Nigel Smith, Head of Catastrophic Injury at Brain Injury Group member law firm, Clear Law Solicitors looks at the benefits of early rehabilitation following a brain injury.
The purpose of rehabilitation is to restore an injured person to as productive and independent a lifestyle as possible using medical, functional and vocational intervention.
Early rehab = Greater chance of improvement
It is well recognised that following a brain injury, the earlier rehabilitative treatment can be realistically commenced, the greater prospect it has in maximising any potential improvement or recovery by the injured party or improving quality of life. However, it should not be overlooked that rehabilitation is a postcode lottery and is dependent on the availability of rehabilitation services and the availability for the funding of such services.
The funding and availability of placement at rehabilitation units for those with a moderate to severe brain injury is not uniform. The majority of such referrals are NHS referrals funded by the NHS but other possible sources of funding for such rehabilitation would include provision by Local Authority Social Services, medical insurance, the utilisation of damages from a compensation claim giving rise to the brain injury and self-funding.
The identification of such rehabilitation needs involves a decision in which the injured person’s clinical team, the patient and the family are involved, and a decision made is not only to determine what rehabilitation will be provided, but whether the rehabilitation unit identified is able to provide a suitable service.
Many people continue to improve for many years after the initial trauma. However, the most obvious progress occurs in the first 6 months or so post trauma and after that, improvement tends to be less obvious and more subtle. But it can take about 6 months or so after the initial trauma before a clear picture emerges of the likely long-term consequences of the injured party’s brain injury and before any important decisions can be made.
“Mild head injury” rehabilitation
For those suffering what is described as “mild head injury”, research has identified that management and rehabilitation can achieve a good recovery although a proportion of injured people continue to experience significant ongoing disability. In some cases this is due to diffuse axonal injury and cognitive impairment but other symptoms are made worse by factors such as pain, stress, personality issues or litigation and in the case of children, behavioural or learning difficulties predating the original head injury. Psychological therapy using CBT may be helpful and it is clear that the emphasis of effective treatment for mild head injury lies mostly in the field of psychological intervention or medication prescription or both.
Rehabilitation of moderate to severe brain injury
The remainder of this article concentrates on rehabilitation of moderate to severe brain injury after the post-acute phase when the Claimant is either being transferred to residential transitional living unit, or being transferred home, supporting by community rehabilitation teams or outreach teams.
Symptoms of brain trauma
Such significant brain trauma can include some or all the following problems:
- paralysis, spasticity;
- memory, linguistic and cognitive or intellectual damage;
- hearing and visual problems;
- behaviour and anger management issues, and the loss of basic bodily functions, such as balance and mobility, eating and swallowing, and incontinence.
Poly trauma is common with moderate to severe brain injury, and many brain injury sufferers face additional disabilities because of those other injuries. Challenges with work can be made much more difficult, including return to work. Despite advances in early diagnosis and treatment of moderate to severe brain injury, the brain injury will be a life changing experience for many and supporting the patient, family members and care providers in an important part of brain injury rehabilitation.
Rehabilitation of motor deficits and disabilities
In addressing issues of motor deficits and disabilities, specific tools and coping strategies will assist, and examples of this include the preparation of written detailed list of steps that a brain injury sufferer will need to complete an identified task, the use of prompts and visual aids to help the injured person remember things, and the use of assistive devices to move around, such as a walker or a wheelchair.
Additionally, early treatment from a Physiotherapist and a Speech and Language Therapist can help to improve spasticity, walking, talking and swallowing, and the use of visual aids and equipment can help to assist a person in terms of visual handicap and difficulty in communication.
Psychological intervention can help addressing such physical problems of sleep disorder and chronic pain and addressing executive function problems which would include planning, cognitive flexibility, abstract thinking, initiating appropriate actions and inhibiting inappropriate actions.
Medical treatment can also help to alleviate the effects of a brain injury in terms of problems affecting hearing, such as loss of hearing tinnitus, visual issues and increased sensitivity or intolerances to sounds.
If an injured person is not entirely state dependent available funding (see above) can facilitate the appointment of a case manager, and the setting up an interdisciplinary team for treatment in various medical fields identified such as physiotherapy, occupational therapy, speech and language therapy, psychology and nursing, vocational rehabilitation.
The appointment of a vocational rehabilitation expert can assist an adult person back into work or to find work or rehabilitation which would improve that person’s vocational skills. In the case of an individual still in education (such as a child or college student) it can include making appropriate arrangements for suitable provision to be provided to that person.
How long will rehabilitation be for a brain injury?
Anyone suffering from moderate to severe brain injury is likely to need some form of rehabilitation for the remainder of their lives. This may be in the form of support with independent living and various therapies. A brain injury is known to lead to the issues of depression, anxiety, substance abuse and anger management problems. It is likely and probable that there will be some need for input from psychologists and/or psychiatrists for lengthy periods.
What can rehabilitation do for a brain injury?
An excellent example of what can be achieved for the victim of a severe brain injury, admittedly many years after the original collision event, is James Sedge.
In June 2016 James, then aged 21, was knocked down in Sheerness town centre and suffered a severe brain injury. He was left unable to speak and articulate, was doubly incontinent, was unable to stand and walk, had developed epilepsy (which was reasonably controlled by medication) and had significant cognitive and intellectual limitations. After treatment at several hospitals he was discharged in October 2017 to the Little Oyster, a residential home in Sheerness for elderly persons, many of whom were suffering from Alzheimer’s disease or dementia. He had no quality of life apart from family visits and the odd trip organised by the home for its residents.
In 2008 his mother sought legal advice and proceedings were issued in the Royal Courts of Justice against the driver of the vehicle who knocked James down. Liability was disputed but after a trial on liability in January 2011 (almost five years after the road traffic collision) the driver was found 75% to blame for the collision.
There then followed a dispute over James’ potential for rehabilitation. The driver’s insurers argued that it would not be beneficial for him to be moved from a settled environment into trialled independent living and adapted alternative accommodation. Such a proposed regime would require significant rehabilitation and support, and they argued it would not achieve anything meaningful. The course of action advocated on behalf of James however was supported at a Best Interest Meeting.
Following a contested application this was approved by a High Court Judge. The effects and benefits of that trial regime were astounding. By the conclusion of the litigation in 2015 several of the Defendant’s medical experts had revised their initial pessimistic views of James’ potential rehabilitation prospects. Whilst James’ injuries would always prevent him from being able to live a normal independent life alone, the rehabilitation progress that James had achieved in less than 3 years, had resulted in James regaining a significant amount of function in terms of co-ordination of hand to eye movement, to be able to partially feed himself and to drink liquids, (he was initially only capable of PEG feeding), to be able to stand independently and with support make steps (with the expectation of his Physiotherapy Team that he would eventually be able to walk with aids) to articulate certain sounds and words, as well as being able to communicate with the assistance of the electronic and communication aids.
None of this would never have been possible without the significant input provided by intensive rehabilitation even though this only began almost six years after the original traumatic injury.
Rehabilitation improves lives and the opportunity, if available, to utilise and maximise rehabilitation should never be lost, at any time. And the earlier it starts the better the potential prospects.
Useful information on Funding Care after a brain injury
This article has been produced by Nigel Smith of Clear Law Solicitors
Nigel is the Head of Serious Injury and Catastrophic Law at Clear Law Solicitors. He is a Solicitor of more than 30 years post qualification experience, and a specialist in major trauma, and acquired brain injury claims.
Brain Injury Group member firm Clear Law have offices in Manchester but act for clients nationwide.
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