Mental exercises

Several thousand British adults, children and adolescents suffer severe traumatic brain injury (TBI) each year, typically in car accidents. Many other adults acquire such injuries in the workplace. They affect all aspects of the victim's life: physical, cognitive, emotional, behavioural and social, and do so both at home and in work and educational settings. The lives of their family are also transformed for the worse. For example, the extra strain on marriages causes most to fracture within a few years of injury.

Without intensive and extensive rehabilitation the great majority of adult and child victims suffer a long-term loss of independent functioning, requiring many hours of care each day, a drastically reduced quality of life and a total inability to return to work. Effective rehabilitation changes all that for most severe TBI victims, resulting in massive benefits to the victim and to their family - as well as to insurers in the form of reduced levels of settlement.

The results of rehabilitation for severe TBI are now accumulating. DN Cope, a leading American expert, has concluded: "A very strong case can be made for the assertion that TBI rehab works. It works in ways that make a worthwhile difference to TBI victims and to society."

British and American research reports all agree with Cope's statement in finding a reduction of at least 50% in the need for care, with about one-third returning to some form of work. American results for the home-based approach seem rather better than for the residential variety; this has been supported by our own experience at Reach.

Rehabilitation works
We reviewed our completed adult rehabilitation cases from mid-2003 to mid-2004, comparing the situation at the beginning and at the end of rehab (contact with our clients is very difficult once rehab ends). Before rehab their average daily care need was 16 hours per day and none had returned to work since injury. After the completion of the rehab programme their average care need was for 4.7 hours per day (meaning that many of them were completely independent in their daily lives) and 80% had returned to either full- or part-time work, or were in a position to do so.

Rehabilitation after severe TBI is already cost effective. How can it be made significantly more so? One possible answer may be found in the rapidly developing field of neurogenesis.

For many years neuroscientists and those working with TBI victims believed that there is no way to repair either the damaged or the ageing brain - and that TBI in the middle aged and elderly was particularly intractable.

However, in 2005 a key study on mice was reported in the Journal of Neuroscience and was reviewed in The Economist. It found that physical activity beginning in old age, even after an inactive life, can help rescue the brain from mental decline. Exercise seems to stimulate the growth of new neurons in certain parts of the brain, a process termed neurogenesis.

Physically active young mice performed better on tests of new learning than their physically inactive counterparts. This was also true, although to a lesser extent, for older animals. It showed that the difference in performance was related not only to level of activity, but also to what was going on in the animals' brains. In short, physical activity promoted neurogenesis and the new neurons were responsible for improved performance.

What of humans? It has already been shown that we can also grow new neurons, even as adults. There is a long way to go but the implications for people may be rather straightforward: exercise may fight the ravages of age, not just on your body, but in your mind as well. It is an even further step to the rehabilitation of TBI. But we can speculate that appropriate combinations of physical and mental exercise, in addition to the right diet, may further improve both rehabilitation outcome and its cost effectiveness.

' Heather Batey and Phil Feldman are with Reach personal injury services