We have reached the final part of our blog-series about Traumatic Brain Injury. In the previous blog posts, we gave an introduction and discussed diagnosis and treatment. This blog post will be focusing on recovery from a traumatic brain injury.
In our last blog post we wrote about some of the advice medical professionals may give you if they are discharging you from hospital following a less severe brain injury. You may be advised to see your GP the week after you are discharged from hospital to see how you are coping. You may also have a number of follow-ups at a head-injury clinic, usually with a specialist, such as a neurologist. Depending on the effects of your head injury, you may also require other types of treatment to help you with recovery, these can include:
- Physiotherapy to help with physical weakness, stiffness or poor coordination.
- Occupational therapy to help make appropriate work or home adjustments if you are struggling with everyday tasks.
- Speech and language therapy
- Psychological therapy to help deal with and cope with changes in psychological wellbeing as a result of the brain injury.
There are also charities that you can contact for support for those affected by brain injury and their families. You can contact Headway, the brain injury association, by telephone email or search for their local services. They offer a wide range of services, including rehabilitation programmes, carer support, social reintegration, community outreach and respite carer (short-term support). You can contact them in all cases for support and advice.
In the more moderate-severe cases, in the first few weeks, swelling, bleeding or changes in brain chemistry often affects the functioning healthy brain tissue. As a result, the individual may not open their eyes or display any signs of awareness. We discussed these states of consciousness in more detail in our last blog post, in case you are interested. As the swelling decreases and blood flow and brain chemistry improves, brain function usually improves, resulting in the individual gaining consciousness and demonstrating signs of awareness, for example responding to stimuli or family members.
Most commonly, when an individual regains consciousness after their brain injury, a period of confusion and disorientation follows. Medical professionals refer to this as a confusional state, but sometimes it can be called post-traumatic amnesia. During this time, they may have difficulties paying attention, remembering things, sleeping or knowing what is real or not. Additionally, they may be more agitated, nervous, restless and frustrated. This is very distressing for them but also for family members, as this type of behaviour may not be ‘typical’ for them. There is no specific duration an individual will experience this confusional state, some days they may appear to be ‘back to normal’ and other days displaying some of these new behaviours. Most medical professionals will advise you on how to deal with this but also reassure you that it is normal.
Rate of improvement for each individual varies but usually the fastest improvements occur during the first 6 months post-injury. During these months, an individual may show improvements in the way they think and move.The speed of improvement will then begin to slow-down but is ongoing for years. Because of this, medical professionals often advise the individual to do whatever they can to support their brain health, for example avoiding alcohol and drugs and exercising.
Following a moderate-severe injury, it is difficult to say whether a person will ever return to ‘normality’. There are many factors that play into this including their age, medical history, environmental factors, level of independence prior to the injury and of course severity of injury. With that being said, unless there are some pressing medical issues that can only be dealt with in a hospital inpatient setting, there will be a discussion about discharging the individual from hospital. To decide what the next steps will be, there will be a formal discharge meeting, usually involving the medical professional in charge of their care, social service staff, hospital or rehabilitation staff and possibly their GP. They will assess and discuss things such as:
- What remaining difficulties do they have – physical, cognitive, emotional and behavioural?
- Will the patient be safe in their home environment? Can a home visit be arranged to check this?
- How will their continuing needs for rehabilitation be met?
- What type of support and follow-up will there be at home?
- What medications will they need? When should they be taken, and for how long?
- Could there be any risk to others (e.g. children in the family) if they return straight home?
- Have they (and their family) been advised on how best to manage remaining problems and those that are likely to occur later?
There are many possible outcomes from this meeting.
- The person may be allowed home one (or more) day/s a week, with a possible overnight stay/s, on a trial run basis, before actually being sent home. An occupational therapist from the hospital, rehabilitation team or social services should visit the home initially to assess you and your relative’s needs and any home adaptations that may be required. By doing this on a trial run basis also helps family members think of any adaptations they think are needed for the home and gives them the opportunity to ask questions and get help while still in contact with the hospital team. If discharge is agreed, the individual and family are usually given the contact details of the neurological rehabilitation team, so that they have someone to contact for advice in the future. It is important that the family do not feel rushed into bringing the individual home before they are ready. The family should only accept a proposed discharge date when they are certain that necessary assessments have been completed and feel that there will be sufficient support (for example arranged home services) and all necessary equipment in place at home.
- They may be assessed as requiring long-term residential care. Funding for this is means-tested and it is common for the family to have to contribute towards costs. However, if they are entitled to nursing care then this should be funded by NHS Continuing Healthcare. There are many residential homes which specialise in caring for people with brain injuries. These units provide long-term rehabilitation services and enable people with brain injuries to continue to maximise their potential for improvement, so it is important to access one of these units if possible. You can contact Headway for information or view their approved list of providers.
- If long-term care is not needed, they may be provided NHS funded Intermediate Care. This is an integrated programme of therapy and treatment, which usually lasts no more than six weeks. It can be provided in your relative’s own home or in a care home and is designed to support the transition from hospital back into the home environment.
In terms of life after discharge, individuals often:
- Need some assistance from another person. It could during the day, at night, or both. For example, they may require assistance with most daily activities, including getting dressed in the morning or bathing, or only at meal times preparing food.
- Have trouble with thinking and forming new memories. This can sometimes affect how they carry out daily activities and therefore can dictate how much assistance is needed.
- May be diagnosed with a psychological disorder, commonly depression. This can be a direct result of their brain injury or due to the trauma associated with the accident or dramatic life changes they have to cope with, for example losing their job, ability to drive or independance.
In terms of care after discharge, individuals may continue rehabilitation in an outpatient or community setting, with the latter often used in the interim between leaving hospital and going home. In some cases, this option may not be offered because rehabilitation needs have been assessed and deemed unnecessary or the individual is unsuitable. If you are in this situation and think there may be a benefit, you can contact these services directly yourself or discuss it with the GP or Consultant in charge of care. Follow-up reviews and assessments will usually be in an outpatient setting and may be managed by the GP and/or specialist Consultant usually through the NHS. It is possible that these will stop or not occur as regularly as you woud hope, so it is possible to see a specialist Consultant in a private setting too.
Phoenix Mental Health Services has a brain injury clinic, run by our specialist Dr Martine Stoffels, and we offer a range of services including:
- Initial neuropsychiatric assessment
- Development of individual treatment plan
- Medication initiation and optimisation
- Treatment of neuropsychiatric conditions, such as depression, anxiety, psychosis, OCD, PTSD and attention disorders, secondary to the brain injury
- Mental capacity act assessments including lasting power of attorney (LPA) for Health and Finance
- Reports for the DVLA
- Risk assessments and development of risk management plans
We also offer specialist intervention packages including neuropsychological assessments, talking therapies, sleep assessments, dietary and nutritional advice, repetitive Transcranial Magnetic Stimulation and assessment and treatment of attention and concentration difficulties. You can contact us here for more information.