Page 19 - PIC Magazine Autumn Issue 16

One case study clearly demonstrates this and just how music can rapidly change the direction of effective rehabilitation within a MDT. As a result of a cycling accident, the patient suffered numerous effects from his TBI. He presented with challenging behaviour and was in a prolonged state of post traumatic amnesia in which he was not oriented to time or place. He had a tracheostomy to help with his breathing and was fed by a tube, which he would frequently pull out, so his hands had to be restrained.
He was also in a wheelchair but Physiotherapy had helped him become able to stand assisted, though his balance remained poor.
His challenging behaviour meant physio was difficult and unsurprisingly, he became disengaged with the whole process of rehabilitation.
Following his disengagement, a multidisciplinary team became involved in Mark’s recovery including physiotherapy, occupational therapy, SaLT and psychology. As part of this team, Chroma also introduced the patient to NMT.
Through participation in group music therapy, and choosing and watching music videos that were personal to him, helped improve his concentration and level of engagement, so much
so, he was able to maintain focus whilst practicing balance and standing with the physio – something that
had not been possible before due
to disengagement. Rhythmic guitar playing was also used to improve pacing and symmetrical walking patterns during physiotherapy.
NMT also helped improve his level of communication and his recovery continues to improve today.
Through NMT, new neural pathways can be created, bypassing the damaged brain tissue, which makes it possible for victims of a brain injury to re-learn and develop a degree of movement, coordination, speech, motor skills, even emotions – results first thought almost impossible
to achieve. Effective rehab in the acute phase of a brain injury is fundamental to achieving the very best rehabilitation outcomes for the patient.
The personal gains that can
be achieved through effective rehabilitation demonstrate the need. But what about the cost?
Savings in cost of care or support are calculated on the basis of difference between pre-rehabilitation and follow- up support costs minus the costs of rehabilitation. Worthington found
that initial costs of rehabilitation are generally offset by savings in care costs within 2 years. Wood et al concurred that with less dependence and support required as a result of effective rehabilitation, can amount to a per capita lifetime reduction of over 1 million pounds per annum in the cost of supporting such people in the community.
A brain injury can affect the victim in numerous ways which is why a multidisciplinary team is required for rehab to prove effective. One team cannot do it all. To address the effects of the brain damage, specialists in each field are required, for example physiotherapists for helping rebuild muscle strength.
Post-acute Neurologic Music Therapy (NMT) can have a positive impact on the lives of individuals living with a brain injury and any associated costs are off-set by significant savings in the longer-term.
Again, the biggest cost is incurred
through the constant after-care
required to support the victims’
daily living. Effective rehabilitation
from the onset of injury would help
alleviate this cost, as Wood suggested.
Studies show the cost effectiveness of
rehabilitation is greatest for those who
receive treatment within 2 years of injury. (1,2,3,4)
With the right rehabilitation from
the onset of injury, the brain can be rewired in order to learn skills that have been lost due to damage to the brain. Communication, cognitive skills, motor skills, can all be improved with NMT. NMT uses music as a hardwired language to create new neural pathways which allows the body to re-learn skills.
With NMT, the possibility of the victim being able to regain some sort of independence is high. And though
in the short term, therapy may seem to be expensive, when you offset
the savings in aftercare and support, the overall costs become much less of a burden on the economy and the healthcare sector.
The personal gains experienced by patients as well as the clear cost effectiveness of acute phase
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References:
1. Brain Injury, 1999, VOL. 13, NO. 2, 69± 88, Clinical and cost effectiveness of post-acute neurobehavioural rehabilitation, R. L1. Wood, J.D. McCrea, L.M. Wood and R.N. Merriman
2. Brain Injury, August 2006; 20(9): 947–957, Cost-benefits associated with social outcome from neurobehavioural rehabilitation, Andrew D. Worthington, Sarah Matthews, Yvonne Melia, & Michael Oddy
3. Neuropsychological Rehabilitation 2007, 17 (2), 230–243, Efficacy of rehabilitation for functional skills more than 10 years after extremely severe brain injury, Liz Parish and Michael Oddy
4. Brain Inj, Early Online: 1–8, The clinical and cost-benefits of investing in neurobehavioural rehabilitation: A multi-centre study, Michael Oddy, & Sara da Silva Ramos
Daniel Thomas
Joint Managing Director of Chroma Therapies.
PARTNERS IN COSTS
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