UK Acquired Brain Injury Forum Time for Change Conference Showcases Beacons of Hope

UKABIF’s online #TimeforChange summit this month provided solid proof that, since the campaign’s launch in January 2019 and despite the Covid-19 pandemic, action to improve the lived experience of brain injury remains in full swing.

Of the many hot topics on the 2-day conference agenda, here are 14 sparks of optimism in the realm of brain injury rehabilitation provision:

Budding TBI biomarkers

Biomarkers (medical signs) of traumatic brain injury (TBI) found in body fluids could be important internal indicators of brain damage, as explained by #TimeforChange speaker, Dr Leighton Chan.

Scientists are still trying to evaluate their diagnostic and prognostic value, but one such potential biomarker showing promise is neurofilament light (Nfl).

Nfl is a protein that breaks away from neurons after brain damage and collects in the cerebrospinal fluid where it can be measured as a reflection of the extent of the injury.

Dr Chan, who is Chief of Rehabilitation Medicine at America’s NIH Clinical Center, is particularly interested in monitoring Nfl levels as a tool for treatment and rehabilitation in the long term.

N-ROL on!

A new online neurorehabilitation project is proving a wow with people with a wide range of neurological conditions in the UK.

Launched after Covid-19 blocked physical access to neurorehabilitation services, N-ROL enabled support to continue via virtual provision [1].

N-ROL is a collaboration between London’s UCL Queen Square Institute of Neurology and the UK’s brain injury recovery charity, Same You, set up by Game of Thrones actress, Emilia Clarke.

At the #TimeforChange summit, the charity reported “very positive results” from combining physical and remote rehabilitation.

N-ROL’s support services include:

• Compensatory strategies for cognitive deficits.
• Emotional and educational support for stroke survivors.
• Carer giving café for stroke survivor carers.
• Fatigue management group.
• Communication groups to improve comprehensibility.
• Physical strength and fitness groups.
• Upper limb recovery support.

Cheers for 100 years!

The #TimeforChange summit proved the perfect place to celebrate a centenarian in the progression of neurorehabilitation globally.

The Archives of Physical Medicine and Rehabilitation (APMR) celebrated its 100th birthday this year as a leading publisher of reports on important developments in physical medicine and rehabilitation worldwide.

Its American editor, Dr Leighton Chan, urged anyone involved in research to share their findings on the APMR platform. [2]

The wings of change…

The mythical bird, the phoenix – the emblem of the Royal College of Occupational Therapists (RCOT) – sent renewal hopes soaring at the #TimeforChange summit.

For there are at least 12 ways to rebuild rehabilitation services post Covid-19, according to a new report, ‘Rehabilitation in the wake of Covid-19 - A phoenix from the ashes’.

The recommendations for a better, more co-operative model’ by the British Society of Rehabilitation Medicine (BSRM) include:

• Access to early rehabilitation for patients with severe disabling illness/injury.
• Immediate access to acute rehabilitation after release from intensive and high dependency units.
• Provision of rehabilitation prescription (RP) for ongoing needs.
• Involvement of rehabilitation medical consultants from an early stage. 
• A completed complex needs checklist before discharge.
• Supported discharge to home and early community-based rehabilitation.
• Assessment programmes for those discharged to care settings.
• Development of rehabilitation pathways by critical care, acute medical and specialist rehabilitation teams.
• Close networking between level 1, 2 and 3 services, with adequate capacity at all levels.
• Collaborative commissioning arrangements. 
• Networking with GPs to identify late rehabilitation needs.
• Covid-positive and Covid-negative rehabilitation streams 

HITS alright!

The Liverpool Head Injury Tomography Score (Liverpool HITS) is proving a hit in improving communication between neurosurgical and referral centres [3], the UKABIF conference heard. 

The new scoring system defines ‘surgically significant’ mild traumatic brain injuries in a bid to guide local trauma units how best to manage referrals. 

Devised by staff from The Walton Centre and Liverpool University Hospitals NHS foundation trusts, the system is reported to be significantly reducing workload without impacting patient care.

Powerful politics

Rhonnda, MP Chris Bryant, Chair of the UK’s All-Party Parliamentary Group on Acquired Brain Injury, has four family reasons to fight for change in neurorehabilitation, as he revealed during the summit.

His father, mother, stepmother and aunt all experienced neurocognitive conditions, driving his mission to make all MPs recognise the reality of the “hidden epidemic” of brain injury.

   Substantial, robust, clinical and cost-effective evidence emphatically supports the role and value of neurorehabilitation.   

MP Chris Bryant, Chair of APPG for Acquired Brain Injury. (House of commons speech 2019)

Policing priorities

Times are changing in the criminal justice system, bringing new approaches to identifying and dealing appropriately with offenders with neurological impairments, the conference heard.

Stan Gilmour, Director of Thames Valley Police’s Violence Reduction Unit, outlined a 5-year national vision to improve support for vulnerable people and enable the police, public health teams and other partners to work better together.

He also revealed worrying evidence of the prevalence rates of neurological impairments in young people who offend, compared to the general population, including:

• Traumatic brain injury:       65 - 72 per cent in custody compared to 24 - 31.6 per cent generally.
• Communication disorders: 60 - 90 per cent in custody compared to 5 - 7 per cent in generally.
• Learning disabilities:          23 - 32 per cent in custody compared to 2 - 4 per cent generally.

Schools of thought

Leading special educational needs experts have identified missing links in the provision of neurorehabilitation to young people with brain injury in school.

Summit speakers, Gill Robinson, OBE, SEND representative of the Teaching Schools Council, and Ali Ashley, Co-chair of the National Network of Special Schools, outlined 4 key areas needing attention: 

• Connectivity between the medical support team and school staff, not just the headteacher.
• Sharing of information between classes and schools.
• Streamlining the number of external professionals involved to facilitate communication with schools.
• Improved understanding of learning needs specifically linked with the varying types of brain injury.

Domestic abuse action

The Disabilities Trust is throwing its weight behind moves to tighten domestic abuse protection laws after new evidence showed 81 per cent of female survivors suffered blows to the head. [1]

Discussing her report, ‘ABI and Domestic Abuse: Working Together to Create Positive Change’, Jocelyn Gaynor, the trust’s Head of Foundation, pointed to current amendments to the draft Domestic Abuse Bill being tabled by MP, Chris Bryant.

The amendments include screening women, with their consent, for traumatic brain injury following domestic abuse and a new civil order to replace the existing Domestic Violence Protection Order.

Sporting chances

Exponential growth in research into links between sports and brain injury is fueling calls for collaborative action to tackle head injuries, UKABIF trustee, Dr Michael Grey revealed.

Enhanced education campaigns in schools and joint working between sport, government and health professionals are needed to improve awareness and understanding of concussion and other brain injuries, he said.

To that aim, Dr Grey and a team of researchers at the University of East Anglia launched the SCORES project earlier this year to test former professional football players for early signs of dementia.

Participants will be monitored for the rest of their lives in the hope that the findings will shape improved sports safety practices. 

Prize surprises

UKABIF’s 2020 awards for inspiration and innovation in brain injury rehabilitation were announced at the summit as follows:

• Mike Barnes Award for Innovation - Dr Ellis Parry of Neumind for the app, Alfred, which uses ‘smart prompts’ to enhance practical and clinical support for people with neurological impairments. [2]
• UKABIF Film Award – Andrea Kusec for ‘Metaphors’ which can be seen among the many other UKABIF film award winners on YouTube. [3]
• Stephen McAleese Award for Inspiration – Jason Le Masurier who, despite being told he’d be lucky if he ever walked again after a brain injury in 2007, went on to become a triathlete and a motivational speaker. [4]
• UKABIF Award for Public Engagement – researcher, Georgia Dunning of Salford Royal NHS Foundation Trust for her poster detailing ‘An evaluation of ethnicity in a neuropsychology department’.  

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