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Brain injury in the new normal: How to get a good night’s sleep during the pandemic

Consultant clinical neuropsychologist Dr Keith G Jenkins and Dr Jenny Brooks, consultant clinical psychologist on how to sleep well during the pandemic.

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Getting a good night’s sleep is important all of the time, as we know from our work with people with brain injury, but some people have seen their sleep pattern alter during the pandemic.

This change to the normal time people go to bed and fall asleep and/or wake up in the night, may be due to several factors, including changes to the way the person spends their day in terms of education, work, meeting up with family and friends, seeing support workers and / or attending rehabilitation sessions. Also they are perhaps exercising, playing sport or doing other activities less.

Lower mood, such as feeling sad, having worries or feelings of uncertainty, can also impact on your ability to get to and stay asleep.

Changes to our sleeping habits can lead to a poor sleep-wake cycle, otherwise known as our body clock. Not getting enough sleep, or good quality sleep, can cause fatigue and tiredness throughout the day. You might feel unwell as a result, and this can increase anxiety and worries further, making getting through the day more difficult. It might also mean that relaxing to sleep becomes harder, and a vicious downward spiral can follow.

Fortunately, there are some very simple things we can all do to support a good night’s sleep. These include going to bed and getting up at the same time each day to support your body clock, exercising during the day if you can safely do so and trying not to exercise too close to bedtime. Avoiding caffeine or nicotine close to bedtime – or reducing them if you can’t stop completely – can also help.

Be aware that alcohol might mean that you fall asleep faster, but it can disrupt the second stage of sleep, meaning that the quality of your sleep may be reduced, which can then lead to you feeling tired the next day.

It’s generally best to avoid things that may cause you upset or stress before your usual bedtime, like a difficult phone call or a scary TV programme. It is also important to reduce your exposure to blue light, for example from smartphones and laptops, before bedtime.

Blue light tricks your brain’s body clock into thinking it’s daytime and suppresses the production of melatonin. This is the hormone you need to feel sleepy.

Try to have a bedtime routine that supports you in winding down, whether that means a bath, listening to music or a relaxation CD. It’s also really important to ensure that your bedroom supports your sleep, so consider things such as lighting and temperature. Most people tend to find that a tidy bedroom can help the room feel more relaxing too.

Of course, many people with an acquired brain injury tend to experience fatigue and often find having a nap in the day can help them to manage this. But an afternoon nap should end before half past three in the afternoon at the latest, with your next sleep being in bed for the night. Headway has a very helpful section on its website regarding managing fatigue.

While bedrooms should predominantly be for sleeping, some people have been spending more time in them during the pandemic doing other things – perhaps using them as a quiet space to complete education or work.

For those in hospitals or care homes, increased bedroom time may be due to isolation procedures. If this is the case, perhaps consider having a chair or a beanbag to sit on, rather than lying on your bed during the day. Where possible, try to come out of your room for meals.

If you find it is taking a long time to get to sleep, try getting out of bed and doing something else, like reading a book or a magazine, and then return to bed when you are feeling sleepy.

The advice we have given here is in line with the recommendations on the NHS website.

A good night’s sleep is crucial to thinking at our best, which is especially important if you are working or being educated at home; and there are some other simple things that you can do to boost your productivity in these scenarios.

Firstly, make sure you have a shower and get dressed rather than working in pyjamas or dressing down. Getting dressed helps you to psychologically get into work mode. Have a designated workspace and, if possible, keep the area tidy.

Have a timetable of when you’re going to work and try to stick to it. As we’ve mentioned, writing a timetable down and ticking off jobs completed supports feelings of achievement. Make sure you schedule regular breaks during which you move away from the workspace. You might go into your garden or make a drink, for example.

Try to minimise distractions. That might mean moving your mobile phone out of reach, turning off the TV and considering where the quietest places are. If you live with other people, you might want to consider how to ensure they don’t disturb you. This might just mean letting them know what your work timetable is.

One distraction that can’t be ignored, however, is the need to wash our hands to prevent the spread of the virus.

We hope you have found this guide useful and wish you a safe and happy summer as we all continue to rise to the challenges presented by COVID-19.

This is one of five blogs in a series on living in the new ‘normal’ with a brain injury, based on a webinar produced for ABI London (ABIL). See below for links to other articles in the series. Dr Keith G Jenkins is consultant clinical neuropsychologist at St Andrew’s Healthcare and chair of Headway East Northants. Dr Jenny Brooks is a consultant clinical psychologist working independently and a director of The ABI Team. For any questions about this topic email update@standrew.co.uk. 

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WFNR reflects on 25 years of progressing neurorehab

The international group has helped make significant positive change for patients globally

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An organisation established to advance the development and improve the quality of neurorehabilitation across the world is marking its 25th anniversary. 

The World Federation for Neurorehabilitation (WFNR) is committed to advancing research, education and clinical practice in neurorehabilitation throughout the world, and is credited with helping to redefine and recognise the specialism.  

It is also hailed as helping to bring about significant positive change for patients globally. 

With over 5,000 members worldwide and 37 Special Interest Groups, the WFNR is also affiliated to 41 National Societies, showing the international reach it has built since its inception in 1996. 

Professor Mike Barnes, founder of the WFNR, said: “Our original aim has been met – to create a global organisation bringing together health professionals with an interest in neurorehabilitation.  

“It is now a recognised and respected sub-speciality of neurology. We now serve our patients much better than we used to and I think the WFNR has played a major role in that change. Thank you everyone!”

Following its landmark anniversary year, the multidisciplinary organisation will hold its 12th biennial World Congress for Neurorehabilitation which rotates around the continents, with the next WCNR heading to Vienna, Austria, from 14 to 17 December 2022.

“Today the WFNR is a true advocate for neurorehabilitation,” said Professor David Good, WFNR President. 

“We’re extremely grateful to all our members who have contributed to the success of the organisation in so many ways. Congratulations to the WFNR for all that it has achieved over the last 25 years.” 

Looking to the future Professor Volker Hoemberg, President-Elect said: “Neurorehabilitation has an exciting future. The WFNR will continue to play a major role as a ‘translational hub’, educating members about new science and technology.  

“There are so many new advances on the horizon; the use of brain computer interfaces, virtual and augmented reality, artificial intelligence, and better biomarkers to name just a few. 

“The future looks bright for our patients.”   

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Neuropsychology

People with prior mental ill health hit harder by pandemic disruption

Research lays bare impact on jobs and healthcare during the COVID-19 pandemic

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People living with depression or anxiety pre-pandemic have been more severely affected by disruption to jobs and healthcare, a new study has revealed. 

The research found that those with higher levels of anxiety and depression symptoms experienced a much greater likelihood of disruptions to both their professional and personal lives.

The study, which looked at data from 59,482 people, found that this group of people were 24 per cent more likely to have had delays to medical procedures, 12 per cent more likely to lose their job, and 33 per cent more likely to have had disruption to prescriptions or medication during the first eight to 10 months of the pandemic than those with average levels of anxiety and depression symptoms.

Lead author Dr Michael Green, of the University of Glasgow, said: “During the pandemic, many people lost their jobs or lost their income and faced disruptions to healthcare. Our study shows that this disruption was particularly likely to affect people with prior mental ill health.

“We need to ensure that healthcare and support for economic hardship are not overly difficult to access for these vulnerable people, especially as existing pandemic economic supports like furlough are removed.”

Professor Nishi Chaturvedi, of the MRC Unit for Lifelong Health and Ageing at UCL, who co-leads the COVID-19 Longitudinal Health and Wellbeing National Core study, said: “The anxiety and depression experienced by the participants of the study go beyond the mental ill health reported to GPs and healthcare services. 

“This is a largely hidden group of people vulnerable to potentially long-lasting health and socioeconomic consequences of the pandemic.”

Lead author Dr Giorgio Di Gessa, of the UCL Institute of Epidemiology & Healthcare, said: “Policymakers should take these findings into account in the provision of future healthcare and economic support, as failing to address these disruptions risks widening health inequalities further. 

“Special care should be taken by pharmacists and primary care staff to ensure people with mental health difficulties do not miss appointments, procedures and prescriptions.

“It is also important to note that pre-pandemic psychological distress was generally more common among women, younger generations, ethnic minorities, and those with fewer qualifications, meaning the overall impact of disruption on these groups is larger.”

The work was conducted as part of the COVID-19 Longitudinal Health and Wellbeing National Core study, led by UCL researchers and funded by UKRI. The study involved researchers at UCL, King’s College London, the University of Glasgow, the University of Leicester, the University of Edinburgh, and the University of Bristol.

In each of the longitudinal studies, respondents answered questionnaires designed to assess mental health about three years before the pandemic on average. They later reported the disruptions they experienced between March and December last year.

The researchers compared disruptions faced by people whose responses showed “average” levels of anxiety and depression to disruptions affecting people with more anxiety and depression than average, regardless of whether they had a clinical diagnosis or were seeking treatment for a mental illness.

The research team looked at the disruptions of the pandemic in three areas: healthcare (medication access, procedures or surgeries, and appointments); economic activity (employment, income, or working hours); and housing (change of address or household composition). 

They found that people with prior mental ill health were more likely to face economic and healthcare disruption, but had no greater likelihood of housing disruption.

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‘Make safety guidance enforceable rules’

The Drake Foundation says sport must “stop being tentative and go for enforced law changes rather than guidance” to protect players

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Guidance around safety protocols in sport must become enforceable to ensure players are properly protected, an organisation founded to fund research into head injuries has said. 

The Drake Foundation has called for more stringent enforcement of new policies to help improve player safety, including the guidance released by the FA which recommends only ten higher force headers in training each week. 

While the Foundation – which has enabled much of the groundbreaking research around sport-related head impacts – says it welcomes the guidelines, questions around their efficacy were raised when Tottenham manager Nuno Espirito Santo admitted he did not implement the recommended limit in his training sessions, saying “I do not count how many times out players head the ball”. 

Lauren Pulling, CEO of The Drake Foundation, said urgent action needs to be taken to ensure such important safety advice has to be followed, and governing bodies need to “stop being tentative” in their approach. 

Speaking to NR Times, she said: “I think for players to feel safe, youth players going into the game to feel safe, there need to be universal enforced law changes that minimise their cumulative exposure to head impacts, not just in the game but in training as well.

“We want to see more from sports governing bodies. We’re really pleased to see recent changes to guidelines like the limit on full contact training in rugby and guidance to reduce heading in football in training in particular – but we’d question whether it could go even further. 

“I think we need to stop being tentative and go for enforced law changes rather than guidance.”

Since its inception in 2014, The Drake Foundation has funded eight pioneering research projects to provide an evidence-based understanding of the link between sport-related head impacts and long-term health outcomes. 

The majority of these projects focus on rugby and football, including HEADING, BRAIN and the Drake Rugby Biomarker Study, with a goal of affecting positive change in professional sport, which can be translated into grassroots sports settings and have benefit to wider society. 

Having been one of the first funders of research in this area, and one of the first organisations to actively push for change around head injury in sport, the Foundation believes if change is not properly implemented, there could be serious consequences for participation as well as player health. 

“Not just within elite sports, but also in the amateur and grassroots game, people tell us action needs to be taken, not just for the athletes themselves but for the future of the game,” says Lauren. 

“What does the future of sport look like if people are dropping out? We need to see some big changes to protect the players and protect the game so we don’t see another generation of this happening. 

“We try to stay with the science, we provide the evidence base upon which sports governing bodies then make informed decisions. We do want to see more from sports governing bodies and hope the guidance becomes enforceable.”

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