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2 hours ago
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Rather like Ian Sample himself trying to read Orlando Swayne’s book, I was nervous reading his article, braced for half-digested truths or oversimplifications on neurotherapy (The doctor who mends broken brains: why there is room for hope after a stroke or head injury, 3 June). But he paints an accurate picture of the way brains retain neuroplasticity and the reality of the postcode lottery around therapy and rehabilitation services.
I am a speech and language therapist specialising in stroke and neurorehabilitation, and I can attest to what he and Dr Swayne state in the article – that sadly, for some people, the damage caused by neurotrauma cannot be recovered from, but for others, the vital neuroplasticity continues for months and, in some people I have seen, years at a time.
I remember working with a gentleman in intensive care after a brainstem stroke. A little like Jean-Dominique Bauby in The Diving-Bell and the Butterfly, he had locked-in syndrome and could only communicate by blinking one eyelid. The consultants in the intensive therapy unit and his family had not noticed it and had written him off. But one of the nurses and I started to see the intentional nature of his blinking and it turned out that he was cognitively intact and could communicate in full sentences by dictating a letter at a time. He went on to access specialist inpatient neurorehabilitation and, while he remained a wheelchair user, was able to return to work.
Sample’s article is also correct that provision of expert neurorehabilitation, by optimising recovery and function in a body and brain, can save money. The more independent a patient can become, the less reliant they are on nursing or social care, and the more likely they are to return to paid employment.
The NHS is struggling for resources as never before. I know trusts that are making staff redundant to avoid bankruptcy. The tragedy is that often a little extra spent now can save a greater sum in the future, but many trusts feel they cannot commit to even a small amount of extra spending.
John Swan
Cheltenham, Gloucestershire
Dr Orlando Swayne is correct to highlight the worryingly low intensity of therapy provided in NHS stroke units. There are many reasons for this, including staff shortages. One way forward in improving neurorehabilitation is enhancing the training given to staff. Some need greater understanding of neurophysiology, neuropsychology, musculoskeletal anatomy and human movement. Particularly important is training to set improved person-centred goals, smarter treatment skills and consistent use of outcome measures.
Also, care must have a 24/7 approach, so that therapists’ recommendations are implemented by nursing and support staff outside therapy time. We do a fantastic job in the NHS and we have great technical resources. But greater attention to improving what therapists are doing with survivors of acquired brain injuries is needed if patients are to fulfil their recovery potential.
Jonathon O’Brien
Department of occupational therapy, University of Liverpool
Seven years ago I suffered a significant head injury when I came off a horse at speed. The years that have followed have been interesting. There was the moment when just two months after the accident, I stood up with in front of my husband’s family and announced that the family was a farce and stormed out. I have shown up at a friend’s house 200 miles away on the wrong weekend, and just last week I realised I had booked an Airbnb in Budapest for the wrong month.
I have a prefrontal lobe injury, which means my logic can be impaired. But I also run two businesses and published a book last year. My point is that the brain can heal to an extent. When I look back at how unable I was to do anything seven years ago, and where I am today, I can clearly see that the brain is incredibly remarkable and I am in awe of what it achieves each day.
Marcie Shaoul
London
In January 2025, at a London teaching hospital, our daughter underwent 11 hours of neurosurgery to remove a brain tumour. This was followed by weeks on a post-neurosurgery ward, where she was assessed by a team of therapists, who recommended she be repatriated to a neurorehabilitation centre. However, simply because of the postcode, she was rejected by the nearest centre and repatriated to an acute medical ward at a local hospital, where she stayed for weeks. She was discharged to the residential care home where she lived before her neurosurgery, a facility not equipped to address her rehabilitation needs.
NHS community therapy was not forthcoming for several weeks after that discharge, and eventually amounted to six physio sessions. In desperation, we are privately funding additional physiotherapy, a neuro-occupational therapist, hydrotherapy and music and art therapy. In recent weeks, more than a year since the neurosurgery, an NHS speech and language therapist has seen our daughter and provided guidance, for example, on eating with a fork. She will soon be seen by a community learning disability specialist, while an assessment by a neuropsychologist remains outstanding.
We are in our 70s and most of our time is taken up with transporting our daughter to therapies here and there, while attempting to get social services, who fund her care, to understand that she needs to live in a therapeutic environment.
Our daughter is slowly making some progress. Reading this interview with Dr Orlando Swayne has made us realise that we should not give up. Sadly, we feel NHS managers gave up far too early and have largely left us picking up the pieces.
Dr Jill Fenton and Nick Fenton
Hastings, East Sussex
The article has resonated with my own experience of having a stroke in 2024. I didn’t receive medical care for two days, being alone in a remote part of the Western Isles. It was not considered a major stroke in that I could walk, if only a few steps, and could speak using limited vocabulary. Writing was not possible for some time. But I received no aftercare other than several scans and medication. I was confused, had no understanding of what I was going through and what the medical profession was telling me.
As an artist, I had been drawing the intricate root systems of trees, so, after day nine, I started a new drawing and this was the day fear began. I could not recognise what my hand was producing, strange faces appearing that were not my work. I continued similar drawings when I had enough energy every few days, instinctively thinking that doing this might help in some way to repair the damage. I numbered them by the days, watching for any signs of improvement, and later by months. I have now reached 21 months and drawing in a way I could not have done before. I feel a real connection between roots and my neural pathways, and I am sure that doing this work has been responsible for my good-enough recovery.
There were many days when I felt like giving up. I am lucky to have the artistic background to create an interesting body of work, which I am planning to share with others who might be inspired to try this amateur brain training.
Linda Leroy
London
The struggle to recover from my stroke of 13 years ago, at the age of 65, was helped not only by early therapeutic interventions, but also by my declared intention to return to work as soon as possible. I believed I would receive help if I was still seen as a better investment of health resources. Believe me, I needed the help. The first challenge was the goal of bending over and tying the laces of my shoes.
My government work for 22 years had been in writing policy for people with disabilities. I was suddenly a subject of all that policy work. One thing my job impressed on me was that if one was not considered an employed or employable member of society, you were less likely to get the attention you needed to return as an active member of society. So it’s great this study shows the benefits of early intervention. Now let’s ensure everyone has access.
Norm Mohamid
Toronto, Canada
Thank you, Ian Sample, for highlighting the need for early intervention with strokes and brain injuries. When I had a major stroke 18 years ago (I was 36), I was lucky to have extensive rehabilitation that included physiotherapy, and occupational and speech therapy. I relearned how to walk, write and speak. My life is pretty good now, though I have some “deficiencies” from the stroke, which I take medication for.
The thing that has always maddened me is when your typical layperson asks why neuroplasticity hasn’t helped me further. People think it’s this magical growth, like the tail of a gecko that’s fallen off in a fight. Neuroplasticity does not mean your brain repairs everything. I’ve honestly spent so much time explaining this to people.
Anna Bauer Ross
Toronto, Canada
