Acquired Brain Injury: Is there a demographic?

The Department of Health’s cross-departmental strategy on Acquired Brain Injury (ABI) will be looking at research into societal, congenital, medical and environmental causes of ABI, Fiona Kenny, Head of Case Management and Rehabilitation Services at Bush & Co looks at the clinical observation in terms of prevalence and whether or not there is a demographic we need to consider.

What does a leading case management service see?

Clients who present with a brain injury, regardless of the cause (personal injury or clinical negligence) have to navigate and adjust to changes in their day-to-day lives, depending on the severity of the injury. A brain injury is all encompassing and the catastrophic nature of the injury affects the family and clients social network. According to Fiona “these injuries are no respecter of age, social background, ethnicity of social standing, and as such has such widespread effects, being unique to the individual client.”

Fiona shares the view of all of our brain injury case managers in that early access to specialist regional centers of excellence for the management and support of Acquired and Traumatic Brain Injuries is vital to maximise recovery and prevent some of the longer term social complications. Fiona commented “We know that the more proactive we are with rehabilitation and case management, the better outcomes we are able to support the client to achieve.”

Is there an ABI demographic?

We asked Fiona, in her experience as a nurse and leading Bush & Co’s case management and rehabilitation services if she felt there was a demographic we should all be considering when it comes to brain injuries.

“As I mentioned, a brain injury is no respecter of age, social standing, gender etc so it’s difficult to say there is a demographic as such that we should focus on when understanding how best to support people following ABI. What our brain injury case managers do see though is a prevalence amongst some groups of people, for example young men.

“Access to statistics for TBI is challenging because mild and moderate TBI is often underreported. However we do know from the most recent NICE guidelines on head injury and early management that head injury is the commonest cause of death and disability in people aged 1-40 years in the UK*. The causes of death and disability changes as the population ages because the older population are more likely to be affected by acute and chronic disease, such as cancer and stroke.

“Annually, admissions for ABI fluctuate between 293,000-301,500*. We also know that men are 1.6* times more likely to sustain a brain injury than women, although there is evidence that this gap does appear to be closing. Historically men have engaged in more risk taking behaviour than women and as such have been more prone to sustaining a brain injury.

“In addition, between 33% and 50% of these are children aged under 15 years*.”

The best practice approach

Fiona went on to say “Best practice brain injury case management is to approach each client as an individual with a unique set of needs; ignoring any prevalence. As a brain injury case manager the role is to see the whole picture of the client within assessment, ensuring that they review the full clinical and social picture for the client. The assessment should also take into account the family, friends and community, because as discussed brain injury has widespread effects regardless of age, gender and any other demographic.”

“The accessibility and availability in statutory support is also vital when considering best practice. We are currently seeing extensive challenges across Great Britain in accessing statutory support as we continue to be challenged by covid-19. The case manager needs to be adept at making innovative recommendations in order to ensure the rehabilitation programme delivers what the client needs, within the constraints within health and social care.

“It is really important that the brain injury case manager builds a relationship with the client, taking into account the clients wishes, where possible. It is also vital that case managers refer to and follow current research and guidance in relation to management of TBI.

“Only with all of this will be fully understand the needs of people following brain injury, regardless of their circumstances pre-injury.”

Mitigating the prevalence

Prevention of traumatic brain injury should remain a focus is the only way to mitigate the prevalence we see amongst certain groups. In Fiona’s mind, “the use of national campaigns aid this and we have seen great progress in the field of support in relation to concussion awareness, both in rugby and football.

“For children the incidence of road traffic accidents is higher in the winter months and campaigns such as Glow Week really help to focus attention on protecting children from being involved in accidents. The wearing of cycle helmets for adults and children is also a key campaign, again focusing on prevention.

“A really positive step is the Government’s focus on brain injury research and working with brain injury organisations to understand more the prevalence and demographic breakdown of clients so that we can work to promote safer practices, and target rehabilitation when needed.”

* NICE Guidelines: Head Injury and Early Management 2019 (expected to be updated in September 2022) https://www.nice.org.uk/guidance/cg176/chapter/introduction