No rehab for brain trauma patients

‘Ill-equipped families’ must look after them

DESPITE the burgeoning numbers of traumatic brain injuries in the country, the victims of this trauma end up being worse off because of a critical shortage of rehabilitation centres. A UCT study has revealed that most head injury patients, who needed acute care while in provincial hospitals, ended up in the care of their ill-equipped families for rehabilitation – resulting in poor rehabilitation, and putting these survivors at risk of becoming perpetrators of violence in the future.

The subject came under the spotlight at the weekend as the country joined the world in commemorating World Head Injury Awareness Day on Friday.

South Africa is one of the worst affected countries by brain injuries, with almost 90 000 cases of traumatic brain injuries reported every year.

According to the National Institute of Occupational Health, the three most common causes of head injuries include car crashes, bicycle, or vehicle-pedestrian accidents, which accounted for 50 percent of brain injuries, and falls, at 25 percent, and violence accounted for 20 percent of brain trauma.

An audit conducted at Groote Schuur Hospital in 2009 revealed that of 10 046 trauma patients admitted that year, 24 percent were classified as head injury patients, with 654 having moderate to severe traumatic brain injuries. Of the 654 serious patients, only 16 were admitted to a public rehabilitation facility. Over a fiveyear period between 2008-2012, only less than 9 percent of this group of patients made it to the Western Cape Rehabilitation Centre – the only dedicated rehab centre to public patients in the province.

In the latest research published in the South African Medical Journal, researchers revealed that due to lack of rehab support services in the province, “the majority are instead discharged to unprepared families who typically become their main support structure”.

But they warned that releasing these patients to their family members not only resulted in patients’ frustration, depression and other behavioural issues, including memory, sleep disturbances and communication problems, but it also put their families under strain.

The research examined challenges that brain injury survivors faced, and created guidelines in helping care workers and families manage and cope with brain injury in under-resourced areas.

Neurosurgeon Professor Allan Taylor wrote that of the 175 family members versus 354 survivors interviewed as part of the study, families also reported that their own mental health was adversely affected due to stress of having to look after head injury patients, fatigue, frustration and burn-out. The families said not only were they poorly informed about the impact of brain injury, but they failed to understand the changes in behaviour of survivors.

Taylor, who called brain injury a “hidden pandemic’’, argued that such stresses on families not only compromised their ability to care for their loved ones, but they also adversely affected survivors’ recovery.

“People with previous brain injury are more likely to be violent after their injury. They tend to have less control over their emotions and quickly become angry. They also may have less insight into what they are doing and can easily fall prey to taking drugs, getting involved with criminal activity,” Taylor said.