rehabilitation for adults with acquired brain injury and learning disabilities. An independent family business with a 30-year track record, it has six residential care homes in Northampton. Find out more at www.richardsoncares.co.uk

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The danger of Z-drugs for dementia patients

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Strong sleeping pills known as ‘Z-drugs’ are linked with an increased risk of falls, fractures and stroke among people with dementia – according to research from the University of East Anglia.

Sleep disturbance is common among people with dementia and the impact for patients and their families is significant.

To date there are no proven effective treatments available, however people with dementia are often prescribed Z-drugs (zopiclone, zaleplon, and zolpidem).

But a new study published today reveals that stronger doses of these drugs are linked with an increased risk of adverse effects.

These adverse effects were found to be similar or greater than those for higher dose benzodiazepines or ‘benzos’ – which are also used to treat sleep disturbance, and are known to have several adverse effects.

The team say that patients already taking higher doses of Z-drugs should not stop taking their medication suddenly, however they should seek a review with their GP.

Prof Chris Fox, from UEA’s Norwich Medical School, said: “As many as 90 per cent of people with dementia suffer sleep disturbances and it has a big impact on their mental and physical health, as well as that of their carers.

“Z-drugs are commonly prescribed to help people sleep – however these medicines were never licensed for dementia and they have been associated with adverse events such as falls and fracture risks in older people.

“We wanted to find out how they affect people with dementia, who are frequently prescribed them to help with sleep disturbance.”

The team analysed data from 27,090 patients in England diagnosed with dementia between January 2000 and March 2016. The average age of the patients was 83 and 62 per cent were women.

They looked at the adverse events for 3,532 patients who had been prescribed Z-drugs and compared them to people suffering sleep disturbance who had not been prescribed sedatives, and patients who had been prescribed benzodiazepines.

They also looked to see whether Z-drug dosage played a part in adverse outcomes.

Prof Fox said: “We studied a range of adverse outcomes including fractures, falls, deep vein thrombosis, stroke and death – over two years. And we were particularly interested to see whether higher doses led to worse outcomes.”

Higher dose Z-drugs and benzodiazepines were defined as prescriptions equivalent to ≥7.5mg zopiclone or >5mg diazepam daily.

“For patients prescribed Z-drugs, 17 per cent were given higher doses. And we found that these patients on higher doses were more at risk of falls and fractures, particularly hip fractures, and stroke – compared with patients who were not taking any medication for sleep disturbance,” said Prof Fox.

Those on lower doses however (≤3.75mg zopiclone or equivalent) were not found to have an increased risk of adverse outcomes.

And there were no differences in adverse events for Z-drugs compared to benzodiazepines, except lower mortality rates with Z-drugs.

Prof Fox said: “This research shows us that higher dose Z-drugs should be avoided, if possible, in people living with dementia, and non-pharmacological alternatives preferentially considered.

“Patients already taking higher dose Z-drugs should not stop taking their medication, but we recommend that they should make an appointment to see their GP for a review,” he added.

Prof Clive Ballard, of the University of Exeter Medical School, who collaborated on the study, said: “Our findings serve an important caution regarding the harms of sleeping tablets in people with dementia.

“This research is a very timely and unfortunately necessary reminder that sedative medications are not a helpful way to manage social isolation during Covid-19.

“Our study also highlights the importance of research to develop non-drug approaches to help people with dementia to sleep – whether they are at home or in residential care.”

Dr Ian Maidment, Reader in Clinical Pharmacy at Aston University and lead pharmacist on the study, said: “Z-drugs are widely used to treat insomnia in people living with dementia, but are only recommended as a short-term treatment for the maximum of four weeks. Our work shows the importance of clinicians including GPs and pharmacists reviewing patients on long-term Z-drugs.”

The study was led by UEA, in collaboration with researchers from The Quadram Institute, Aston University, University College London, and the University of Exeter.

‘Adverse effects of Z-drugs for sleep disturbance in people living with dementia: a population-based cohort study’ is published in the journal BMC Medicine on November 24, 2020.

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