Every year 1.4 million people attend hospital following a traumatic brain injury (TBI) in the UK. TBI leads to a variety of physical, psychological and social difficulties which require a diverse range of rehabilitation options from a variety of health practitioners across different settings.
One of the more holistic options for treating TBI has recently attracted some attention – comprehensive holistic neuropsychological rehabilitation, or CHN.
CHN is a comprehensive, multidisciplinary, and neuropsychologically-oriented rehabilitation programme used to treat cognitive, behavioural, psychological and physical factors resulting from a TBI.
CHN is a more intense, viable alternative to the multidisciplinary team (MDT) approach, whereby patients typically receive out-patient rehabilitation treatment for up to five days per week. It is aimed at people with very complex needs, not those who can be managed by community programmes. In such cases it is twice as likely to make gains when compared with a multi-disciplinary approach.
These include:
CHN includes one-to-one and group-based treatments, and may also be successful for patients who are many years post-injury.
A case example of the type of TBI patient who would likely benefit from CHN is a young man who sustained injuries in a collision when he was in his teens. For various reasons the claimant did not receive any rehabilitation treatment for over two years post-accident. Intensive treatment via CHN should enable him to gain the benefits detailed above.
Psychosocial morbidity is often associated with increased long-term disability, unemployment, and poorer rehabilitation treatment outcomes following TBI. Furthermore, impaired self-awareness is a common symptom of severe TBI, and is a strong predictor of long-term functional outcomes and employment. To be truly effective, clinical interventions in the post-acute phase of recovery need to incorporate an accurate assessment of self-awareness into specific treatment interventions. Given the correlations between awareness, mood and psychological disability, and long-term outcomes following TBI, it is important to address the psychosocial variables when conducting a comprehensive neuropsychological evaluation.
CHN is a cognitive-behavioural approach with a transdisciplinary team specialising in brain injury rehabilitation. Treatment is carried out on an individual and team basis with a low patient to staff ratio, involves the patient’s family, and includes community-based vocational sessions. It is a more intensive form of treatment than the traditional MDT model and it is for this reason that it provides better and earlier functional results.
We would consider using CHN in circumstances where the claimant suffered moderate-severe TBI and has high physical needs and/or a mix of physical, cognitive and behavioural problems. The treatment is effective in the long-term, with patients still able to make significant functional gains 5 – 10 years post-injury, so it can be implemented even years after a claimant has sustained TBI.
For example where you have a claimant who has had very little rehabilitation, CHN is more effective than the standard MDT approach in restoring the person to as close to normal as possible.
There are only two NHS Trusts which are known to offer a 5-day intensive neuropsychological rehabilitation programme using the CHN approach – the Wolfson Neurological Rehabilitation Centre at St George’s University Hospitals in London (“the Wolfson”) and the Oliver Zangwell Centre, Cambridgeshire Community Services NHS Trust. There are also other services nationally; however, they do not publish or publically present their work, so not much is known about them and we understand that they may not really use the CHN approach or offer level 2 intensity. Furthermore, we understand that there is a similar service in Birmingham. In the event that claimants are not based in those areas, then similar treatments are available via private clinics.
CHN would help to contain the future costs to insurers in respect of care and support, medical treatment, equipment, and loss of earnings. The reason for this is that patients typically make greater improvements cognitively and physically; this in turn enables them to lead more independent lives without the need for such high-level support or specialist equipment. Additionally, they will likely have some residual earnings capacity. It also leads to improved social behaviour. As such, whilst the initial outlay may be higher than with a traditional MDT approach, the long-term benefits make this a more cost-effective approach.
Information from the Wolfson confirms that, when compared with in-patient treatment, CHN via Wolfson Outpatient Cognitive Rehabilitation Services (WOCRS) represents a reduction of 36% in care costs. Furthermore, the time from referral to admission is also reduced – from 68 to just 13 days – which in turn will ensure that further costs are saved as claimants will receive the required treatment sooner, and thus improvements should take place sooner.
CHN is a high-intensity alternative to the traditional MDT approach. A CHN programme can be used to treat cognitive, behavioural, psychological and physical factors resulting from TBI, and leads to successful outcomes even when rehabilitation does not commence until years after the injury was sustained.
The initial costs of CHN tend to be higher than standard MDT due to the high-intensity nature of the programmes. However, this initial outlay is outweighed by the significant gains which can be made via the programme, leading to a shorter rehabilitation period and a reduction in future costs of rehabilitation and care, amongst other heads of loss.
If anyone wishes to discuss the matter in more detail, please do not hesitate to contact Kirsty Wareing, Solicitor in the Complex & Catastrophic Loss team and Brain Injury Special Interest Group member on kirstywareing@keoghs.co.uk.
Kirsty Wareing
The service you deliver is integral to the success of your business. With the right technology, we can help you to heighten your customer experience, improve underwriting performance, and streamline processes.