About Brain Injury
Acquired Brain Injury (ABI)
An Acquired Brain Injury is a non-degenerative injury to the brain that has occurred since birth. It can be caused by an external physical force, by disease or by internal physiological events.
ABI includes:
- Traumatic Brain Injury (TBI) – which includes open, closed or penetrating head injury – occurs as a result of road traffic accidents, sport or leisure pursuits, assaults, falls or battle; and
- Non-Traumatic Brain Injury – which may be caused by:
- strokes and other vascular events, including subarachnoid haemorrhage;
- tumours;
- infectious diseases (eg, encephalitis, meningitis);
- hypoxia (lack of oxygen), often accompanied by ischaemia (lack of blood supply), resulting in a “hypoxic-ischaemic” brain injury after cardiac arrest;
- metabolic derangement, most commonly due to severe hypoglycaemia (low blood sugar); and
- toxic products taken into the body through inhalation or ingestion, for example due to carbon monoxide poisoning.
Extent of ABI
Most is known about the numbers of people with TBI and stroke.
“Head injury is the foremost cause of death and disability in young people …” (Health Select Committee report: HEAD INJURY: REHABILITATION (2001) http://www.publications.parliament.uk/pa/cm200001/cmselect/cmhealth/307/30702.htm
According to the Department of Health’s National Service Framework for Long Term Neurological Conditions (NSF) (2005) and the National Stroke Strategy (2007):
- about 8000 people of working age are hospitalised in London with a TBI each year
- about 3000-3500 people under 65 (approx 1000 under 50) suffer a stroke each year in London
- there are approx 55,000 people of working age living with the long-term effects of a TBI in London. (there are no comparable estimates for stroke or other forms of ABI.)
Not only the personal but also the economic consequences of ABI are enormous. In the UK the annual costs of direct and informal care and lost productivity after stroke have recently been estimated at £7.0 billion*. Similar data describing the overall economic burden of TBI in the UK are not available, but the cost must be of similar magnitude as that of stroke as it has been estimated to be about $50 billion annually in the USA [1] [2] [3]
Effects of Brain Injury on the person and family
A serious brain injury – from whatever cause – can be life-changing for the individual and their family and friends.
TBI mainly affects young people, particularly in the age range 16 – 29 (and more men than women), whereas stroke affects in the main older people, although, importantly, about 25% will be under 65 and 10% under 50.
After TBI (and, for example, encephalitis), people usually become mobile again fairly quickly , and the main difficulties initially and long term often result from a complex mixture of physical, cognitive, emotional and behavioral problems, and typically a change in personality and a lack of awareness of how the brain injury has affected them.
This in general contrasts with difficulties experienced by younger stroke survivors, which most commonly result from problems with physical mobility and personal care, as well as communication and spatial orientation, although there can also be problems of a cognitive kind, for example, to do with short-term memory, concentration, reasoning and planning.
Every brain injury is different and the effects will depend, for example, on the extent of the injury and part of the brain that has been damaged. Fatigue is a common experience after a brain injury from many causes.
In many cases after ABI, there is limited physical or sensory disability. The residual effects are largely “hidden”, and thus less easy to observe. This is well recognised to result in misunderstandings, and thus loss of employment, relationship breakdown, low self-esteem, and social isolation for the person, as well as their family. The process of adjustment is very difficult for all. The affected person will in most cases have a normal life expectancy.
Even a ‘mild’ stroke or head injury (the latter often called ‘post concussion syndrome’) can in some cases lead to long-term problems.
For more information on ABI and its effects see, for example:
Headway
http://www.headway.org.uk/About-Brain-Injury.aspx
The Stroke Association
http://www.stroke.org.uk/information/what_is_a_stroke/common_problems.html
Different Strokes
http://www.differentstrokes.co.uk/
The Encephalitis Society
Services needed
To achieve the best level of recovery, people will need specialist rehabilitation and support services across the whole care pathway – both as an inpatient and in the community.
Rehabilitation services currently available [give link to services page]
Where people after a brain injury have complex needs, they will initially need specialised inpatient neurological rehabilitation, often followed by day- patient or community rehabilitation, in order to achieve maximum levels of recovery. For these gains to be maintained, they will also need knowledgeable support in the community. This will often be long term, sometimes life-long, and, as identified in the NSF for Long Term Conditions, will require integrated working between Health and Social Services with involvement from other agencies as appropriate
With the right interventions – and, importantly, long-term follow-up and support and encouragement – the person can be helped to be as independent as possible, and to have a good quality of life.
Currently there are shortages of provision – in terms of expertise and capacity – in rehabilitation at all levels, and a lack of recognition that impairments following brain injury often require long-term support.
Without appropriate rehabilitation and follow-up support services, people will continue to “fall through the gaps” in service, and are at risk of relationship breakdown, homelessness, alcohol and drug dependency, or finding themselves in the criminal justice system.
Specialised inpatient neurological rehabilitation – the specialised pan-London neuro-rehabilitation consortium commissions services across London, at present via nine specialist providers. This should provide equity of access across London. However, waiting times can still be too long, and timely and appropriate discharge can on occasion be a problem.
Specialist community neurological rehabilitation and follow-on support – although there are some very good services available, provision varies markedly across London. Some PCTs have local multi- or inter-disciplinary teams which may or may not include specialist physiotherapy, occupational therapy (OT), speech & language therapy (S & LT,) and neuropsychology. However others have no such service, in which case people may be referred to specialist regional outreach teams.
The amount of intervention any of these teams can provide, and the extent of any follow-on services, are often limited. Some people get nothing. It’s very much a post-code lottery.
Specialist Vocational (work) rehabilitation services – returning to work is very important for people after a brain injury, either to their previous employment or, if this is not possible, in some other form of productive activity, It provides opportunities to re-build self esteem and re-integrate into society, as well as the more obvious potential financial benefits. In order to achieve this, there is often a need for specialist brain injury vocational rehabilitation services, since the more-general, mainstream providers do not have sufficient expertise and understanding of the effects of ABI to work effectively with this client group.
In some areas, community teams and Headway Centres in London provide some vocational rehabilitation, or prepare people to engage in more specialist vocational rehabilitation. However there is currently only one specialist brain injury vocational rehabilitation service in London. There is also, of course, a need to educate employers and colleges about the needs of this group, particularly their cognitive and behavioural needs.
Long-term support in the community
Headway and other voluntary sector organisations, such as Different Strokes, have an important role as part of the long term care pathway. Headway provides important social rehabilitation and long-term peer support to survivors and carers and family members. There is a major lack of capacity in terms of Headway support services in London.
[1] Department of Health. Reducing Brain Damage: faster access to better stroke care’. National Audit Office, London, 2005.
[2] Thurman D. The epidemiology and economics of head trauma. In Head Trauma: Basic, Preclinical, and Clinical Directions. Miller L, Hayes R, eds. New York, NY: John Wiley & Sons, 2001.
[3] Finkelstein E, Corso PS, Miller TR. The incidence and economic burden of injuries in the United States. New York, NY: Oxford University Press, 2006.
