For the Brain Injury Rehabilitation Trust (BIRT), research is an important part of seeking new and imaginative solutions to meet the needs of our service users and mainly focuses on the following areas:

  • Clinical outcomes and cost benefits of brain injury rehabilitation
  • Technology to support cognition and independent living after acquired brain injury (ABI)
  • Cognitive, emotional and functional impact of acquired brain injury

Find out more about these publications.

Effective rehabilitation

Estimates suggest that approximately 760,000 people in the UK are living with the long-term effects of a head injury. Individuals suffering from brain injuries have little reduction in life-expectancy, however many cannot return to work and will require full-time care. Thus, there is a significant economic burden associated with acquired brain injury

Over the years BIRT has consistently demonstrated that neurobehavioural rehabilitation is cost-effective. The first study of this kind, was conducted in 1999 by Professor Rodger Wood et al.

Since then, two other studies have led to similar results. In 2006, Worthington and colleagues found that rehabilitation led to significant improvements in level of independence, level of care, functional ability and productive occupation. The researchers carried out economic analyses and determined that the initial costs of rehabilitation were offset by savings in direct care costs within two years.

The estimated savings in direct care costs projected across an individual’s lifetime were between £0.9 to £1.1 million, depending on how much time had elapsed between sustaining the injury and admission to rehabilitation.

Seven years later Oddy & Ramos repeated the analyses in a different cohort using changes in supervision levels before and after rehabilitation. They found significant gains in all areas of functioning were associated with reductions in direct care costs both in individuals who sustained their injury within one year of admission (68% reduction) as well as in those who sustained their injury more than one year before admission (37% reduction).

Savings in societal costs are likely to add to those in direct costs, as those who become more independent require less direct supervision, which in turn enables informal carers to return to work, resulting in an overall reduction of costs associated with loss of productivity. Wider benefits resulting from enhanced sense of self-efficacy and individual and caregiver well-being are still to be investigated.

Behaviour in social situations may change after brain injury

Social situations can become difficult to deal with after brain injury. This may be caused by problems in reading emotions on oneself and others, communication difficulties, disinhibition and impulsivity, which often result in responding in a manner that is not considered socially appropriate (e. g. immature or inappropriate humour, difficulty in making advantageous decisions on personal matters). This area of function is typically called "social cognition". Due to the impact these difficulties have on a person's relationships and social roles, they are often a key target area in rehabilitation. At the Brain Injury Rehabilitation Trust (BIRT) we believe that the first step towards improving social cognition is to understand the nature and degree of difficulties presented. There are not many tools available to measure this.

A well-known and widely used test is The Awareness of Social Inference Test (TASIT), which is very comprehensive, but time consuming. To address the lack of instruments available for measuring social cognition, Charlotte Cattran, Michael Oddy and colleagues developed the BIRT Social Cognition Questionnaire (BSCQ). The BSCQ comprises 28 questions, and two forms, one for self-report by the person with brain injury, and one for a proxy-report by a relative, clinician or carer.

Difficulty in understanding one's own difficulties is common after brain injury (lack of self-awareness) as is difficulty in understanding other people's perceptions - what is usually known as theory of mind. For these reasons, having a good understanding of how the person views their behaviour, as well as how others see it, is very important in working with those with impaired social cognition.

The authors of the tool believe that it will be a very useful instrument to screen for problems in social cognition after brain injury and other neurological conditions. The study reporting the development of this tool is published in the journal Neuropsychological Rehabilitation, and professionals can obtain the two versions of the questionnaire and scoring sheet from Dr Sara da Silva Ramos.

Automated voice prompts improve learning

Assistive technology for cognition (ATC) is the term used to describe technology that extends or augments mental functions. Guide is an automated prompting technology that supports users during their daily routines. It's currently available throughout the Brain Injury Rehabilitation Trust (BIRT) to support rehabilitation of a number of activities, including making tea, cold snacks, self-managing medication, and many others.

Guide provides verbal prompts and voice recognition allows the user to interact with the technology in a natural conversational manner. Guide was initially developed by Brian O’Neill and Alex Gillespie to help amputees with executive dysfunction don their artificial limbs safely and independently. The project was then furthered by using the system to support activities of daily living that can be challenging to individuals with acquired brain injury (ABI).

In a single case study, Guide was used to help an individual with severe cognitive impairment which affected his ability to get going and carry out their morning routine independently. It was found that using Guide successfully encouraged the person to get ready and significantly reduced the person’s need for supervision both in the hospital and at home. These positive findings suggest that interactive verbal prompting is not only helpful to ensure that complex routines are correctly followed, but also helps with motivation.

Making houses that help with rehabilitation and support

Our transitional living smart house has been developed with the aim of seeing service users crossing its doorway and moving on into their own homes with personalised recommendations for technology. The house is equipped with a system that enables the provision of support aimed at reducing risks. Automated doors and window blinds provide assistance to those with limited dexterity or mobility. Sensors and automatic shut-offs of water and electric systems offer a safety net to reduce risk of harm, while reminders and prompts help overcoming memory, executive or motivational problems.

an example of the Brownswood smart house

A pilot study evaluated the effectiveness of the technology through an analysis of a log of all individual requests for help, and of the occupancy data recorded by the system. Usability was assessed by asking service users and staff about their experience and impressions of interacting with the smart house environment.

The house settings supported the person’s general safety and well being, and monitored their personal care and domestic skills. The data gathered informed the rehabilitation team about goal achievement, and evidenced areas of need. For example, a significant reduction in the number of pager alerts associated with cooking demonstrated that the kitchen safety goals of one of the individuals were partially achieved.

However, persistent complex needs with managing finances, social vulnerability, and coping with unplanned events were still apparent at the end of the assessment period. While we found that technology is limited in terms of the range of skills it is able to support, transitional living in a service with smart home features was crucial to establish the extent to which a person with cognitive impairment is safe to spend long periods of time within the home without supervision.

BIRT aims to continue gathering evidence about the effectiveness of this technology to increasing independence, reducing costs of long-term support, and the effects that living in this environment may have on the service users’ perceived sense of control and mood.

A pilot study evaluated the effectiveness of the technology through an analysis of a log of all individual requests for help, and of the occupancy data recorded by the system. Usability was assessed by asking service users and staff about their experience and impressions of interacting with the smart house environment.

The house settings supported the person’s general safety and well being, and monitored their personal care and domestic skills. The data gathered informed the rehabilitation team about goal achievement, and evidenced areas of need. For example, a significant reduction in the number of pager alerts associated with cooking demonstrated that the kitchen safety goals of one of the individuals were partially achieved.

However, persistent complex needs with managing finances, social vulnerability, and coping with unplanned events were still apparent at the end of the assessment period. While we found that technology is limited in terms of the range of skills it is able to support, transitional living in a service with smart home features was crucial to establish the extent to which a person with cognitive impairment is safe to spend long periods of time within the home without supervision.

BIRT aims to continue gathering evidence about the effectiveness of this technology to increasing independence, reducing costs of long-term support, and the effects that living in this environment may have on the service users’ perceived sense of control and mood.

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