NR
issue 7 Q3 2018
neuro rehab
biting back
times ice age Brain cooling study raises rehab hopes
An age-old miracle cure returns
QUARTERLY
rolling recovery
Saving lives in the concrete jungle
the big debate What now for brain injury care in Britain?
power surge
Switching onto the spinal tech revolution mapped out conflict zones of client care
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welcome
EDITOR'S NOTE
Welcome to the latest edition of NR Times, your quarterly update on issues affecting professionals working with brain and spinal injuries and neurological conditions. If forecasts were right, you're reading this with the heatwave still sizzling along. As you struggle to cool off, have you noticed your concentration levels dropping? New research suggests heat slows the brain down. A Harvard study compared brain speeds between students with and without air conditioning. Those without were significantly slower at maths and cognitive speed and memory tests. The paper offers a fleeting glimpse at a largely misunderstood factor in brain-related science and healthcare; temperature. As we report this issue, however, where heat can hinder, the cold can heal. It’s long been known that cooling the brain after an injury can help to limit damage. Yet little is known of exactly why – or how to optimise such treatments. But progress is afoot. Scientists in Scotland are leading the way towards life-saving cooling devices to be used after brain injury and stroke. Find out more on p36. Another often-overlooked influencer on brain health is diet. Fuelling the body in the interests of the brain is nothing new – in fact, the food-based therapy we cover this quarter has been around for almost a century. It is having a resurgence though, as professionals realise the areas of the brain nutrition can reach that some drugs cannot. Perhaps more widely celebrated as a force for good in neuro care than cooling and diet, is technology. Brain and spinal tech development, backed by vast budgets around the world, promises much for the future of neuro-rehab. But the path from lab to
ward can be frustratingly long. Sometimes, perhaps through overly eager university PR teams, we see very early stage breakthroughs vaunted as the next big thing. It may be years before they see the light of day in a hospital setting – if at all. In this edition we seek out the real picture of the technologies we should be getting excited about. You’ll also find the first in a series of our ‘study guide’ features, which neuro-rehab professionals in various fields should find useful. If you missed it, you can also catch up on the recent Commons debate on brain injury. We hope you find something to inform and inspire you this quarter. Failing that, NR Times doubles up as a handy fan to help keep your brain at prime temperature in this blistering heat. Andrew Mernin Andrew@aspectpublishing.co.uk
Published by Aspect Publishing Ltd in association with UKABIF 20-22 Wenlock Rd, London, N1 7GU. Registered company in England and Wales. No. 10109188. Features labelled 'sponsored' are paid for by our sponsors who support the production of this magazine.
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contents
06
news The latest from the world of neuro-rehab
20
believe the hype Your guide to a surprisingly common threat
24
centre ground Putting clients first in the face of conflict
04
NRtimes
30
special k An age-old miracle cure bites back
36
ice age Brain cooling study raises rehab hopes
contents
The
BIG DEBATE
52
new horizons The spinal tech we really should be excited about
39
The nation's brain injury challenge dissected
60
rolling recovery Saving lives in the concrete jungle
64
events
Dates for your diary in the months ahead
66
clocking off
Notes from the sidelines of neuro-rehab
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analysis
Short-termism, poor access to care and gaping holes between paediatric and adult services are exacerbating the burden of child brain injuries, a report suggests.
Children let down by brain injury care gaps An in-depth study conducted in the US and
the US cause around 640,000 A&E visits, 18,000
employment, and engagement in a healthy lifestyle.
submitted to the American Congress outlines many
hospitalisations and 1,500 deaths.
“It is widely recognised that children with
issues hindering the delivery of rehab to brain
The leading causes of these incidents are
brain injury are under-identified for health and
injured young people.
unintentional falls and being struck by or against
educational services and under-served by existing
While carried out by US-focused organisations –
an object, whereas for those 15-24 years of age, the
support, placing them at risk for poor health and
the Centers for Disease Control and Prevention
leading causes were motor vehicle crashes and falls.
educational outcomes.
in collaboration with the National Institutes for
Sports and recreational activities accounted for an
“Understanding the gaps in care and developing
Health – it offers insights for child brain injury
estimated 325,000 A&E visits among children
approaches for optimal assessment, access to
treatment globally.
and teens.
services and service delivery is critical to ensuring
The extensive paper, The Management of Traumatic
Against such numbers, the report warns: “There
that children with TBI have the best possible
Brain Injury (TBI) in Children: Opportunities for
is frequently an incomplete understanding about
treatment and outcomes.”
Action, suggests a lack of knowledge, infrastructure
the effects of TBI beyond the initial injury among
One of these gaps is a “substantial variation” in
and consistency in services is at the heart of
parents, healthcare professionals and educators.
acute injury care for children. “Not only are there
problems in getting young people the long-term
This often creates barriers to optimising outcomes
inconsistences in TBI assessment, but also in the
treatment they require.
for children across their lifespan, including
comprehensiveness of discharge recommendations
Annually, TBIs in children (aged 14 and under) in
the achievement of high school graduation,
for all severity levels of TBI,” the report says.
06
NRtimes
analysis Other gaps include: • A lack of monitoring of children with a TBI over a
they gave the RP to GPs AND patients.
prolonged period of time after their injury
As it launched its campaign, the alliance said:
• Poor awareness of the implications of brain
“The rehabilitation prescription is a valuable
injury and possible pathways among parents
tool that documents the rehabilitation needs of
• Difficult access to schools-based support services
the individual with an acquired brain injury. It
• Following concussions, a dearth in ‘return to play’
has no value if the individual and their GP don’t
guidelines for activities beyond organised sports
receive a copy. And if the individual and the
• A drop-off in access to care following the
GP don’t know what rehabilitation is required,
transition from adolescence to adulthood
then no access to services can be planned or
• Limited “TBI recognition” training for
implemented.”
professionals involved in the care and support of
It remains to be seen whether RP mark two will
young people
fix these issues. In recent correspondence with
• A lack of hard evidence and research on
the ABI Alliance, NHS England said: “Key things
long-term outcomes for children with TBI
that will be included in every RP-2019 include a clear list of actions for the GP, the patient’s
Although the report focuses largely on the US, its findings mirror many of the challenges faced in the UK, says Katy James, head of the Children’s Trust's brain injury community service. “Our experience of supporting children in the community is that all too often the full impact of a child’s brain injury is not recognised and in many cases the injury is forgotten about as the
Will new rehab prescription fix old failings?
ongoing rehabilitation needs and the services that they have been referred to.” A contact number for a major trauma centre (MTC) key worker on hand to give advice, and a ‘patient comments’ section, will also be included. Another of the alliance’s recommendations is that the RP should be used for all patients with ABI, not just those that have been through
child gets older. Children and young people with
A new version of the rehab prescription
an MTC. NHS England’s response suggests
acquired brain injury often experience ‘hidden
(RP), which sets out an individual’s required
this may be looked at in the future. It told the
disability’ - cognitive, communication and
treatment after a trauma, is to be introduced
alliance: “We hope the new RP will exceed
emotional difficulties that are not immediately
next year.
the recommendations of [the ABI Alliance].
apparent or are not understood by care givers
NHS England says the RP has been updated
Although it has initially been designed for major
or educators.
by clinical experts and patient representatives
trauma patients, it is anticipated that this RP
“We also know from experience that these
and is currently undergoing a final review in
could be adapted for other patient groups,
difficulties can become more of a problem
primary care.
including others with ABI.” It is hoped, therefore,
as children face the challenge of moving into
Once launched in April next year, 'RP-2019'
adolescence and towards adulthood.
will be developed with the involvement of the
“And yet we find that support services in the
patient and/or their carers, the authority says.
UK are limited and often there is a lack of
Crucially, copies will apparently be given to the
collaboration between health, education and
patient, their GP and their next care provider. If
social care. Provision can be haphazard and
this point is delivered, this would fix what many
influenced by postcode, the nature of the injury
neuro-rehab experts see as a major flaw in the
and parental ability to have a voice for their child.
RP system.
Young people moving from children to adult
Last year the Acquired Brain Injury (ABI)
services often hit a ‘black hole’. While recent
Alliance launched a campaign to ensure that
developments from regional networks and
all patients leaving hospital after treatment for
that RP-19 will eventually be mandated for use
awareness-raising activity is promising, there
an ABI receive a copy of their RP, with one also
in all trauma centres, not just MTCs.
remains no national framework and we are still
forwarded to their GP. A Freedom of Information
The alliance intends to continue campaigning
a long way off from a cohesive and equitable UK
request sent to all clinical commissioning groups
for everyone with ABI to get access to the RP. It
model of provision for children with acquired
in England last year showed that recognition of
is also pushing to better educate CCGs and GPs
brain injury. More needs to be done to build the
the RP was "inexcusably low", the alliance said.
on the role and need for RPs, as well as neuro-
evidence base and research the long-term impact
Of 24 trusts that responded, less than half said
rehab services generally.
Recognition of the RP was inexcusably low among CCGs
of ABI in order to shape services.”
MORE NEWS
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