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Brain injury

Oliver Zangwill Centre to close

“Devastation” at the loss of the specialist neuro-rehabilitation resource and concern at how the needs of ABI survivors will now be met

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The Oliver Zangwill Centre, known nationally for its work in delivering neuro-rehabilitation, is to close, it has been confirmed. 

The announcement has been met with anger and devastation by charities and those the Cambridgeshire centre has supported over the years, with fears raised about what resources can fill the gap its closure will leave. 

The Oliver Zangwill Centre has supported people aged 16 to 64 who have non-progressive brain injury and require cognitive rehabilitation since its opening in 1996, with patients coming from well beyond its Cambridgeshire and Peterborough CCG area. 

In that area alone, around 4,000 people are admitted to hospital each year with an acquired brain injury (ABI) diagnosis, although Cambridgeshire and Peterborough CCG claims referrals to the centre have decreased in recent years. 

In a consultation earlier in the year, involving charities including UKABIF and Headway – as well as local people, former patients, and those with professional and personal interest in neuro-rehab – many expressed their views as to why the Oliver Zangwill Centre is a ‘lifeline’ for so many and cannot be lost. 

However, sadly its closure has now been confirmed, with a recommendation made for it to take effect from June 30. 

The announcement has been met with frustration, particularly at a time when advances are being made on behalf of ABI survivors through the creation of the ABI Strategy. 

Chloe Hayward, executive director of UKABIF, told NR Times that confirmation of the closure is “devastating”. 

“There are so few of these specialist units, and the Oliver Zangwill Centre is right up there with the best of them. Many people will suffer as a consequence of its loss,” she said. 

“Specialist neuro-rehab gives people the leg-up to get back to the best of their ability, and by removing this centre that chance is diminished. 

“I worry that because decision making is going to be devolved, we will see more of this. When all decisions are taken on a regional basis, I fear that we will see more of this and the regions not providing what is needed. It’s a very big concern. 

“While Chris Bryant and Gillian Keegan are spearheading national policy, we also need to consider what is happening regionally, and that must align for it to have the positive effect we need.”

Headway said it believes a key priority for the ABI Strategy should be the equitable access to specialist neurological rehabilitation and support services – a concept completely undermined by the decision to close the Oliver Zangwill Centre.

“At a time when the government is in the process of putting together a ground-breaking pan-departmental ABI Strategy to better support people living with an acquired brain injury, we should be looking at creating more of these centres of excellence, not closing them,” said chief executive Peter McCabe.

“Each year, around 350,000 people are admitted to UK hospitals with an acquired brain injury. For many patients, early access to specialist neurological rehabilitation will significantly increase their chances of making a meaningful recovery. 

“And yet currently access to specialist care such as that provided by the respected Oliver Zangwill Centre varies significantly across the country.

“Rather than improve lives, ultimately the cost of this move will largely be paid by brain injury survivors and families unable to get the help and support they deserve and need.

“Whilst hugely disappointed, this strengthens our resolve to make sure the ABI Strategy is strong enough and robust enough, so that every survivor has the best chance at a meaningful and fulfilled life after brain injury.”

Brain injury

New therapy reduces veteran headaches after brain injury

Cognitive Behavioural Therapy for Headache also shown to have positive impact on PTSD symptoms

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The first therapy to be developed specifically for post-traumatic headaches significantly reduced related disability in veterans following a traumatic brain injury (TBI), a study has revealed. 

Cognitive Behavioural Therapy for Headache (CBTH) was also shown to reduce co-occurring symptoms of post-traumatic stress disorder (PTSD) comparably to a gold-standard PTSD treatment.

Furthermore, the therapy was shown to be appealing to patients with low drop-out rates, and is easy for therapists to learn and deliver, increasing its potential to be widely used and to improve the lives of servicemen and women and veterans globally. 

CBTH, which uses cognitive behavioural therapy concepts to reduce headache disability and improve mood, includes key components such as relaxation, setting goals for activities patients want to resume, and planning for those situations.

“We are excited by this development in the treatment of post-traumatic headache, which along with TBI is poorly understood and for which treatment options are so limited,” said Dr Don McGeary, associate professor at The University of Texas Health Science Center at San Antonio (UT Health San Antonio). 

“To find the first major treatment success for post-traumatic headache, which is arguably the most debilitating symptom of TBI, and that the treatment also significantly reduces co-morbid PTSD symptoms, is a major breakthrough.”

Both TBI and PTSD are prevalent in post-9/11 military conflicts, and the two conditions commonly occur together. 

Post-traumatic headaches, or headaches that develop or worsen following a head or neck injury, become chronic and debilitating in a large percentage of those who experience a TBI such as a concussion, inhibiting their ability to engage in the activities of daily life. 

When PTSD is co-occurring, it can worsen the headaches and make them more difficult to treat.

Effective treatments exist for PTSD but not for post-traumatic headache, which along with TBI, scientists are still working to understand. 

Migraine medications commonly used to alleviate the headache pain do not relieve related disability. They also often have unwanted side effects, and their overuse can worsen headaches.

In the study, Dr McGeary and his team developed CBTH by modifying a psychotherapy for migraine headaches. They evaluated its efficacy with co-occurring post-traumatic headache and PTSD symptoms.

The study was conducted at the Polytrauma Rehabilitation Center of the South Texas Veterans Health Care System. 

Participants had clinically significant PTSD symptoms and headaches persisting more than three months following a TBI. They were randomly assigned to receive either CBTH, a leading PTSD treatment called Cognitive Processing Therapy (CPT), or the usual care provided at the VA Polytrauma Center.

At the end of treatment, researchers found that, compared to usual care, those receiving CBTH reported significant reductions in disability and in negative impact on function and quality of daily life. 

They also showed improvement in PTSD symptoms comparable to the group that received CPT. All of these treatment gains were maintained six months after treatment completion.

CPT, on the other hand, led to significant and lasting improvements in PTSD symptoms, but on its own did not improve headache disability. 

“This was a surprise,” said Dr McGeary. 

“If theories about PTSD driving post-traumatic headache are correct, you’d expect CPT to help both PTSD and headache. Our findings call that into question.”

Interestingly, CBTH did not reduce headache intensity or frequency compared to usual care. 

Dr McGeary said its dramatic reductions on negative life impact are likely due to its building patients’ confidence that they could control or manage their headaches, a concept known as “self-efficacy.” 

That sense of control was key to helping patients “get their lives back,” he said.

“If you can improve a person’s belief that they can control their headache, they function better,” Dr McGeary said. 

“That’s because, when dealing with a long-term, disabling pain condition, people make decisions about whether they’re going to actively engage in any kind of activity, especially if the activity exacerbates the pain condition. 

“They make those decisions based on their perceptions of their ability to handle their pain.”

In comparison to CPT, CBTH requires fewer and shorter therapy sessions—typically eight sessions of 30-45 minutes each. CPT typically involves 12 sessions lasting 60-90 minutes each.

CBTH requires only two hours to train clinicians to deliver the therapy, compared to CPT, a complex treatment that requires significant training and acquired skill. 

The research team now hope to broaden their study to be as representative as possible. 

Dr McGeary said: “We need more women, more racial and ethnic diversity, veterans as well as active military of different branches, with varying comorbidities, in different geographic regions attached to different hospitals and medical systems because we’re comparing to usual care.”

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News

Pioneering project could revolutionise capacity assessment

Sector-leading research is set to generate a framework of wellbeing indicators for patients

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Specialist neurological care provider PJ Care has partnered with the University of Leicester for a sector-leading research project that could revolutionise the assessment and care of residents who lack capacity.

The two have come together in a knowledge transfer partnership (KTP) to support the creation of a centralised system at PJ Care to create algorithms that will generate a framework of wellbeing indicators for those who are non-verbal as a result of their neurological condition.

So far, a review has been completed of existing research into this area, which will be published jointly by PJ Care and the University of Leicester later this year.

Leading the project is Dr Allan Perry, consultant clinical neuropsychologist and director of clinical services at fast-growing PJ Care.

“The current models for assessing the health and wellbeing of those without capacity and who cannot readily communicate their feelings and experiences are limited and don’t take advantage of the recent advances in technology and data analysis that can give us much more detailed information,” he explains.

“There is a wealth of monitoring technology that we use which allows us to collect real-time data on a number of wellbeing indicators such as a person’s oxygen levels, heart rate, fluid intake and the number of steps they take to reach a certain distance.

“We believe this data can be analysed by an algorithm to provide insights into personal wellbeing, sense of agency, independence and self-determination, that are more accurate than those offered by traditional methods. We can then apply this information to tailor our care to that individual.

“While there is plenty of information on bringing more technology into the care sector and using the data being created by it, this isn’t being married with the questions posed by a person’s capacity as yet. We don’t believe any other care provider is delivering anything like what we are proposing to.”

PJ Care is a specialist neurological care provider with three specialist care centres – the first of which has just celebrated its 21st anniversary – for more than 200 adults with progressive conditions such as young onset dementia and Huntington’s disease, and care and rehabilitation for people with acquired brain injuries.

Dr Zehra Turel holds a PhD in cognitive neuroscience from the University of Leicester and serves as KTP research associate for the project, working with Professor John Maltby and Professor Elizabeta Mukaetova-Ladinska of Leicester’s Department of Neuroscience, Psychology and Behaviour.  

She says there is an urgent need for an accurate assessment tool for those who have difficulty communicating.

“We have so far uncovered that the available wellbeing measurements neglect or fail in understanding of the clinical populations such as cognitively impaired individuals, with or without capacity,” says Dr Turel.  

“This project will provide micro and macro insights about residents’ health and wellbeing, and support decision-making at both resident and business level.

“With the increasing use of new data-driven technologies and streamlined data collection at PJ Care, this project will improve personalised care and provide more accurate and faster predictive and preventive measures, and more informed decision-making along with lowering costs and simplifying internal operations.”

“This KTP has the potential to develop resources that could not just be transformative for PJ Care and how our staff support people without capacity, but, eventually, for the whole care sector,” says Dr Perry.  

“We will be looking to market this if it proves to be as effective as we believe it will be.”

 

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Brain injury

Research sheds light on nerve cell changes after brain injury

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An injury to one part of the brain changes the connections between nerve cells across the whole brain, new research has revealed. 

Traumatic brain injury (TBI) affects one in three people and can lead to physical, cognitive and emotional disabilities. 

One of the biggest challenges for neuroscientists has been to fully understand how a TBI alters the cross-talk between different cells and brain regions.

In a new study from University of California, Irvine, researchers improved upon a process called iDISCO, which uses solvents to make biological samples transparent. 

The process leaves behind a fully intact brain that can be illuminated with lasers and imaged in 3D with specialised microscopes.

With the enhanced brain clearing processes, the UCI team mapped neural connections throughout the entire brain. 

The researchers focused on connections to inhibitory neurons, which are extremely vulnerable to dying after a brain injury. 

“Our study is a very important addition to our understanding of how inhibitory progenitors can one day be used therapeutically for the treatment of TBI, epilepsy or other brain disorders,” said Dr Robert Hunt, associate professor of anatomy and neurobiology and director of the Epilepsy Research Center at UCI School of Medicine whose lab conducted the study.

The team first looked at the hippocampus, a brain region responsible for learning and memory. Then, they investigated the prefrontal cortex, a brain region that works together with hippocampus. 

In both cases, the imaging showed that inhibitory neurons gain many more connections from neighbouring nerve cells after TBI, but they become disconnected from the rest of the brain.

“We’ve known for a long time that the communication between different brain cells can change very dramatically after an injury,” said Dr Hunt.

“But, we haven’t been able to see what happens in the whole brain until now.”

To get a closer look at the damaged brain connections, Dr Hunt and his team devised a technique for reversing the clearing procedure and probing the brain with traditional anatomical approaches.

The findings surprisingly showed that the long projections of distant nerve cells were still present in the damaged brain, but they no longer formed connections with inhibitory neurons.

“It looks like the entire brain is being carefully rewired to accommodate for the damage, regardless of whether there was direct injury to the region or not,” explained Alexa Tierno, a graduate student and co-first author of the study. 

“But different parts of the brain probably aren’t working together quite as well as they did before the injury.”

The researchers then wanted to determine if it was possible for inhibitory neurons to be reconnected with distant brain regions. To find out, Hunt and his team transplanted new interneurons into the damaged hippocampus and mapped their connections, based on the team’s earlier research demonstrating interneuron transplantation can improve memory and stop seizures in mice with TBI.

The new neurons received appropriate connections from all over the brain. While this may mean it could be possible to entice the injured brain to repair these lost connections on its own, Hunt said learning how transplanted interneurons integrate into damaged brain circuits is essential for any future attempt to use these cells for brain repair.

“Some people have proposed interneuron transplantation might rejuvenate the brain by releasing unknown substances to boost innate regenerative capacity, but we’re finding the new neurons are really being hard wired into the brain,” said Dr Hunt.

Dr Hunt hopes to eventually develop cell therapy for people with TBI and epilepsy. The UCI team is now repeating the experiments using inhibitory neurons produced from human stem cells.

“This work takes us one step closer to a future cell-based therapy for people,” he said.

”Understanding the kinds of plasticity that exists after an injury will help us rebuild the injured brain with a very high degree of precision. However, it is very important that we proceed step wise toward this goal, and that takes time.”

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