Advances in medicine now mean that those who have sustained a brain injury have both an increased chance of survival and an improved ability to lead a fulfilling life through the rehabilitation process. At JMW, we will do everything we can to support our clients and give them the best possible rehab post-injury.

About Rehabilitation

As every brain injury is unique, there are five main goals for rehabilitation:

1. To improve the quality of life after injury
2. To maximise independence
3. To use care and support effectively where necessary
4. To encourage meaningful activity as much as possible
5. To facilitate neurorecovery whenever and wherever possible

Each rehabilitation programme is tailored to the injured person, the specific injury and any personalised goals. Typically, the programme will involve several specialists with combined experience and skill in brain injury rehabilitation, emotional support, and physical therapy like physio and occupational therapy (OT).

A therapy plan will be created that takes into account the type of injury sustained and the immediate and long-term impact of the injury on the individual. Each plan is tailored to the patient and will be developed as rehabilitation progresses and goals are achieved. It is crucial to provide appropriate treatment tailored to the individual's needs to ensure timely and suitable care through various pathways.

Physiotherapy

Physiotherapists work to strengthen muscle groups, improve neurorecovery and help regain balance and general motor skills. They will suggest exercises to improve physical ability and help to make the person more mobile and increase independence. Injections may be required to aid mobility and spasticity.

Occupational Therapy

Occupational therapists help people to develop independence in carrying out daily tasks such as dressing, washing, cooking and leisure activities. An OT will also help the person to develop the skills that underlie these activities, such as budgeting and planning, and help to find ways around any remaining problems, often with the use of adaptive equipment. At a later stage, the OT may help with difficulties that may be encountered in the home environment and advise on any adaptations that may need to be made. They will also be involved in planning for returning to work.

Psychological Therapy

Emotional support is a vital part of rehabilitation from the very beginning of the patient's journey to better help them and their family come to terms with the life-changing nature of the injuries. A clinical neuropsychologist is a psychologist who specialises in the assessment and treatment of behavioural, emotional and cognitive problems following brain injury. A neuropsychologist can advise on how to build upon the person’s existing skills and abilities and how to reduce some of their difficulties. By addressing wellbeing and emotional stability, the therapist aims to help the patient adapt to their new life, and treat depression if it arises.

Speech and Language Therapist

A speech and language therapist (sometimes referred to as a SALT or SLT) helps people to improve their communication skills. This may include understanding and expressing both written and spoken language and improving speech clarity. The speech and language therapist will work with family members to help the person to communicate as best they can in their daily life and will identify any communication aids that may be helpful. They may also be required to assess swallowing difficulties and provide guidance on how these should be managed safely.

Nurse

The care provided by the nursing team within rehabilitation units is the foundation for the rehabilitation programme provided by the multidisciplinary team. Nurses will assist with personal care and prepare the person to participate in their rehabilitation sessions. On in-patient units and in the community, there are specialist nurses who take on specific roles, such as the management of epilepsy or behavioural programmes.

Vocational Rehabilitation

Usually occurring following discharge from hospital, this rehabilitation develops the person's physical and mental abilities and supports them to return to work or voluntary work. It may also recommend further study to enable a change of job or career or to help find a vocation the person would now like to pursue. This may later involve helping the person to find work and liaising with their prospective employers to prepare them for a successful return to the workplace.

Recreational Therapy

A complementary form of therapy that may include sports that help to encourage both an active mind and body, as well as help social interaction with other people in a similar situation. For people who are not keen on sport, there are groups who participate in art and gardening, knit and natter groups, and others that can be a good outlet for hobbies and friendship.

Support

Brain injuries can be life-changing events, both for the injured party and their family and friends. The injured person may feel like a ‘new’ person, which can be distressing for them, and difficult to adjust to for those closest to them.

Families

Family members have a very important role to play in helping the injured person throughout their rehabilitation journey. A good working relationship between the family and the rehabilitation team is essential in making sure that rehabilitation programmes are followed correctly. Research suggests that the patients who make the best recovery are those whose family is actively involved and can help them to maintain the skills learned in rehabilitation once the patient has gone home. 

Often, family members provide a “caring role” for their loved one. They offer prompts, reassurance, advice and practical support, such as taking on domestic roles that the person provided before they were injured. Sometimes it is necessary to be with the injured person in the community to make sure that they are safe. For example, if the person is disinhibited, they could become lost or have lost spatial awareness and could walk out into the road when it is unsafe to do so.

Sometimes, relatives will need to learn new skills so that they can help to provide the best support. However, it is important that the family member focuses on their primary role as somebody who provides love and encouragement. 

Family members are usually invited to participate in multidisciplinary meetings with staff members to help keep them informed of their relative’s progress. Sometimes the family will need to act as an advocate for the injured person when they lack the capacity to make decisions for themselves.

Friends and Colleagues

Relationships the injured person had with friends and colleagues may change due to changes in their behaviour or because they are no longer able to work. People affected by brain injuries can feel very isolated, particularly following discharge from hospital when they are no longer surrounded by fellow patients or healthcare professionals and participating in regular rehabilitation.

To help maintain positive, healthy relationships with someone who has been affected by a brain injury, try to remember these tips: 

Be flexible: about where and when you meet. Some people affected by brain injury may struggle in loud, busy environments and may find it difficult to stick to a schedule. They may find it easier to meet somewhere local to them, especially if they are no longer able to drive or use public transport independently.

Some days are harder than others: the complexity of a brain injury can make it difficult to predict or understand how the injured person is feeling. Whether it is fatigue from a busy day or something that has triggered a change in behaviour, try not to take it personally. Ask what support the person needs, if any, and give them time. Be a listening ear and allow them to express how they are feeling. Knowing someone is there to listen can be of great comfort. 

Find new activitIes and arrange a rota: while it may be different to the things you did together before, doing something new that accommodates the person’s needs can mark a new chapter in your relationship and provide something positive for you to focus on. It can also be helpful to incorporate friends and family into a rota to ensure the injured person has regular contact with different people they trust.

Be aware of depression and do not mind cancellations: just because someone says they are coping well, it does not mean they are not struggling. It can be difficult to ask for help or admit that everything is not OK. If someone appears to lack motivation or continually cancels plans, it may be a sign they are struggling with their mental health.  

Rehabilitation Case Management

It is common, following a brain injury, for a case manager to be instructed as part of the claims process. Conducting an immediate needs assessment is crucial to identify the best possible outcomes for the individual's circumstances. Case managers work together with the legal team as well as with healthcare and social care providers, co-ordinating a multi-disciplinary approach to meeting the needs of the client, and their family.

The purpose of case management is to promote a client’s quality of life and maximise their potential. The case manager will advocate for the client and consider all aspects of their life. They will work closely with the client, their family and/or support network. Case managers provide the clinical support and expertise for those going through a litigation process.

Managing serious, complex, and catastrophic injuries, including multiple injuries such as musculoskeletal, psychological, orthopaedic, brain injuries, burns, and spinal injuries, requires tailored rehabilitation plans and timely intervention. Case managers facilitate communication between all parties involved, and keep the client's needs as the priority.

Case managers oversee the complete care needs and rehabilitation of the injured person through rehabilitation case management, to help the client meet their rehabilitation goals and coordinate outcome-focused rehabilitation programmes.

What does a case manager do?

Case management covers a wide range of issues but examples of things a case manager may get involved in include:

• Setting up and monitoring a care package for the client. This could be through a care agency or private employment.
• Researching appropriate residential placements, if appropriate
• Coordinating with statutory services, such as health and social care, to check that the client’s needs are being met.
• Coordinating with statutory and private therapy and services to promote the client’s rehabilitation and/or wellbeing.
• Researching work, recreation, leisure or play activities to promote the client’s rehabilitation and inclusion. For instance, hydrotherapy, outdoor pursuits, vocational rehabilitation or accessing social/leisure groups.
• Ensuring that the client’s property promotes their independence and accommodates their therapy and care needs. This may involve working with architects, builders and therapists.
• Liaising with professionals involved to give the client access to equipment which will promote their independence, comfort and safety.
• Research and planning to enable the client to go on holiday or to a social/leisure activity. 

Bringing a legal claim could fund the cost of rehabilitation, care, and a case manager.