Patients need motivation to recover. The NHS must offer hope | Kate Allatt

Our NHS is under attack from all angles. People are living longer, we don’t eat well or exercise enough. Yet we expect more from the NHS; more people are visiting A&E departments and minor injury units year on year, and costs are rising.

How do we tackle this? What if we focus on marginal gains, the performance strategy that helped British Cycling to success in multiple Olympics?

This is an approach that focuses on “small incremental improvements in any process adding up to a significant improvement when they are all added together”. Could this improve patient outcomes and reduce waste in the health service?

One incremental enhancement we could seek in the NHS might be to improve our understanding of and response to the barriers to patient motivation. For example, could we find a way of encouraging stroke survivors to practise their rehabilitation exercises as frequently and intensively as they are prescribed? Patient adherence to rehabilitation regimes after discharge from hospital is described as “less than ideal”. By addressing these barriers, we will be more able to efficiently allocate therapy time, and thereby reduce GP appointments and hospital readmissions.

You might wonder what makes me an expert on this.

L​owering ​​patients’ expectations of ​recovery​ can be extremely damaging

In February 2010, at the age of 39, I had a huge brainstem stroke and was diagnosed with locked in syndrome. I was on life support and in intensive care for nine weeks, and was then written-offin rehabilitation after a further six weeks. My husband received a phone call telling him that I would never walk or talk again.

Over eight painstaking months in rehabilitation, I obsessively willed my body back to life, practising actions or movements 450 times per week. Slowly I learned how to do basic things like eat again, and at the end of it all I walked out of hospital. I went for a run on the first anniversary of my stroke. I’m now a motivational speaker and go to the gym every day.

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I never gave up pushing my body to improve: to speak, to eat, to run and to hug my kids. I managed to use my bad prognosis to galvanise my recovery, but the risk is that lowering patients’ expectations of recovery can be extremely damaging. Recovery should be measured in terms of improvements, not “getting better” – and that is always possible. My only focus, with three young children at home, was on when I would achieve my goals, not if.

Since embarking on my career in advocacy and stroke activism, I’ve found many reasons why patients lack the motivation to try to help themselves. They may be suffering from post traumatic stress disorder, which is common after a stroke and, just like depression, it affects mood and motivation levels. The side effects of the drug treatments for strokes – sleeping pills and muscle relaxants – can also affect motivation. After a brain injury many patients suffer varying levels of executive dysfunction affecting the set of mental skills that help to get things done, which can be mistaken for apathy or laziness. The overwhelming tiredness felt by those suffering from neurological fatigue can leave patients unable to complete normal daily tasks and therefore non-compliant with their treatment plans. It may be that some patients simply hate exercising or have no family support.

It is futile prescribing a stroke rehabilitation plan if – for any of these reasons – the patient is unmotivated before the therapy session starts or they are left at home trying to manage their own condition. The NHS should be offering hope and encouragement to motivate patients. And to do that, they need to listen to expert patients.

My advice to the King’s Fund Leadership Summit is that we need a better understanding of patient motivation to help rebuild the lives of stroke survivors. If patients adhere to clinical advice about practising their exercises as frequently and intensively as I did, just imagine how much we could improve their outcomes and reduce the waste in the NHS. But to do this we must understand the complex reasons why patients don’t do this already and listen to those who have struggled through similar experiences.

I don’t promise anything when I speak to people now – I just offer possibilities. I talk about how to optimise improvement, but never use the word recovery. After a life-changing event none of us will ever be the same as we were, even if we physically improve really well. We need to embrace that new self and strive to be the best version of ourselves that we can be, both in hospital and back home.

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Patients need motivation to recover. The NHS must offer hope | Kate Allatt

Hitting the right note: the orchestra helping stroke survivors recover – video

Strokestra, a pioneering collaboration between the Royal Philharmonic Orchestra and Hull integrated community stroke service uses group music-making to drive recovery in stroke survivors. Patients try out instruments, listen to and play alongside world-class musicians. With funding from Hull Public Health, the pilot programme involved 50 patients and carers and ran from May to October 2015. This is their story

Hitting the right note: the orchestra helping stroke survivors recover – video

Nutritional Tips to Help Recover from Brain Injuries

Besides taking pain-killers to assist you while recovering from a brain injury, being aware of nutritional values can also assist post-TBI. From simple things like changing your diet and eating healthy, to looking towards natural remedies, there are many ways to help in your recovery. Listed below are nutritional tips to help recover from brain injuries.

Eat small meals, frequently.

Eating on a routine schedule, every three to four hours, helps your brain/body signals recover after head trauma. You should try and stick to healthy foods because weight gain commonly happens after a brain injury. Eat balanced meals that combine healthy fats and oils, carbohydrates, and protein. Healthy fats and oils include avocados and nuts. Fresh fruits, vegetables, and grains contain healthy carbohydrates; and lean meats, fish, beans, and eggs contain healthy proteins. Besides balancing healthy meals, you should also snack in between to boost your energy throughout the day. Small, healthy, snacks such as: fruit, trail mix, cheese, and energy bars will keep you fueled and satisfied.

Avoid alcohol, caffeine, smoking, and excessive sweets.

After a traumatic brain injury, it is best to stay away from substances that cause problems in concentration, memory, balance, and have been linked to increased headaches. Alcohol is known to impair cognitive abilities, and balance, which can lead to repeat injury; caffeine and nicotine have vasoactive substances that changes the size of the blood vessels in your brain, which can lead to headaches; and high-sugar foods can result in glucose abnormalities which can, also, trigger headaches. Studies show that people who consume these substances do not often recover completely, and recover at a much slower rate.

Skip the conventional drugs, and reach for natural remedies.

Effects of conventional drugs have been shown to have limited benefits in improving symptoms that result from brain injuries. Because of this, researchers have begun studying natural compounds and vitamins that have been proven to have neuroprotective and anti-inflammatory properties. These substances include green tea which contains epigallocatechin-3-gallate, L-theanine, and a lesser degree caffeine. Epigallocatechin-3-gallate has been shown to have antioxidants and anti-inflammatory effects in brain injury studies using animals. L-theanine offers protection from excitotoxic injury immediately following a concussion; omega-3 fatty acids and DHA which have been found to improve cognitive function, increases nerve repair, reduces nerve swelling, and stabilizes cellular energy production; and vitamin E, which has been shown to improve cognitive performance and reduce nerve damage.

Stay hydrated.

Because nausea and vomiting are known to follow a traumatic brain injury, it is best to keep meals light and stay hydrated; in order to regain the electrolytes, and fluids, lost after emesis. This is why it has been advised to drink fluids high in electrolytes to nurse a hangover after excessive alcohol consumption. It has been proven that there is a high risk of fainting due to dehydration which would, also, increase the risk of repeat injury.

Fish oil.

After suffering a head injury, you should double the dosage and take up to four grams of fish oil. You should continue this for seven days, according to Dr. Steelsmith, of Steelsmith Natural Health Center in Honolulu, Hawaii. It has been reported that fish oil contains large amounts of DHA and omega-3 fatty acids EPA that assist in healing a concussion as reported in the Journal of Neurosurgery.

Although staying healthy is something that should be done regularly, it has proven to also be the best way to help aid in the recovery of traumatic brain injuries. Eat right, stay hydrated, everything in moderation, and look towards natural remedies before reaching for any harsh medications. Stay healthy, folks!

References:

Nutritional Tips to Help Recover from Brain Injuries

Why did Andy Murray fail and how can he recover?

Prof Robertson says that turning into master of the thoughts is “the most critical variable” for excellent athletes like Murray, and unresolved conflict can be a “huge magnetism” that would make it hard for the brain to execute at peak degree.

“If he had had some type of emotional incident or some variety of conflict 5 minutes before the match, then it’s going to be significantly more hard for to be on top type and for consideration to be focused on exactly where it requirements to be,” he adds.

What else would have stopped Murray?

Winning the championship

Murray’s good results final year would also be “a huge monkey on his back” and would have dragged on his functionality, says Prof Robertson. Whereas ahead of Wimbledon, every win may give a sense of progress, this year Murray was evaluating himself to winning the championship in 2013, so it would be tougher to have a sense of achievement. “He hadn’t had that energy impulse above the final 9 months and that plays out in the brain,” he explains.

Choking

The significantly-feared sporting phenomenon of choking may have also played a element in Murray’s loss yesterday. When you succeed or count on to succeed, the brain secretes dopamine. And when a player chokes, seeming to lose handle of his game, it can indicate that the brain has launched to a lot dopamine in response to the intense emphasis on good results. “If you want it also a lot, if the stress is too great, then that exercise can go past optimal peak and can interfere with the orchestrated working of the brain that wants to function to precisely and in such a superbly synchronised way for this kind of large-level sport,” says Prof Robertson.

Public Stress

The potential King and Queen of England viewing Murray play would have been the “crowning point” of public expectation and pressure. Prof Robertson says that mass idolisation, or high status people desperately wanting him to win, would be an additional burden. “The leading athlete can control his or her mind and he has to neglect they’re there,” he explains.

But you can not attain accomplishment without having hitting a handful of troughs, so here’s how to choose oneself up…

Cheer up Murray: how to move on from failure

The morning soon after Murray was knocked out of the Wimbledon championship, he has to come to turns with losing that precious trophy. To help him cope with the failure, here are a couple of suggestions on how to move on from physiologist Dr Nerina Ramlakhan.

Stay Calm

To cope with failure and move on to good results, you have to discover to regulate your emotions. Dr Ramlakhan suggests breathing techniques, meditation and yoga as “power tools” to keep calm, but says that practice off the court will increase functionality in the game. “When you’re playing a game and you’ve received the eyes of the globe on you, you are not going to be pondering, ‘What’s that mindfulness method?’ It demands to turn out to be an unconscious competence.”

Turn off the negative voices

When you’re in a nerve-racking scenario, the portion of the brain that handles stress—the flight of battle response—can disconnect you from logic. “You may well start off to pay attention far more to that adverse self talk,” explains Dr Ramlakhan. “A whole lot of athletes have got to their level of achievement due to the fact they are perfectionists, they’re very difficult on themselves. But one particular has to find out how to flip the volume down on that voice.”

Eat nicely

“Really don’t fall into a self-pity slump of not hunting soon after your self but make confident to consume appropriately,” says Dr Ramlakhan. Nutrition can influence ranges of adrenaline, nicely-becoming hormones like serotonin and oxytocin, and melatonin to assist you rest. Murray should make positive to preserve his physique in a best state of balance.

Disconnect

The day soon after a main loss, athletes are allowed a blow out, says Dr Ramlakhan. Whether or not you dance at a celebration, view a film, or play a game, it’s critical to switch your thoughts off. “A whole lot of athletes have an component of introversion so it may possibly effectively be that he needs to get some time out and reflect on the game,” she adds.

Grieve

Murray ought to give himself time to mull above his reduction or beat himself up, if that is his tendency. “He could need some time to be quiet and grieve a bit,” says Dr Ramlakhan. “Do no matter what he demands to do to come to terms with what’s occurred and disconnect it. Have a cry if you require to, speak to someone about it, then choose yourself up and move on.”

Visualise achievement

Top athletes require to strengthen their cognitive muscle groups, and need to target on re-creating confidence by visualising success, as an alternative of focusing on failure, says Dr Ramlakhan. Pondering about mistakes—even in an energy to stay away from them—will only make the issue worse. For instance, if you are advised not to feel about pink elephants, you will most most likely pink elephants. Similarly, worrying about past errors can embed people routines in the brain. “You generate synaptic pathways that visualise that much more obviously, so you are going to go back and do the same factor again,” explains Dr Ramlakhan. “You need to exchange these neurological connections with ones that are more powerful: visualise what you do want, what did go effectively, and do that over and over once more.”

The very good news is that failure can be an exceptional instructor, and could be the path to potential accomplishment for Murray.

“You have to strategy it as a source of understanding rather than as a blot on yourself,” says Prof Robertson, “I think he’s a sophisticated enough person that – assuming items are going Okay in his lifestyle a lot more normally – he will be capable to conquer this.”

You might have misplaced this time, Murray, but the Wimbledon title will be waiting to be reclaimed. There is constantly up coming 12 months.

Dr Ian Robertson is writer of The Winner Impact, which uncovers the psychology of success.

Dr Nerina Ramlakhan is a pressure professional at Capio Nightingale Hospital and author of Exhausted but Wired, on how to overcome sleep issues.

Why did Andy Murray fail and how can he recover?

Rachel Kelly: How poetry helped me recover from depression

When I was awake in the dark hours of the evening, and suffering from that sense of full isolation that is at the heart of feeling depressed, I would repeat these snatched lines to myself, prayer-like. I wasn’t alone right after all.

Assessment: Sane New Globe: Ruby Wax on beating depression

It was only when the antidepressants started to work that I could focus on entire poems – and only short ones. I turned to Gerard Manley Hopkins’s poems which celebrate the healing power of nature, poems this kind of as Pied Beauty. Nature was reaching out and grabbing me by the collar as I recovered, my mood completely summed up by Hopkins’s celebration of even the smallest miracles of creation. The language performed for me, rekindling my enthusiasm for phrases and refreshing my own stale vocabulary.

Glory be to God for dappled factors –

For skies of couple-colour as a brinded cow

For rose-moles all in stipple upon trout that swim

Fresh-firecoal chestnut-falls finches’ wings

A poem can also give a various narrative from the adverse story in our heads. This was how I felt when I read through George Herbert’sLove (III) for the duration of my 1st breakdown. During the very first verse I felt a bolt of electrical power pierce via me. All the hairs on my arm stood on end. It was the 1st time that had happened in a even though.

Really like bade me welcome,

But my soul drew back,

Guilty of dust and sin,

But sweet-eyed love, observing me expand slack,

Did welcome me in.

Yes: my soul had been drawing back. Yes: I required enjoy to bid me welcome. The thought that my soul was “guilty of dust and sin” appeared the most perfect description of the depressive sickness. The poem pinpointed a sense of guilt that I should be depressed whilst blessed with a loving residence and husband, one thing I had not previously acknowledged. Herbert’s words had been bursting through the clouds of my mind. It appeared we had been to the very same location and spoke the same language, albeit that his go to was centuries in the past. I had identified a companion on my journey.

I’m not the initial to derive comfort from poetry. Apollo was the god of poetry as effectively of medicine. In 1751 Benjamin Franklin founded the very first American hospital, the Pennsylvania Hospital, in which studying and inventive writing were between the remedies prescribed for psychological illness. Freud, Adler, Jung and other people recognised the healing energy of phrases, and this led to the 1969 founding of the Association of Poetry Therapy.

Read: GPs to prescribe library books to fight nervousness, depression and romantic relationship issues

These days, figures in the literary and philosophical worlds advocate their own brands of healing phrases. Alain de Botton‘sThe School of Existence has lately begun programs in mindfulness and poetry. William Sieghart, the founder of the Forward Poetry Prize, invites audience members at literary festivals to request “Poetry Prescriptions” to suit their certain emotional and psychological demands. As Boris the bard, endorsing the importance of poetry, humorously suggests, “There is no acknowledged disaster, That poetry can’t master.”

There’s even some scientific proof that poetry adjustments the way we think. The arrangement of poetry, even the clearest, has distinct conventions to constant prose. This presents enough of a challenge to get our brains working differently. Research by Philip Davis and the neuroscience department of Liverpool University discovered that readers of Shakespeare, when they came across an uncommon but entirely comprehensible grammatical development, would show a spike in neural activity. Even even though the readers understood what was being stated, their brains have been shocked into activity. The requirement to concentrate in the second helped me quit regretting the past and fearing the long term in the adverse mental spiral characteristic of depression.

In this way, poetry can work in a similar way to mindfulness, forcing us into the current. Robert Frost, demonstrating my level properly, put it far greater when he said a poem can be a ‘momentary remain towards confusion.

Black Rainbow, my memoir about how poetry helped me recover from depression, started existence as a series of poetry recommendations to buddies. They knew what I had been through and asked for poems I thought could aid them in instances of need to have. With the book’s publication, readers have been sending me the poems and prose that have assisted them. Quickly probably I won’t need to have to clarify that poems can be as good as tablets in assisting you recover.

Rachel Kelly’s memoir about how poetry helped her recover from depression, Black Rainbow: How Phrases Healed Me – my journey via depression’ is published by Yellow Kite Books, a subsidiary of Hodder &amp Stoughton, £16.99. All author proceeds are going to the charities SANE and United Response.

Read through: How writing aided Edward St Aubyn exorcise his demons

Rachel Kelly: How poetry helped me recover from depression

How poetry aided me recover from depression

When I was awake in the dark hours of the night, and struggling from that sense of complete isolation that is at the heart of feeling depressed, I would repeat these snatched lines to myself, prayer-like. I wasn’t alone right after all.

Assessment: Sane New Planet: Ruby Wax on beating depression

It was only when the antidepressants started to work that I could concentrate on whole poems – and only brief ones. I turned to Gerard Manley Hopkins’s poems which celebrate the healing power of nature, poems this kind of as Pied Attractiveness. Nature was reaching out and grabbing me by the collar as I recovered, my mood completely summed up by Hopkins’s celebration of even the smallest miracles of creation. The language performed for me, rekindling my enthusiasm for phrases and refreshing my very own stale vocabulary.

Glory be to God for dappled factors –

For skies of couple-colour as a brinded cow

For rose-moles all in stipple on trout that swim

Fresh-firecoal chestnut-falls finches’ wings

A poem can also supply a different narrative from the unfavorable story in our heads. This was how I felt when I read through George Herbert’sLove (III) during my initial breakdown. In the course of the very first verse I felt a bolt of electrical energy pierce through me. All the hairs on my arm stood on finish. It was the initial time that had occurred in a while.

Enjoy bade me welcome,

But my soul drew back,

Guilty of dust and sin,

But sweet-eyed adore, observing me expand slack,

Did welcome me in.

Yes: my soul had been drawing back. Yes: I needed adore to bid me welcome. The concept that my soul was “guilty of dust and sin” seemed the most excellent description of the depressive sickness. The poem pinpointed a sense of guilt that I ought to be depressed even though blessed with a loving home and husband, something I had not previously acknowledged. Herbert’s phrases have been bursting by means of the clouds of my mind. It appeared we had been to the identical place and spoke the same language, albeit that his pay a visit to was centuries in the past. I had found a companion on my journey.

I’m not the very first to derive comfort from poetry. Apollo was the god of poetry as effectively of medicine. In 1751 Benjamin Franklin founded the initial American hospital, the Pennsylvania Hospital, the place reading and innovative writing were amid the treatment options prescribed for psychological illness. Freud, Adler, Jung and other folks recognised the healing power of words, and this led to the 1969 founding of the Association of Poetry Therapy.

Go through: GPs to prescribe library books to fight nervousness, depression and romantic relationship troubles

Today, figures in the literary and philosophical worlds advocate their personal brand names of healing words. Alain de Botton‘sThe School of Existence has lately begun courses in mindfulness and poetry. William Sieghart, the founder of the Forward Poetry Prize, invites audience members at literary festivals to request “Poetry Prescriptions” to suit their distinct emotional and psychological wants. As Boris the bard, endorsing the relevance of poetry, humorously suggests, “There is no recognized catastrophe, That poetry can not master.”

There’s even some scientific proof that poetry adjustments the way we feel. The arrangement of poetry, even the clearest, has distinct conventions to steady prose. This presents ample of a challenge to get our brains operating in a different way. Investigation by Philip Davis and the neuroscience division of Liverpool University found that readers of Shakespeare, when they came across an uncommon but entirely comprehensible grammatical development, would display a spike in neural activity. Even even though the readers understood what was getting explained, their brains had been shocked into action. The necessity to focus in the minute helped me end regretting the past and fearing the long term in the damaging mental spiral characteristic of depression.

In this way, poetry can work in a equivalent way to mindfulness, forcing us into the present. Robert Frost, demonstrating my level flawlessly, place it far greater when he explained a poem can be a ‘momentary remain against confusion.

Black Rainbow, my memoir about how poetry helped me recover from depression, began daily life as a series of poetry suggestions to buddies. They knew what I had been by way of and asked for poems I considered could help them in instances of want. With the book’s publication, readers have been sending me the poems and prose that have aided them. Soon maybe I won’t need to clarify that poems can be as great as pills in helping you recover.

Rachel Kelly’s memoir about how poetry helped her recover from depression, Black Rainbow: How Phrases Healed Me – my journey through depression’ is published by Yellow Kite Books, a subsidiary of Hodder &amp Stoughton, £16.99. All writer proceeds are going to the charities SANE and United Response.

Study: How writing assisted Edward St Aubyn exorcise his demons

How poetry aided me recover from depression