Programme

08:55   09:25

Registration tea/coffee

09:25   09:30

Welcome

Ms Shirley Anderson

SSR President

Morning Session                  Chair:

Ms Sheena Muir

09:30   09:40

Brief History and Overview

Dr Brian Pentland

09:40   10:30

Behavioural Problems following Brain Injury

Dr Rodger Wood

10:30   10:50

Communication Problems following Brain Injury

Dr Ann-Marie Pringle

10:50   11:05

Tea/Coffee    Exhibition

11:05   11:25

Swallowing Problems following Brain Injury

Ms Vicky Mayer

11:25   11:45

Managing Nutrition after brain Injury

Mrs Elizabeth Fourbister

11:45   12:15

The Vegetative and Minimally Responsive States

Dr Sarah Wilson

12:15   12:30

Discussion

12:30   13:30

Lunch             Exhibition

Afternoon Session               Chair

Ms Jane Arroll

13:30   14:00

Cognitive Problems following Brain Injury

Dr June Gilchrist

14:00   14:30

Mild/Moderate Brain Injury

Professor Graham Teesdale

14:30   14:50

Outcome Measures in Brain Injury Rehabilitation

Dr Brian Pentland

14:50   15:05

Tea/Coffee    Exhibition

15:05   15:25

Development of Inpatient Brain Injury Services

Mr Douglas Gentleman

15:25   15:45

Community Services for the Treatment of Disability after Acquired Brain Damage

Professor Tom McMillan

15:45   16:15

Community re-integration: choices and constraints

Dr William McKinlay

16:15   16:30

Discussion

Close

Brief History & Overview

Dr Brian Pentland, Clinical Director/Consultant Neurologist

Rehabilitation Directorate, Astley Ainslie Hospital, Edinburgh

Head injury rehabilitation in Scotland dates from World War II with the establishment of the Brain Injury Units at Bangour Village and Kilearn Hospitals.  As well as providing acute management these units recognised the need to address social and psychological needs and the importance of a team approach with occupational therapy needs, psychology etc.  These units were not maintained in peacetime.  In 1972 the Mair Report recommended the urgent development of a national service and twenty years later a gesture towards this was made.  In the last 20 years or so there have been developments in social work, voluntary, educational and vocational services provision for this group, but there is a long way to go.

Behaviour Problems Following Brain Injury

Dr Robert L I Wood, BA DCP PhD Cpsychol FBPsS

Clinical Director/Consultant Neuropsychologist, Brain Injury Rehabilitation Trust

Qualified as a Clinical Psychologist in 1977 and then specialised in neuropsychology, receiving training in neurosciences at Cambridge University then at the Department of Neuroscience at Addenbrooke’s Hospital, Cambridge, and Department of Neuropsychology at the Institute of Neurology, Queen’s Square, London.  First appointed as Clinical Neuropsychologist at the Departments of Surgical Neurology and Clinical Neurology at Morriston Hospital, Swansea.  In 1979, appointed Senior Clinical Neuropsychologist at the Kemsley Brain Injury Rehabilitation Unit, St Andrew’s Hospital, Northampton, becoming Consultant Neuropsychologist in 1984.  Awarded Doctor of Philosophy, University of Leicester, in 1985.  Appointed as Clinical Director of Brain Injury Rehabilitation Services, Casa Colina Hospital for Brain Injury Rehabilitation, Los Angeles in 1986, then in 1989 appointed as Visiting Professor in Rehabilitation Medicine at the state University of New York (held concurrently with position as Clinical Director of Brain Injury Rehabilitation services in Los Angeles).  Appointed Clinical Director of the Brain Injury Rehabilitation Trust in 1991.

My research work has involved conducting objective outcome studies relating to the clinical and cost-effectiveness of post-acute neurobehavioural rehabilitation as well as other research relating to the neurobehavioural legacies of acquired brain injury.  I have more than 40 publications relating to acquired brain injury and rehabilitation comprising a series of clinical case studies, various book chapters, four edited volumes and one single author book.

Abstract

Over the last 10 years, there has been a growing awareness of long term (often permanent) cognitive, emotional, behavioural, and personality changes resulting from brain injury.  The term that has grown in use to denote this complex, subtle, yet pervasive constellation of cognitive-behaviour change is ‘neurobehavioural disability’.  It comprises elements of executive dysfunction, deficits of attention diminished insight, poor social judgement, labile mood, problems of impulse control, and a range of personality changes that, when combined with specific cognitive problems and pre-morbid personality characteristics leads to serious social handicap, undermining a person’s capacity for independent social behaviour.  Clinical experience has shown that the range of problems comprising neurobehavioural disability require different treatment approaches and rehabilitation structures than exist in acute neurorehabilitation units.  Post acute neurobehavioural rehabilitation has therefore, evolved over the last ten years as a sub-speciality of brain injury rehabilitation, to address the long-term sequelae of brain injury.

This presentation attempts to elucidate the nature of neurobehavioural disability in respect of its underlying cerebral pathology and the social impact caused by its behavioural manifestations and underlying cognitive impairment.

Communication Problems Following Brain Injury

Dr Ann-Marie Pringle, Head Speech and Language Therapist,

Rehabilitation Directorate, Astley Ainslie Hospital Edinburgh

Ø       Graduated as a Speech and Language Therapist in 1987 from the City University, London

Ø       Worked with adults with acquired communication disorders in the Victoria Hospital, Fife, and the Royal Infirmary, Edinburgh

Ø       Obtained Scottish Office funding to investigate communication disorders in brain tumour in the Department of Clinical Neurosciences, Western General Hospital, PhD in this area followed by 3 years’ postdoctoral research into communication impairments following right hemisphere damage.

Ø       Currently Head of the Speech and Language Therapy department in the Astley Ainslie Hospital where I have been for the last two years based in the Charles Bell Pavilion where the caseload consists mainly of patients with traumatic brain injury

Abstract

‘Aphasic patients communicate better than they talk: people with traumatic brain injury talk better than they communicate’.  Speech and language therapists working within the field of traumatic brain injury (TBI) are becoming increasingly aware that the terms ‘language disorders’ or ‘dysphasia’ are insufficient to describe the multi-faceted nature of communication impairment following TBI.  Cognitive Communication Disorder has recently been gaining popularity as a more accurate descriptor, acknowledging the significant impact of damage to cognitive functions, such as attention and memory, on communication.

The nature of Cognitive Communication Disorder will be described, as will current difficulties regarding the availability of reliable and valid assessment methods and treatment strategies.

Swallowing Problems Following Brain Injury

Vicky Mayer, Department of Speech and Language Therapy

Rehabilitation Directorate, Astley Ainslie Hospital, Edinburgh.

Qualified 1994 with BSc (Hons) Speech Pathology and Therapy (QMUC).  Took up present position as Speech and Language Therapist in Charles Bell Pavilion in July 1994.

Abstract

AIM:  To evaluate the dysphagic population of brain-injured patients admitted to the Rehabilitation Medicine Directorate of the Astley Ainslie Hospital (AAH) in order to define current management practice.  There are currently no national accepted guidelines on the management of dysphagia in this client group (though pathways for stroke care are in place)

METHOD:  A data-collection form was devised to capture information on; gender, age, feeding status prior to admission to the AAH, videofluoroscopic examination prior to admission to the AAH, the type of assessment undertaken here, the dysphagic symptoms present, and the type of intervention undertaken.  Data were collected on all admissions over a 6-month period, both from the brain injury unit and, for comparison, from the stroke unit.

RESULTS:  Data collection is still ongoing – results will be fully analysed and the implications for patients with brain injury will be discussed.

CONCLUSION:  The next step would be to ascertain a national picture of dysphagia management in brain injury by extending this audit to brain injury rehabilitation services across Scotland, with a view to drawing up recommendations for best practice.

Managing Nutrition After Brain Injury

Mrs Elizabeth Fourbister, SRD

Senior Dietician, Royal Victoria Hospital, Dundee.

I qualified at Queen Margaret College, Edinburgh in 1979.  I moved south of the border, where I worked in a number of London teaching hospitals with specialist posts in paediatrics and diabetes education, finally managing the Nutrition and Dietetics Service for Richmond, Twickenham and Roehampton Health Authority and being founder member of the editorial board of Practical Diabetes.

Following marriage, a career break to bring up 2 daughters and a return to Scotland. I held a variety of part-time posts for Dundee Healthcare Trust, before becoming part-time Dietician at Centre for Brain Injury Rehabilitation, Dundee in 1997.

Abstract

Much has been written about the nutritional management of patients with traumatic brain injury in the acute stage, but a very little during rehabilitation.  There is increasing awareness of the prevalence of nutritional depletion and malnutrition amongst hospital admissions.  The prevalence of nutritional depletion amongst traumatic and anoxic brain injured patients entering rehabilitation has been found to be higher than reported in acute hospital admissions.

This session will discuss possible strategies for ensuring appropriate nutritional care of brain injured patients and the essential role of the Dietician in the inter-disciplinary rehabilitation team.

References

Ø        McWhirter J & Pennington C (1994), Incidence and Recognition of Malnutrition in Hospital.  British Medical Journal 308, 945-949

Ø        Thomson MA, Carver AD, Sloan RL (2000), Nutritional Status of Traumatic and Anoxic Brain Injured Patients on admission to Rehabilitation. (Presented BAPEN 2000 awaiting publication)

Ø        British Society of Rehabilitation Medicine, Rehabilitation After Traumatic Brain Injury. British Society of Rehabilitation Medicine, London, 1998

The Vegetative and Minimally Responsive States

Dr Sarah Wilson, Senior Lecturer in Health Psychology

Department of Health Psychology, University of Glasgow

I am a neuropsychologist and a health psychologist.  I graduated from University of Wales, Swansea and the Institute of Psychiatry, London.  I joined the staff of the then Royal Hospital & Home for Incurables, Putney (now the Royal Hospital for Neuro-disability) in 1980 to develop psychological assessment techniques for people with severe physical disabilities, which lead on to work on severe brain injury and the assessment and treatment of vegetative state patients.  My interest in the most severely brain-injured patients has continued through moves to the University of Surrey and, in September 1999 to the Department of Psychological Medicine at the University of Glasgow

Abstract

Our understanding of both vegetative and minimally responsive states is extremely limited.  Working from established definitions of both the vegetative and the minimally responsive states, a review will be made of published scientific evidence to see how understanding of these conditions has been enhanced within the last decade and whether accepted models of these conditions should be revised.  The assessment, management and treatment of these patients will then be addressed and this will include a discussion of behaviourally based approaches to the assessment of these patients.

Cognitive Problems Following Brain Injury

Dr June ME Gilchrist, Consultant Clinical Neuropsychologist

Ninewells Hospital, Dundee

My BSc and PhD were carried out at Glasgow University where I worked on research into long term memory storage before retraining as a clinician.  Having been seduced into clinical work I have continued to work since 1980 with brain injured patients and their families.  At present I am a consultant neuropsychologist at Ninewells Hospital in Dundee where I now work largely in acute neurosciences.

Abstract

This is now a huge and rapidly expanding field and today we will look at some of the cognitive problems faced by brain injured patients and how these problems affect their day to day lives.  We will also look at the assessment of these problems and what can be offered to help these patients and their families.

Mild/Moderate Brain Injury

Professor Graham Teasdale, Professor of Neurosurgery

Institute of Neurological Sciences, Southern General Hospital, Glasgow

Qualified in Medicine from the University of Durham Medical School, Newcastle Upon Tyne where an interest in head injuries was stimulated by Professor HG Miller.  Later training in neurosurgery at the Institute of Neurological Sciences, Glasgow initiated many years of productive collaboration with Professor Bryan Jennett, Professor Douglas Miller and may other colleagues.

Professor and Head of Department of Neurosurgery, University of Glasgow since 1981, currently Associate Dean for Research in Medicine.  President of the Society of British Neurological Surgeons, Chairman of the European Brain Injury Consortium, past President of the Section of Clinical Neurosciences, Royal Society of Medicine and founding President of the International Neurotrauma Society.  Fellow of the Academy of Medical Sciences and Fellow of the Royal Society of Edinburgh.

Research interests include Guidelines for the Management of Head Injuries, Influence of Genetic Factors, Assessment of Outcome and Incidence of Disability.

Abstract

Interest in the Outcome after “Mild” or “Moderate” Head Injury is moving interest away from the long-standing focus on obviously severe injuries.  The recently reported comprehensive study (Thornhills, Teasdale GM, et al. Disability in young people and adults one year after head injury: Prospective cohort study.  British Medical Journal. 2000, 320: 16314635) in an urban, Scottish population, found a failure to recover previous lifestyle in a very high proportion of adults admitted to a general hospital.  Less surprising was the low level of service provision to disabled survivors.  Issues raised include the interpretation of the terms mild and moderate injury, the factors leading to impaired recovery and possible interventions.

Outcome Measures in Brain Injury Rehabilitation

Dr Brian Pentland, Clinical Director/Consultant Neurologist

Rehabilitation Directorate, Astley Ainslie Hospital, Edinburgh

Qualified University of Edinburgh 1974.  Junior posts in Edinburgh, Whitehaven and Dundee.  Appointed Consultant 1982 and part-time senior lecturer 1983.  Clinical Director 1991 and Acting Head of Rehabilitation Studies Unit, 1991.

Abstract

The effects of brain injury are protean, the recovery protracted and the goals of rehabilitation interventions vary.  No single outcome measure will serve the needs of the health planner, clinician or researcher.  There are an increasing number of instruments available to study short vs long-term outcome of population, specific aspects of recovery or particular sub-groups of the head-injured population.

Suggestions on how to choose the appropriate measure of outcome in different settings will be made.

Development of Inpatient Brain Injury Services

Mr Douglas Gentleman, Consultant, Centre for Brain Injury Rehabilitation

Royal Victoria Hospital, Dundee

Douglas Gentleman qualified in Glasgow in 1978 and trained in neurosurgery in Glasgow and Southampton.  He became consultant neurosurgeon in Dundee in 1992, and with other local clinicians and managers, planned and opened a new Centre for Brain Injury Rehabilitation at the Royal Victoria Hospital there, where he now works full-time.  His clinical and research interests have always centred on traumatic brain injury, and he has written many papers and book chapters on this subject.  He is chairman of the Scottish Head Injury Forum, a patron of Headway Tayside, and the secretary of a SIGN guideline group on the early management of head injury.  For four years he was a member of the training body for doctors in rehabilitation medicine.

Abstract

Specialist in-patient services for rehabilitation after acquired brain injury are scarce in the UK.  A new NHS centre opened in Dundee in 1997 to treat younger adults (16-65) from Tayside who have a recent severe traumatic or vascular brain injury and need specialist rehabilitation by a multi-professional team before discharge into the community.

The model will be described in detail, and summary data will be presented on the first 100 patients treated in the centre.  The strengths and weaknesses of this model of rehabilitation will be discussed, including its place within the range of treatment settings that should be available in a comprehensive regional brain injury rehabilitation service.

Developing Community Services for the Treatment of Disability after Acquired Brain Damage

Professor Tom McMillan, Professor of Clinical Neuropsychology

Department of Psychological Medicine, University of Glasgow.

Professor T M McMillan holds the degrees of Bachelor of Science in Psychology from the University of Aberdeen, Master of Applied Science in Clinical Psychology from the University of Glasgow and Doctor of Philosophy in Psychopharmacology from the University of London.  He is a Chartered Clinical Psychologist and a Fellow of the British Psychological Society.  He is Professor of Clinical Neuropsychology in the Faculty of Medicine at the University of Glasgow.  He is seconded two days per week to Greater Glasgow Health Board where he advises on development of rehabilitation services for brain injured people and on the rehabilitation needs of individuals referred to them.  For 10 years he was Head of Clinical Psychology for Neurosciences at St George’s Healthcare, London.  He has worked clinically and in research with people who have brain damage since 1981.  He has written several books and monographs on the nature, effects, rehabilitation and services required by brain injured people and has authored more than 70 scientific journal articles.  He has worked in the area of assessment and rehabilitation of brain injured people and has been advising on their long-term placement and care needs for more than 15 years.

Community re-integration: choices and constraints

Dr William McKinlay,

Director, Case Management Services Ltd, Edinburgh

Dr Bill McKinlay holds a BA in Psychology from Strathclyde University, an MSc in Clinical Psychology from the University of Newcastle-upon-Tyne, and a PhD from Glasgow University.  He is a Chartered Clinical Psychologist and Director of Case Management Services Ltd, as well as being Associate Editor of Brain Injury.  He has 25 years experience of working in the research and clinical management of patients with brain injury, and has held posts at Glasgow University, at the Western General Hospital in Edinburgh, and was a consultant at the ScotCare Brain Injury Rehabilitation Unit for a number of years.  He has published a variety of papers and chapters mainly in the area of brain injury.

Abstract

Reintegration into the community continues to be the point of maximum difficulty in the rehabilitative process after brain injury.  Patients returning to the community will often be unable to resume work and the risks of social isolation developing are well recognised.  There is a growing trend towards community-based rehabilitation.  One of the factors driving this would appear to be the possibility of reduced cost, which is not in itself an argument for such an approach.  However in many cases there may be real clinical advantages and these, together with some possible disadvantages will be discussed.  Rehabilitation in the community may also make more explicit the extent to which there may be conflicts between the goals of the injured party and the goals significant others would like them to pursue.