Dr Andrew Bateman, Chair of the United Kingdom Acquired Brain Injury Forum (UKABIF), welcomed delegates to the organisation’s 10th Annual and 20th Anniversary Conference, held this month at the Royal Society of Medicine in London. The conference programme reflected the issues outlined in the recently published report by the All-Party Parliamentary Group (APPG) on Acquired Brain injury (ABI) entitled ‘Acquired Brain Injury and Neurorehabilitation: Time for Change’.

The development and future of specialised neurorehabilitation was discussed by Colonel Alan Mistlin, Chair of the Clinical Reference Group for Rehabilitation and Disability. Neurorehabilitation is crucial in order to maximise recovery after ABI. It is one of the most cost-effective interventions available to the National Health Service and reduces acute hospital stay, provides functional independence and facilitates a return to work. However, there are large variations in provision and access to services and a lack of neurorehabilitation personnel. “The current services are probably not what we would set up now, but there’s lots of work in progress” concluded Alan.

The updated Rehabilitation Prescription (RP) was discussed by Hannah Farrell, University Hospitals Birmingham NHS Foundation Trust. The RP documents comprehensively the rehabilitation needs of the individual with ABI and identifies how those needs should be addressed longer term. The RP should be given to the patient on discharge and a copy sent to their General Practitioner to facilitate ongoing rehabilitation. Hannah said “The RP is not just a tick box exercise to generate money. It should be used for every patient with rehabilitation needs and a copy sent to their GP; this is a major challenge going forwards”.

Chris Bryant MP and Chair of the APPG on ABI focused on the ongoing lobbying campaign surrounding the issues and recommendations set out in its report. “I’m dedicated to this cause because ABI is a hidden epidemic. I’ve campaigned so hard because it impacts on so many government departments”. Chris summarised the report which outlines the critical role of neurorehabilitation in the ABI care pathway, and the need for RPs for all brain injury survivors following discharge from acute care so they know what neurorehabilitation they need. The report reviews the implications for children and young people with ABI when most of their neurorehabilitation takes place in the education system. The high incidence of ABI amongst offenders is discussed, as is the impact of neurorehabilitation on behavioural change and reoffending. The current issues in sport-related concussion are outlined as well as the need for an improved welfare system that is easily accessible. The report summarises the key issues and makes a number of crucial recommendations. Chris said that the APPG is determined to unite government departments and drive change for brain injury survivors.

Brain injury can make offending behaviour more likely. Being an ‘offending type’ can make having a brain injury more likely, and a brain injury can make people far more prone to the effects of alcohol which also increases their probability to offend. The prevalence of ABI in the offender population is significantly higher than in the general population. There is clear evidence of the different causality of brain injury between men and women in prison, with the females being at greater risk of repeated brain injury from domestic abuse. Dr Ivan Pitman, Brain Injury Rehabilitation Trust (BIRT) discussed the findings from BIRT’s Brain Injury Linkworker service in a women’s prison which is based on a stepped care model and focuses on identifying brain injury and implementing interventions to support the offender.

With regard to children and young people with an ABI, Professor Nathan Hughes, University of Sheffield said “Recognising brain injury is key to being able to provide the right support in schools, to prevent disengagement, exclusion and possible offending behaviour”. Nathan discussed the issues surrounding the recognition and response to ABI and the discriminatory criminal justice processes. He emphasised the need to change systems and processes to ensure these young people obtain the appropriate and timely support, and ultimately prevent their propensity to go on to offend.

“The cornerstone of disability law is that the employer has a duty to make reasonable adjustments for the employee” said Emma Satyamurti, Leigh Day looking at the challenges of returning to work following a brain injury. Emma reviewed examples of ‘reasonable adjustment’ including a change of tasks, location, working hours and different approaches to managing absence and performance behaviour.

Dawn Astle concluded the formal conference programme by telling the story of her father, Jeff Astle, the footballer nicknamed ‘the King’ by fans, who won five caps for England. Jeff was the first British professional footballer to die from chronic traumatic encephalopathy (CTE), aged just 59 years. The impact of sport-related concussion on late dementia, CTE and other chronic neurological conditions is uncertain and further research is needed. The Jeff Astle Foundation was established in 2015 to raise awareness of brain injury and to provide support to those affected.

Various awards were announced at the conference. The winners of the UKABIF Film Award 2018 were Kathryn Cann for the County Durham and Darlington NHS Foundation Trust, Lauren Nicholas for the Royal Hospital for Neuro-disability, Anne Johnston and Jeremiah Humphreys-Piercy. The UKABIF Stephen McAleese Award for Inspiration went to Verity Fisher at the National Star College in Cheltenham.

UKABIF thanked conference sponsors Cygnet Health Care, Elysium, Irwin Mitchell solicitors, Leigh Day and Sintons Law, the many companies that exhibited and the excellent poster presentations.