How outdoor activities can support individuals in their recovery from brain injury
August 14, 2019
I’ve spent the last quarter of a century seeing families with catastrophic brain injury; the main focus of our discussion is that the family need to have a plan for the whole of the injured person’s life, even if that stretches over 50 years ahead. Because most of my clients are too badly injured to ever work, leisure becomes an important part of the discussion and plan; how will they fill their days with real enjoyment and without boredom and frustration. I must have discussed an awful lot of leisure activities, and most of them are outdoors. One of my earliest clients became an avid fell walker, and that ticked all the boxes for him; exhilarating in all weathers, and giving a variable range of experience, wonderful settings, tranquil, solitary, and healing.
So when I discovered that a new brain injury rehabilitation unit was to be opened in the Lake District, based on existing, extensive outdoor activities, I was interested and excited.
As a result, I’ve now learnt a bit about the research that suggests that outdoor activities can help individuals in their recovery from brain injury. To start with, one paper found that, in the general population, physical exercise has the potential to have a positive effect on mental alertness, mood, self-esteem and self-worth in all age groups (Baumeister RF et al, Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles?).
Studies on the benefits of outdoor activity in addressing problems associated with traumatic brain injury 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 et al,) recorded a range of positive outcomes. 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.
A UK pilot programme (Walker A et al,….. A pilot programme of goal planning and outdoor adventure course participation), revealed a high level of achievement (over 80%) on selected, identified, specific and mainly practical goals. The authors considered the strength of the project appeared to lie partly in the motivation provided by the outdoor activity course, which appeared to later encourage participants to work towards broader goals. Motivation can be hugely important following severe brain injury.
Rehabilitation aims to provide the tools needed for people to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. This should be relevant to their daily life. This holistic approach with contextualised interventions results in “learning by doing and reflection”. Experiential learning and rehabilitation through outdoor activity is therefore about improvements in self-esteem, self-awareness and self-confidence, lifting of mood and clinical depression, as well as cognitive improvements. Importantly learning can then be internalised, and transferred and applied to daily life.
As always, claimant lawyers should claim for the cost of optimal (outdoor) rehabilitation, coupled with maintenance top up, for life.
Bill Braithwaite QC is a trustee of the Lake District Calvert Trust.