The Brain Injury Rehabilitation Trust (BIRT) recently produced a publication called Changing Lives to mark our 25th anniversary. As part of the celebrations, we asked some of the key influencers in the field of brain injury to share their thoughts about the key developments in brain injury rehabilitation over the last 25 years, as well as how they see things developing over the next 25 years.

Below are extracts from some of these interviews.

Dr Aikaterini Fotopoulou

Psychoanalysis Unit, University College, London (UCL)
"One of the exciting developments that I have observed has been in research that has shown that brain injuries are not always permanent but rather that the brain has all sorts of ways of reprogramming itself after an injury. Unlike other organs in the body, the brain is 'plastic' and dynamic. Scientific developments and research mean that we can exploit this in our approach to rehabilitation so we can understand more clearly how and why treatment works in relation to the dynamic brain and its ability to find new 'ways round' some injuries. For patients with a brain injury, this means there are many more ways to approach rehabilitation with regards deficits caused by a brain injury than previously thought."

Dr Pam Klonoff

Clinical Director, Centre for Neurorehabilitation, Phoenix, Arizona
"One of the developments I have seen in recent years in the field of brain injury rehabilitation is the wealth of knowledge over the integration of neuroscience and rehabilitation, particularly with a focus on techniques which help improve quality of life and move towards allowing patients to reintegrate into society and live more independently.

"Over the next 25 years I can see this developing further so that rehabilitation providers continue to approach rehab more holistically, applying proven techniques which integrate technology and psychology and consider the whole person rather than just their symptoms. I can see a move towards improved social awareness of brain injury and the impact it has on patients and a greater understanding of what that means so that people with a brain injury are given more of a 'voice' in society."

Dr Andrew Worthington

Director / Consultant in Neuropsychology & Rehabilitation, Headwise, Birmingham
"I have seen huge changes in brain injury rehabilitation in the last 25 years. One of the most pleasing changes has been the recognition of the importance of recognising the impact of brain injury on the friends, family and those around the person with the injury.

"I can see this understanding starting to develop into new practices around rehab so that increasingly we are assessing not just the individual with a brain injury but we are considering the impact that their injury and the rehab we offer will have on the while family unit and be able to tailor support to fit. This more holistic approach means we can offer better ways to support families affected by brain injury by better understanding the impact the injury has on other individuals living with the impact of the brain injury – emotional and financial impact on family units is particularly important to recognise. "The Brain Injury Rehabilitation Trust have been leaders in the field in evidencing that neurobehavioural rehabilitation can deliver significant outcomes years after initial injury. I can see this research has become more widely recognised and is changing practice in rehab so that adults with brain injury can be offered help years after their injury when improvements in independence and quality of life were previously not considered possible."

Professor Mark Solms

Professor in Neuropsychology, University of Cape Town, South Africa
"When I trained 30 years ago, the field of neurorehabilitation was quite separate from the field of academia and research. Rehabilitation was undertaken by people on the 'front line', people who had a real insight into the human effects of brain injury but whose insight was rarely shared with academics or neuropsychologists. Over the last 25 years gradually the two have come together and that has been so interesting because it has meant a greater understanding of scientific, academic neuropsychology and how that is informed by and can inform applied rehabilitative neuropsychology.

"Moving forward into the next 25 years I can see this continuing to develop so that neuropsychologists can use data and findings from neurorehabilitation to start to determine a more precise understanding of the mechanisms of the mind. So that we can layer on top of our existing understanding the mechanisms of language, memory, skilled movement and so more developed understanding of the mechanisms of the mind such as feelings, desires and aspirations. That’s where the two disciplines coming together will become really interesting – and useful in terms of supporting people with a brain injury."

Professor Dan Hoofien

Dept. of Psychology, The Hebrew University of Jerusalem, Israel
"In the last 25 years the three biggest advancements I have seen in the field of neurobehavioural rehabilitation are:

  • The influence of the Cognitive Revolution in psychology - greater interdisciplinary communication and research
  • A greater understanding of the effect of psychotherapeutic intervention
  • Proven efficacy – both clinically and economically – of neurorehabilitation

In the next 25 years I can see that we will continue to embrace new developments in “brain machine interfaces” like those recently developed in the US where neuroscientists have developed a chip that may eventually replace the hippocampus for people with neurological impairments."

Pascale Bruguiere

Service de Médicine et Physique et Rédaption, Hôpital Pitié-Salpêtrière, Paris
"One of the things I have noticed over the last 25 years is the integration of disciplines in making assessments of people with a brain injury. In France we now have a more rounded, combined approach which is informed by neurological, psychological and neuropsychological practice. There has also been a lot of work around raising awareness of prevention of brain injury in France – particularly successful in the field of Shaken Baby and Stroke injuries."

Professor Johnathan Evans

Professor of Applied Neuropsychology, Institute of Health and Wellbeing, University of Glasgow
"One of the key developments in brain injury rehabilitation in the last 25 years has been the move towards developing interdisciplinary programmes that address cognitive, emotional and behavioural difficulties in an integrated way and embed interventions very clearly in the context of everyday functional activity.

"What I think we can look forward to in the next 25 years is the development of a more robust evidence base for demonstrating the efficacy of specific neuropsychological rehabilitation interventions.This is needed to inform clinical guidelines to support commissioners in making decisions when commissioning brain injury rehabilitation services and help clinicians to select interventions to match the needs of their clients. The challenge with respect to gathering evidence in relation to very specific interventions is that large randomised trials are often not feasible. It may be necessary to make much more use of single case experimental design methodology, which has a high level of scientific rigour but is feasible to use in clinical settings. Recent advances in development of methods of statisical analysis for SCED studies provide researchers with the tools required to produce methodologically strong SCED evidence.

"We are just at the beginning of being able to apply Assistive Technology for Cognition (ATC) in brain injury rehabilitation and I hope that the next 25 years will see the rapid development of ATC specifically designed for supporting cognition in people with ABI."

Dr Andrew Bateman

Neurorehabilitation Clinical Manager and Director of Research, The Oliver Zangwill Centre for Neuropsychological Rehabilitation
"Over the last 25 years we have seen more recognition that people need support for their cognitive, emotional and physical difficulties and BIRT have been leading the way in a clinically-led holistic approach to rehab. Investment in research is desperately needed to test the interventions being developed and show how they reduce the cost to society and improve quality of life – particularly in relation to emotional and cognitive rehabilitation interventions.

"Looking ahead we face rwo main challenges: the strained health economy and the ageing population, both of which will have implications for those working to support people with a brain injury. Technology will undoubtedly play a role more and more in the coming years – including self-management tools and computer resources to support independent living. Technologies to connect and support family members are needed too."

Liz Parish

Clinical Specialist Occupational Therapist, the Brain Injury Rehabilitation Trust
"The biggest change I have seen in the last 25 years has been the number of specialist rehabilitation services for people with a brain injury. In the next 25 years I can see a move to more intensive rehabilitation options in the community. Studies elsewhere have shown that intensive outpatient rehabilitation in domestic settings can be effective (both in terms of clinical outcomes and cost saving) and it would be great to see infrastructure developed to support this approach in the UK."

Professor Oliver Turnbull

Clinical Neuropsychologist and Academic, University of Bangor, South Wales
""The biggest single change over the last couple of decades has been the realisation that Cognitive Rehabilitation has not been as successful as had been hoped. Rather, what has become clear is that emotional and behavioural outcomes in rehabilitation, both for patients and for the individuals around them are more substantial and useful indicators and measures of change in individuals with a brain injury.

"Over the next 25 years I would like to see the knowledge of the importance of emotional and behavioural rehabilitation inform better ways to prove and measure these outcomes with more intellectual rigour. This would then support a more systematic approach to enabling interventions with emotional and behavioural therapies sooner in the rehabilitation process. I can also see a shift alongside this towards involving the families in this rehabilitation approach so that we can deliver effective psycho education and work collaboratively with families of people with a brain injury to deliver more effective rehabilitation."

Dr Ivan Pitman

Clinical Neuropsychologist, Redford Court
"One of the greatest developments is a greater understanding of the effects of brain injury – so that we now understand that brain injury can not only cause physical disabilities but also significant neurological impairments. We have also developed an understanding that brain injury affects not just the patient but also those around them – notably their families and loves ones. Also, more support has been made available for the families of adults living with a brain injury.

"I expect to see this approach continue to develop, with a greater emphasis on helping people to live more independently by working more closely with their families on how to support them with this through the employment of assistive technology. I can see this might mean there would be less reliance on support workers in the community as adults with a brain injury have access to more advanced technologies to support their independence."