Author: Rachael Hansford

Latest implantable and external neurostimulation technology for drop foot correction and gait rehabilitation

Posted on September 24, 2013 by - Sponsored Feature

This article was submitted by Otto Bock Healthcare and they have sponsored its publication in ACNR. Dr Michael Jauch is clinical partner to Otto Bock Healthcare UK for Functional Electrostimulation. Dr Jauch graduated in Germany.  He undertook postgraduate training in orthopaedics in Germany and the UK as well as training in orthopaedic and neurological rehabilitation in Germany. His Postgraduate work in experimental orthopaedics was undertaken at Imperial College, London. Since 2011 he has operated an FES clinic at BMI Blackheath Hospital, London.

The ability to negotiate the environment independently is fundamental to all aspects of daily life and almost all aspects of social participation are dependent upon adequate mobility. The insufficiency in dorsiflexion during gait results in difficulties in walking, such as slowness, tripping and tiredness1-3, leading to a reduction in mobility and independence as well as increased risk of falls.” NICE 4.

For many patients who suffer from central or upper motor neuron lesions, e.g. stroke, multiple scleroris or head injury, walking becomes a challenging task. In many cases, the damage to the central nervous system results in paralysis and a drop foot.

This article concerns CNS lesions. Lesions to peripheral nerves are an exclusion criteria for the application of Functional Electrical Stimulation (FES).

Walking speed has been shown to be a clinically relevant outcome. Some researchers even considered it to be the ‘almost perfect’ measure of community ambulation5. Reduced gait speed was shown to be related to the increased risk of future hospitalisation, future lower extremity limitation and even mortality.

ottobock-1National Guidance

Since the introduction of FES as a drop foot treatment, a number of studies have demonstrated that FES significantly improved walking speed and patient’s quality of life6-8. These health and quality of life benefits, particularly improved independence, are in line with the goals of the Department of Health Reablement initiatives.

NICE published interventional procedural guidance on FES in 20093 stating that the current evidence on the safety and efficacy (in terms of improving gait) of FES for drop foot of central neurological origin appears adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance, consent and audit. For implantable devices, an interdisciplinary healthcare team should be involved in deciding which patients should have the procedure3.

Other guidance includes the government’s National Stroke Strategy. It acknowledges FES as a new technology with which service providers need to keep pace9.

The National Service Framework for long term conditions includes a quality requirement (QR7) advocating appropriate assistive technology/equipment10.

In a 2010 report, the effectiveness and cost-effectiveness of surface FES as treatment for drop foot was examined. The conservative model on the use of surface FES to treat drop foot after stroke shows that it is likely to be cost effective compared to no treatment. This report suggests that it is reasonable to assume that the QALY gain may be higher for implantable systems11.

The National clinical guideline for stroke (ICSWP) 2012 of the Royal College of Physicians12 differentiates between Therapeutic Electrical Stimulation (TES) which long-term use aims to improve recovery of function vs Functional Electrical Stimulation for immediate functional improvement. It concludes that so far the findings of RCTs and papers about therapeutic electrical stimulation are contradictory regarding impairment and activity and that there are so far no cost-effectiveness studies in this area. It therefore recommends to use TES only in the context of clinical trials. However, FES can be used where arrangements for clinical governance, audit and consent are in place.

 Treatment options

Ankle-Foot Orthosis (AFO)

Conventional treatment options for drop foot are primarily physiotherapy and the use of an AFO. AFOs aim to support the foot and ankle, but as it is a passive device, it will not activate the users’ own muscles to enhance walking. Additionally, medical therapy (such as baclofen and botulinum toxin) or surgery for refractory cases (tendon transfer, arthrodesis) may sometimes be used3,13.

Surface FES

Surface electrodes are applied over the common peroneal nerve in the area of the head of the fibula and a battery-powered stimulator which is controlled by a foot switch or sensor provides timed stimulation of nerve/muscle from heel lift to heel strike, providing the necessary foot lift during the swing phase of the gait cycle.

Clinical studies evaluating the effectiveness of drop foot stimulation suggest that it provides many benefits to patients, such as an improved confidence in walking, increased walking speed and endurance, less effort during walking and reduced spasticity. Additional benefits are related to a potential reduction in the risk of falling 14-18.

The FES systems available nowadays have developed considerably since their introduction in 1961, but still some technical side effects are observed, such as the lack of selectivity of muscle recruitment to electrode placement, as well as pain, tissue irritation and possible skin damage associated with the passage of current through the skin17. Taylor et al. identified problems with locating the electrodes for effective stimulation as the most common non-physiological reason for discontinuing the use of the surface stimulator18. Electrode positioning becomes even more of an issue for patients with upper limb impairment.

Surface stimulators currently available are:

Pace by Odstock: A wired system containing a pocket sized control unit, self adhesive skin electrodes and a wired foot switch.

WalkAide by Trulife: A self-contained system which contains surface electrodes, control unit and an inertial gait sensor within one cuff to be worn immediately below the knee.

L300 by Bioness: A cuff based system worn below the knee. A control unit and foot switch are worn separately from the cuff and communicate wirelessly.

MyGait by Otto Bock Healthcare: the newest surface stimulator launched in 2013. A cuff-based unit with the stimulator worn in the cuff linked wirelessly to a foot switch and a patient remote control. The novelty of this stimulator is that it provides two channels of stimulation to combine two different muscle groups where indicated.

Implantable FES

A newer alternative to surface stimulators are implantable devices (the StimuStep from Finetech Medical and the ActiGait from Otto Bock), which overcome most of the problems encountered with surface stimulators and thus are more desirable for the following reasons:

  • Electrodes are surgically implanted, and hence no surface electrodes required
  • Optimal electrode position achieved and controlled during surgical implantation
  •  No need for technically challenging electrode placement by patient lengthening daily set-up [13]
  • No soft tissue or skin reactions
  • No discomfort / pain due to constant electrical sensation through the skin. Improved ease of use and cosmetic appearance.

New Developments

The main new development for surface stimulation is the launch of the MyGait, the first two channel wireless surface stimulator, in early 2013. Clinical follow-up studies will be carried out in time. First results from pre-launch field studies (based on 17 patients) showed that 12 out of 17 patients preferred MyGait over their previous or other fitting, 57% of patients felt MyGait to be an improvement over their previous system.19

Indications for MyGait are stroke, cranio- cerebral injury, multiple sclerosis, Incomplete spinal cord injury and infantile cerebral palsy.

Implanted stimulators are still a new development in themselves. Both StimuStep and ActiGait have been implanted in a number of European countries in recent years. ActiGait was launched in the UK in late 2011 in our clinic. Main indication for implanted devices is drop foot secondary to stroke. There are suggestions of benefit for other upper motor neuron conditions, but still with lack of scientific support and regulatory issues.

StimuStep

An implanted system with electrodes (2 channels) imbedded into the epineurium of the common peroneal nerve’s deep and superficial branches. The implant receiver under the skin receives power and control signals from the control unit, which is triggered by a footswitch. The control unit is worn on a belt below the knee and needs to be positioned on top of the below skin receiver unit . Communication between the external control unit and the footswitch is wired.

ActiGait

The system consists of a heel switch (3 in diagram above) which communicates wirelessly with a control unit (1), which is worn on a magnetic clip anywhere discreet as chosen by the patient. This unit allows the patient to adjust the intensity of the stimulation. An electromagnetic signal is painlessly sent through the skin at the upper thigh via a lightweight antenna (2) to the implant (4), which converts that signal into electric current for the 4 channel electrode cuff positioned around the Common Peroneal Nerve. The four channels can be programmed to allow for selective nerve bundle stimulation and balanced dorsiflexion / eversion.

ottobock-p27

Review ActiGait vs StimuStep

A clinical follow-up (a mixed population of 46 cases since 2006 of which 42 were reviewed for the study) of StimuStep  was presented by Taylor20,21. The StimuStep users were selected from existing surface FES users. Reasons for selection of the implant were skin irritation, patients’ difficulties with electrode placement or anticipated long term use. Indications were stroke (18 cases), MS (17 cases, 1 bilateral), traumatic head injury (3), incomplete spinal cord injury (2), brain tumour (1), Parkinson’s (1), transverse myelitis (2) and cerebral palsy (1). 4 patients were not followed up due to : 2 non-functioning implants, 1 explantation because of infection and 1 for poor response because of abnormal nerve anatomy. The main benefits to patients reported were improvements in walking speed (18%) and a three-minute walking distance (23%).

Complications were reported as 6 electrode failures, 9 cases of nerve dysfunction (likely due to epineural electrode positioning and direct pressure on the receiver). Electrical sensation only improved 1 point out of 10 in comparison to surface stimulation with two cases even more uncomfortable level of sensation than surface stimulation. Five cases of skin reaction were reported. The patient still needs to wear a cuff directly on the skin which has a large contact area and some contact pressure. Despite implanted device patients still experienced issues with electrode and control box position. 11 of the first 16 cases also had reliability problems with the stimulation channel to the superficial branch of the nerve.

ActiGait was the subject of a safety and performance study conducted in three centres in Denmark1, which established safety using nerve conduction velocity and performance improvements in walking speed (20%) and distance walked in four minutes (14%). Long-term improvements were detected in walking speed and distance when stimulated, and the orthotic effect of stimulation showed statistically significant improvement. Furthermore, qualitative responses highlighted improvement in confidence with less fear of falling, promoting the long-term potential to provide a positive effect on personal well-being, safety and performance1,8.  Similar patient benefits were reported in a more recent study22 showing a 24.5%  increase in walking speed, and 17% increase in walking distance in the six-minute walking test. In addition to walking speed and endurance, the kinematic and biomechanical changes were investigated in five subjects by Ernst et al23. The study demonstrated a restored ankle joint movement towards a more physiological pattern as seen in normal gait.

The ActiGait implant complication rate was followed up by the manufacturer’s internal quality control24. Since the introduction of the newest revision of the device in February 2011, 115 implantations were reviewed (mixed population, indication stroke). All reported complications had been operator-caused (surgical procedure / general surgical risk), none have been caused by the implant. The complications reported were 4 cases of infection and 4 cases of temporary nerve damage (3 of which are functional with ActiGait in situ at the time of writing). Surgical reasons were established as causes for those nerve damages. Since the last revision of the surgical procedure 60 implantations have been carried out with no nerve damages, no implant failures nor incidents with external components. For licensing reasons the main indication for ActiGait is stroke. However, first implantations have been carried out for alternative indications in our practice, such as head injury and multiple scleroris with very good individual outcomes in the improvement of quality of life. Further work will be undertaken in implantations for other indications.

It appears that by direct comparison the benefits of both implants are compatible. However, comparing the reported complications, ActiGait has despite higher case numbers a lower complications rate, none of which are caused by the device itself.

References

1.Burridge JH, Haugland M, Larsen B, Pickering RM, Svaneborg N, Iversen HK, et al. Phase II trial to evaluate the ActiGait implanted drop-foot stimulator in established hemiplegia. Journal of Rehabilitation Medicine, 2007;39(3):212-8.

2.Burridge J, Taylor P, Hagan S, Wood D, Swain I. The effect of common peroneal nerve stimulation on quadriceps spasticity in hemiplegia. Physiotherapy, 1997;83(2):82-9.

3.National Institute for Health and Clinical Excellence. Interventional procedures overview 278: Functional electrical stimulation for drop foot of central neurological origin. 2009.

4.National Institute for Health and Clinical Excellence. Clinical guideline 8: Multiple Sclerosis; National clinical guideline for diagnosis and management in primary and secondary care. 2004.

5.Wade D. Measurement in Neurological Rehabilitation. Oxford, UK: Oxford University Press; 1992.

6.Kottink AI, IJzerman MJ, Groothuis-Oudshoorn CG, Hermens HJ. Measuring Quality of Life in Stroke Subjects Receiving an Implanted Neural Prosthesis for Drop Foot. Artificial Organs, 2010;34(5):366-76.

7.Barrett C, Taylor P. The Effects of the Odstock Drop Foot Stimulator on Perceived Quality of Life for People With Stroke and Multiple Sclerosis. Neuromodulation: Technology At The Neural Interface. 2010;13(1):58-64.

8.Burridge JH, Haugland M, Larsen B, Pickering RM, Svaneborg N, Iversen HK, et al. Patients’ perceptions of the benefits and problems of using the ActiGait implanted drop foot stimulator. Journal of Rehabilitation Medicine. 2008;40:873-5.

9.Department of Health. National Stroke Strategy. 2007.

10.Department of Health. National Service Framework for long term conditions. 2005.

11.CEP10012: Centre for evidence-based Purchasing. Economic report: functional electrical stimulation for drop foot of central neurological origin. NHS Purchasing and Supply Agency. 2010. London.

12.Intercollegiate Stroke Working Party. National Clinical Guideline for Stroke, 4th edition London: Royal College of Physicians 2012. ISBN 9781860164927

13.CEP10010: Centre for evidence-based Purchasing. Buyer’s guide: functional electrical stimulation for drop foot of central neurological origin. NHS Purchasing and Supply Agency. 2010. London.

14.Mann GE, Jolley CL, Taylor PN. An Investigation into the effect of functional electrical stimulation on mobility and quality of life in patients with multiple sclerosis. Proceedings of the 10th Annual Conference of the International FES Society. July 2005, Canada.

15.Daly J, Roenigk K, Holcomb J, Rogers JM, Butler K, Gansen J, McCabe J, Fredrickson E, Marsolais E, Ruff R. A randomized controlled trial of functional neuromuscular stimulation in chronic stroke subjects. Stroke, 2006, 37(1):172-8.

16.van Swigchem R, Weerdesteyn V, van Duijnhoven HJ, den Boer J, Beems T, Geurts AC. Near-Normal Gait Pattern With Peroneal Electrical Stimulation as a Neuroprosthesis in the Chronic Phase of Stroke: A Case Report. Arch Phys Med Rehabil, 2011, 92:320-4.

17.Waters RL, McNeal D, Perry J. Experimental correction of foot drop by electrical stimulation of the peroneal nerve. Journal of Bone Joint Surgery Am, 1975, 57:1047-1054.

18.Taylor PN, Burridge JH, Dunkerley AL, Lamb A, Wood DE, Norton JA, Swain ID. Patients’ perceptions of the Odstock Dropped Foot Stimulator (ODFS). Clinical Rehabilitation, 1999, 13:439-446.

19.Otto Bock Healthcare, Internal Report: MyGait Field Test Results, April 2013.

20. Taylor P, Wilkinson IH, Humphreys L, Kwan Y, Slade-Sharman D, Khan M, Hobby J. Clinical Experience of the STIMuSTEP Implated Dropped Foot Stimulator. International IFESS Conference 2012, Banff, Alberta, Canada.

21.Taylor P, Wilkinson I, Samuel V et al. A comparison of external and implanted EFS for correction of dropped foot. An audit of the STIMuSTEP service in Salisbury. 4th Annual UKRI IFESS Conference 2013.

22.Rohde V, Wachter D, Ernst J, Liebetanz D. Perneal stimulation for foot drop management after chronic stroke: Experience in 25 Patients, 63. Jahrestagung der Deutschen Gesellschaft fuer Neurochirurgie, 2012, Leipzig.

23.Ernst J, Grundeya J, Hewitta M, von Lewinskia F, Kaus J, Schmalz T,  Rohde V, Liebetanz D. Towards physiological ankle movements with the ActiGait implantable drop foot stimulator in chronic stroke. Restorative Neurology and Neuroscience. In Press.

24.Statement about ActiGait Complication Rates by Dr. Andreas Hahn (Managing Director, nStim Services) 16 April 2013.

ACNR 2013;13:5:26-28

Posted on September 20, 2013 by - Industry News

Event details: Monday 23 September (18.30-20.00), Hall B

Please visit www.eisaiepilepsysymposia.eu to fill in a short questionnaire which covers your personal experience in epilepsy management and also some of the issues that will be discussed during the session, you can also post questions to the faculty. Post-event, this site will host footage of the symposium.

The Eisai-sponsored symposium at the XXI World Congress of Neurology in September, entitled ‘Under the Spotlight: Epilepsy management – are we on the right track?’, will take an innovative approach to highlight the key issues in epilepsy management today.

Hosted by television health correspondent, Sue Saville, and involving an interactive panel discussion of international epilepsy experts, the symposium will address current ‘hot topics’ in the treatment and management of epilepsy.

Professor Michel Baulac (Hôpital Pitié-Salpêtrière, Paris, France) will focus on the issues involved in the management of individuals with newly diagnosed epilepsy, such as the importance of correctly diagnosing the patient’s seizure type and getting the initial treatment correct in order to ensure long-term positive outcomes, highlighting important considerations when selecting and initiating the most appropriate antiepileptic drug (AED) for monotherapy.

Professor Elinor Ben-Menachem (Sahlgrenska University Hospital, Gothenburg, Sweden) will then cover key challenges involved in the decision-making process for patients who are refractory to monotherapy and require adjunctive treatment with other AEDs, including the crucial importance of individualising treatment for each patient’s particular needs.

Dr Manny Bagary (University Hospital Birmingham NHS Trust, UK) will further expand on the need for a patient-focussed approach to epilepsy management that looks beyond just controlling seizures and addresses the overall quality of life of the patient, including the identification and management of side effects and comorbidities, such as depression and anxiety.

Professor Eugen Trinka (Paracelsus Medical University, Salzburg, Austria) will then discuss the direction of epilepsy management in the future, including the need for AEDs with unique mechanisms of action and other important issues that are likely to impact the daily clinical practice of delegates.

Covering the spectrum of epilepsy management, the interactive session promises to be stimulating, though provoking and informative for delegates, providing practical advice which they can take home and apply to their current daily practices.

This symposium is sponsored by Eisai Europe Ltd

Date of preparation: August 2013
EpiGen-EU0048c

Alzheimer’s Research UK conference

Posted on August 25, 2013 by - Industry News

Conference details: Alzheimer’s Research UK conference, Belfast, N.Ireland
Report by: Alzheimer’s Research UK

March 2013 saw over 200 dementia researchers from across the UK (and beyond) gather in Belfast for the 14th annual Alzheimer’s Research UK conference. The conference is the UK’s largest annual meeting on dementia research, and each year is hosted by one of the 15 Alzheimer’s Research UK Network Centres of excellence across the country. This year marked the first completion of the cycle, with the conference hosted by the Northern Ireland Network, organised by Professor Christian Hölscher, from the University of Ulster in Coleraine.

The two-day event consisted of 4 sessions of short talks, a keynote lecture from Professor Mathias Jucker (from the University of Tübingen, Germany), a panel discussion on immunotherapy to treat Alzheimer’s disease, a poster session, and a moving and motivating address from the actor and Chancellor of the University of Ulster, James Nesbitt. In his speech Nesbitt called for more dementia research funding, “or else face a dementia catastrophe” and urged the government to commit to long term funding for research into dementia.

The short talks given at the conference covered a wide range of topics, from insulin signalling in Alzheimer’s disease to neuroimaging studies demonstrating the effect of genetic risks for Alzheimer’s on brain structure as well as studies on amyloid-beta oligomer formation, and the effects of amyloid-beta on synapse loss. Dr Oleg Anichtchik from the University of Cambridge presented a new mouse model for Dementia with Lewy bodies. The mice express a truncated form of human α-synuclein at levels lower than endogenous α-synuclein, and present abnormal aggregation of α-synuclein and memory deficits at 3 months of age. Professor Anne Stephenson, from University College London, demonstrated a potential function for the Alzheimer’s amyloid precursor protein. She showed data supporting a role for amyloid precursor protein in trafficking, showing it can control the sub-cellular location and the surface expression of neurotransmitter receptors with a role in learning and memory. A particular highlight was data presented by Professor Kevin Morgan, demonstrating the reliability of a panel of plasma and CSF biomarkers for predicting AD diagnosis, for which they have developed a high throughput surface plasmon resonance detection system.

The keynote lecture “Prion-like aspects of cerebral amyloidosis” was given by Professor Mathias Jucker, from the University of Tübingen, Germany. Professor Jucker discussed the evidence that exogenous injection of the amyloid-beta-containing brain extracts can induce amyloid pathology in a previously unaffected brain, akin to the infection spread of prion disease.

The first day concluded with an expert panel discussion on immunotherapy as a treatment for Alzheimer’s disease. Dr Eric Karran, the Director of Research at Alzheimer’s Research UK, succinctly summarized several years of research and what have been several disappointing clinical trials for both bapineuzumab and solanezumab. The panel, Professor Clive Holmes, Professor James Nicoll, Professor Hugh Perry (all from The University of Southampton) and Professor Mathias Jucker, chaired by Dr Pat Kehoe (The University of Bristol), then took questions and suggestions from the delegates. The resulting discussion addressed important issues such as why these drugs may have failed and identified potential hurdles that need to be overcome in order to develop a successful therapy. This was a very interesting session for all involved, and provided a forum in which, regardless of job title, everyone could discuss and contribute to the advance of a promising area of research. This was followed by a banquet dinner including live traditional Irish entertainment from the folk bands Sons Of Caliber and Emerald Armada.

The conference concluded with the awarding of the poster prize, which went to Claire McDonald from Trinity College Dublin, and the Jean Corsan Prize and talk. The Jean Corsan Prize is awarded to the best published paper by a PhD student, and this year went to Dr Daniel Davis from the University of Cambridge. His work showed that delirium (confusion and disruption in thinking) is a strong risk factor for dementia and cognitive decline, which was not associated with “traditional” markers for dementia such as Braak stage, amyloid or α-synuclein.

Following the main conference a PhD day was held at the University of Ulster. The event, exclusive to PhD students, allowed them to present their projects, and also included career advice in a session entitled “Life after the PhD”.

Life After Brain Injury – UKABIF demands action

Posted on December 11, 2012 by - Industry News

An acquired brain injury (ABI) is defined as a non-degenerative injury to the brain which has occurred after birth and includes traumatic brain injuries (TBIs), i.e. those caused by road traffic accidents, falls and assaults, and non-TBIs i.e. those caused by strokes and other vascular accidents, tumours and also infectious diseases.  Approximately one million people live with the effects of an ABI in the United Kingdom (UK) and require specialist rehabilitation services and support both in hospital and the community.

There is very little accurate and reliable data on the provision of healthcare services for people with ABI in the UK.  The National Institute for Clinical Excellence (NICE) estimates that the acute hospital care costs for TBI are £1 billion annually (this does not include all types of ABI) and Gustavsson et al (2011) stated that the overall cost of TBI in the UK (and again an underestimate for ABI) was approximately £4.1 billion.

In 2001, The Health Select Committee published their Third Report into Head Injury (Health Committee 2000-1) with a list of 28 conclusions and recommendations; most have not been acted upon.  Although the National Service Framework for Long Term Neurological Conditions has been in place since 2005, very little progress has been made and rehabilitation services continue to vary hugely around the UK.

In July this year, the UK Acquired Brain Injury Forum (UKABIF) a membership organisation and charity that aims to promote better understanding of all aspects of ABI, launches a Campaign ‘Life after Brain Injury? Improve Services Now’ to improve rehabilitation services and support for people with ABI.  UKABIF’s Manifesto ‘Life after Brain Injury – A Way Forward’ outlines the necessity of acute and early access to rehabilitation for adults with ABI to ensure optimal recovery, focusing on the need for specialist neurorehabilitation teams to manage care pathways and the cost implications of not providing adequate rehabilitation.  Published studies clearly show that by providing rehabilitation, the savings made offset the costs, even when rehabilitation is not carried out immediately after injury.  Over a lifetime, optimal recovery results in significant savings to health care costs.

Acute and early access to rehabilitation services

Rehabilitation after an ABI should start acutely to prevent complications, with the patient’s care pathway clearly defined, and referral to a local specialist neurorehabilitation service at the earliest opportunity; this is crucial and often overlooked.  Patients who have an early referral programme in the acute stages of recovery have significantly better social integration, emotional well-being and vocational functioning (Reid-Arndt et al 2007).  Turner-Stokes (2008) demonstrated the effectiveness of early intensive rehabilitation with specialist programmes for those with complex needs, and specialist vocational programmes for those with potential to return to work.  Residential, social and behavioural rehabilitation programmes can all decrease the number of care hours needed, which also increases the brain injured person’s capacity for independent social activity (Wood et al 1999).  In a study up to two years post-injury, patients showed a 54% reduction in the care hours required compared to pre-admission; patients between two and five years post-injury showed a 33% reduction, and patients over five years post-injury showed a 21% reduction (Wood et al 1999).

Managing the Rehabilitation Programme

If someone has been assessed as needing rehabilitation they should be referred to a ‘post-acute’ rehabilitation centre.  However, in many parts of the UK there is no suitable rehabilitation facility and people with brain injuries may have to go home too early or go to inappropriate places, such as nursing homes, where insufficient rehabilitation is provided.  The independent sector provides much of the high quality brain injury rehabilitation available in the UK and a number of organisations offer specialist facilities and provide services to meet the needs of a range of people with ABI including the most difficult cases.

Following a specialist rehabilitation programme, ABI patients show a significant reduction in dependency at discharge, as measured by the Functional Independence Measure (Turner-Stokes et al 2006).  More intensive rehabilitation is associated with rapid functional gains once the patient is able to engage (Turner-Stokes et al 2011).

A multidisciplinary team (MDT) is required with an expertise in neurorehabilitation, comprising a core medical team and additional professionals depending on the nature of the brain injury; integrated services and an MDT rehabilitation programme promote brain recovery and enable people to recover more quickly and efficiently (Turner-Stokes et al 2011).  The team should be led by Allied Health Professional specialists e.g. a physiotherapist with access to a Consultant in Neuro­rehabilitation over a timescale that is determined by the patients’ progress and gains.

What is the Way Forward?

UKABIF is asking for the following:

  • Appropriate commissioning for specialist brain injury rehabilitation should be made compulsory and each clinical commissioning group should have a named neurological lead.
  • Funded National Neuro Networks should be established to ensure neurological pathways are available throughout the stages of recovery (patient journey).
  • A National Audit of Rehabilitation should be carried out and the collection and reporting of accurate data on newly ABIs made compulsory by all providers along the patient journey, from Acute to Community services*
  • A review is required of The Health Select Committee Report and the National Service Framework (NSF) for Long Term Neurological Conditions.
  • As implemented with Stroke though Healthcare Emergency Planning and the Care Quality Commission

We need your help

To support our Campaign, please ensure that your team has a named neurological lead and if not, request one and review the information and support available for people with an ABI in your area.  The full document is available to view on our website http://www.ukabif.org.uk. For further information on how to support this campaign, please contact:

Chloe Hayward, UKABIF,  T: 0845 6080788, E: info@ukabif.org.uk  http://www.ukabif.org.uk