Q & A: An expert’s insight in to Intensive Care

A road traffic accident can happen in an instant, but the consequences can be life long. And right from the moment a person with a severe head injury is fighting for their life in intensive care, until they are requiring physiotherapy and social care on a less frequent basis when they are trying to lead an independent life in their community, rehabilitation is critical.

Doctor John Hell, Director of the Neurosciences Intensive Care Unit at Southampton General Hospital, knows more than just about everyone when it comes to treating someone in a critical condition and giving them a shot at leading a working, or independent, life once again – having worked at the neurology unit for eight years.

Jack Hyom spoke to Doctor Hell, who gave his expertise on the importance of intensive care and rehab.

Q: Following Headway’s fears of significant cuts to its services, are there going to be any changes in rehabilitation at Southampton General Hospital?

A: I think there are going to be changes to rehab all over the country. It’s becoming increasingly recognised that the most important determinant following major trauma and particularly following traumatic brain injury, in terms of getting people back to independent life and back to their work or study, is effective and timely rehabilitation.

Q: What are the main methods of rehabilitation here?

A: Our patients on the intensive care unit will get specialist neurological therapy right from the outset and they will have physiotherapy involvement in making sure that they maintain the maximum range of movement that they can, and get back to full strength and mobility as early as possible.  This will continue with the community physiotherapy that happens thereafter, and also the rehabilitation physiotherapists will carry on this in their own units.

Q: Just how important is the rehabilitation process?

A: Rehabilitation is vital in order to re-orientate the patients as to what’s happened, how it’s affected them, and how they are likely to deal with any disability afterwards. The disability may be physical which is reasonably straightforward. Much more worrying is the loss of higher functions and difficulties with memory and mood swings. This is where rehabilitation is very important in getting patients able to cope back in the community on their own.

Q: Does the rehabilitation, from the NHS, continue outside of hospital?

A: There are community rehabilitation teams around Hampshire that are very active in actually making sure that after the initial rehabilitation process, they will then go on and seamlessly continue their rehabilitation once they get back to the community.

Q: Do the seriousness of head injuries and the importance of rehabilitation get underestimated?

A: I think there is a historical perception of head injuries not making a particularly good recovery but I think that, with time, we are seeing this improve. As results improve and the word gets out, people are expecting more and more from the results following a traumatic brain injury. But if rehabilitation is not given the prominence that it deserves, then these patients will not make a full recovery.

Q: Is there a problem in terms of funding rehabilitation in the long term?

A: Long-term rehabilitation funding is always a problem because it is usually expensive and Primary Care Trusts struggle with meeting the needs of some of these patients. We try and assist in any way we can, in identifying which patients will benefit most from what type of care, and then we seek funding for all patients where it’s appropriate that they should go to a rehabilitation unit according to their needs.

Q: What do you think the future holds for the treatment of head injuries at Southampton General?

A: I hope that we will continue to go from strength-to-strength and we will continue to provide the best possible care we know of in this country and, in fact, internationally. I think that we are actually on a par with most centres, if not better. We are awaiting results of a national study in this country, called RAIN, which will look at the outcome for different neurological intensive care units around the country and, hopefully, we will see where we are in relation to other centres. But, whatever we do initially will need to be matched by appropriate funding for rehabilitation thereafter, to enable these patients to actually get a good result.

Q: Can you sum up how important the patient-nurse interaction is in their recovery?

A: I think that, even though it is nice to see very smart and tidy rehabilitation facilities, what really matters is much more related to the interaction between the patient and the staff, and how committed and dedicated all those staff are to improving their rehabilitation then exactly where the rehabilitation is done. But, certainly the model with the military at Headley Court is something that we can only aspire to in the NHS at the moment. The facilities and the money aren’t there to treat with the number of patients that we are trying to deal with, and I think there is still a lot of work to be done with regards to getting all of our patients effectively rehabilitated and back to work if we can.

Q: How difficult is it to assess the needs of a patient upon arrival?

A: The difficulty we have when traumatic brain injury patients are admitted is that, regardless of what we can see on their scan, although somewhat influenced by their mechanism of injury and also their initial Glasgow Coma score, which is an indication of how severe their brain injury is, we cannot actually predict what sort of outcome they are likely to get. The best prediction we can make is that some of them will die and, of the ones that survive, they will have had a life changing event and there will be some disability going forward, which we cannot predict with any accuracy at all at the outset. Unfortunately, the only way of predicting outcome is to wait after the initial treatment and see how the patient starts to recover.

Q: Do people tend to have a different mindset after rehabilitation and change the way they look at life?

A: In my experience, when patients have made a good recovery, even if there is no obvious disability to the outside world, their family will have seen a change in the person, and that is not necessarily a change for the worse. Under circumstances, the patient can actually have changed their mindset and feel very differently about life after their head injury and they can go on and actually have a very satisfactory quality of life and enjoy life to the full, despite the fact they are not exactly the same as they were before they actually suffered their traumatic brain injury.

There does seem to be this sort of feeling that they have survived something catastrophic and they want to get the most out of every day thereafter. It is very variable. But certainly, patients do have a life changing event when they suffer traumatic brain injury and it is not always for the worse. Occasionally, patients will actually be better afterwards then they were before their injury.

Life-changing experience

David Hyom, 24, who was a passenger when a van collided with his colleague’s car at Lee-on-the-solent four years ago, has been indebted to intensive rehabilitation after suffering a near-fatal head injury. He has gone on to go back to his old job, own his first home and will be travelling worldwide with girlfriend Becky Wiltshire, who is a nurse at the Intensive Care Unit at Southampton General Hospital. They spoke exclusively to Buzz news about the importance of rehabilitation.


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