Rehabilitation after brain injury

Ella Rhodes reports on a keynote in the student stream of the Society's Annual Conference.

To conclude the highly popular student conference, the Deputy Warden of Goldsmiths University of London, Professor Jane Powell, delivered a moving keynote address about her neuro-rehabilitation work with patients with traumatic and acquired brain injury. Her work has focused on the quality of life of these patients post-injury. Many are left with deficits in cognition, social skills, movement, sensory and perceptual problems and, potentially, reduced quality of life in general.

Professor Powell spent much of her career in the development of an outreach team that was focused on improving the quality of life of brain-injury treatments after discharge from hospital. She gave the example of one of the team’s patients, Ben, a 22-year-old who suffered brain injury following assault. His problems ranged from having difficulty following conversations to PTSD symptoms such as flashbacks to the assault, in which he hit his head on a kerb.

Powell said in the late 1980s and early 90s there was little support for brain-injury patients post-discharge, and quality of life for these people was rarely assessed. She and a team from across 10 different countries developed the QOLIBRI scale to measure quality of life in this particular group. Its 37 questions with seven subscales aimed to measure some of the typical issues with quality of life patients suffer following brain injury. Initial work with the scale showed patients with the most severe disability following brain injury had lower quality of life. However, Powell pointed out, only 30 per cent even of these patients with the most severe disability rated their quality of life as low.

The outreach team that Powell has been involved with was started in 1992 after the Department of Health funded 10 ‘model’ services to develop community-based rehabilitation teams for brain-injured people. The team, was, and is, truly multidisciplinary – though neuropsychologically led it also involves support from occupational therapists, physiotherapists and speech and language specialists.

This group aims to help patients set achievable goals for patients to move towards more independent living and better overall quality of life. In Ben’s case he was driven to live a more active, independent life and the team helped him along with this; encouraging his uncle to allow Ben to have more responsibility on the building sites on which they both worked, supporting Ben to get out using public transport, and teaching him strategies to tackle the anxiety he felt in social situations.

In a randomised control trial, Powell and her team looked at the effects of this kind of outreach work on patients’ lives. They found around 70 per cent showed a marked improvement in at least one area of their lives. In more recent, ongoing work, patients in the outreach teams care are being assessed on a number of measures, including quality of life at admission, discharge and six months after discharge to assess whether the gains given by outreach work are maintained in the long term. So far, increases in quality of life have been seen after discharge. Powell said some of the best predictors of good quality of life are improved self-organisation skills, good mobility, psychological wellbeing and socialising. The best predictor of all is that a person is involved in productive employment, which includes voluntary work and participation in family work.

Powell finished her talk pointing to another patient’s testimony of her work with the outreach team and recovery – human resilience is a truly astounding thing. 

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