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Rehabilitation finding a voice

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Dr Andrew Bateman

Chair of the United Kingdom Acquired Brain Injury Forum

Rehabilitation has a dramatic impact on a person’s life after an injury or trauma that’s often invisible to the naked eye.

Rehabilitation has an image problem. Among the general public it is not well understood and when asked, “what does rehabilitation mean to you?”, I wonder what idea springs to mind.

For most of the general public, ‘rehab’ is a thing for people overcoming a drug or alcohol addiction, but the term rehabilitation covers a far broader spectrum.

Yet the teams implementing the multiple strands within rehabilitation are often invisible despite their very patient and skilled work.

Making rehabilitation visible

A life-changing event such as a traumatic head injury can result in many interacting problems. Often, we meet brain injury survivors who appear to ‘look fine’ but the difficulties they are experiencing are not visible: altered emotions, communication skills and thinking skills, strained relationships, loss of employment and many more challenges.

The almost invisible work in the background of these scenarios involves identifying and working with these – almost invisible – problems.

The team of rehabilitation doctors, psychiatrists, psychologists, speech and language therapists, occupational therapists and physiotherapists must devise plans that grasp the interactions between the problems. And this work requires more than a quick check-up.

Rehabilitating after a brain injury

Brain injury doesn’t dramatically alter the life expectancy of an individual, so survivors may be left with residual impairments for a long time.

One of the most overlooked aspects of rehabilitation is that which supports people with long-term conditions and disabilities to manage their health and wellbeing in the longer-term.

Professionals providing rehabilitation are found in a wide number of health and social care settings. This workforce is multi-disciplinary and across sectors.

They may be working to provide ‘prehab’ (prepare for treatment), offering rehab at an early stage after a brain injury to prevent conditions escalating, or later, providing rehabilitation that helps people re-gain function and independence.

Sometimes, rehabilitation is described as ‘slow-stream’ because the progress made takes months or years.

Who has the right to rehabilitation?

Whichever scenario, there is strong evidence that rehabilitation is cost-effective and beneficial for people after brain injury. Survivors, however, are not always clear that they have a right to rehabilitation and across the UK there is inconsistency in the rehabilitation services available.

This is compounded by a lack of information about the services, with no one place or directory for such information.

One of the many ways that this problem can be solved is through spreading the idea of rehabilitation prescription.

If doctors use the language of rehab prescription with their patients, as they come home to the community holding a rehabilitation plan, then they can hold their local MPs and community health service providers to account if the prescribed treatments are not available.

We may yet need a pile of unfulfilled prescriptions to identify the inequalities and missing services.

Rehabilitation is gaining traction in government

Rehabilitation professionals and brain injury survivors requiring their help in the UK at least have cause for optimism. In the last year or so, the All Party Parliamentary Group has been chaired by MP Chris Bryant (Rhondda).

He has taken these issues into debates, engaged with ministers from all departments of government, and explained the economic benefits of paying attention to the need for rehabilitation.

Charities, such as United Kingdom Acquired Brain Injury Forum, the Society for Research in Rehabilitation and the British Society of Rehabilitation Meeting, will be holding conferences this autumn where clinicians and academics will be engaging with this image problem.

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