neuro rehab
NR
issue 5 Q1 2018
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spin doctor Free wheeling on the road to recovery plot thickens The power of stories after serious injury
QUARTERLY
stronger together BRAIN INJURY LOBBY FINDS ITS VOICE
curious case In search of the missing rehab prescriptions
robot dawn
A revolution in patient data
signal lost
When the brain can't visualise
Christchurch Group is the UK’s leading provider of neurological rehabilitation, caring for and rehabilitating patients with complex brain and spinal injuries and neurological conditions in eight highly specialised centres across the country.
Our interdisciplinary therapy teams and industry-leading clinicians are committed to providing the very highest levels of rehabilitation through individually tailored, goal driven rehabilitation plans for all of our residents. All Christchurch Group centres offer residents a rehabilitation pathway delivered through expert Lead Consultants working alongside psychologists, behavioural specialists, nurses, occupational therapists, physiotherapists, speech and language therapists, dieticians and rehabilitation assistants. To find out more or discuss the funding options available, please contact our referrals team on 07595 655239 or email referrals@christchurchgroup.co.uk
Neurobehavioural rehabilitation
Specialist nursing
Spinal injury rehabilitation including ventilated care
Long term maintenance
Stroke rehabilitation
Outpatient rehabilitation
Community support and outreach
For more information visit:
ChristchurchGro
www.christchurchgroup.co.uk
Christchurch Group Neurological Rehabilitation
welcome
EDITOR'S NOTE
Welcome to the latest edition of NR Times, your quarterly update on issues and developments impacting on professionals working with brain and spinal injuries. In NHS spending terms, neuro-rehab is a mere spec on the national healthcare map. Making itself heard as decisions about the future of public health are pondered has therefore been difficult-to-impossible in recent years. As every other healthcare discipline shouts for more funding, support and consideration, the brain injury lobby’s voice is one of many. On the occasions that it is in earshot of high ranked decision-makers who are actually listening, they may be surprised to learn of rehab economics. Yes, treatments are relatively expensive and labourintensive – but the long-term savings they could offer the NHS far outweigh upfront costs. Other lesser known neuro-rehab truths include the sheer volume of undiagnosed brain injuries and the many hidden challenges which impact on all angles of a patient’s life. We hope new focus on brain injury issues by crossparty MPs will help to get such messages to the top table. Chris Bryant MP insists it will, in our feature about the newly formed All-Party Parliamentary Group on acquired brain injury. Beyond governmental support, collaboration among brain injury professionals is proving a powerful force in improving patient outcomes. The rehab prescription has been hailed as a major step forward since it became part of official guidelines. But various recent conditions have conspired to stop it living up to its full potential. In this issue, we see how all professions involved with
trauma patients are pulling together to ensure a huge opportunity for change is not missed. In our first of four editions of 2018, we also report on some of the emerging trends which may shape your work this year. Rehab cycling, new approaches to diet and artificial intelligence are a few of the stops we visit. We also explore goal-setting, the potency of stories in recovery and aphantasia - the strange brain condition that robs the mind's eye of pictures. Read on for all this and more.
Andrew Mernin Andrew@aspectpublishing.co.uk
Published by Aspect Publishing Ltd in association with UKABIF Aspect Publishing, 20-22 Wenlock Rd, London, N1 7GU Registered company in England and Wales. No. 10109188. All contents ©2018 Aspect Publishing Ltd. 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.
18
signal lost When the brain can't visualise.
22
perfect harmony Get the inside track on neurologic music therapy.
26 30
food for thought Why rehab diet plans may need an urgent rethink.
04
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soaring ambition Your guide to goal-setting in rehab.
contents
32
spin doctor Free wheeling on the road to recovery.
40 cover story Brain injury lobby finds its voice.
38
access denied
Fighting back against funding rejection.
44 48
rise of the robots A new dawn in data beckons.
curious case In search of the missing rehab prescriptions.
52
ever after The role of stories in young people's recovery.
56
events
Dates for your diary in the months ahead...
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clocking off
Notes from the sidelines of neuro-rehab. NRtime
05
analysis
Global commission calls for urgent action Healthcare professionals, researchers and policymakers have been urged to play their part in arresting the world’s accelerating TBI crisis, as NR Times reports. Traumatic brain injury (TBI) looks likely
Among several recommendations, the report
to remain the largest global contributor to
urges an international consensus on definitions
neurological disability until at least 2030,
and standardised epidemiological monitoring of
an international commission has forecast.
TBI, to allow accurate measurement of key
The predicted burden of disability
factors such as incident rates and access to care.
surrounding TBI across the world “far exceeds”
The report also underlines the value of
that related to dementia and cerebrovascular
centralised care, explaining: "There is growing
disease, says the Lancet Neurology
evidence of a relationship between management
Commission’s extensive report.
in high-volume centres and improved outcomes,
The paper estimates that the global annual
which suggests that care for the most critically ill
cost of TBI could be as high as US$400bn
patients should be centralised.
(£296bn), or around 0.5 per cent of gross
"Substantial gains could be made from provision
world product.
of adequate prehospital care, appropriate referral
Between 50 and 60 million people experience
and continuity along the chain of care, with early
a TBI each year, while studies suggest half the
access to effective rehabilitation,” it adds.
world's population will have at least one TBI in their lifetime. The report aims to pave the way for what it calls a “long overdue”, concerted effort to tackle the global TBI problem, which is a "public health challenge of vast, but insufficiently recognised, proportions”. It sets out priorities and expert recommendations for all parties involved in TBI, including healthcare professionals, researchers, funders and decision-makers. Over 70 expert authors representing institutions spanning the globe contributed to the report, with a further 250 contributors via the International Initiative for Traumatic Brain Injury Research (InTBIR). A lack of uniformity in the characterisation and management of TBI in different countries around the world is a continual theme throughout the report.
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The commission also calls for: • More research into links between TBI and increased risk of later neurological diseases, such as stroke and dementia • Better strategies for TBI prevention to deliver cost savings that could fund improved access to care and research • Professional sporting organisations to lead by example by immediately removing anyone with a suspected concussion from play • Healthcare policies which improve access to acute and post-acute care, reducing the burden of TBI on patients, families and society • More "robust evidence" on potential medical, surgical and rehabilitation interventions to inform guidelines and improve outcomes • Studies aimed at improving the precision of diagnosis, classification and characterisation of TBI
• The development of a "validated set of quality indicators" to enable the benchmarking of care quality • Greater collaboration between public and private funding bodies - as well as industrial partners to support the development of national and global biorepositories and databases which could foster vital TBI research • The introduction of validated outcome measures which factor in the overall burden of disability caused by TBI, driving better clinical management and aiding the high quality research needed to take TBI treatments forward.
analysis
Global TBI in numbers US$400bn: Estimated global financial burden of TBI each year 50 to 60 million: Approximate annual number of TBIs internationally 6.5 years: The typical gap between clinical research and its translation into improvements in care (or between study publication and systematic review) 5 to 15 per cent: The possible attributable risk of dementia as a result of TBI – an area which needs more investigation, says the commission 30 to 40 per cent: Mortality rate of severe TBI (according to observational studies on unselected populations) 1 million: number of deaths caused by TBI each year (As cited in the Lancet Neurology Commission, referencing various studies.)
are experiencing more TBI caused by falls among the elderly. In low and middle-income countries, TBIs as a result of traffic accidents are increasing, according to the report. International conflict
Despite billions of dollars of investment, no effective drugs exist for the acute setting
and sports-related concussions are also adding to growing worldwide TBI rates. The report concludes: "Clinicians and researchers, in consultation with patients and their families, need to play their part in taking these recommendations forward. Collaboration
A dearth in TBI-relevant drug treatments is
It continues: "Huge opportunities exist for
between funding agencies will be required to
particularly concerning to the commission. It states:
improvements in characterisation of initial severity,
coordinate the strategy and conduct of research,
"Despite investment of many billions of dollars by
outcome and prognosis, and for more accurate
and commitment from policymakers will be
pharmaceutical companies, no effective drugs exist
tracking of disease processes, by building on the
essential to facilitate research and ensure timely
for treatment in the acute setting – a failing due, in
current scientific advances in modern neuroimaging,
implementation of research outputs.
part, to insufficient targeting of therapies to patients
genomics, disease biomarker development, and
“Implementation of prevention strategies and
in whom the relevant mechanism is active. We
pathophysiological monitoring. Developments
provision of optimum clinical care in different
need better methods to characterise TBI to allow
in these technologies could facilitate the goals of
settings should be a priority for clinicians and
identification of patient subgroups with a common
precision medicine in TBI.”
policymakers alike. Integration of all these efforts
dominant disease mechanism, who are more likely
The commission comes amid rising levels of TBI
should deliver rich dividends in terms of better
to respond to specific treatments – a concept now
in countries of all economic status. High-income
and more cost-effective care, with huge benefits
being popularised as precision medicine.”
nations like the UK, with its ageing population,
for patients, their families, and society as a whole.”
MORE NEWS
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