UK: NICE Guideline: Rehabilitation for Chronic Neurological Disorders Including Traumatic Brain Injury

There's an acquired brain injury clinic in one of the hospitals here in Belfast and it seemed to have a high proportion of young rugby players. I know of one person, who was told by a Doctor that they may have ME/CFS, who was briefly referred to this clinic.

 

Hopefully they are trying to help and they have the support of other clinicians to try to treat "Chronic Neurological Disorders Including Traumatic Brain Injury". However, the title brings to mind the comment "sorry, I haven't a clue".

 

Apparently, people with Acquired Brain Injury have reported being first misdiagnosed with ME/CFS.

 

@Hutan

Would FND then be considered physical as in the case of the above?

 

Interestingly, in the case of 'FND Acquired Brain Injury', a lot more support, rehabilitation, and medical care are offered.

It seems possible the excluded conditions 'disclaimer' in the scope indirectly implies ME/CFS and LC are the two possible acquired brain injury conditions.

The new NICE Guideline looks like it is being created to align the following existing guides of care.

 

You know, I think this may be the most accurate definition of FND ever. In the end, it really is just all about loopy cycles with labels and arrows, same as how it started. Although when you think of it, it's completely expected that people stuck in circular reasoning would only produce circular arguments.

 

For mentioned reasons, I thought it was just another unproven new age theory. I’m surprised to see it recognised by NICE as part of established neurology.


The lengths these people will go to have no ends.

 

This information on how to ‘tackle’ the rise of FND has been taken from a law firms website. The tone and approach is eerily similar to a well known insurance advisor. Blame is now being placed on doctors and case managers for perpetuating the idea that the patient is ill due to organic causes without visible brain injury imaging.

https://www.blmlaw.com/news/the-rise-of-functional-neurological-disorder-and-how-to-tackle-it

Some information on Claire Collins expertise.

https://www.blmlaw.com/people/claire-collins

 

It looks like someone is back in the business of undoing biological medicine....

Which way this guideline goes will be telling.
The law firm’s advice says FND is treatable, but it doesn’t name the secret treatment. My bet is CBT and graduated activity.

 

I see no definition of "functional". Surprising from a partner in a law form.

 

The piece mentions nothing about the fact that law firms now contact people with minor head injuries unsolicited and try to encourage them to make claims.
The whole thing is of the legal industry's making it seems.
The good thing about the quoted article is that it is so garbled and incompetent that most doctors will see through it. That is not to say that the professional rehabilitationists will not lap it up.

 

I was struck by the similarities of some of the ideas to those of Arthur Cott of McMaster from circa 1985. We know that he worked with major insurance companies in drawing treatment guidelines on behalf of the Canadian Insurance Bureau in circa 2000.

 

I agree, and you honestly also can't miss the similarities between ME/CFS and ABI. From my reading of various sources, it feels like ME/CFS has been syphoned off Acquired Brain Injury due to it not being recognised by neurology, and NTBI can't be viewed using brain imaging.

I made a second call to Headway today to discuss my inability to wake up, a clear symptom of brain injury I have yet to see defined in any ME/CFS resources. A different operative this time agreed it is very different from general fatigue. She recommended requesting a referral to a neuropsychologist specialising in brain injury as post-viral syndromes can also involve injuries that aren't visible in scans, so neuropsychological assessments are used to determine its presence.

 

ABI - Acquired Brain Injury
NTBI - Non Traumatic Brain Injury.
@Trish I think that’s correct.

 

@Keela Too is correct. Sorry for not clarifying the abbreviations.

 

I should also add non-Traumatic Brain Injury (nTBI) is more often referred to as Traumatic Brain Injury (TBI) or Acquired Brain Injury (ABI) without the distinction, so it appears to be covered less extensively. A bit like NICE’s omission of mentioning indirect head injury within the current head injury guidelines, which a Coroner raised issues with.

Up-to-date NICE acknowledge sometimes the guidelines do not make clear what life changing conditions are covered. I wonder how many other conditions are in the same boat that need a coroners letter to rectify.

 

Latest update.

Dear Colleague,


RE: NICE committee to develop a Rehabilitation for Chronic Neurological Disorders Including Acquired Brain Injury guideline

The National Guideline Alliance (NGA), on behalf of the National Institute for Health and Care Excellence (NICE), is looking to recruit committee members to develop a clinical guideline on Rehabilitation for Chronic Neurological Disorders Including Acquired Brain Injury.

We are looking for experts in Rehabilitation for Chronic Neurological Disorders to join our clinical guideline committee. We need people with a professional or practitioner background in the topic.

Chronic neurological disorders include:

1. acquired brain injury (causes including trauma, tumours, infections, metabolic insults and disorders of the blood supply)

2. acquired spinal cord injury resulting in neurological impairment

3. acquired peripheral nerve disorders

4. progressive neurological diseases (including Parkinson’s disease, multiple sclerosis, motor neurone disease and Duchenne’s muscular dystrophy)

5. functional neurological disorders

See the scope of this guideline for further information about what will be covered.

The committee membership has been produced based on the topic areas that will be covered in the guideline. We are recruiting for the following areas:

Core members of the committee (who would be expected to attend all meetings):

· General practitioner

· Dietician

· Commissioners of services which may impact on people with CND. 1-2 committee members e.g. health, social care, education.

Co-opted members (who would attend 1 or 2 meetings):

· Individuals who support people with CND in access/return to education or work and leisure. 1-2 committee members e.g. special educational needs advisors, vocational rehabilitation advisors.

· People in social care roles who are involved with assessing/interventions for people with CND. 1-2 committee members e.g. social worker, care worker


If you or any of your colleagues would like to apply, there are more details on the NICE website.

Applications must be sent to NGAApplications@RCOG.ORG.UK for the attention of Hayley Shaw by 12pm on Monday 14th March 2022.

We would appreciate it if you could circulate this information widely in your organisation and to any other people or organisations who may be interested in this topic.

If you have any queries about Committee membership or the recruitment process, please contact Lisa Boardman at LBoardman@RCOG.ORG.UK.

Kind regards,

Hayley



Hayley Shaw | Project Manager