favour of Traumatic Brain Injury TBI and Degenerative Diseases Traumatic Brain Injury TBI TBI can occur as a consequence of a focal impact upon the head by a sudden acceleration or deceleration within the cranium or by a complex combination of both movement and sudden impact ID: 259232
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Slide1
Arguments in
favour
of Traumatic Brain Injury (TBI)
and Degenerative Diseases. Slide2
Traumatic Brain Injury (TBI)
TBI can occur as a consequence of a focal impact upon the head, by a sudden acceleration or deceleration within the cranium, or by a complex combination of both movement and sudden impact.
In addition to this primary injury, secondary injuries may occur minutes, even days following the injury.
TBI can be
categorised
as mild, moderate or severe by the Glasgow Coma Scale. Slide3
Prevalence
1 million- minimum estimate of people in the UK living with long-term effects of TBI
558- UK residents per 100,000 sustaining a brain injury (1/200)
Every 90 seconds- someone is admitted to hospital in the UK with TBI
353,059- UK admissions to hospital with acquired brain injury between 2011-2012Slide4
Risk Factors
TBI is a condition that any of you could experience, at any time, without any predisposition.
On top of this, the highest incidence of TBI is 15-24.
Males are twice as likely to have TBI, however, when matched for severity the prognosis of females is worse.
Although categories of mild, moderate and severe are derived from the Glasgow Coma scale, alone, these cannot predict the long term effect of TBI.
Instances of TBI is greater in lower socioeconomic groups.
Thinking more globally, the prevalence of TBI in developing countries is increasing significantly. This is due to the rate of automobile use increasing much faster than safe infrastructure on which to drive. Slide5
Symptoms
Aside from the communication and social aspects we have touched on, such as impaired executive functioning, there are many more consequences.
Physical impairments, such as loss of co-ordination.
Sensory impairments, such as loss of smell, taste or sight.
Mood and personality changes which may lead to a loss of self for both the individual and their friends and family. Slide6
Degenerative Diseases
Degenerative diseases are a result of a continuous process based on the degeneration of cells, affected tissues or organs deteriorate over time.
Strongly linked with age. Currently 16% of the European population is 65+ and expected to each 25% by 2030.
Therefore, the prevalence of degenerative disorders will increase.
Degenerative diseases may be genetic, or a result of medical conditions such as alcoholism, a tumor or stroke. Others may be a result of viruses and often the cause is unknown. Slide7
Commonly cited diseases and prevalence
Alzheimer's- 850,000 people living with dementia in the UK alone. Expected to rise to £2 million by 2051. One person diagnosed every 3 minutes. That is 325 so far today….. Majority of cases not inherited, but family history of the condition is a risk factor.
Parkinson's- 127,000 people in the UK. A suspected genetic element.
Huntington's- 10,000 people in the UK. Inherited faulty gene. Slide8
Quality of Life
Some examples:
TBI, Parkinson’s Disease and DementiaSlide9
TBI (1)
Work implications (returning to normal life)
Tested a number of areas including
speaking under time pressure
Production of oral language
Verbal reasoning
Result – 85% of time successfully predicted whether someone was in employment.
Isaki
, E. and
Turkstra
, L. (2000) Communication abilities and work re-entry following TBI.
Brain Injury 14 (5) 441-453.
Slide10
TBI (2)
Living with cognitive communicative difficulty following TBI
Concluded that
communication difficulties plus memory problems, fatigue and irritability = “unsatisfactory interpersonal relationships”.
O’flaherty
, C. and Douglas, J. (1997) Living with cognitive-communicative difficulties following traumatic brain injury: using a model of interpersonal communication to characterize the subjective experience.
Aphasiology
11 (9) 889-911.
Slide11
TBI (3)
Carer impact…
Study assessed impact of 5 different disabilities arising from head injury (1 of which was speech and language)
Looked at 2 measures:
caregivers’ ‘perceived stress’
‘strain’
Results for – Speech and language link for both stress and strain (statistically significant for ‘strain’)
Connolly, D. and O’Dowd, T. (2001
)
The impact of the different disabilities arising from head injury on the primary caregiver.
British Journal of Occupational Therapy.
64 (1) 41-46.Slide12
Parkinson’s Disease
NICE guidance – CG35
SLT “should be available”
In particular LSVT (or similar)
Speech intelligibility
Effective communication (e.g. AAC)
SwallowingSlide13
Dementia
RCSLT position paper on dementia
Key area relating to
QoL
:
Specific assessment of dysphagia
Reduce stress on caregivers – by providing management strategies
Assessment of consent to treatment
Reduced social exclusion
RCSLT (2005)
Speech and Language Therapy for people with dementia.
London, RCSLT.Slide14
Current provision/ initiatives for TBI
Inpatient rehabilitation-
- A prospective study looked at 3 inpatient centres between
1989
and 1996. Patients received a MDT approach with physical
, occupational,
psychological,
and speech
therapy. It found that increased
therapy intensity potentially
enhances
outcomes (Cifu et al, 2003).
- Another study looked at patients
with
aphasia after TBI
who were admitted
in
the post-acute phase for a
late inpatient
rehabilitation
programme. They found all
functional, cognitive and language scores increased
significantly, suggesting inpatient rehabilitation may even be beneficial at later stages (Demir et al, 2006). Slide15
Current provision / initiatives for TBI
Community based SLT:
- 52 people with TBI who were at least 1 year post injury, received 12 weekly group sessions (1.5h each) working on social communication skills. All patients had improved social communication compared to controls, which was maintained at 6 months post treatment (Dahlberg et al, 2007). Slide16
Current provision / initiatives for degenerative diseases
Dementia
Asking every hospital to appoint a ‘dementia champion’- It has been found there is now a shift
towards more positive and
person-centred approach and participants
’ perceptions about dementia being challenged and
altered (
Alzheimer
Scotland, 2014).
Providing online dementia training resources- over 377,000 NHS staff have already received Tier 1 dementia training (Department of Health, 2015). Slide17
Current provision / initiatives for degenerative diseases
P
arkinson's disease-
-LSVT has the most evidence of effectiveness (
Ramig
et al, 2007). 90
% of
people with hypokinetic dysarthria will show improve in speech and voice after LSTV (Theodoros et al, 2006).
-
Noble et al (2006) found that 80% of
patients with Parkinson's disease
felt SLT had helped them, but around 43% of patients have no contact with SLT services (Miller et al, 2011)
- This shows that although there is effective treatment, there needs to be better access to this provision. Slide18
References
Alzheimer Scotland, (2014).
Evaluating the impact of the Alzheimer Scotland
Dementia Nurse
Consultants/Specialists & Dementia Champions
in bringing
about improvements to dementia care in
acute general hospitals
http
://www.nes.scot.nhs.uk/media/2711490/impact_evaluation_-_
executive_summary.pdf
Cifu,D.X
.,
Kreutzer,J.S
.,
Kolakowsky-Hayner,S.A
.,
Marwitz,J.H
. and
Englander,J
., (2003). The
relationship between therapy intensity and rehabilitative outcomes after
traumatic brain
injury: a
multicenter
analysis.
Archives
of Physical Medicine &
Rehabilitation,
84, 1441-1448
Dahlberg,C.C
.,
Cusick,B.A
.,
Hawley,M.S.W
.,
Newman,J.K
.,
Morey,C.E
.,
HarrisonFelix,C.L
. and
Whiteneck,G.G
., (2007). Treatment
efficacy of social communication
skills training
after traumatic brain injury : a randomized treatment and deferred
treatment controlled trial.
Archives
of Physical Medicine &
Rehabilitation,
88
,
1561-1573
Demir
, S.O
.,
Altinok,N
.,
Aydin,G
. and
KÃseoglu,F
., (2006).
'Functional and
cognitive progress
in aphasic patients with traumatic brain injury during
post-acute phase.
Brain Injury,
20,
1383-1390.
Department of Health, (2015).
Dementia
.
https://www.gov.uk/government/policies/improving-care-for-people-with-dementia
Noble, E., Jones, D., Miller, N., and Burn, D., (2006). Speech and Language therapy provision for people with Parkinson's disease
. International Journal of Therapy and Rehabilitation , 13
(7) 323-327.
Miller, N., Noble, E., Jones, D., Deane, K., and
and
Gibb, C., (2011). Survey of speech and language therapy provision for people with Parkinson's disease in the United Kingdom: patients' and carers' perspectives.
International Journal of Language & Communication Disorders
., 46 (2). 179-188
Ramig
et al, (2007). Intensive
voice treatment (LSVT®) for
patients with
Parkinson’s disease: a 2 year follow
up.
J
ournal
of
Neurol
ogy
&
Neurosurg
ical
Psychiatry
,
71
,
493–498
Theodoros et al, (2006).
Treating the speech disorder in
Parkinson’s disease online.
Journal of Telemedicine and
Telecare
,
12, 3, 88–91Slide19
Speech and language therapy:
a long-term investment
UK – NHS – we all contribute to it.
Cost to the NHS: TBI - £4.9 bill; Dementia - £19.1 bill; Multiple sclerosis - £2.3 bill; Parkinson’s disease - £2 bill (Imperial College London, 2013).
Speech and language therapy – prevent later, potentially avoidable expenditure.Slide20
Malcolm’s story
Idiopathic Parkinson’s disease.
Speech deterioration due to lack of speech therapy.
Issues with self-esteem -> social isolation -> depression -> unemployment.Slide21
Costs on different levels
Financial implications for Malcolm and his wife.
Relationship problems.
NHS paying for clinical psychology, counselling, medication.
State benefits an additional cost.Slide22
Preventable?
Early speech and language therapy input.
Benefits of speech therapy to Malcolm: improved breathing, clearer, louder speech -> more confident -> improved relationship -> independence.
Financial benefits on micro and macro level.Slide23
Pre-emptive
Local health services can save £20,000 yearly with coordinated approach to Parkinson’s disease – includes speech therapy (National Institute of Clinical Excellence, 2006).
Therefore – pre-emptive approach with these types of illnesses -> avoid later costs.
Long-term investment that pays off.Slide24
ConclusionSlide25
A broader picture of Traumatic Brain Injury
Thomson et
al’s
(2000) Cochrane review reported that cycling helmets
redcued
the risk of brain injury by 88
%
Vehicle safety laws have significantly reduced rates of TBI in high-income countries
In the US, firearms are the leading cause of TBI with a survival rate of 9%
Contrast this with the UK, where fall-related incidences are the leading cause, and survival rates are 89%
This may not be a case for funding, or relevant to speech therapy, however, it may be an interesting point to raise to the NRA. Slide26
Traumatic Brain Injury
As mentioned the costs of TBI are vast and long-term and have both a micro and macro affect.
Speech and language therapy has proven to better equip individuals post-TBI for autonomy. In turn this reduces the cost to society, increases their contribution to the economy and in doing so, reducing the likelihood of depression. Slide27
Degenerative Diseases
In terms of Parkinson’s, speech therapy has proven able to increase the volume and clarity of individuals speech. This has a significant impact on their ability to communicate effectively and enable
socialisation
.
Speech therapy can enhance the QOL of those with degenerative diseases. Equally, if confidence is maintained the likelihood of them staying in work is increased. Slide28
REMEMBER
Any one of you, at any point, particularly if you are between 15-24 could get TBI. So think of this not only as an investment into healthcare but as an investment in yourself. Slide29
Wear your helmet (hair-met)