Brain Injury Community Rehab Team (BICRT)

Part of the NSW state-wide Brain Injury Program, the Brain Injury Community Rehab Team (BICRT) are specialised clinicians who have extensive experience in adult brain injury. The comprehensive programs adopt a multidisciplinary approach and are customised for each client. Programs are delivered in clients’ homes, in the community or at Royal Rehab, and are focused on what each client wants to achieve, and the areas that are important to them in their daily life.

Be Pain Smart Clinic

Clients with chronic pain often feel misunderstood or do not have their pain experience validated. The Be Pain Smart Service is a state-wide icare funded project, hosted by Royal Rehab, and managed by the Agency for Clinical Innovation (ACI). In only its second year of operation, this new initiative is designed to address the negative effects of pain through a multidisciplinary assessment and management service for people with spinal cord injury and/or traumatic brain injury across NSW. The Be Pain Smart Service has been going from strength to strength, running 50 clinics and providing 180 multi-disciplinary appointments over FY22, representing a significant increase on the previous year. Due to COVID-19 restrictions, the clinics were run mainly via telehealth, with the remaining appointments being either face-to-face or a hybrid of face-to-face and telehealth as appropriate. The clinic also provides outreach services across NSW, with sessions held at Royal Rehab and five other sites, including virtual clinics at Prince of Wales Hospital (SCI), Liverpool Hospital (TBI), Tamworth (TBI), Port Kembla Hospital (TBI) and Mid-North Coast (TBI) and an on-site clinic visit at Prince of Wales Hospital (SCI). Senior Clinical Psychologist Regina says, “In the Be Pain Smart Service, the whole team, medical doctors, physiotherapists, and clinical psychologists, listen to the client’s whole story because we are not just treating their arm or their leg, but their whole body, person, and life. “This gives the client the opportunity to understand how their pain impacts not only on their physical capacity and functional activities but also on their mental health, participation in leisure and recreational activities, and social connections. “The intradisciplinary approach provides hope to the clients and a clear pathway for clinicians. Working closely as a team, and being present while another clinician assesses and educates a client ensures our team has a better understanding of each clinician’s role in the intradisciplinary team. “Collaboration is the best way to help our clients to manage their pain. Seeing the whole team together means the client gets all their questions answered,” she says.

The whole team, medical doctors, physiotherapists, and clinical psychologists listen to the client’s whole story because we are not just treating their arm or their leg, but their whole body, person, and life.

- Regina, Senior Clinical Psychologist, BICRT

Naomi’s story

Fifteen years ago, Naomi was on her way to work when she was involved in a high speed motor vehicle accident which resulted in a significant traumatic brain injury, a broken back and two broken legs.

Naomi underwent intense rehabilitation for the first few years following the accident where she says that she had to, ‘learn how to do everything again,’ including how to sit and to swallow.

With time, Naomi was able to self-manage what she describes as her ‘uncooperative body,’ which includes right sided lower limb spasticity that causes her right foot to drop and curl. Naomi also has quadruple vision, meaning that she sees four of everything all the time. Two years ago, Naomi started having a series of falls caused by her lower limb spasticity, including a serious fall down a flight of stairs where she sustained a second brain injury. One of the lecturers at the college where Naomi was undertaking her diploma in theology, suggested that she seek assistance from Royal Rehab. Her lecturer was a disability specialist and was familiar with Royal Rehab’s services. Following a visit to her GP, Naomi was referred to Royal Rehab’s Brain Injury Community Rehabilitation team. Whilst Naomi had been receiving weekly physiotherapy for many years, she had not been seeing a physiotherapist that specialised in working with brain injury patients. When she started her physiotherapy with BICRT’s specialist clinicians, Naomi immediately noticed a significant difference. Assessing Naomi, the BICRT also referred her on to receive specialist care including Botox treatment to her right calf and foot which stopped her foot from tightening and turning in when she walked, reducing falls.

The team also recommended Naomi wear a nerve brace (Bioness L300- electrical stimulation device) on her right leg to help with her gait and leg function. Naomi says the nerve brace was a ‘game-changer’ and she now walks with a normal gait. In fact, Naomi now walks approximately 12km every day! The team’s occupational therapists helped Naomi to extend the amount of time she could stand and helped her to address her jumbled handwriting; whilst Naomi can spell, she has trouble translating letters into the correct order onto the page. Naomi’s speech pathologist has also helped her with strategies to support her studies; she checks in with Naomi to make sure she is able to follow the work in class; and she organised a ‘smart pen’ or ‘live scribe’, that records lectures whilst Naomi is writing - and then sends the recordings to her computer. Significantly, she has also helped Naomi advocate for the opportunity to undertake verbal assessments instead of written assessments. Now able to complete assessment tasks orally, Naomi’s grades have improved from a 51% average to a distinction average. Presently Naomi works with vulnerable groups at her local church where she is Director of Community Care. She says she is incredibly grateful for all the support she has been provided by BICRT and Royal Rehab. “I have achieved all my goals - and they were not little goals,” she says. “Just having clinicians who understand the nuance of brain injury has made such a difference. I feel like Royal Rehab are advocating for me clinically and are referring me on to people who are helpful.” Naomi’s advice for those considering contacting BICRT is not to hesitate. She says, “They’ll help you to get closer to achieving what you want - my quality of life has improved exponentially, and I feel empowered to keep going.”

Client Naomi Deck.