The UK Acquired Brain Injury Forum (UKABIF) recently hosted a two-day virtual summit exploring the issues faced by the neuro-rehab community. The conference brought together academics, politicians and practitioners to discuss topics such as brain injury in sport, domestic abuse, training and education.
Two years after the launch of the All-Party Parliamentary Group (APPG) on Acquired Brain Injury’s report, ‘Time for Change’, UKABIF hosted a virtual conference to update on the group’s progress since. The two-part ‘Time for Change’ summit took place online in November.
Around 200 delegates were welcomed to the virtual event which featured speakers from the USA’s National Institutes of Health, The Walton Centre in Liverpool, St George’s Hospital in London, University College London and the Defence and National Rehabilitation Centre.
The first part of the summit explored new developments in the management of traumatic brain injury (TBI).
Dr Leighton Chan, chief of the Rehabilitation Medicine Department at the National Institutes of Health (NIH), spoke about the progress in developing biomarkers for TBI, including neurofilament light protein (NFL) which the NIH is currently developing.
A 2018 BMJ literature review called NFL “one of the most promising biomarkers to be used in clinical and research setting in the next future.”
The biomarker can measure neuro-axonal damage (a type of TBI) and distinguish between mild, moderate and severe brain injury up to one year after the injury occurred.
Chan said: “Our NFL findings need to be reproduced in larger groups, but we think it’s a commercially viable option”. COVID-19 was also a key talking point with a series of short presentations focused on the impact of the pandemic on neurorehabilitation and how services have adapted to deliver therapy online.
Speakers, including Nicky Ellis, director of Hobbs Rehabilitation, and Dr Margaret Phillips from Royal Derby Hospital, emphasised the need for flexibility and adaptability to ensure those in need of neuro-rehab continue to have access to the treatment they need.
University College London researchers spoke about the development of Neurorehabilitation Online (N-ROL), a telerehabilitation initiative launched this year at the National Hospital for Neurology and Neurosurgery at Queens Square.
The virtual neuro-rehab service was funded by Hollywood star Emilia Clarke’s charity, Same You.
The project at Queens Square concluded in November, however the organisation is now working with East Lancashire Hospitals NHS Trust to roll out ‘N-ROL@ELHT’. Meanwhile, Dr Mike Dilley, consultant neuropsychiatrist at St George’s Hospital, London, highlighted the barriers between physical and mental health.
“No health without mental health has to be the continuing focus going forward; integration is non-negotiable,” he said.
He also discussed the progress being made by Neurosciences Operational Delivery Networks and suggested that delegates identify their Integrated Care System Lead and lobby them.
An update was also provided on the progress of the National Rehabilitation Centre (NRC), which is part of the overall Defence and National Rehabilitation Centre (DNRC) at Stanford Hall in Nottinghamshire.
The original idea for the centre was proposed by the 6th Duke of Westminster in 2010, who wanted to ensure that seriously injured sailors, soldiers and members of the RAF could get the best possible care.
The DNRC’s defence facility opened and began treating patients in late 2018, transferring staff from the UK’s previous defence rehab centre at Headley Court in Surrey.
Since opening the defence arm of the facility, work has now begun on developing the ‘national’ element of the institution; a project led by the Nottingham University Hospitals Trust (NUH).
The first patients are expected to be admitted to the National Rehabilitation Centre in November 2024. Professor Mark Lewis, NRC board member, said: “The NRC is an opportunity for the
UK to continue to be a world leader in neurorehabilitation.”
The second part of the summit explored issues including domestic abuse, education and sport.
Kicking off the conference was MP for Rhondda, Chris Bryant, who referred to brain injury as a “hidden epidemic that is real”.
He argued that neurorehabilitation is one of the most cost-effective interventions currently available to the NHS.
This set the theme for the remainder of the event, which focused primarily on the progress of the APPG on Acquired Brain Injury’s report, titled ‘Acquired Brain Injury and Neurorehabilitation: Time for Change.’
Bryant, chair of the AAPG, also said that COVID-19 had created an opportunity to improve neurorehabilitation as more people require access to services, especially in the community.
He pointed out that rehabilitation prescription remains “patchy” with many not receiving a prescription when they are discharged from hospital.
A significant portion of Bryant’s Q&A was focused on the prevalence of brain injury
in UK prisons, which he said is “shockingly high”.
In a 2019 study of over 4,000 prisoners, hospitalised head injury was found in 24.7 per cent of participants.
Bryant said: “We need to work together to support the needs of people with brain injury and the criminal justice system needs to be led by public health approaches that keep people in the right place, with the right kind of support.”
In a first study of its kind, the Disabilities Trust set up a service at HMP Drake Hall to identify and rehabilitate female offenders with a history of brain injury.
The study revealed that 64 per cent of female offenders at the Staffordshire prison reported a history indicative of brain injury, and 62 per cent reported that they had sustained a traumatic brain injury due to domestic violence.
Alarmingly, research from the Prison Reform Trust has found that around half of female prisoners have experienced physical, sexual or domestic abuse. Speaking on behalf of the Disabilities Trust was head of the foundation, Jocelyn Gaynor.
She said: “We need to ensure the screening is sensitive and trauma-informed.
“We all need to work together to better support these individuals.”
The world of sport, especially football, came under fire from Bryant for its response to concussion and brain injury.
The Labour MP was critical of sports’ bodies, with the exception of the Rugby Union.
“The Football Association’s response [to concussion and head injury] has been shocking; they have been knowingly negligent,” said Bryant.
“If they don’t get it right, then we’ll have to legislate like the USA.”
With proven links between heading footballs and brain injury, the FA has come under scrutiny in recent years for continuing to allow players to direct the ball with their head.
In a 2018 interview with BBC 5 Live, Dr Bennet Omalu, who discovered the brain disease chronic traumatic encephalopathy (CTE), said heading a ball should be restricted in professional football and banned for those under the age of 18. Speaking to the BBC he said: “It does not make sense to control an object travelling at a high velocity with your head.
“I believe, eventually, at the professional level we need to restrict heading of the ball. It is dangerous.”
This notion was reinforced by Dr Michael Grey, reader in rehabilitation neuroscience at the University of East Anglia who, while speaking at the conference, said: “We need to reduce the risk in football, particularly for young children.
“We need to keep up the campaigns and awareness, as well as pressure on government in order to make change.”
Following the confirmation from the Department of Work and Pensions that assessors are being trained in brain injury, Bryant said he is “determined” to ensure that Michael Gove follows through with
his promise to bring together a cross- departmental ministerial committee to address the impact of ABI across government departments.
Bryant said: “It’s vital that assessors understand brain injury and how it affects life not only on a day-by- day basis, but also in the long-term.”
