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Maintaining progress amid the madness



Many of our personal injury clients at Irwin Mitchell suffer from Traumatic Brain Injury (TBI).

They rely upon case managers, rehabilitation therapists and support workers to help them function.

Things that we take for granted can only be done with a lot of scaffolding in place.

So what happens in a pandemic, when social distancing is enforced? The most obvious impact is that all of the treating therapists and support staff are unable to attend to provide the usual treatment and support.

This has a devastating impact on the person with the injury. It can take a long time to build a successful rehabilitation package.

After brain injury, people can get into very bad habits with sleep, food, spending money and structuring their days.

With the right amount of input and support, they can start to live more of a normal life.  Without that support in place, they can very quickly slip back into a chaotic lifestyle.

Lots of professional people are using video conferencing to keep their businesses going.  This does not always work well for someone with a TBI.

Many injured people have a lower attention span, and can’t cope with a long video call with a therapist.

A video call is also harder for the therapist to manage, as they can’t see who else (or what else) is in the room with the client. Some clients have problems with drug and alcohol addiction.

In a face to face session, the therapist would be able to see or smell evidence of such a problem, but not by video.

One of case managers was telling me about the difficulties of doing a cooking session with a client by video.

While the essentials of the session could be done, the risks are magnified, as the therapist is not in the room to help with using knives or a hot stove.

Many brain injured people can’t actually understand what the virus is or how they should adapt their behaviours.

They don’t get social distancing and don’t realise that they can’t just pop to the shop to get a few things.

Case managers are sending information in different formats, but that is only effective with a small number of clients.

Some clients with memory difficulties can understand the information, but will forget an hour later and go outside.

Normally these clients would have support workers to help them, but without that structure, there is nothing to reaffirm the message.

Other examples is where someone is struggling, as they find it hard to work with people that they do not know, as two of their therapists have been furloughed.

There are other therapists available, but they do not want to work with them, especially by video.

They struggle with technology, and would have to go to a family member’s house to make a video call.

Another example is where a client is used to living alone with support, but they have lost their support workers.

In this example the client tries to return to living with their parents until the crisis is over. One of the big problems here is fatigue and overstimulation.

For them, living in a large family environment is very difficult.  When there are a lot of people making noise in the house, they get agitated and fatigued.

They need to take a nap, but this is very hard in a large family house, especially at a time when everyone is at home all day.

Where previously the case manager was helping people to progress, many have admitted that maintaining where they are is all that they can hope for at this time.

The battle is to stop them from slipping back too far before the crisis is over.

The virus is obviously having a massive impact on the mental wellbeing of many of our clients and as brain injury is perceived as a hidden disability, in the current climate, the impact can be far greater than it appears.

Steve Hill is a senior associate solicitor at Irwin Mitchell.

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