Insight

  The admissions team invest a lot of time in developing our contact base of social workers, solicitors, case managers and other professionals who can refer people to our homes. We accept people from across the whole country, so we’ve created a national network over several years. This is enabling us now to reach out to as many people as possible who may need our support. Richardson Care was established over 30 years ago and the provision for adults with acquired brain injury has increased significantly in the last seven years. It has taken some time to build up our network of contacts but our aim is to grow at a sustainable rate.

Goal setting is always a hot topic in neurorehabilitation – it has, in many ways, become much more than the sum of its parts and, as a concept, it is saturated with literature. There is frequently new research evaluating components of goal setting or describing emerging ideas in the field, and this can be difficult to navigate, even with all the time in the world. As clinicians, however, there is rarely ever any spare time at all. If we listen to what we are told about how important goal setting is for our service users and teams, we need to know exactly what it is, why it matters, and how we can do a good job of it.

Personality changes are sometimes referred to as neurobehavioural disability (ND), especially when associated with social difficulties. The concept of ND involves impairments of numerous aspects of functioning including the abilities to self- monitor and self-regulate, to control frustration, anger and aggression, to tolerate delay in gratification, and to self-motivate. These impairments can lead to a sense of being overwhelmed when facing situations requiring control and management of internal impulses or coping with social situations or tasks.

Factors that likely influence rehabilitation potential and recovery and predictions of the same include previous abilities, age at onset/injury, individuality, drive, underlying motivation, health, support, environment, the exact nature of injury and the exact nature of individual pre-morbid neurology. Other influencers include our understanding of the brain, how it works, how it repairs and how it responds in the short, medium and long term after injury. Alongside our developing but yet still poor understanding of how exactly treatments and therapies work, even where we ‘know’ that they do, it is therefore impossible to pinpoint and prescribe a very exact treatment or approach for a specific individual's neurology, type of insult and likely natural recovery.

William Wordsworth urged to the world to “come forth into light, let nature be your teacher”. He was obsessed with the natural world’s power to help, heal and nourish. Surely then, the lake poet would have approved of the owners of his old Cumbrian bolt hole. For they are also channelling the power of nature, in the name of rehabilitation.

Good vibrations are bouncing around the communal room at Cygnet St William’s when NR Times arrives. Partly, it’s down to the surprisingly large quantity of cakes on offer. A local Headway representative is already tucking in, as is Paul, a friendly patient with a beaming smile. Manager Alison King and consultant psychiatrist Dr Tony Perini are also in good spirits. But it’s perhaps not just the iced treats fuelling their positivity.

Two of the most powerful ingredients of Accessible Dreams’ work are the very things that are restricted right now. Travelling to exciting horizons, and being able to hang out with friends new and old once there, are at the heart of the experiences the group creates. And at the time of writing, one is currently impossible from the UK, while the other is enabled only in a world of separation, screens and clever apps. But Nicola Cale, who runs Accessible Dreams, sounds surprisingly chipper when NR Times calls her.

"It’s not the cards you’re dealt that matters, it’s how you play them that counts.” For Jessie Ace, this is a mantra that inspires her every day. It has helped her overcome her career dreams and confidence being shattered by her multiple sclerosis (MS) diagnosis, and underpins the positivity that now enables her to inspire so many others with chronic illness around the world.

UK charity The Children’s Trust, which supports children with brain injuries and their families, says demand for its services is at the highest point in its 36-year history. At the same time, however, donations are declining rapidly as people become more cautious amidst economic uncertainty. And it is not alone, with similar challenges being felt elsewhere in the third sector that supports neuro-rehab.