The Evidence for a Serious Brain Injury Cognitive & Occupational Rehabilitation Programme

Unique Clinician-led Custom Traumatic Brain Injury (TBI) Cognitive & Occupational Rehab

Our unique and ground-breaking serious brain injury rehabilitation programme offers participants a clinician-led, tailor-made programme that includes cognitive and occupational therapy within the outdoor adventure setting of the stunning Lake District. The aim of the programme is to build greater independence and self-esteem for those with acquired brain injury.

Here we examine the evidence for the need for this type of programme:

Traumatic Brain Injury (TBI) is an injury to the brain caused by a trauma to the head.
TBI is not a single event, but can be a chronic and often progressive disease with long-term consequences. Even after an ostensibly good recovery, patients might have to live with a continuing process of coping and adaptation.

TBI represents 30-40% of all injury-related deaths and neurological injury

It is projected to remain the most important cause of disability from neurological disease up to 2030 – two to three times higher than the contribution from Alzheimer’s or cerebrovascular disorders.

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A report by the Centre for Mental Health – “Traumatic brain injury and offending. An economic analysis” states that approximately 1.3 million people in the UK are living with head injury-related disabilities, with these injuries causing around 160,000 hospital admissions each year.

TBI also has a marked impact on the economy, at a cost of £15 billion a year. This figure comprises lost work contributions, premature death and health and social care costs. This £15 billion does not, however, include the human cost of head injury to the injured and their families’ well-being and quality of life, which is clearly the biggest cost.

Clinically-led Acquired Brain Injury (ABI) Rehabilitation for Young Persons & Adults

Wide-ranging impact
The impact of a TBI on an individual may be wide-ranging with not only a reduction in cognitive abilities and executive function, but also in mental health difficulties, problems in psychosocial functioning and a reduction in self-esteem and self-awareness.

The results of a study on longer term outcomes (Hoofien D., Gilboa A., Donovick PJ. Traumatic brain injury (TBI) 10-20 years later: a comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning. Brain Inj 2001 Mar; 15: 189-209) reveal relatively high rates of depression, psychomotor slowness, loneliness and family’s sense of burden amongst people with TBI.

Studies of adolescent and young adult in-patients

Another study of adolescent and young adult in-patients, evaluating cognitive, behavioural, depressive and self-awareness disorders (Viguier D., Dellatolas G., et al A psychological assessment of adolescent and young adult patients after traumatic brain injury Brain Inj 2001; 15: 263-271) highlighted a discrepancy between patient and clinician’s evaluations suggesting a lack of self-awareness of behavioural and cognitive disorders in TBI patients.

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It was mooted that correlations of depressive mood with anxiety and cognitive complaints seemed compatible with some degree of lack of self-awareness of cognitive and behavioural difficulties in the TBI patient group.

A further study on identity, grief and self-awareness after traumatic brain injury (Carroll E., and Coetzer R., Identity, grief and self-awareness after traumatic brain injury Neuropsychological Rehabilitation 2011; 21: 289-305) revealed that 90% of participants suffered from low self-esteem at levels deemed clinically significant.

TBI is also a huge “hidden disability” within prison populations, according to the University of Salford. Prisoners who have had head injuries are more likely to experience a variety of mental health problems including severe depression and anxiety, substance use disorders, anger and suicidal thoughts.

Outdoor Adventure Neuro Rehab Therapy Programme – Building Confidence & Self-Esteem

Physical exercise has the potential not only to improve physical health but also to have a positive effect on mental alertness and mood in the general population. Exercise can result in an increase in self-esteem and self-worth in all age groups from children to older adults (Baumeister RF., Campbell JD., Krueger JI., and Vohs KD., Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles? Psychological Science in the Public Interest 2003; 4: 1-44). Studies on the benefits of outdoor activity in addressing problems associated with TBI point to improvements in self-esteem, self-confidence, increased control, memory and planning.

A Three-day Outward Bound Experience

A one year outcome study of a three day Outward Bound Experience (Lemmon J., LaTourrette D., and Hauver S., One Year Outcome Study of Outward Bound Experience on the Psychosocial Functioning of Women with Mild Traumatic Brain Injury. The Journal of Cognitive Rehabilitation; 1996: July/August 18-24) recorded a range of positive outcomes

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At the one-year evaluation, 83% of the participants ranked themselves above their pre-course rating in an understanding of their strengths and limitations. Other positive changes over the same time span included: ability to rely on others (50%), higher self-esteem (58%) and improvement in problem solving (50%). It was commented that the outdoor challenge course allowed therapists to help the participants recognise and acknowledge their thoughts, feelings and behaviours during the course and that one year later the participants were calling on this understanding to improve their daily functioning.

Another UK pilot programme (Walker A., Onus M., Doyle M., et al., Cognitive rehabilitation after severe traumatic brain injury: A pilot programme of goal planning and outdoor adventure course participation. Brain Injury 2005; 19: 1237-1241), incorporated a context-sensitive approach to cognitive rehabilitation with a focus on goal planning with goal attainment as an outcome measure. The results revealed a high level of achievement (over 80%) on selected, identified, specific and mainly practical goals. In discussing the results, the authors considered that the strength of the project appeared to lie partly in the motivation provided by the outdoor activity course, which appeared to later encourage participants to work towards broader goals.

Cognitive Rehab & Occupational Therapy Treatment Programme for Adolescents & Adults

An Australian study (Thomas M., The potential unlimited programme: an outdoor experiential education and group work approach that facilitates adjustment to brain injury. Brain Injury; 2009; 18: 12, 1271-1286) was similarly positive. Participants attended a standard 9 day outward bound course adapted to meet the needs of the participants.

Fortnightly meetings…

Fortnightly meetings over a period of three months were then facilitated by rehabilitation staff who had also attended the course. The focus of these meetings was on “restructuring” tasks including achievement of individual goals, problem solving, further life planning and social skills development.

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A comparison group matched as far as possible to the experimental group who did not attend the course was also evaluated using Quality of Life Analysis. The findings were as follows:
1. Understanding: Participants reported that they gained insight into personal strengths, limitations and unexpected capabilities as a result of engaging in the programme’s activities.
2. Re-integrating Identity: Participants identified increases in self-confidence and competence and this had a positive impact on their sense of identity. Several participants noted that they felt they had more control and responsibility for the direction of their life.
3. Acceptance: Participants stated that the OOE outdoor activitycourse had helped in the processing of their acceptance of the impact of their injuries on their lives.
4. Restructuring: Participants who attended most of the follow-up groups were seen to report most improvements as shown by QOLI evaluation. This may be the result of the follow-up group providing time for reflection, to set and refine personal goals as well as group encouragement and support.

The Lake District Calvert Trust ABI Rehabilitation Programme

TBI can have profound long-term consequences not only to individuals but to their families, carers and society as a whole . The impact of a TBI on an individual is immediate but TBI survivors may also have to live with a continuing and developing needs of coping and adapting (Maas AIR., Menon DK. et al., Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology Commission 2017 16: 987-1048).

Post TBI, an individual may have to cope with a reduction in cognitive abilities

Physical exercise is known to improve physical health and also to have a positive effect on mental alertness and mood in the general population.

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It has been shown that post TBI an individual may have to cope with a reduction in cognitive abilities, a reduced ability to plan and make decisions, mental health difficulties such as depression, and psychosocial problems with a lack of self-awareness, self-esteem, self-control, apathy or aggressive behaviour (Levin HS., Goldstein FC., Williams DH., et al. The contribution of frontal lobe lesions to the neurobehavioural outcome of closed head injury in Frontal Lobe Function and Dysfunctional 1991 p318-338 New York: Oxford University Press).
Physical exercise is known to improve physical health and also to have a positive effect on mental alertness and mood in the general population. The pathology associated with TBI can be characterised by a reduced capacity of neurons to metabolise energy and sustain synaptic function which often results visibly in emotional and cognitive problems (Wu A., Ying Z., and Gomez-Pinilla F., The salutary effects of DHA dietary supplementation on cognition, neuroplasticity, and membrane homeostasis after brain trauma. J Neurotrauma 2011; 28: 2113-2122). The neurogenerative effects of exercise are beneficial to neurocognitive functioning and neuroplasticity and the detrimental effects of TBI on the vasculature may be reduced by carefully selected exercise/activity programmes. It has been suggested that the concept of exercise providing a “scaffolding” may aid the understanding of the benefits of exercise to the injured brain. It is thought that physical exercise reinforces the adaptive processes of the brain post TBI, facilitating the development of existing networks, helping to compensate for those lost through damage (Archer T., Influence of Physical exercise on Traumatic Brain Injury Deficits: Scaffolding Effect 2011 Neurotox Res (online) DOI 10.1007/s12640-011-9297-0).

Confidence Building Traumatic Brain Injury (TBI) Rehab in NW England’s Lake District

The Lake District Calvert Trust (LDCT), inspired by its experience in the provision of outdoor activity for people with disability over the last 40 years, the encouragement, advice and enthusiasm of leading clinicians and academics, and the limited but positive initial results of research of outdoor activity in rehabilitation following TBI has developed a proposed post-acute ABI rehabilitation programme which will support brain injury survivors in a new residential centre.

More information on TBI can be found on this Wikipedia page.

An exciting and innovative rehabilitation programme

This exciting and innovative rehabilitation programme, delivered by a team of clinicians and specialists in outdoor activity, will be tailored to each individual participant’s needs.

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Rehabilitation aims to provide the tools needed for people to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. This should be relevant to their daily life. This holistic approach with contextualised interventions results in “learning by doing and reflection”. Experiential learning and rehabilitation through outdoor activity is therefore not simply about the specific skills learned or the satisfaction of completing a challenge; but with improvements in self-esteem, self-awareness and self-confidence, lifting of mood and clinical depression, as well as cognitive improvements. Importantly learning can then be internalised, and transferred and applied to daily life.

Clinically supported Cognitive Brain Damage Occupational Rehab in the healing Lake District

The LDCT ABI Rehabilitation Programme acknowledges and supports The Lancet Neurology Commission Report in 2017 recommendation:  There is a clear need for studies to inform guidelines on rehabilitation approaches and optimum timing of rehabilitation in TBI. Such guidance would need to take into account the growing evidence that the diversity of disability after TBI is best addressed through a holistic approach to rehabilitation delivered by a multidisciplinary team”.

Evaluation and research will be integral to the ABI Rehabilitation programme and the LDCT is delighted that this will be carried out at PhD level in conjunction with the University of Newcastle under the supervision of Dr Rob Forsyth.

For further information on Calvert Reconnections, our serious brain injury cognitive and occupational rehabilitation programme, call us on 017867 85381.

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