Out and about best thing for brain injured
Brain-damaged people benefit by resisting the urge to withdraw from the world. Elisabeth Wynhausen reports

November 12, 2005

ROGER Rees first saw Adelaide man Bill Verrier four or five years after the industrial accident that had left Verrier brain-damaged. Verrier, then in his early 40s, was in a wheelchair. He could sit, but not much else. His right arm dangled uselessly. He had very little speech and had lost the ability to swallow.

Verrier still presents a disconcerting sight. Despite years of surgery, his face is disfigured. He drools a bit because he has little control of his salivary glands.

To top it off, he is covered in tattoos and gets about in a Hell's Angel T-shirt. But when people see Verrier they visibly brighten - he emanates resilience, says Rees, renowned for the rehabilitation of brain-injured people.

Since that first meeting with Rees eight years ago, Verrier has learned to communicate. He now walks with a quad stick.

"I just persuaded an insurance company to provide him with a state-of-the art treadmill. He's walking on the treadmill against all the odds. He's a street fighter," says Rees, who regards Verrier as the embodiment of the perseverence and positive spirit critical to the rehabilitation of brain-damaged people.

"He just says 'well, I've got one life, I've got to make the most of it'."

The same could be said of the singular Rees, the Emeritus Professor of Disability Studies and Rehabilitation Studies in the School of Medicine at Flinders University in South Australia, a white-haired iconoclast with the demeanour of a kindly uncle.

"He's not like any other psychologist I've ever met," says Jaime Gardner, the manager of the community re-entry program Rees established at Flinders University 15 years ago.

"People with brain injuries see him more as a friend than as the doctor treating them."

It is as if Rees manages to enter into the sometimes closed-in world of the brain-injured, which means that he treats them as complex individuals rather than as a collection of "deficits", the usual approach of neuro-psychology texts.

"Brain injury," as Rees notes, "is the greatest single cause of permanent acquired disability in our society."

No fewer than 30,000 people a year in Australia are admitted to hospital with brain injuries, usually as the result of traffic accidents. Most recover, but some 2500 a year, mostly young men, are left with severe permanent disability.

In his book, Interrupted Lives: Rehabilitation and learning following brain injury (IP Communications, 2005), Rees writes: "When their injuries occur, they are thrust into a chaotic and mysterious world swinging between being and non-being. They no longer function in customary ways ...

"Rather, they are open to the effects of their injury every waking hour. They cannot get away from it and for some, devoid of help, it is too much to bear. One strategy is to withdraw."

Though retreating to a bed in a curtained room will make brain-damaged people feel safe, their rehabilitation depends on them having demands made upon them.

"The brain is used to responding to physical demands, intellectual demands, to social demands," Rees says. "It's wired like that. Even if areas are damaged (and the damage is diffuse), through meaningful activity ... we can generate information flow - which does not occur when a person is left to their own devices."

While the lack of facilities throughout Australia means other programs for brain-injured people typically allow a defined time to show improvement, the Flinders program is more open-ended.

"People can go on developing," says the optimistic Rees. "If you give them roles to play, and responsibilities, invariably they rise to it, provided you have a structure."

Only that day Rees had talked to a brain-injured man on anti-depressants, suggesting the centre help him get into a training program which leads to a job as a security guard, for instance, in a shopping centre. "He has good interpersonal skills. So we're recognising his strengths rather than his deficits."

This is critical, according to Rees, who likes to spout poetry and can sound like a 60-something hippie (promoting peace, understanding and "positive language templates" to reshape the way brain-injured people feel about themselves).

The fundamentals of his approach came together after someone took Rees into the back wards of the Royal Adelaide Hospital.

He decided it was possible to do something; at a time when rehabilitation programs were more or less restricted to activities in hospitals, Rees and a group of his students took some 20 young people with brain injuries for a long weekend to an old house on Hindmarsh Island.

It was the first of many such outings. In Interrupted Lives Rees observes that people "who have experienced the trauma of brain injury or stroke find themselves out of step with their family, friends and community".

"Unless there is a concerted effort to build friendships, provide support for them and their families, and include them in every aspect of family and community life, there is little chance of rehabilitation."

In the community re-entry program "each person with brain injury is assigned a mentor who supports and guides them as they try to come to terms with change in every aspect of their lives, from the basics of walking, talking and thinking to learning everything anew.

"We're trying to give participants greater autonomy by making them the centre of their own community," says Rees. "We've developed social networks for these people across the city.

"There's one participant, a 33-year-old man who developed epilepsy following a traumatic injury and needs anti-convulsive medication to control his seizures."

Rees himself talked with the man's chemist, who now monitors the required medication, sees him every three days and goes to his house if he doesn't show up at the pharmacy. The man needs to take his medication with food, so Rees has introduced him to the people in a nearby cafe. The result, says Rees, "is that he now finds taking the medication there quite easy." The 33-year old, like every other participant, has trouble managing money. "We get in touch with their local banks (which) develop an understanding relationship with them."

This is the essence of what Rees calls "connoisseurship". In his view connoisseurs of brain injury are people with a thorough understanding of the subject.

"As people in the community improve their understanding, then they can become effective advocates or mentors for people with brain injury," he says. "When this occurs, people with brain injury ... no matter how disabled, are more likely to be included in everyday activities."

But even in Adelaide, that day is still a long way off.

"If I drop my guard, or my colleagues drop their guard," says Rees, "all these guys will disappear into nursing homes or be wandering the streets, not knowing what to do."

http://www.theaustralian.news.com.au/common/story_page/0,5744,17206388%255E23289,00.html