The road to recovery
Recovering from a brain injury can be a slow process, taking months or years, but what does it involve, and what outcome can a patient expect? A number of years ago, science communicator James Piercy suffered a severe head injury and has had to rehabilitate himself. He's since made it his mission to use his experience to help others to better understand the process. He started by telling Chris Smith how his life changed forever...
James - I was just out for a normal drive like everybody does every day. A nail punctured the tire of the car that I was in. it spun off the road and hit a tree. So, in a minute, my life kind of changed. I was treated by the East Anglian Air Ambulance at the scene as we kind of heard described earlier on and flown to Addenbrooke's Hospital. When I get to hospital, I'm put in a CT scanner and they find that there's really quite a severe injury actually to my brain.
Chris - What does the scan look like? Which bit of your brain is affected?
James - The most obvious thing you can see when you look at the picture and I have looked at the picture a lot, it's quite a large area of bruising and bleeding. Now often in brain injuries, you might have a haemorrhage, kind of on the surface of the brain or just outside the membranes around the brain. And in most cases, you'd have a surgery to remove that blood. My injury actually was intercerebral, actually, inside the brain so it wasn't treated. But it's very important to make sure that it's not going to get worse. So, I have got a little whole drilled in the top of my head and they use that to monitor the pressure and the blood flow inside the brain. The real problem after a serious brain injury is that things can get worse. There's nothing you can do really about the initial injury, but you can give treatment to stop things getting worse inside the brain.
Chris - I suppose we should emphasise here that because your skull is a sealed space, if the brain swells, there's nowhere for it to swell into because it presses on the skull and that can obviously compound the injury that's already been done.
James - Well, that's right and also, that increased pressure then will restrict blood flow to other areas of the brain. So, we get this hypoxia, this lack of oxygen to certain parts of the brain and then that's what causes these secondary injuries.
Chris - When did you first become aware that you'd ended up out of the car accident and you were in a hospital?
James - Yeah, I don't know. It's not like in the movies where you suddenly wake up and realise what's going on. I had a prolonged period of post traumatic amnesia, so I just couldn't store memories. So, I don't remember waking up. I don't remember being told what had happened to me. I had the kind of more gradual realisation that I was in a hospital and really, not very well.
Chris - How has it affected you?
James - I've had to learn over the last 4 years or so that I need to slow down. I can't do things at the pace that I used to do. I can do everything that I used to do but it takes longer, and it's much harder work. So the biggest change I've had to make in my life really is to plan things. I need to know in advance what I'm doing and when I'm doing it.
Chris - How long did it take you to realise the constraints that you were facing in terms of what you used to be able to do and what you now could do?
James - Probably, 6, 8 months, but yeah, my family would say, "He hasn't learned yet" because I still push myself too hard sometimes because I expect to be able to do things that I've done for 40 years.
Chris - What did you do to recover or rehabilitate yourself from your injury?
James - Mostly, I just had to try and do things. I had quite a bit of support from professionals when I was in the hospital and a little bit as an outpatient afterwards, just really trying to do everyday things - so making cups of tea and beans on toast and normal things. What I had to really push myself to do is the things that were normal for me - so trying to get back to work, so using the computer, cooking the kid's dinner at the end of the day.
Chris - A person who is pushing themselves to do things like you did, what is that doing to the brain in order to promote recovery?
James - What we need to do really is relearn and when we're learning things as young children, we're reinforcing these neural pathways in the brain, making connections that the neurotransmitters will pass along from cells in the brain and we're just reinforcing new pathways. So, repeating actions continuously and pushing is hopefully cementing and reinforcing these new pathways in the brain and helping us to learn stuff.
Chris - Some people characteristically get much better outcomes than others, don't they? Have you any instinct for what makes that difference?
James - It's kind of a big unknown around brain injury really. There's some fascinating research which came out in 2014 building on an idea of something called cognitive reserve. The idea of cognitive reserve is that some people have this kind of backup if you like, enhanced ability to relearn things. So, this study used number of years of education as a kind of proxy measure for this cognitive reserve. The thinking being that the longer you've spent learning stuff, the better you ought to be at learning new stuff or relearning things. What they found was a really dramatic result. People who had done further in higher education, been through a university, had a huge increased chance of having made a good recovery after 6 months, something like 6 times the chance of a better recovery. So, using your brain seems to help it recover after injury.
Chris - In your case, have you been able to recover pretty much all your function or a bit with some limitation, you can hold down a job and go about your life in a happy go lucky way?
James - I can do everything that I used to be able to do, but everything takes me a bit longer and I still suffer enormously from cognitive fatigue. So, things that are very taxing on the brain will get me literally really very tired. So, going to supermarket, sort of very busy, noisy environment, 6 million different kinds of baked beans to choose from and banging trolleys into, that will leave me really exhausted. There was an interesting study. They put some people in fMRI scanners and got them to carry out simple tasks and compared the brain activation of people with brain injury to those without. And they found that the brains of people who have had an injury were actually more active. They're literally working harder to do the same tasks. So, that may explain this kind of problem of fatigue.
Chris - What would be your advice to somebody who may find themselves in the same position as you and what would you urge them to do?
James - It's easy to say, "Just have a go and try and do stuff" but you need to give that caveat of, "Don't try and do too much too soon". A common story is pushing too hard, trying to go back to work too soon and not being able to cope, and then having a huge kind of psychological effect of failure really. So, try things, do things, but accept that you will have limitations and you're never going to be back to the same person that you were before. It's really very unusual for people to make 100 per cent recovery and be the same as they were before their injury. But you can get close to it and you can embrace the new you and run with that.