ISSUE 9 Q1 2019
KINDNESS CONQUERS ALL Why compassionate therapy is no soft touch THE ARNI WAY Strongman tears up stroke rule book
QUARTERLY
MAINSTREAM MARVELS The life-changing tech hidden in plain sight
SPORTING CHANCE Childhood concussion breakthrough
RECRUITMENT CRISIS Fixing the people power outage Â
WHEEL WILL OVERCOME A revolution in accessible gyms
ESCORTS, TINDER AND AN AGE-OLD TABOO
NRTIMES 01
A major breakthrough in special communication tech NeuroChat is a neuro-communication system based on Brain-Computer Interface technology for people with severe speech and movement disorders. Millions of people around the world need special communication facilities after a stroke, neurotraumas and diseases such as as cerebral palsy, motor neurone disease, cerebrovascular disease and multiple sclerosis. NeuroChat allows typing without any speech or movement. Users mentally choose letters and objects on a virtual key board and, with the help of advanced technology, can regain the ability to communicate. More than 250 patients are already using NeuroChat for everyday communication.
Without this training most of them become permanently disabled and limited in daily activities. Hospitals and rehabilitation centres lack finances, specialists and equipment to help all these people. The unique features of our solution:
A revolution in home-based
• We move rehabilitation to homes, converting B2B
stroke neurorehabilitation
• We boost neuroplasticity by integrating a robotic
to a B2C model exoskeleton with contemporary neurotechnologies
Stroke affects around 15 million people worldwide. About 80% of stroke survivors must train intensively for several months to recover
like Brain-Computer Interface • We introduce a rental model to make neurorehabilitation affordable for millions of people worldwide
from motor or speech impairments.
• We reduce social and personal cost for stroke rehabilitation
NeuroChat and NeuroBotics
This is a union of Russian companies, developers,
are members of Industry
neuroscience, artificial intelligence, VR, AR robotics,
Union Neuronet
science laboratories and institutes in the fields of neuromarketing, medicine, pharmacy and more. Neuronet covers a wide range of market segments including neuroeducation, neuromarketing and communications, neuroassistance, neuropharmacy, neuromedicaltechnition, neuroentertainment and sports. There are around 300 members from across Russia and 250 supported projects, backed by over £60,000 of investment. Contact info@rusneuro.net for more information.
R USS IA’S LAT E ST R EH AB INNOVAT IO NS A RE C OM I N G TO T HE UK I N T R O D U C I N G N E U R O C H AT A N D N E U R O B OT I C S …
NeuroChat enables: • Communication with family and friends on social networks and messaging platforms • Writing and receiving SMS • Various Internet services such as news feeds, an online diary and many more • 5 languages of interface and an integrated translator • Up to 8 hours of usage of the wireless neuro headset on one charge • Both hospital and home usage • Integration with external devices, including smart home technologies
Contact NeuroChat here: www.neurochat.pro/en/ www.instagram.com/neurochat www.facebook.com/neurotrend
Our products:
NeuroPlay EEG headset Neuro training device Neuro – wheelchair Brain-Computer Interface (software)
Find out more Visit our European site: www.aneurotech.eu Our Russian HQ: www.neurobotics.ru
Visit NeuroNet, NeuroChat and NeuroBotics on stand 600 at the European Neuro Convention in Birmingham on 26 & 27 March.
EDITOR'S NOTE
Welcome to NR Times, your quarterly update on neuro-rehab issues and developments affecting professionals and patients.
The ‘patient-centred approach’ is pretty much a given among reputable care providers. It generally means putting patients' needs and motivations first, with an overarching aim of improving their quality of life. But what if the patient expresses their wish to pay for a sex worker, or set up dates via apps like Tinder and has socially inappropriate behaviour that could put them in difficult situations? Our cover story this issue looks at the problems faced in navigating the potentially tricky issue of sex after a severe injury or the onset of neurological disease. What radiates from all the experts we speak to is that the impact of an individual’s sex life beyond the bedroom cannot be underestimated. In a neuro-rehab context, sex can be intrinsically linked to self-esteem, confidence and, of course, life quality. It can also be clouded by embarrassment among patients and loved ones, however, making it often awkward to address. There may also be legislative and logistical factors to consider. We hope our coverage on this topic helps to remove some of these barriers and challenges. Other discussion points this quarter include the personnel shortage in the care sector and various ways to beat it. In the neuro-rehab field, the issue is exacerbated by the urgent need for growth in service coverage amid rising brain injury numbers. Also on our agenda this edition is compassionfocused therapy, and its potential for success where more widely-used approaches might fail. Expert updates on childhood concussion, injury classification and stroke recovery are also offered, as are a couple of inspiring stories that typify the power of determination in rehab. Meanwhile, if you’re a regular reader of NR Times,
04
NRTIMES
you may notice our front cover is marginally less shiny than usual. Having awoken to the need for everyone to do their bit to curb the global plastic waste crisis, we’ve swapped our laminated cover for a biodegradable varnish. We’ve also replaced our polythene mail-out bags for those made from potato starch. This means the entire magazine – including the wrapper you may have received it in – can be thrown on the compost heap to become worm food; ideally after you’ve read it! Andrew Mernin Andrew@aspectpublishing.co.uk
Sales: Jane Reed Jane@aspectpublishing.co.uk Chloe Hayward Chloe@aspectpublishing.co.uk Design: Aimee Thompson aimee@aspectpublishing.co.uk
Published by Aspect Publishing Ltd, with UKABIF serving as an editorial advisory panel 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.
Omo Neurexa plus with the Manu Neurexa plus
L300 Go Bioness FES system
Walk On Carbon fibre drop foot orthosis
Redefining the path to rehabilitation. Developed in close collaboration with professionals, physicians and therapists, Ottobock provides a complete range of stroke solutions for both upper and lower body. Our quality soft orthoses have been specially developed to support the rehabilitation therapy programmes which are so important to restoring a patient’s movement and quality of life. Visit www.ottobock.co.uk/path2rehab or email orthoticsuk@ottobock.com today for more information. Otto Bock Healthcare PLC 32 Parsonage Road, Englefield Green, Egham, Surrey TW20 0LD T +44 (0) 1784 744 900 · F +44 (0) 1784 744 901 · bockuk@ottobock.com · www.ottobock.co.uk
CONTENTS
12
NEWS The latest from the world of neuro-rehab.
30
SPORTING CHANCE Childhood concussion breakthrough
34
FITNESS FOR ALL A revolution in accessible exercise
44
MAINSTREAM MARVELS How to get consumer tech working for your clients
48 06
NRTIMES
STUDY GUIDE Classification of brain injury
CONTENTS
52
THE ARNI WAY The strongman transforming stroke care in the UK
58
KINDER CARE Why compassion-focused therapy is no soft touch
62
SECTOR IN CRISIS The great recruitment challenge facing rehab providers
COVER STORY
38 The many taboos of sex and rehab
68
FUNDING GAP Leader calls for more stroke investment
72
EVENTS Dates for your diary in the months ahead
74
CLOCKING OFF Notes from the sidelines of neuro-rehab
NRTIMES 07
NEWS ANALYSIS
The missing link in solving prison problem?
08
NRTIMES
ANALYSIS Offenders at every prison and probation setting in the UK should have access to a member of staff trained in brain injury signs and symptoms, experts have urged.
“My head’s like a patchwork quilt under there,” says Wendy, an inmate at HM Prison Drake Hall in Staffordshire. “He beat me bad, bad, bad… I was just knocked out, unconscious, so many times.” Before slipping into the criminal justice system, Wendy suffered domestic violence in a four-year relationship. She is now part of a damning statistic; more than six in 10 female offenders have a history of acquired brain injury (AB)). This is according to research led by The Disabilities Trust, which found that of 173 female offenders at Drake Hall examined against the Brain Injury Screening Index, 64% had a history indicative of a brain injury. The vast majority of injuries (96%) were traumatic, while a third were sustained before the individual committed their first known offence. The Disabilities Trust’s findings follow the introduction of the charity’s Brain Injury Linkworker Service at the facility. The service provides support to women with a history of ABI, developing a “sustainable pathway” that supports rehab and helps prisoners to manage the transition between custody and the community. From the women supported through the service, there were 196 reports of severe blows to the head - 62% of which were sustained through domestic violence. Nearly half (47%) of the women with brain injuries had been in an adult prison five or more times and 33% sustained their first injury prior to their first offence. Following its findings, The Disabilities Trust has called for linkworkers – or a similar role with a strong understanding of brain injury – to be accessible to all prisons and probation settings. To date, the linkworker service has been rolled out into eight prisons, HMP Drake Hall, Preston, Leeds, Aylesbury, Bullingdon, Durham, Deerbolt and Cardiff.
An independent assessment of the charity’s research by Royal Holloway, University of London, found that women seen by the linkworker experienced improved mood and self-esteem, and enhanced confidence and positivity; key factors that have been previously identified as being essential for a woman to engage in rehabilitative programmes. The linkworker service also offered practical guidance for staff working with women with a brain injury, and alleviated pressure from other service provision such as mental health. It concluded that a brain injury linkworker service provides a strong framework which will benefit offenders and prisons by identifying and managing brain injury. Offenders helped by the service include ‘Sarah’ who says of her brain injury: “I was becoming very anxious about these problems that I was seeing ...not remembering the names of the people I’d spoken to or not being able to express myself properly ‘cause I’m forgetting what I’m saying.” Another, 'Helen', says: “When I was counting
From the women supported through the service, there were 196 reports of severe blows to the head - 62% of which were sustained through domestic violence screws in the work area I had to count them three times. It gets me very stressed, like when people tell me ‘go and tell this person [something]’ and [I’m] forgetting it.” As well as the rollout of a linkworker service, or something similar, The Disabilities Trust
called for the inclusion of brain injury screening as a routine part of the induction assessment on entry to prison or probation services. All prison and probation staff should also receive basic brain injury awareness training, it said. The charity also sought assurances that brain injury support would be aligned with “gender-informed” practice. It also recognised that further research is needed to examine the potential effect of brain injury on re-offending behaviour – as well as the role of neuro-rehab in contributing towards the reduction of re-offending behaviour. The landmark Time for Change report, published in October, made similar recommendations. The report, by the All-Party Parliamentary Group for ABI, called for reforms to criminal justice procedures and processes to factor in the needs of people with ABI. More ABI training for staff in the police, court, probation and prison services was also urged; as was brain injury screening for children and adults on entry to the criminal justice system. If a brain injury is identified, its impact, severity and related deficits should be measured and “appropriate interventions planned by a trained team”, the report said. Also, it recommended that all agencies working with young people in the criminal justice system, schools, psychologists, psychiatrists, GPs and youth offending teams work together to ensure individual needs are addressed. As the APPG report stated, evidence now emphatically links ABI to offending in young people, with prevalence rates for traumatic brain injury (TBI) as high as 60% in some studies (most recently, a 2018 comprehensive review published in The Lancet Psychiatry). In comparison, UK brain injury charity Headway says only around one in 200 people
NRTIMES 09