Acquired Brain Injury

Acquired Brain Injury (ABI) is a broad term for any brain injury that happens after birth, rather than being present from birth. It includes injuries caused by:

• Trauma (e.g. road traffic collisions, falls, assaults)
• Stroke or brain haemorrhage
• Lack of oxygen (hypoxic or anoxic brain injury)
• Infections (e.g. encephalitis, meningitis)
• Brain tumours and some treatments
• Certain toxins or metabolic problems

An ABI can affect movement, balance, thinking, memory, communication, behaviour and emotions. The impact can range from mild to very severe.

At The Royal Buckinghamshire Hospital, we provide specialist inpatient neurorehabilitation for adults with ABI, including people with complex medical and neurological needs.

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Causes of Acquired Brain Injury

Common causes include:

• Traumatic Brain Injury (TBI) – from impacts to the head, such as road traffic accidents, falls, sports injuries or assaults
• Stroke and haemorrhage – interruption of blood supply or bleeding in the brain
• Hypoxic or anoxic brain injury – due to cardiac arrest, respiratory failure, strangulation, near-drowning or severe low blood pressure
• Infections – such as encephalitis or meningitis
• Brain tumours – and sometimes surgery, radiotherapy or chemotherapy
• Toxic or metabolic causes – such as severe liver failure, carbon monoxide poisoning or other toxins

Many patients have more than one contributing factor, such as trauma combined with hypoxia or multiple injuries (polytrauma).

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Symptoms and effects

The effects of ABI depend on the cause, severity and which parts of the brain are involved. No two injuries are the same, but common difficulties include:

Physical and movement problems

• Weakness or paralysis on one side of the body
• Poor balance and coordination
• Spasticity, stiffness or involuntary movements
• Problems with walking, transfers and stairs
• Fatigue and reduced stamina
• Headaches, dizziness or visual changes

Cognitive (thinking) difficulties

• Problems with attention and concentration
• Memory difficulties, especially new learning
• Slower processing speed
• Difficulties with planning, organising and problem-solving
• Reduced insight into difficulties

Communication and swallowing

• Slurred or unclear speech
• Word-finding difficulties or reduced fluency
• Problems understanding complex language
• Difficulty reading, writing or using numbers
• Swallowing problems (dysphagia), with risk of choking or chest infections

Behavioural and emotional changes

• Irritability, agitation or disinhibition
• Impulsivity and poor judgement
• Low mood, anxiety or emotional lability
• Changes in personality and relationships
• Reduced motivation or apathy

These changes can have a major impact on independence, work, family life and participation in everyday activities.

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Diagnosis and assessment

Diagnosis usually starts in an acute hospital, where scans and tests are used to identify the brain injury and treat any life-threatening problems.

As patients move into rehabilitation, more detailed assessments help to understand the pattern of strengths and difficulties and guide treatment. This may include:

• Neurological examination
• CT or MRI brain imaging
• Formal cognitive and neuropsychological testing
• Assessment of mobility, balance and physical function
• Speech, language and swallowing assessments
• Evaluation of daily living skills and home environment

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Treatment and management

There is no single treatment for ABI. Management focuses on:

• Medical stability and prevention of complications
• Rehabilitation to maximise recovery and independence
• Education and support for the person and their family
• Planning for long-term needs, including return home, work or education where possible

Medication may be used to manage specific symptoms such as pain, spasticity, seizures, mood or sleep problems.

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Neurorehabilitation at The Royal Buckinghamshire Hospital

The Royal Buckinghamshire Hospital offers specialist inpatient neurorehabilitation for adults with ABI, including people with complex physical, cognitive and behavioural needs.

Multidisciplinary team (MDT)

Your rehabilitation programme may involve:

• Consultants in Rehabilitation Medicine and Neurology
• Specialist rehabilitation doctors and nurses
• Physiotherapists
• Occupational therapists
• Speech and language therapists
• Neuropsychologists and clinical psychologists

The team works with you and your family to set clear goals, review progress and plan for the next stage of recovery.

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Rehabilitation focus areas

Physiotherapy

• Strength, balance and endurance training
• Gait re-education and walking aid prescription
• Transfer practice (bed, chair, toilet, car)
• Management of spasticity and tone, including positioning and splinting
• Falls prevention strategies

Occupational therapy

• Relearning everyday activities such as washing, dressing and toileting
• Kitchen and domestic skills where appropriate
• Assessment for equipment, wheelchairs and seating
• Recommendations for home adaptations (grab rails, ramps, bathroom changes)
• Energy conservation, pacing and fatigue management

Speech and language therapy

• Assessment and management of speech, language and communication difficulties
• Augmentative and alternative communication (AAC) if needed
• Swallowing assessments and strategies to reduce choking and aspiration risk
• Advice on food and fluid textures and safe eating techniques

Neuropsychology and emotional support

• Cognitive assessment (attention, memory, planning, insight)
• Strategies to support thinking and behaviour
• Support with adjustment, mood and coping
• Education for families and carers about ABI and its effects

Family, social and discharge planning

• Support and education for relatives and carers
• Liaison with community services, case managers and insurers
• Planning for safe discharge home or to an appropriate care setting
• Advice on return to work, driving and other long-term considerations where appropriate

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Complications we aim to prevent or manage

Without specialist rehabilitation, people after ABI may be at higher risk of:

• Contractures and loss of range of movement
• Pressure ulcers and skin breakdown
• Recurrent chest infections
• Malnutrition or dehydration
• Falls and injuries
• Unmanaged pain or spasticity
• Carer strain and breakdown of support

Our goal is to reduce these risks and support a safe, sustainable level of independence and care.

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Who may benefit from admission?

Inpatient ABI rehabilitation at The Royal Buckinghamshire Hospital may be suitable for adults who:

• Have had a recent acquired brain injury (traumatic, hypoxic, stroke-related, tumour-related or other causes)
• Have ongoing issues with mobility, cognition, communication or behaviour
• Need coordinated multidisciplinary rehabilitation beyond the acute hospital phase
• Have complex needs that cannot be safely managed at home or in a standard care setting

We accept referrals from acute hospitals, GPs, neurologists, rehabilitation consultants, case managers, solicitors and insurers.