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How outdoor activities can support individuals in their recovery from brain injury - Bill Braithwaite QC

27/08/19. For many years practising as a brain injury specialist, I've seen people who, following severe brain injury, have found salvation in outdoor activities.

The outdoors offers such a wide range of therapeutic options, from the peace and quiet of fell walking and fishing, to the excitement and drama of white water, kayaks, competitive sailing, and much, much more. So, when the Lake District Calvert Trust decided to open a brain injury rehabilitation unit, centred round its wonderful outdoor facilities on Bassenthwaite Lake, I was thrilled. In fact, I thought that the launch of what will be the UK’s first intensive Acquired Brain Injury (ABI) rehabilitation centre focused on outdoor activities is the most exciting development in brain injury rehabilitation for the last twenty years.

Calvert Reconnections, run by the Lake District Calvert Trust, will open its doors shortly after a £1 million fundraising programme. They have converted a wonderful, old, restful, listed barn into a residential unit for up to a dozen participants, and are going to use all the fantastic facilities which they have built up over many years, coupled with dedicated and knowledgeable staff with vast experience of disability, and corresponding and developing ability.

Working with leading clinicians and academics, the new centre will combine traditional multi-disciplinary clinical therapies with physical and sporting activity in the outdoors to support individuals in their recovery from brain injury, and in their return to an enjoyable life.

Activities included in the programme include canoeing, hand biking, cycling, rock climbing, orienteering, sailing and horse riding. The focus is on ‘learning through doing’ in the outdoors, supported by a multi-disciplinary team in a purpose-built residential centre. I am very hopeful that they will gradually widen the range of activities, to include for example gardening, vegetable growing, and many other restorative pastimes. For those with severe brain injury, for whom competitive employment is not an option, time can hang heavy on their hands, and so activities such as these may be a lifetime blessing.

Various studies suggest that outdoor activities can help individuals in their recovery from brain injury.

For example, one paper found that physical exercise has the potential not only to improve physical health but also to have a positive effect on mental alertness and mood in the general population. Exercise can result in an increase in self-esteem and self-worth in all age groups from children to older adults (Baumeister RF., Campbell JD., Krueger JI., and Vohs KD., Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles? Psychological Science in the Public Interest 2003; 4: 1-44).

Studies on the benefits of outdoor activity in addressing problems associated with Traumatic Brain Injury (TBI) also point to improvements in self-esteem, self-confidence, increased control, memory and planning.

A one-year outcome study of a three-day Outward-Bound Experience (Lemmon J., LaTourrette D., and Hauver S., One Year Outcome Study of Outward-Bound Experience on the Psychosocial Functioning of Women with Mild Traumatic Brain Injury) recorded a range of positive outcomes.

At the one-year evaluation, 83% of the participants ranked themselves above their pre-course rating in an understanding of their strengths and limitations. Other positive changes over the same time span included: ability to rely on others (50%), higher self-esteem (58%) and improvement in problem solving (50%). It was commented that the outdoor challenge course allowed therapists to help the participants recognise and acknowledge their thoughts, feelings and behaviours during the course and that one year later the participants were calling on this understanding to improve their daily functioning.

Another UK pilot programme (Walker A., Onus M., Doyle M., et al., Cognitive rehabilitation after severe traumatic brain injury: A pilot programme of goal planning and outdoor adventure course participation), incorporated a context-sensitive approach to cognitive rehabilitation with a focus on goal planning with goal attainment as an outcome measure. The results revealed a high level of achievement (over 80%) on selected, identified, specific and mainly practical goals. In discussing the results, the authors considered the strength of the project appeared to lie in partly in the motivation provided by the outdoor activity course, which appeared to later encourage participants to work towards broader goals.

The Calvert Reconnections Process

Step 1: Pre-Admission Clinical Assessment and Screening

A clinical assessment, based on medical history, reports and progress, will be undertaken by qualified senior staff to confirm that the programme will be of benefit to the participant. The assessment will underpin an individualised care and rehabilitation plan that will be formally agreed with the participant and their advisors. This plan will identify both the course duration, their start date, any additional support required and the cost of the programme.

Step 2: Admission & Assessment

A two-week period of ongoing assessment as part of the admissions process to support the participant in transitioning to the new environment and rehabilitation programme. The clinical assessment will be reviewed and the programme further tailored to ensure that individual needs are being met and suitable rehabilitation goals are being set.

Step 3: Ongoing Rehabilitation Provision

Typically, a 10 to 24 week programme of residential rehabilitation tailored to the individual’s needs and focusing on developing cognitive and executive skills. Participants, clinical staff and the Trust’s specialist team of coaches will work together to plan, undertake and maximise the benefits of challenging activities in the unique environment of the Lake District. The focus will be on achieving personal goals and enhancing cognitive and executive skills. Regular reviews and assessment of progress are completed with the senior staff team.

It will be very exciting when it opens!

Bill Braithwaite QC is a trustee of the Lake District Calvert Trust (LDCT).

Bill sits on the LDCT Board and advises on a number of key initiatives, including the launch and development of Calvert Reconnections, the UK’s first intensive Acquired Brain Injury rehabilitation centre focused on outdoor activities.

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