What do we know about local provision?

Prevalence of traumatic brain injury in the Tees Valley

In 2018/19 almost 2000 children and young people who attended A&E with a head injury had sustained a traumatic brain injury.

1,418 were children under the age if 16 and the majority had no loss of consciousness and were discharged
580 were aged 16-25 and the majority had no loss of consciousness and were discharged
Less than 10% were admitted to a ward

The local NHS patient pathway for severe paediatric brain injury is as follows:

Severe traumatic brain injury – patients are admitted to either James Cook University Hospital or The Great North Children’s Hospital (formerly known as the RVI Newcastle)
Non-traumatic brain injury – the majority go to the Great North Children’s Hospital but also to James Cook University Hospital as well as district hospitals
After initial stabilisation and acute care, children receive limited daily in-patient neuro-rehabilitation
The in-house multidisciplinary team – comprises physiotherapist, occupational therapist, speech and language therapist, neuropsychologist, play therapist, ward teacher, paediatric neurologist

Treatment
There is short-term goal setting and assessment to facilitate discharge
In-house neuro-rehabilitation only focuses on mobility, improving speech/communication, swallowing, activities of daily living and self care
Cognitive Rehabilitation Therapy is not provided
Once a child is considered medically stable, they are discharged to home.
Very few are admitted to a specialist unit

Discharge to home:

Access to limited community rehabilitation. e.g. Short blocks of physiotherapy, occupational therapy, speech and language therapy, & intermittent neuropsychology support
Engagement with Educational psychologist and Special Educational Needs Coordinator who are often lack understanding of acquired brain injury as a complex hidden disability
Commonly neither are trained in neuro-rehabilitation techniques.

Problems with community provision across a range of sectors and professions:

A lack of understanding and an unfamiliarity with the complexity and challenges of acquired brain injury that leads to incorrect assumptions
No emphasis on ongoing recovery
No cognitive rehabilitation therapy for children
Infrequent and short-term approaches – are not enough to make a difference or deliver any lasting improvements
Disjointed and uncoordinated ad-hoc approaches
Services and professionals all have different aims and priorities – so no common goal setting
Unrealistic expectations and poor outcomes for children and young people

Impact

Traumatic brain injury alone costs the state £15 bn a year!

What do children and young people need for better outcomes?

Well coordinated, integrated community neuro-rehabilitation support – managed by a knowledgeable Case Manager/ Care Coordinator, taking on both the child and family’s specific needs
Increased access to community based support which is intensive, individualised and supplements and compliments existing services
Non-clinical cognitive rehabilitation therapy (CRT) (not currently provided)
Individualised and rehabilitative education support which starts at home and then integrates into school – currently not provided
Detailed assessments to determine their changed and emerging needs post brain injury with ongoing cognitive development support
Peer mentoring, education, advocacy and practical support for families aimed at reducing parental burden and improving individual health and wellbeing

This is not provided by public services and why MATRIX Neurological was formed!

Being integral to local public, private and third sector networks is essential to maximise the benefits of local resources to get the best possible outcomes for children, young people and their families; especially in times of austerity.

We use ‘the lived experience’ to deliver services that fill the gaps, deliver better outcomes, drive improvements, build partnerships, pool resources and save money.

Our innovative work delivers significant benefits to society and savings to the public purse.