Frequently asked questions
Common questions about The Brain Injury Rehabilitation Trust (BIRT) and brain injury
Questions about brain injury
What is brain injury?
How do you get a brain injury?
How does brain injury affect people?
How is brain injury treated?
Will my friend ever fully recover?
Why is it so hard to tell me whether my friend will recover fully?
Is there anything that may make someone’s behaviour or symptoms worse?
How will I know when my friend/relative has reached her rehabilitation potential?
What sort of medication do people with brain injury take?
What can families do to help their relative live as independently as possible?
Questions about the Brain Injury Rehabilitation Trust (BIRT)
What is the Brain Injury Rehabilitation Trust?
What services do you provide?
How much do your services cost?
Who pays for the service?
What support is available for families?
How are referrals made to your services?
Which service is best for my relative with brain injury?
What sort of community based support is available?
How can I ensure that my relative/friend receives the best possible care?
What is brain injury?
As the brain is involved in just about everything we do, injury to the brain can have a very wide range of effects. These effects vary from one person to another depending on the exact nature of the brain injury and its severity.
It is helpful to distinguish between the initial effects when the person first sustained their brain injury and the longer-term effects. Read more about the
effects of brain injury.
How do you get a brain injury?
Brain injury is caused either by sustaining an injury to the head or by having an illness that causes brain injury. Brain injury can happen through road traffic accidents, assaults or falls (often called traumatic brain injuries) or by having an illness such as encephalitis, brain haemorrhages/strokes (also called cerebrovascular accidents CVA) or a brain tumour.
There are some differences in terms of likely risk depending on
age and the mechanism of injury. For example, traumatic brain injuries tend
to occur more in the very young, the very old and young men between 16-30. Strokes
tend to occur more in the older adults. However, a brain injury can happen to
any of us at any time.
How does brain injury affect people?
The effects will vary from one person to another, depending on the exact nature of the brain injury and its severity. They can include physical effects (eg on movement, vision, touch or taste), cognitive effects (eg on thinking processes such as memory and concentration) and effects on behaviour (eg self-control, motivation etc).
Read more about the initial and longer term
effects of brain injury.
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How is brain injury treated?
See our leaflet on The neurobehavioural approach to brain injury rehabilitation (download pdf).
The treatment of brain injury occurs in a number of different stages and differs greatly from case to case due to differences in the severity and nature of the injury.
When an injury is a result of an accident the initial treatment may occur before the person reaches hospital. The paramedics at the scene of the accident and en route to the hospital will work to stabilise the person’s condition and give immediate assistance. For other conditions such as encephalitis or a brain tumour the onset may be less obvious and the speed of intervention will depend on the progression of symptoms and the accuracy of the diagnosis.
Once a person reaches hospital the doctors will work rapidly to identify the immediate effects of the accident or illness and attempt to limit any further damage to the brain. Means of limiting further damage include prevention of swelling (oedema) by drugs, giving oxygen and draining blood or excess fluid. In extreme cases it may even involve surgery. More commonly surgery is used to repair damage to blood vessels or to the linings of the brain.
As the person’s medical condition stabilises the rehabilitation phase begins. In the early stages this may take place within the acute medical setting as the person may still requires considerable medical and nursing care. However, most rehabilitation takes place once the acute medical management is over and the person enters the phase known as post-acute rehabilitation. Here the person may be treated within a hospital setting and then discharged home or they may transfer to a specialist rehabilitation centre for further rehabilitation before plans are made for returning home or to other settings.
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Will my friend ever fully recover?
This is such an important question for people and it is a difficult question to answer. We know that there are patterns of recovery from brain injury and can draw a graph of a typical ‘recovery curve’. What we can’t do is tell you whether your friend or relative fits that typical curve, because everyone is different and every injury is different. The most important questions are how long does recovery take and how complete will it be? The answer to both questions is: ‘It depends.’
Download our leaflet, The family following acquired brain injury (download pdf).
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Why is it so hard to tell me whether my friend will recover fully?
It is not just that everyone is different and suffers a different injury. It is also because the brain is so complicated – it controls so many different parts of the way we think, breathe, walk and talk. So, it depends on which function we are talking about and some recover faster than others. For example, the ability to walk may return faster than the ability to remember.
It also depends on the nature and severity of the injury. As a general rule the more severe the injury, the longer recovery may take, and the less complete it may be. The brain does have considerable ability to heal and we are learning more about this all the time. Another general rule is that mild injuries recover completely, more severe injuries take more time to overcome and very severe injuries may result in permanent difficulties.
There are also different types of recovery, which may occur over different timescales.
There is healing of the brain so that there is complete recovery, which tends to happen earlier in the process.
There is recovery where different parts of the brain take over functions or where the brain re-wires itself, which sound like a good thing but there can be some costs to this, for example if the wires get ‘crossed’ and send out confusing signals.
There is recovery which takes the form of learning to do something differently, for example by using a compensatory strategy.
What this means in practice however, is that it is never too late to achieve positive goals and make new recovery. We have recently published a study demonstrating gains in independence made by clients in our continuing rehabilitation service more than ten years after injury.
So the answer to this question is that, although some people do not recover completely, some do and those who do not can continue to make progress for the rest of their lives.
Download our leaflet, The family following acquired brain injury (download pdf).
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Is there anything that may make someone's behaviour or symptoms worse?
It is always a worry that you might do something to make things worse. In general people do recover reasonably well in terms of their physical health once they are past the acute stage. A small minority of people are unfortunate enough to develop epilepsy as a result of their injury or illness. Frequent seizures can create additional problems for people and post-traumatic epilepsy should always be managed carefully and with advice from your GP and/or neurologist.
However, there are other things that can make symptoms appear worse because they exacerbate the problems created by the original head injury. The most obvious example of this is alcohol. Not only is someone who has had a brain injury likely to be more sensitive to the effects of alcohol, but also alcohol does have a direct effect on a number of symptoms, for example, making people less inhibited or more aggressive. After a brain injury there is likely to be increased sensitivity not just to alcohol but also to the effects of all recreational drugs.
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How will I know when my friend/relative has reached her rehabilitation potential?
People can continue to change and develop many years after their injury. It is always possible to make further progress, however long it is since the brain injury occurred. However, the speed of progress will reduce and the necessity for external support and guidance will vary at different times. You are likely to see more progress in the first few months or years, but many people will look back five or ten years after their injury and still see changes in what they can do and achieve.
Download our leaflet, The family following acquired brain injury (download pdf).
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What sort of medication do people with brain injury take?
See our leaflet on Medication following brain injury (download pdf).
In the early stages many people are prescribed anti-epileptic medication, even if they haven’t had a fit or seizure, in an effort to reduce the likelihood that they will have one. Doctors have different view on how helpful this is and not all centres will prescribe anti-epileptic medication as a routine. Where it has been recommended initially, there is always a plan to reduce the dosage over time as the risks of seizures reduces. It is important to discuss this with your GP and medical specialists.
When seizures are a problem then longer-term anti-epileptic medication may be required. However, the same medications may be used to help stabilise mood if this is a problem (lots of drugs have more than one function and your doctor will advise you as to what is the right medication and the right amount in each case). Antidepressant medication is also used sometimes to help support people whilst they are working out a way of coping with all the changes they are experiencing. More information is contained in our leaflet Medication following brain injury (download pdf).
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What can families do to help their relative live as independently as possible?
Families are really important and their love and support is a vital ingredient in the rehabilitation process. They have a great ability to motivate their relatives and keep them going when times are hard. They can help the professional staff by encouraging the person with a brain injury to keep going and participate fully in their rehabilitation. They can also help by explaining to them what is going on and why the professionals are suggesting what they are. Relatives and friends are more likely to be trusted than stranger or professionals they have only just met. It is really important therefore for families and staff to work together.
Families also help the rehabilitation team by providing information about what the person was like before, what interested and motivated them, what were their likes and dislikes. This is all vital information and family and friends are the main source of this information.
One of the difficult things for families, as their relative recovers and wants and needs to do more to help themselves, is to stand back and encourage them to do things even if they struggle or maybe fail to begin with. The temptation is to do things for them, sometimes because it is easier or quicker, sometimes because it is hard to watch someone you care about struggling, and sometimes because you nearly lost them you want to wrap them up in cottonwool and not let them do anything risky ever again. These are all really difficult things to work through and talking about it can help.
Download our leaflet, The family following acquired brain injury (download pdf).
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What is The Brain Injury Rehabilitation Trust?
The Brain Injury Rehabilitation Trust (BIRT) is a division of The Disabilities Trust. It is the means by which The Disabilities Trust provides its brain injury services. BIRT was established in 1991 in Milton Keynes, and now has nine main brain injury services in the UK. BIRT is a leading European provider of specialist brain injury rehabilitation, helping people regain lost skills, recover social independence and rebuild their lives following acquired brain injury. In 2005 we provided services for 300 Service Users in our residential and community-based services.
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What services do you provide?
We provide a range of services including assessment, intensive rehabilitation and continuing rehabilitation in our residential centres throughout the UK. We also provide community-based support in our supported houses and in Service Users’ own homes. Our website contains
details and locations of all our current services.
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How much do your services cost?
Each residential service has a basic weekly cost which depends on the service provided. This covers all clinical, therapeutic, care and management costs as well as those for accommodation and meals.
Some service users may require additional one to one support which is negotiated with the referrer/funder and is charged in addition to the basic weekly fee.
Supported housing costs have a basic fee. These may vary slightly according to the rent of the individual property. The costs of
own home packages vary depending on the amount of support provided.
Costs for specific services can be obtained by following links for
Assessment and rehabilitation,
continuing rehabilitation and
Community Services and by contacting the unit/service you require.
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Who pays for the service?
Funding is usually met by one or a combination of the following sources:
health authorities
Social Services departments
medicolegal (via personal injury solicitors or insurance companies)
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What support is available for families?
Support and information is widely available through our website.
We have a range of information about brain injury in the
downloads section of the website, including a series of
clinical leaflets.
All our services provide support to families and friends of service users through review meetings, family support sessions (both individual and group meetings), information leaflets about the service and facilities available. Residential services have family days and social events where families can meet the team of staff and other families in similar situations to themselves.
Visit our
links page for information about a range of organisations, including some supporting families.
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How are referrals made to your services?
Referrals can be made by a consultant in rehabilitation medicine or other health professional, a social worker, a solicitor, an insurer and individual, friend or family member.
In the first instance, the referrer should contact the Unit General Manager of the service or the clinical lead. Our website contains
contact details for all our services.
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Which service is best for my relative with brain injury?
You can find information about each of our services by following the links for
assessment and rehabilitation,
continuing rehabilitation and
community services. The Unit General Manager of each service will be pleased to discuss with you what facilities are available and how their service might best meet your relative’s needs. You and your relative are welcome to visit any of our services to look round and find out more about the service what is available there. Please contact the Unit General Manager first to make an appointment by contacting each unit directly.
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We currently provide 24 hour
supported housing in England and Wales in shared accommodation. This provides a cost effective option for people who need 24 hour supervision as support costs are shared and welfare benefits can contribute to daily living expenses.
We also provide
own home packages where a tailored package of care is provided in a service user’s own home. The amount of support provided depends on assessed need.
Our website also contains more information about
community services.
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How can I ensure that my relative/friend receives the best possible care?
As a service registered by the Commission for Social Care Inspection or, in the case of
York House, the Healthcare Commission, we receive regular visits to ensure we maintain the standards required by these independent bodies. You can see copies of our reports by visiting the CSCI and HCC websites.
We have our own quality assurance division, and have achieved accreditation from an international, independent not-for-profit organisation called CARF (Commission on Accreditation of Rehabilitation Facilities). CARF promotes quality rehabilitation services by establishing standards for organisations to work to in developing their services. You can read more about CARF by visiting www.carf.org
We are also an Investor in People.
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