Michelle Devine
Director of Clinical Services at the Priory Highbank Centre
Each individual’s unique personality and the varied nature of neurological injuries makes rehabilitation a highly complex business for patients, relatives and clinicians.
“We’re now seeing people survive catastrophic injuries, which, whilst progressive in terms of medical advances, also brings its own challenges in terms of complex long-term rehabilitation management” explains Michelle Devine, Director of Clinical Services at the Priory Highbank Centre.
For those who have sustained very severe brain injury, for example, as the result of road traffic accident, the initial stage for any family can be: ‘Will they survive?’
Later, once the patient is stabilised, the question becomes: ‘What is the outcome going to be?’ It’s a grieving process – you can still see and touch the person you know and love, but it’s different because of the injury.
Everyone wants the best for the patient, but the treating team may have different views from the family, so managing expectations of potential outcomes is crucial to the process.
Devine believes that, despite the plethora of outcome tools which can capture patient progress, it isn’t always possible to capture the subtlety of change in a measurable fashion for many of the most severely impaired patients.
As with all rehabilitation, the goal is to maximise potential and enhance the quality of the patient’s life.
Guidelines manage ethics
There are guidelines for Prolonged Disorders of Consciousness (PDOC), assessments such as SMART@ Sensory Modality and rehabilitation techniques, which are helping to align laws and ethics with the reality of complex, long term rehabilitation. The Mental Capacity (2005) played a key role in ensuring the rights of the patient are considered fully.
Delivering rehabilitation methods at a rate and pace that the patient can cope with is key.
Devine stresses we should always, “see the person, not just the condition”, as this individual approach supports the longer term treatment plan. Within the world of severe brain injury, remaining focused on the patient and finding meaningful plans for future treatment and care is imperitive.
