Brain Injury Professionals

The role of a brain injury case manager is to work with people who have suffered from a serious head injury and support them through their rehabilitation and integration back into the community.

Very often, case managers work privately for individuals who have a personal injury claim, funded by interim payments from the claim. Sometimes however the job title “case manager” is used within the NHS, especially in community support teams.

Case managers come from a wide variety of backgrounds including nursing, physiotherapy, psychology, occupational therapy and vocational (employment or study-based) rehabilitation.

Brain injury case managers assess and work closely with the individual and their families, and liaise with other agencies and brain injury therapists to plan and put into place support after a brain injury.

The case manager’s assessment identifies the clinical, psychological and social needs of the injured person. The case manager usually writes a report setting out recommendations for care and rehabilitation. Case managers aim to integrate different services from the National Health Service, social services and the private sector to manage the rehabilitation programme.  If the individual is involved with a brain injury claim for compensation, they also have support from the case manager during the claim process.

A case manager will usually be a member of an organisation such as the British Association of Brain Injury Case Managers http://www.babicm.org/ or Case Management Services UK http://www.cmsuk.org/

A registered dietician is qualified to provide information about food and practical dietary advice for people on normal or therapeutic diets.

As well as providing advice about nutrition and promoting a healthy diet, dieticians offer advice on food-related problems and are involved in the diagnosis and dietary treatment of disease.

Advice from a dietician can enable people who have suffered from a serious head injury to make informed and practical choices about food and lifestyle. A dietician will have trained in both hospital and community settings as part of their learning.

Many dieticians work in the National Health Service where their roles are varied. They may focus on specialist areas, such as for people who are fed by a tube, and will work as part of a multidisciplinary team in hospitals or in a community setting to gain patients' co-operation in following recommended dietary treatments.

Whilst most dieticians are employed in the NHS, some also work in education, research and on a freelance basis.

Nutrition is the study of nutrients in food; a nutritionist can establish how nutrients are used by the body, and the relationship between diet, health and disease.

Dieticians are registered with the British Dietetic Association. Visit http://www.bda.uk.com/

District nurses are senior nurses who manage healthcare within the community, leading teams of community nurses and support workers. They visit people in their own homes or in residential care homes, providing care for patients and supporting family members.

As well as providing direct patient care, district nurses also have a teaching role, working with patients to enable them to care for themselves or with family members teaching them how to give care to their relatives.

Typically much of their work involves visiting patients who may have difficulty getting to the doctors; they can help with wound management, catheter and continence care and medication support. Their work involves both follow-up care for recently discharged hospital inpatients and longer term care for chronically ill patients.

District nurses work alongside general practitioners in preventing unnecessary or avoidable hospital admissions.  Your General Practitioner can arrange a district nurse for you.

The British District Nursing Association website address is: www.cdna-online.org.uk

If you need help accessing an NHS service visit: www.nhs.uk/servicedirectories

Neuropsychologists are not normally medical doctors, but psychologists whose field of study is concentrated on the brain and its functions. They can play a vital role in any specialist treatment programme following a serious head injury, and helping in the diagnosis of other psychological conditions.

Their role involves “testing” a person’s brain function to see how if at all they have been affected by a head injury. These tests involve tasks such as following instructions, drawing, remembering and giving responses to questions.

Neuropsychological testing is completed following a brain injury to assess any damage caused for example to short and long term memory,  reasoning, attention, concentration, planning/ co-ordination skills and other psychological factors.

A neuropsychologist often works in a community team or as part of a rehabilitation programme. After assessing the extent of any cognitive problems after brain injury, they can help advise on support needs or provide continuing one-to-one help.

There is no single register of neuropsychologists in the UK. However to find out more, visit the British Psychological Society at http://www.bps.org.uk/ which many neuropsychologists subscribe to.

A neurologist is a medical doctor who has trained in the diagnosis and treatment of nervous system disorders, including diseases of the brain, spinal cord, nerves, and muscles.

In contrast to a “neurosurgeon”, a neurologist does not generally engage in surgical (operative) procedures as part of their treatment of a head injured patient.

Neurologists perform neurological examinations of the nerves of the head and neck; muscle strength and movement; balance, walking, reflexes; and sensation, memory, speech, language, and other cognitive abilities. They can advise on community treatment programmes, make referrals for specialist therapy and prescribe medication.

Certain neurologists are specially trained in the management and treatment of post traumatic epilepsy, which can occur after a serious head injury. In some areas of the UK there are dedicated epilepsy clinics which, alongside neurologists with expertise in epilepsy, can offer information, counselling and epilepsy specialist nurses.

Neurosurgery deals with the diagnosis and treatment of clinical processes which affect the nervous system. It includes the operative care, intensive care management and rehabilitation of patients with brain injury, spinal injury and other disorders affecting the nervous system.

Most consultant neurosurgeons spend four to five sessions in the operating theatre per week, with the remainder of the time spent on pre- and post-operative ward care of the patients, outpatient clinics, teaching and other administrative duties.

To find out more follow this link: http://www.rcseng.ac.uk/media/media-background-briefings-and-statistics/the-surgical-specialties-7-2013-neurosurgery

For further information can be found at www.sbns.org.uk

Neurosurgeons in England and Wales are members of the Royal College of Surgeons, an independent professional body and registered charity committed to promoting and advancing the highest standards of surgical care for patients – visit http://www.rcseng.ac.uk/

Nurses work in a large variety of specialities where they assess, plan, implement and evaluate care. A qualified nurse is registered with the Nursing and Midwifery Council (NMC). The NMC is an organisation set up by the UK Parliament to protect the public by ensuring that nurses and midwives provide high standards of care to their patients and clients.

To find out more visit http://www.nmc-uk.org/

Nurse practitioners

Nurse practitioners are registered nurses who possess additional high level skills, advanced education, and training enabling them to provide integrated quality healthcare. Trauma nurse practitioners possess a strong background in critical care and emergency medicine.

Neuro-trauma nurses

Neuro-trauma nurses are also registered nurses who possess specific knowledge and experience to care of the head/brain injured patient.  They can be ward based or work as part of a community team.

The British Association of Neuro-trauma Nursing website is : http://www.bann.org.uk/

See also – District Nurse

Occupational Therapy helps individuals who have suffered from a head injury leading to physical, cognitive or social difficulties. Occupational therapists (often shortened to “OT’s”) promote independence in all aspects of daily living to limit the effects of disability.

Following a head injury, the occupational therapist will assess the following areas:

Physical/Sensory changes – the ability to co-ordinate movement, fatigue and the ability to feel things.

Perceptive skills – how we interpret things we see and feel.

Cognitive skills – concentration, memory, planning and organising skills

Psychological skills – changes in behaviour/personality, irritability, anxiety, depression.

The occupational therapist will then agree a plan of action aiming to achieve an individuals overall goal and will use activities that are relevant to that person.

Occupational Therapists work in partnership with individuals and their families after injury to help them regain the skills necessary to carry out roles and activities that are important to them. This can help them to maximise their quality of life.

Further information can be obtained from the College of Occupational Therapists http://www.cot.co.uk/.

All Occupational Therapists must be registered with the Health Professions Council.  This is the UK wide regulatory body responsible for setting and maintaining standards of professionals training, skills, behaviour and health. Further information can be found at http://www.hpc-uk.org/.

Ophthalmology is the medical and surgical management of conditions of the eye.  The specialty covers all age ranges. The range of conditions encountered in ophthalmology is wide - trauma, cataracts, diabetic eye disease, congenital and genetic eye problems.

Visual problems can often occur after a serious head injury. Sometimes surgical treatment is recommended which will general involve a referral to an ophthalmic surgeon.

The Royal College of Ophthalmologists is based in London. To find out more visit http://www.rcophth.ac.uk/

Physiotherapy helps individuals regain movement and function to the body following an injury or illness.

After a head injury, the physiotherapist aims to help an individual regain use in their muscles and joints to enable them to sit and stand without losing balance. Depending upon the persons injuries, they also help individuals to co-ordinate their movements, to learn to walk again and use fine hand movements.

The physiotherapist will use a variety of techniques to facilitate movement, balance and co-ordination. Treatment is aimed at allowing an individual to reach their full potential.

A neuro-physiotherapist is specifically trained and skilled in treating the effects of a brain or spinal injury or the effects of a nervous disease.

Further information can be obtained from http://www.csp.org.uk/

All physiotherapists must be registered with the Heath Professions Council. This is the UK wide regulatory body responsible for setting and maintaining standards of professionals training, skills, behaviour and health. Further information can be found at http://www.hpc-uk.org/.

Play specialists have an important role in helping children who have suffered a serious child brain injury to rehabilitate after their injury.

Play has a special function in the hospital environment, and hospital play specialists lead playful activities and use play as therapeutic tool.

Play specialists work closely as part of the multi-disciplinary team, and:

• organise play and activities in the playroom or at the  bedside
• provide play to achieve developmental goals 
• help children master and cope with anxieties and feelings 
• use play to prepare children for hospital procedures 
• support families and siblings 
• contribute to clinical judgments through their observations 
• teach the value of play for the head injured child
• encourage friendships to develop
• organise parties and special events

A brain injury social worker works with people who are in need of support after a head injury. Their role is to provide information and assistance to increase someone’s independence, acting as a guide and an advocate for that person.

Social workers work in a variety of settings, supporting individuals, families and groups within the community. Those settings may include a persons own home, schools, hospitals and other public sector and voluntary organisations. They also work closely with other health and social care staff.

Brain injury social workers have an understanding of the complexities of head and brain injury. They can also help with state benefits, housing problems, social care assessments and to access services for drugs and alcohol advice. Their tasks typically involve undertaking assessments (often with medical staff), and organising and managing packages of support to enable “service users” to lead the fullest lives possible.

They will be always be qualified social workers and often may be a member of the Brain Injury Social Work Group http://www.biswg.co.uk/

A support worker is someone who looks after and supports a person who could not fully manage for themselves without their help. Usually this would be someone who is trained and paid to carry out support as their job (rather than a friend or family member who cares for that person).

Support workers do not always just provide care: sometimes they are involved in prompting or assisting the person who has suffered a brain injury to organise things for themselves – often the name “enabler” is used for that type of role.

The role of a support worker is varied but essentially they provide the care needed to help a person achieve maximum independence.

Depending upon their injuries, a person who has had a brain injury may require assistance with personal hygiene, dressing, getting in/out of bed, assistance with mobility, preparing and or/heating meals, domestic cleaning, laundry and shopping, or assistance with paying bills.  A support worker can also help a person get involved in recreational activities or assist someone with training or in the workplace.

Whether a support worker is employed via the NHS, social services or privately it is essential that appropriate specialist head injury training is received when dealing with the effects of a head injury.

Speech and language therapists work with individuals after head injury to help them communicate more effectively using spoken or written words.  They will also offer support and guidance to individuals and their families to understand the nature of communication difficulties experienced due to the head injury. The name is often shortened to “SALT’s”

Speech therapy can often contribute directly to helping with memory tasks and word finding problems, and just not just focus on the physical aspects of speech.

Therapists will use exercises and activities to help improve speech and language skills and can introduce the use of communication aids as appropriate. In very severe brain injury they also assist with swallowing difficulties.

Further information can be obtained from www.speechtherapy.co.uk

All Speech and Language Therapists must be registered with the Health Professions Council. This is the UK wide regulatory body responsible for setting and maintaining standards of professionals training, skills, behaviour and health. Further information can be found at http://www.hpc-uk.org/

If you need help accessing an NHS service please visit:

www.nhs.uk/servicedirectories.