Read this page for key information about brain injuries
The brain is one of the most complicated areas of the human body, and the factual information on this page below is intended as a detailed guide for the public.
We are personal injury law firm focusing on the area of serious and catastrophic injury cases. We have over 25 years of experience in cases involving brain injury. Please contact us to discuss what we can do to help or with any questions that you may have.
- Compensation for a brain injury
- Types of brain injury
- Effects of brain injury
- Medical information for brain injury
- Rehabilitation for brain injury
Compensation for a brain injury
3 of the main stages of a brain injury compensation claim are as follows;
- Establishing who was at fault (‘negligence’)
- Connecting the accident with the injury (‘causation’)
- Establishing the amount of compensation (‘quantum’)
The first stage relates to the accident circumstances and so the individual’s injury is not the primary focus. This means that the actual process involved in investigating the circumstances can be similar from case-to-case. The complexity comes from the unique circumstances surrounding each incident, and the interpretation of these circumstances.
The second stage will often involve the gathering of medical expert opinion to prove that the negligent act was the cause of the injury and the symptoms that have developed. For detailed information about these first two stages, please visit the legal expertise page.
It is in the 3rd stage of 'quantum' where a brain injury claim has its own set of unique considerations, compared to other forms of injury. The legal representative will look to prove the value of the case and the compensation that is due by setting out what they seek to claim in a document known as the ‘Schedule of Loss’.
Schedule of Loss
The Schedule of Loss describes the problems a person will have now and in the future due to their injury. It will detail the cost to the injured party of the problems caused by the injury. Each item claimed for in the Schedule of Loss is called a ‘Head of Loss’
The sum total of these costs makes up a very large portion of the total compensation a client will claim and ultimately receive.
Heads of Loss
For each symptom or problem caused by the injury, the legal team will try to find a solution so that the person is put back into the position they would have been if the accident hadn’t happed, as far as possible. The most obvious example would be if the client is unable to work again because of the injuries sustained, then the legal team would ensure that there is a Lost Earnings Head of Loss, which explains and proves the extent of that client’s lost earnings.
It requires a high degree of expertise and medical knowledge to be able to correctly identify all of the Heads of Loss that are unique to a brain injury claim. This is what makes a serious injury lawyer different to a personal injury ’specialist’.
Examples of Heads of Loss that are often pursued in brain injury compensation claims include the following:
Court of Protection Costs
A specialist serious injury Lawyer would always seek an expert opinion on their client’s mental capacity to conduct the litigation and to manage their financial affairs, fairly early in the case.
This can be a complex area as following a serious brain injury, it is often identified that the client no longer has the cognitive ability to understand legal advice and make important decisions about their finances and compensation. If it is apparent that the client does not have capacity to conduct litigation or manage financial affairs, then the client may be regarded as a ‘Protected Person’ and require the services of a Deputy of the Court of Protection. If this is the case, then a significant claim for the Costs associated with making applications to the Court of Protection and indeed engaging a professional Deputy of the Court of Protection, would need to be included in the claim. Depending on the age and needs of the Claimant, this particular Head of Loss can often be well in excess of £100,000.
Depending on the nature of the brain injury, the client may require ongoing specialist therapy in the form of neuro-occupational therapy, neuro-physiotherapy and speech and language therapy for example.
Provided to ensure that our clients have the maximum support with a view to living a full and as far as possible, independent life, specialist therapies such as those listed above, can be very expensive especially if provided regularly and on an ongoing basis. Therapeutic sessions will often be required on a very regular basis to ensure that improvements and gains are maintained, and where possible, strategies learnt. Inevitably, the cost of a team of specialist therapists visiting on a weekly basis for example, year after year, will be very high and the specialist serious injury lawyer will need to build a case through expert evidence to support and prove this head of loss.
Although not categorised as a Head of Loss as such, in brain injury claims it can be very important that there is a ‘provisional damages’ option pleaded by the legal team when the case is brought.
If the legal team seek ‘provisional damages’, then in very specific circumstances, it gives the client the ability to have the case reopened at a point in the future, even if the vast majority of the compensation due has been paid and the case concluded. The reason this method of settlement exists is because with brain injuries it is possible for the injured person to develop further issues in the future, because of their injury. One example would be the development of epilepsy later in life. It may be that there has been no epilepsy by the time the case settles but should the client develop epilepsy in the future because of the brain injury, then there may be significant implications for them. For they may lose their driving licence and not be able to work. They may require additional day-to-day support if the seizures are not controlled. Without a settlement including a provisional damages option, the client they would find themselves unable to seek the additional compensation they require to address the new found problems. It is likely that only Lawyers with experience of brain injury compensation cases will understand and advise their client on the issue of provisional damages.
Types of brain injury
This section contains a brief outline of the different types of brain injury and how they can be sustained.
Should you have any immediate health concerns regarding brain injuries, please do not hesitate to consult a medical professional. The information provided here is intended for educational purposes only.
How a brain injury is sustained
A brain injury is classified by the method that it was sustained. This can be broken down into two main categories: traumatic brain injury and acquired brain injury. Both refer to a brain injury that is sustained during and after birth (a hereditory or congenital brain injury are terms used to describe brain injury caused by a disorder or genetic defect).
Traumatic Brain Injury (TBI)
Traumatic brain injury (TBI) is an injury to the head or to the brain that is caused by some form of trauma. This can include things like assault, falls or car accidents, all of which cause the brain to move around inside the skull, or damage the skull itself. This then causes damage to the brain. The key element to remember is that a TBI injury is caused by an external physical factor, such as a blow to the head.
In addition to any damage caused by the initial injury, the trauma causes something called a ‘secondary injury’. Examples of this include a change in blood flow to the brain, or a change of pressure within the skull. The physical events that follow trauma to the brain have a large impact on the overall damage done to it.
Acquired Brain Injury (ABI)
Acquired brain injury (ABI) is the term used to describe any brain injury (including those that are traumatic brain injuryies) that occur after birth. The most common cause of an ABI is from a build-up of pressure on the brain. Examples of what may cause this include a tumour (unwanted cell growth associated with cancer), or a neurological illness such as a stroke (a blood clot in the brain).
The severity of an injury is very dependent on its type and location, and must be considered on a case by case basis by a medical professional.
Brain injuries are categorised as minor, moderate, or severe.
Minor brain injury
A minor brain injury is commonly referred to as concussion, and common symptoms include brief unconsciousness, nausea, dizziness, mild confusion and headaches. Around 80% of all head injuries fall into this category.
Even with mild head injuries it is important to go to your local hospital and see a medical professional to ensure that the injury is not serious. This is because even mild head injuries can lead to complications. Even if you are initially discharged, be on the lookout over the next few days for the following symptoms.
If you experience any of these symptoms, make sure to go back to the hospital, because whilst unlikely, mild brain injuries can sometimes develop into something worse.
Moderate brain injury
A moderate head injury is an injury that causes between 15 minutes and 6 hours of unconsciousness. If the person experiences amnesia up to 24 hours after the injury, it is also classed as a moderate brain injury. Hospital policy with moderate brain injury is to keep the patient overnight, in order to properly assess the damage and ensure that no serious secondary injuries take place.
Moderate head injury makes it very likely that the victim will suffer some of, but not limited to, the following effects:
One of the issues that arise from a moderate brain injury is that victims often expect their symptoms to go away within a few days. This is unlikely to be the case, as it is typical for symptoms following a moderate brain injury to last between 6 to 9 months. After several weeks, patients who expect to be healthy within a few days can become very anxious that the problems will be permanent. This anxiety can lead to further problems, creating a vicious cycle.
Severe brain injury
A head injury is classed as severe if the sufferer is rendered unconscious for over 6 hours. It is also classed as a severe injury if they suffer amnesia for more than 24 hours.
With severe brain injury, the person will often need to be hospitalised and may suffer permanent and life changing disabilities. These disabilities can be cognitive, behavioural or physical and rehabilitation is required in order to minimise their severity as much as possible.
The extent of the disabilities sustained largely depends on how long the person is unconscious. The longer that this is, the more likely it is that the person will suffer a serious deficit. ‘Very serious injury’ is a further category for those who remain unconscious for 48 hours or more.
Please note this information is a generalisation. The complexity of severe brain injuries means that every case is unique, and only a medical professional who is familiar with the particular circumstances in question can give you in-depth advice. It is possible for someone with a mild brain injury to make limited recovery, just as it is possible for someone with a severe injury to make a complete recovery.
Effects of brain injury
The brain controls everything that we do and is the physical manifestation of our memories and personality. This means that if the brain is injured, the effects and symptoms can be extremely varied. These symptoms can range from physical defects, to drastic changes in personality.
The effects of brain injury fall into three main categories:
Cognitive brain injury
A cognitive brain injury is one that impairs a person’s mental abilities. These include problems with memory, attention span the ability to concentrate, the ability to correctly perceive their surroundings, and the speed at which information can be processed.
Memory problems are a very common symptom of brain injury because in order for a brain to process, store and retrieve information, many different areas of the brain must be used at once. If one or more of these areas are damaged, it will affect a person’s memory.
Post-traumatic amnesia (PTA), the medical term for memory loss, is the period of time where the injured person cannot remember what happened either before or after a traumatic brain injury. During this period, the person may find it difficult, or be unable to create new memories. The severity of the injury will determine the extent of the memory loss, meaning that it can range from the moments just before before the accident, to a period of days, months or even years.
PTA is usually temporary, and given time memories can partially or fully return. However it is also possible that these memories will never be recovered, and this again depends on the exact circumstances of the injury.
In cases of permanent memory loss, brain injury rehabilitation efforts are focused on creating coping strategies because as of yet, there is no in-depth scientific understanding of how to reconstitute a person’s memory abilities.
Attention span and poor concentration
It is very common for someone who has suffered a head injury to have attention difficulties; the inability to multi-task in particular. Our modern lifestyles are quite badly affected when the ability to plan ahead or follow simple instructions is compromised. A person’s poor attention span can be further affected by factors such as stress, fatigue and anxiety. This can lead to a vicious cycle, where a person is irritated by their inability to perform a simple task, which in turn makes them less capable of achieving it.
Attention span and concentration are controlled by a part of the brain known as the frontal lobe. Please see the brain injury medical information page for more details on sections of the brain and the functions that they control.
In order to regain the ability to concentrate, it is necessary to ‘relearn’ how to do so through rehabilitation and distraction management. It may be necessary to isolate yourself from distractions as much as possible, and slowly increase these distractions as the ability to concentrate is gradually rebuilt.
Perceptual difficulties are where the brain is not interpreting the information from our senses correctly. There are a very wide range of problems that can result from perceptual difficulties.
One example would be when a person may try to pick up a pen but lacks the correct hand-eye coordination to do so. Despite being able to see the pen, they cannot accurately determine its position relative to their hand because of an issue with judging distances and spatial relationships. Another example would be the inability to recognise a common object when it is viewed from a non-standard angle.
The brain may have reduced ability to process larger amounts of information in small spaces of time, usually due to changes in neural pathways. A useful analogy for this would be if the road system covering your journey to work was completely changed, then it would take you much longer to find your way to work than before.
Slower information processing will result in issues such as requiring people to speak slower, the need to be given instructions several times before they are understood, and difficulties in replying to questions in a ‘normal’ amount of time. These symptoms can be described as the person being constantly in a state of ‘information overload’.
Physical brain injury
As well as housing our thoughts, memories and personality, the brain also coordinates the subconscious physical processes that are essential to a healthy life. This includes things like breathing, hormonal balance, blood pressure regulation, the digestive system and body temperature regulation. Without these functions, our bodies would not operate correctly and cause an exceptional amount of day-to-day living difficulties.
A severe brain injury can cause irreparable damage to the brain’s ability to control these regular functions, so rehabilitative efforts shift from fixing the problem to learning how to cope with them. In severe cases, full-time carers may be required.
Examples of physical effects
- Movement, balance, and coordination problems
- Chronic pain
- Loss of sensation
- Dysarthria (difficulty with speech)
- Dyspraxia (difficulty with planning and executing movements)
- Hormonal imbalances
Behavioural / Emotional Brain Injury
A brain injury can sometimes ‘rewire’ a person’s personality, causing their behaviour and emotional reactions to change. Exactly what is changed will depend upon which parts of a person’s brain are injured. For example, the frontal lobe is the area of the brain which controls our personality and our impulsivity. If this area of the brain becomes damaged after a brain injury, it is possible that the person will have reduced self-control or restraint. They may not be able to moderate their emotions, resulting in mood swings and irrational behaviour.
Another example would be constantly saying inappropriate things, without any understanding of how or why they may be inappropriate. The person may also go to the other extreme, and have what seems to be an emotionless personality. This is known as “flat affect”. These types of symptoms are perhaps less obviously noticeable than physical problems, but also have a large impact on the injured person and their loved ones' lives.
It is often the case that the injured person does not realise that they act differently to how they were before the brain injury. It is very important that both they and their family understand that these changes in personality are not the injured person’s fault, but are a direct result of the brain injury.
Once these changes are accepted as a manifestation of physical issues, a healthy attitude towards rehabilitation and the development of coping strategies (such as breathing exercises when becoming angry) can be taken.
Below are some examples of behavioural and emotional changes that can develop after a brain injury:
A brain injury can sometimes change a way that a person feels or expresses their emotions. Damage to the frontal lobes may mean that they lose the ability to regulate their emotions, and experience random mood swings that are unrelated to how they are actually feeling.
Unpredictable outbreaks of laughter or crying are common and they may feel like they are on an ‘emotional roller-coaster’. They may have a reduced tolerance for stress and frustration, so even something as minor as having the television volume too loud or losing a set of keys can lead to an extreme verbal or physical outburst.
Examples: seemingly random changes from one emotion to another
Lack of judgement / awareness, and disinhibition
The ability to evaluate and adjust our personal behaviour to the circumstances around us is a complex skill, largely controlled by the brain's frontal lobes. Damage to this area can mean that the person’s self-awareness, their insight into the consequences of their actions, and ability to show empathy or sensitivity are affected. The person may also be unable to distinguish when they are being impolite or breaching social etiquette.
Examples: touching someone inappropriately, speaking your mind regardless of the circumstances, recklessness.
It is not uncommon for the injured person to be uncooperative very soon after the accident because they are disorientated, confused and anxious. They may do things like pull out their IV tubes or experience restlessness because the behaviour acts as a coping mechanism to relieve the stress of the situation. An unusual level of agitation is most often a temporary symptom, going away with time as the person becomes less confused by their situation.
Examples: restlessness, fidgeting, pacing.
Damage to the frontal lobe can also cause a lack of motivation or spontaneity. This is because the person has reduced levels of emotion and forward planning, which makes activities appear extremely overwhelming.
Examples: staying in bed all day, a lack of interest in previous hobbies.
Once the rehabilitation process starts, it is very common for the person to experience depression. This is especially the case towards the later stages of rehabilitation, as they realise the full extent of the problems caused by their injury and any permanent damage that they will have to cope with.
It is worthwhile to note that depression is an important stage of mental recovery, because it means they are aware of the reality of their situation. Only then can the person begin to accept the situation and move forward.
Examples: wishing they had not survived the accident, believing life will never be good again.
It is normal for an injured person to suffer from anxiety, due to the loss of confidence they experience with situations and tasks that used to be commonplace but are now difficult. For example if the person has writing difficulties, they may be worried about signing a cheque at a restaurant. It is important that these difficult situations are faced head on, with an attitude of independence in mind, because if these fears are left to fester then the more likely they are to become a long term problem.
Examples: panic attacks, paranoia, poor quality sleep.
Inflexibility and obsessionality
The frontal lobe is where our ability to reason and make sense of things originates. If the frontal lobes are damaged, the person may be unable to do things differently, and stubbornly stick to a routine or habit. This is because they have lost the ability to consider alternatives on their relative merit, and make a decision based on that analysis. Anxiety will make this worse, because the injured person may think that sticking to a routine will make them feel better.
Examples: strange patterns of behaviour, unreasonable stubbornness, over-attachment to belongings.
After a head injury, a person’s sex drive can either increase or decrease. There are a great many physiological and psychological reasons for this, most of which are due to the hypothalamus (an important structure in the brain which controls hormone levels) being over or under-active.
Examples: increase or decrease in sex drive, misinterpretation of sexual advances
Medical information for brain injury
The brain is a vastly complex area of the body that modern science is only now beginning to understand. There are still many unanswered questions when it comes to the physiology of the brain. This page will provide a general overview for those who have been affected by brain injury, and who may wish to understand some of the brain’s functions.
The 4 key lobes
The brain is made up of 4 key sections, or lobes. These lobes all interact with one another to perform the complex functions that we take for granted.
The frontal lobe is the the most recently evolved area of our species' brain. This section of the brain is what is believed to be largely responsible for problem solving, reasoning, impulse control and judgement. This allows the frontal lobe to exercise control over the powerful emotional responses that is generated by other parts of the brain. For example, during the caveman era it was perhaps an evolutionary necessity to enter an uncontrollable rage when fighting for survival. This is no longer the case, and the frontal lobe allows us to control our emotions, rather than the other way around.
The frontal lobe is also associated with ‘higher emotions’. One example of this would be empathy, which is the ability to view something from another’s point of view, and then draw your own conclusion based on that information. Another example would be our ability to look beyond actions that lead to immediate gratification, and instead seek out a long-term goal.
The occipital lobe is the area of the brain that is largely responsible for our visual perception system. It converts the information from our eyes into things like depth perception, interpreting colours, and detecting motion. Damaging this area of the brain can lead to a reduce field of vision, blindness, loss of balance and coordination, or even hallucinations.
The parietal lobe is responsible for combining the information from all of our different senses (especially touch) to form a general understanding or perception of ourselves, and the world around us. For example if you touch something that is too hot, it is the parietal lobe that processes this information and draws that conclusion. This lobe is important for relative spatial awareness, and so it plays a part in skills like drawing, manipulation of objects, and mathematics.
The temporal lobe plays a key role in the formation and understanding of our long-term memories. It is also involved in interpreting visual information from our eyes, because we must use our memories to comprehend the full meaning of what we see. For example, when you see a mobile phone you can only know to label it as such because of your past experiences with them. Another example would be how communication relies on the memories associated with verbal sounds.
Important structures in the brain
The hypothalamus is a part of the brain that is currently associated with things like combativeness, sexuality, thermal regulation, thirst and hunger. Those behaviours are linked to powerful emotions, and it is the current medical understanding that the hypothalamus plays a part in emotions such as rage and pleasure. It has also been suggested that the logical extension of this is that the hypothalamus plays a part in controlling the feelings associated with these emotions, such as displeasure or disgust.
One key distinction is that the hypothalamus is linked to the expression of emotions, rather than the generation of them. There are however certain situations where it is directly responsible for creating feelings of panic and anxiety.
The amygdala is located within the temporal lobe and is responsible for the creation of emotions. The amygdala controls such emotions such as affection, friendship, love, rage, aggression and fear. These emotions are very important to our ability to judge situations. For example, when a tiger is running towards us we feel fear and know that it is dangerous. Without the amygdala to associate emotions to a situation at hand, we would not know how to judge or respond to it. The most famous response controlled by the amygdala is the ‘fight or flight’ response.
The hippocampus is also located within the temporal lobe, and is associated with the creation and interpretation of long-term memories. For example, if you have a memory of being seasick in the past, the hippocampus would cause other areas of the brain to associate displeasure to travelling on boats. Without a functioning hippocampus, it would not be possible to associate emotions to your memories.
Severe injury to the hippocampus can be devastating to their lifestyle, because all of their previous experiences would no longer have any ‘meaning’ to them. It would be painful indeed to find that your husband or wife, despite being able to remember their wedding day, does not associate any feelings of love of joy to it.
The thalamus is the central relay point for the hypothalamus, amygdala and hippocampus. Each of these three structures must act in unison to form the limbic system, which are the processes involved in motivation, emotions, memories, and learning. Without all three structures acting in unison, as coordinated by the thalamus, the limbic system does not perform correctly.
Rehabilitation for brain injury
The brain is different to other areas of the body, in that damaged cells cannot repair themselves. In order for recovery to occur, the brain must ‘reorganise’ itself through a process known as ‘plasticity’. This means that new neural pathways are developed so that undamaged areas of the brain will take over from the damaged areas.
The aim of brain injury rehabilitation is to aid the growth and development of these new neural pathways so that the brain can learn to operate in a new way, minimising the long-term impact of a brain injury. It is a long process, because the person must effectively re-learn how to do things from scratch.
For any remaining effects or disabilities, rehabilitation aims to develop coping strategies so that the person can learn to live with them and regain control of their life.
It is very important to manage the expectations of rehabilitation after brain injury, because it is a very long process. The person must ‘relearn’ to do all of the things that they now have trouble with. The brain must rewire itself, and this can only be done through long-term repetition. This should be expected to take months or years, rather than weeks.
The first couple of months
Recovering from a brain injury is still a relatively new area of medical science .It is very difficult for medical professionals to predict how much a person will be able to recover within the first few months after their injury. This is because it can take several weeks for the full extent of the injury to manifest itself, and only once the injury is fully understood can an accurate picture be given.
The only safe thing to say is that recovery will take a long time, and that it tends to be the case that the more severe the injury, the longer recovery will take.
6-12 months after the injury
It used to be the case that doctors would tell patients that whatever recovery will take place is going to happen within the first 12 months.
It is true that the largest and quickest improvements tend to take place within the first year, and that improvements after the first year will be slower, and less noticeable. However it is now understood that the brain continues to recover many years into the future.
Over a year later
Over a year after a head injury, patients may reach a ‘plateau’ where they do not show significant signs of any further improvement. Unfortunately, because dramatic and noticeable improvements are usually made over the first year, when the first plateau is reached there is a tendency for this to cause people to give up on the process of recovery.
It should also be understood that recovery from a head injury occurs in quick bursts, in-between periods of little to no change. It is sometimes the case that the person will get worse, taking one step back, before improving by taking two steps forward.
Very long plateaus are sometimes overcome many years after the injury by environmental events. Changing to a new counsellor, joining a new support group, or even something as simple as starting a new hobby can cause new functional gains to be made.
The key to long term functional improvement is to constantly push towards new goals. Always take small steps towards a new goal or improvement, and do not have a time frame in mind. Instead of thinking, “I want to be better in six months time”, try thinking along the lines of, “I want to keep doing this until it is no longer difficult.”
Where it takes place
The different settings of where rehabilitation takes place are as follows:
‘In-hospital’ is the first stage of rehabilitation which takes place while the patient is in hospital. It should be noted that rehabilitation from a brain injury can start as soon as possible, even in the acute stages of intensive care in hospital. Rehabilitation specialists are on staff in order to evaluate the needs of a patient after injury or surgery. Therapy is typically on a one-to-one basis, and because of the limited number of staff and large amount of patients in a hospital, the amount of time spent with each patient can return home.
If a patient is discharged from hospital but cannot live unassisted, they will be sent to an in-patient rehabilitation facility. These facilities exist solely for the purpose of rehabilitation therapy, and are much more intense than their hospital equivalent. It is more like a gym atmosphere (especially in the case of physical rehabilitation), with patients wearing their own clothes and attending several group and private sessions every day. The focus is to restore the patient to as normal a level of operation as possible so that they can be released to go back home.
Out-patient rehabilitation is where the person has sufficiently recovered to be able to live at home, but still requires further rehabilitation. They will travel to a rehabilitation facility or be treated at home, depending on individual needs such as equipment required, their functional ability to travel, and so on. Out-patient facilities are available both on the NHS or privately.
Towards the end of a scheduled rehabilitation programme, patients will be given exercises and routines to undertake by themselves, and this will often signal the end of the NHS’ involvement.
Those who suffer brain injury benefit greatly from continuing care and assistance from rehabilitation professionals, long after the end of the NHS scheduled programme. This is because recovery continues to take place many years after the injury (see the timescales section above). Visit our how to access rehabilitation section for more information on how to find private rehabilitation services.
Types of therapy
This section contains information on the types of therapy that a sufferer of brain injury is likely to require. Please remember that are many different types of therapy and this section is intended only as an overview.
Every brain injury is different and its rehabilitation must be considered on a case by case basis by medical and rehabilitation professionals. For in-depth advice into the nuances of the types of therapy that you may require, it is important that you talk to a medical professional who is familiar with your exact needs and requirements.
Some of the important types of therapy for someone recovering from a brain injury include the following:
Neurological Physical Therapy
Physical therapy is a branch of treatments that focus on overcoming impairments and disabilities that make everyday tasks difficult. Examples of this include balance, coordination and movement.
Neurological physical therapy is a specialist subsection of physical therapy that involves the evaluation and treatment of people with mobility difficulties resulting from damage to their nervous system. After a brain injury it is very likely that the injured person will require this type of treatment. Common difficulties that are caused by nerve damage include problems with balance, movement, muscle strength and vision.
A neurological physical therapist will have their patients undertake physical exercises that are designed to aid nerve regeneration. This will reduce the long-term functional impairment of an injury as much as possible.
Occupational therapy is a branch of treatment that focuses on ensuring that an individual has the daily living and working skills to lead a healthy and fulfilling life. At least one of the following approaches are undertaken to do this: adapting the environment; modifying the task; teaching the skill’ and educating the client.
Examples of the types of everyday skills that an occupational therapist can help with include taking a shower, preparing food and getting dressed.
There is a significant overlap between occupational therapy and physical therapy because their respective goals are similar; namely,improving their functional abilities and allowing them to regain control of their everyday life.
Head and brain injuries can have a critical impact on the emotional, psychological and behavioural aspects of people's lives. As it is a wide ranging field with many varying effects, this section discusses three examples of psychotherapies that have the potential to help people throughout their rehabilitation:
Cognitive therapy (CT) is a branch of treatment that focuses on helping an individual overcome any difficulties they are experiencing by highlighting and repairing dysfunctional behaviours, thought processes and emotional responses. The therapy is based on the principle that health issues such as anxiety, depression and irrational fears are the result of the way people perceive events in a negative light.
Therefore, the aim of cognitive therapy is to improve the ways in which people think, act and feel through a collaborative ‘talking therapy’ programme between the therapist and the patient. The therapist will help the patient to identify the existence of such thought patterns; to recognise the thoughts when they occur; and to help them understand how they develop into their specific health problems. By changing these thought patterns, they are able to reduce their health problems and develop a more realistic way of thinking.
An example of where cognitive therapy would be needed, is when someone has such negative thoughts, that they manifest themselves as a ‘downward spiral’. If a person thinks “I am useless at this task, everything I do is always wrong” then their mood will worsen. Then the person may avoid completing the task at all costs in future, thus their behaviour is confirming their belief of being “useless”. Cognitive therapy then works to amend these negative thought patterns by introducing alternative ways of responding to similar situations, thereby causing the thoughts to recede completely.
Another form of cognitive therapy is a therapeutic treatment called rational-emotive therapy (RET). It is distinctive from cognitive therapy through the way it bases its theory on irrational thought itself.
The principle of the theory is that people do not get upset by the adverse events that affect them, but rather they upset themselves with the sometimes harsh and irrational demands that they place on their lives. People tend to disturb themselves by reliance on 3 core beliefs, that:
- The individual should be loved unconditionally by others and have outstanding achievements.
- Other people are giving, liberal and fair.
- The world is a generous and easy place to navigate and cope with.
It is used as a treatment for people that suffer from the anxiety, stress and depression that result from such views, so the aim of this type of psychotherapy is to reduce irrational emotional pain and encourage the individual to focus on the positive things that occur in life such as their healthy relationships and personal creativity.
Cognitive Behavioural Therapy
Cognitive behavioural therapy (CBT) and is the most widely practiced of these psychotherapeutic therapies. It combines cognitive therapy (CT) with behavioural therapy, as most therapists believe that combining the two provides a more rounded and complete therapy for those with anxiety, depression and so forth.
Simplified, this is usually a type of talking therapy where the individuals discuss how they think and feel about themselves, the world and other people (the ‘cognitive’ element); and they also discuss how their actions affect these thought processes (the ‘behavioural’ element).
It is based on the idea that adverse events do not upset the individual, but rather the meaning that people place on those events upsets them. The aim of cognitive behavioural therapy is to help the individual move away from such heavily polarised thought processes as amplifying negativity and minimising positivity, with the goal of creating a more realistic way of thinking thus reducing stress.
Placing such negative meanings on events and situations can cause a ‘downward spiral’ or a ‘vicious cycle’ that is difficult to escape; however, through cognitive restructuring (assessing the beliefs and assumptions behind the patient's thought patterns), many people who suffer from post-injury anxiety may experience psychological improvements.
How to access rehabilitation
Once an individual has been medically stabilised after their serious injury, the rehabilitation process should begin as soon as possible; though there are various factors that determine which rehabilitation unit a person is referred to. In order to choose the most appropriate venue, a decision must be made via thorough consultations between the patient, their family and medical professionals.
There are numerous head and brain injury rehabilitation centres across the country, with some operated by the NHS whilst others are private facilities. Different hospitals may specialise in different areas of head and brain injury rehabilitation, so it is important to take such factors into consideration; and as with any required appointment at a medical institution, spaces within the rehabilitation hospitals are subject to availability. For this reason it is not uncommon for the most geographically convenient venue to be unavailable, making it necessary for the patient to access rehabilitation in an unfamiliar area.
Furthermore, admission to a particular hospital may be determined by the way in which the rehabilitation programme is funded. As an example, there could be an instance where there may not be any available space at an NHS facility; however, a private hospital can accept a referral from the NHS, who will in turn still fund the programme. Alternative methods for funding also exist, such as from a local authority, through health insurance or simply by self-funding. Once a referral is made, it is imperative that the fund-providing service is be informed, otherwise payment will not be made and admission to the hospital will not be granted.
Some regions of the UK offer regular drop-in centres for people who have suffered from acquired brain injuries (without charge through the NHS), and their goal-based rehabilitation methods may be useful to those who may wish to incorporate them into their programme.
It is advised that several different facilities are visited by everybody involved in the rehabilitation process prior to making a decision. Asking questions helps to build up a wider understanding of each place: Does the hospital provide all the necessary rehabilitation methods as part of its programme e.g. Physical, occupational, speech and recreational therapy? Does it match the required levels of cleanliness? Are other patients content with their treatment? What is the staff-to-patient ratio at any given time? This is just an abbreviated sample, but it is recommended to be as specific to the patient’s needs as possible.
The rehabilitation process for a head and brain injury is not easy and it is not quick, so it requires a high level of commitment from everybody involved.
Choosing the correct hospital will help to improve the whole process.
Other important issues
Head and brain injury rehabilitation requires an incredible amount of hard work. Due to the varied nature of such injuries, precise predictions cannot be made for the extent of the patient’s recovery nor how long it will take, but it is very likely that rehabilitation will be a long and exceptionally fatiguing process.
Physical and Psychological Demands
The physical and psychological demands placed on the recovering individual are considerable, especially once they have been through major surgery, so it is important to keep sight of the ultimate goal of rehabilitation and the benefits that it will bring. Studies have shown that people who show the most improvement after injury are those with a strong and positive mental attitude.
During challenging exercises, the injured person may become much more physically tired than they were previously used to, though in due course their stamina will return. However, the mental strain of these new physical circumstances cannot be underestimated, and despite the extensive psychological exercises and challenges, mental fatigue will take much longer to recede.
For the injured person, the support of their family and friends is of vital importance during the recovery period. In the same way, it is recommended that emotional support is provided for the family through such trying times, for example through specialist brain injury support groups.
It is important for all involved to treat every improvement and progression as a victory, no matter how minor. Be positive. It is a clear sign that you are moving closer to your goal.
Visiting the hospital
When visiting someone who is recovering from a serious head and brain injury, it is important to be mindful of how much of a demanding experience that it can be for them.
Of course, being close to a loved one as often as possible through such a difficult and serious event is a completely natural and understandable reaction – in fact, support from the patient’s family and friends is emphatically and wholeheartedly encouraged. However, it is advised that this is not done to such an extent that it becomes detrimental to the patient’s recovery.
The uncertainty that surrounds recovery from a brain injury means that during the rehabilitation period, family and friends should approach the patient with care; enough to offer comfort and support, but not enough to physically and emotionally drain the strength from the patient, preventing them from achieving optimal results in recuperation exercises.
This can be a difficult period of adjustment in many different ways, both for the injured person and their family. It is key to be composed and attempt to find the right balance. Try to do what is best for the patient, but try not to over-excite them because preventing unnecessary overexertion will encourage a stronger recovery.
If you have any questions that have not been answered in the above sections, please contact us so that we can answer them for you. If we are unable to answer your questions personally, we will be able to point you in the right direction through the medical and professional relationships that we have built up over 25 years.