Trauma Care

exciting times ahead with the leadership of Prof Menon locally and a stellar list internationally: more details here https://www.center-tbi.eu/project/participants

after the coverage on Radio4 this morning of the tragic death of benjamin robinson, I am reminded to post a link to this excellent movie that should be seen by all sports coaches where there's a risk of concussion

ok, so things are a bit more complex than enforcing use of helmets. I'm with one of the commentators  on this editorial - helmet wearing doesn't put me off cycling and I will continue to wear a helmet, as it may just prevent a minor injury. 

an update from Salford

Over the years I have noticed how brain injury is represented in the press and the language in this case of mental impairment is especially curious. However the other slant on this is the fact that a person was murdered by a survivor of traumatic brain injury.

The article reminded me that I once wrote a letter that was published in the Psychologist https://thepsychologist.bps.org.uk/volume-23/edition-7/forum  July 2010 Vol.23 (pp.538-543) at the time of another awful murder incident

Derrick Bird, the handbrake and service provision

In amongst all the speculation about how Derrick Bird arrived at the point of his catastrophic behaviour, consequences of brain injury that can result in ‘episodic dyscontrol’ – or simply loss of that ‘handbrake’ function of the frontal lobe– seems to have been, so far, an untold story.

I note that Derrick Bird is reported to have lost consciousness following an assault in 2007. According to quotes in the Sunday Times, he was punched, hit his head on the pavement, and was found disoriented by a colleague taxi driver, and that he was ‘never the same again’. It is obviously only wild speculation: we’ll probably never know if the assault caused brain injury. However, if there is a ‘brain injury’ part to this story, the case does raise an important issue about service provision.

There is much relevant research, not least to note that the alarmingly high prevalence of brain injury among people in custody. For example, Schofield et al. (2006) reported that 82 per cent recently received into custody in Australia had a traumatic brain injury in the past. UK data on the same subject is shortly to be published by Huw Williams, who has estimated that 65 per cent of prison population may have had a traumatic brain injury and that they are at elevated risk of reoffending, and that violent offences are the most common.

The Sunday Times reported: ‘An NHS Cumbria spokeswoman said there was no record of Bird attending the hospital or his GP in the last six months.’ That he was reported to be not known to NHS services is no surprise: there are few services that, three years after brain injury, offer psychological interventions and support that individuals need when experiencing classic chronic brain injury symptoms of increasing anger and frustration that we think emerge from an increasing sense of threat to identity. That mental health services did not see him would be consistent with a common narrative that the types of problems he had would not merit treatment by mental health services. This is despite the fact that there are treatment options available that can explore the way through this ‘threatened self’, including work toward a compassionate, shared understanding of ‘who I am now’. We have recently described an approach to providing a service with this kind of objective (Wilson 
et al., 2009).

I am certainly not suggesting our brain-injured patients are all at risk of becoming mass murderers. I also am certainly not trying to pretend that a clinic like ours might have helped in this case (although there are specialist units that might). The Oliver Zangwill Centre provides a service for people from around the UK, often years after their brain injury. However, in common with many teams in this field we continue to experience ongoing difficulties of securing NHS funding to enable us to admit patients to brain injury rehabilitation programmes geared to providing coping skills and psychological therapy in this period late after brain injury. This patient group with these types of needs – and the risks of not intervening – continue to be overlooked from a commissioning and public health point of view. 
Andrew Bateman 
Oliver Zangwill Centre for Neuropsychological Rehabilitation 
Ely 
Cambridgeshire 
  
References 
Schofield, P.W., Butler, T.G., Hollis, S.J. et al. (2006). Neuropsychiatric correlates of traumatic brain injury (TBI) among Australian prison entrants. Brain Injury, 20(13–14) 1409–1418. 
Wilson, B.A., Gracey, F.G., Evans, J.J. & Bateman, A. (2009). Neuropsychological rehabilitation: Theory, models, therapy and outcome. Cambridge: Cambridge University Press.

I was pleased to have had chance to attend the launch event,

I have a summary of my tweets from the day at

  http://sfy.co/pMAA ;

some useful resources here

persisting regional variation