26th August 2016

Care and Support for Individuals with Traumatic Brain Injury

The outstanding success of Team GB at the Rio Olympics, has been attributed to secure long term funding. This same success is sparking debate amongst politicians and policy makers around how to catalyse Olympic gold into higher levels of activity amongst the population.

It is well reported that a high percentage of the population is overweight and sedentary, with all the accompanying health risks that this entails. However, encouraging activity itself carries some risk of injury.

Within care settings a significant number of individuals requiring residential or community support will have Traumatic Brain Injury (TBI) and a percentage of these will have been experienced through sports such as horse riding, boxing, rugby and football. Others will have occurred as a result of traffic, or other accidents or assaults.

Research

According to a team at Oxford University, childhood brain injuries, including concussions, are associated with an increased risk of subsequent mental illness, poor school attainment and premature death. The research team, analysed data from more than a million Swedes born between 1973 and 1985 to examine the long-term impact of having a traumatic brain injury before the age of 25.

Despite the research in this area, TBI is not well understood. The effects are phased, with the primary phase resulting in bruising or ruptured blood vessels and a secondary phase, associated with inflammation and toxins, leading to longer term limitations. However, the interaction of the two phases is unclear, so it is often difficult to attribute neurological or psychiatric disturbance precisely to a specific aspect of the injury. What is clear is that TBI can leave a damaging physical, psychological and social legacy for the individual - and it is this legacy that care and support services have to work with.

Effects of TBI

According to the NHS Choices website there are a number of well recognised consequences of TBI/severe head injury.

  • Hormonal effects; damage to the pituitary gland can result in hormonal abnormalities such as an underactive Thyroid gland. This can affect all of the bodies major systems including digestion, circulation and metabolism.
  • Sensory effects; the senses of taste, smell, hearing and vision can all be affected by brain injury, due to the processing functions carried out in the brain. Individuals may lose their sense of taste and smell, or experience blind spots. Some individuals have difficulty regulating body temperature, so that they feel either too hot or too cold.
  • Cognitive effects; individuals may find it difficult to think, process information and solve problems. They may also experience memory problems, particularly with short-term memory, and have difficulty with speech and communication skills. Depression is more common than within the general population.
  • Emotional or behavioural effects; following a severe head injury, individuals can undergo changes to their personality. This can present through anger, irritation or childlike behaviours. Individuals may become intolerant or unable to consider another's point of view which can result in relationship difficulties.

The challenges of TBI arise from fundamental and enduring changes in functional ability and personality. Support packages need to be collaborative, based upon person-centred principles and sustainable. In many ways sustainability will be the hallmark of quality care as it will embed and maintain hard gained progress. Funding is a critical part of the equation here, as to deliver quality TBI support, care providers too need secure long term funding.

A report of the Oxford University research can be found at Childhood head injuries linked to increased risk of adult mental illness and poorer life chances

 

*All information is correct at the time of publishing

Nic Bowler

Welsh Care and Social Services Inspectorate Specialist

Dr Nicholas Bowler is a researcher and consultant to government-level [Welsh Government Review of Secure Services, 2009] – specialising in QA/compliance focused projects. He has interests in clinically relevant training, service development and research. He enjoys working with clients to support them in identifying problems and initiating projects to improve practice.

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