An acquired brain injury can disrupt everything.

Aside from the shock and trauma that both child and family experience when an injury occurs, there is the aftermath.  Returning to everyday life for many, may look like a different everyday life to ‘what-was’ before.

For some, after a period or rehab and recovery, returning to their previous activities can be possible, but for others, getting used to ‘a new normal’, or trying to get back to old activities can be more of a challenge.

Although it is important to recognise that all hobbies and interests hold great weight in any young persons life, in this article, we will specifically look at physical activity and returning to sport post acquired brain injury (ABI).

Brain Chemistry and Exercise

When we exercise, we are literally creating changes within our brains, which is quite incredible when you think about it!

“Exercise has a dramatic antidepressive effect, it blunts the brain’s response to physical and emotional stress’’ (D.J Linden, PhD).   Endorphins, plus the hormones dopamine and serotonin, (sometimes referred to as the ‘happy hormones’ due to their ability to make us feel motivated, focussed, and generally happy), are released after a mere 20 minutes of physical activity, meaning we can make physical changes and boost our brains chemistry as well as our mood in that short amount of time.  What’s more, the hippocampus — the part of the brain associated with memory and learning — has been found to increase in volume in the brains of regular exercisers (https://pubmed.ncbi.nlm.nih.gov/21282661/).

Other main benefits include:

  • Improved working memory and focus
  • Better task-switching ability
  • Encourages good mood (due to endorphin and hormone boost)
  • Encourages better quality sleep
  • Combat fatigue by increasing blood supply, blood circulation, and inducing increase in certain hormones
  • Promotes good heart health
  • Promotes bone and joint health
  • Aids digestion and the digestive system

 

 

Considering that for many, taking part in sport and physical activity is primarily done for enjoyment, the above features are not bad biproducts!  It is no wonder that physical activity is so good for us humans and should be encouraged.

On top of the physical changes that can be created in the body, there are also many other benefits which can be achieved by doing sport or physical activity which are not as often considered; security through routine and structure, a sense of achievement from attending and learning or trying new skills, teamwork, providing a sense of identity and association, and providing an avenue to build confidence.

For a child who was very physically active pre-injury, whose ability to partake in sport is hindered, it is clear to see that they have not just lost being able to play that sport or activity, but lost all of the above which it provides (sense of self, confidence, security, framework, identity, etc).  This is a huge change to navigate, and for this reason, we must not overlook how important it is that we support young people back into sport and physical activity post ABI.

 

What about my child’s injury?

With any ABI, we always need to recognise that every injury is different; how the injury was acquired, the area of the brain affected, the extent of the injury and age of the child. Recovery is another thing which is very individual and every child’s recovery on both a physical and cognitive level will be individual to them, which can make things difficult to predict, but as with rehab and recovery, it is a journey and a path, which can involve lots of small steps over a period of time.

 

‘’getting children involved in organised sports can have a very positive benefit to not just their self-confidence, but to their psyche’’.  Dr Brian MacDonald reports how Leanne Findlay and Robert Coplan found in their journal article https://blog.playbook.coach/building-confidence-in-children-through-sports/

 

Understanding Barriers

As ABI coordinators, we work with many young people who have experienced the hugely difficult situation where returning to physical activity post ABI can be challenging. Challenges can range from physical differences, such as changes to mobility or gross motor skills, balance changes, altered vision or difficulties with proprioception.  There may then be indirect challenges, secondary to the brain injury such as worry or anxiety about returning after a break, and whether doing certain activities will be safe again for their brain.

 

What is the guidance around ABI and return to sport?

Everyone is different.  Some children may be able to return to normal activities post ABI, others may need to have adapted activities, or avoidance or certain activities (which is avoidance, your consultant would generally tell you).

If there are no restrictions following an acquired brain injury, we may begin to encourage certain activities again.  If there are certain restrictions, there are also many options which can be looked into, but with a different pathway in mind.

 

What can we do?

 

  • Understand any medical guidance: any action and plan can go forwards from this.
  • Have a conversation (how is child feeling? What specifically are their thoughts/concerns?). Working with children, their voiced concerns have been things such as;

 

‘I’m worried I’m not going to be good enough’

‘I look different to how I looked before and don’t feel I fit in’

‘I’m worried something might happen to my brain again’

‘I’ve not been for so long and now I’ve lost confidence’

 

  • Reach out to your coordinator, sometimes we may be able to do an ABI awareness session to help with understanding around an injury. This can really help children understand and alleviate anxiety.
  • Find information about inclusive clubs or coaching local to your area
  • Confidence building activities
  • Working with previous clubs to assist with transition back in many clubs will now have welfare officers who may be able to assist).
  • Setting small, achievable goals and tracking these can boost confidence and how reach an end goal.

 

My child isn’t able to do the same activities as they were before their injury- what now?

This is so difficult.

Firstly, it is important to recognise that feeling loss and sadness is a completely normal way to feel.  Talking about feelings can help, and if your child is expressing they may need further support, please do reach out to your coordinator.

If your child loved a certain activity before, but they are now unable, there are still a few things to consider;

  • Can their favourite activity be adapted? (ie boxing to kick-boxing non-contact?), ‘My child loved horse riding but is now far too anxious to ride again’ – How about pony days and enjoying spending time being with and grooming the ponies? Adapted activities still provide the benefits; movement, being outdoors, confidence building, partaking in an activity etc).
  • Staying involved in the social aspect of their previous club can be really important. It is often the case that playing the sport is one aspect, but seeing the same friends can be a huge part of the activity – are their other roles in a club that they could do? Take photos for the club? Help with coaching? (there are lots of junior coaching qualifications now).
  • Are there any other sports or activities which they may be able to do? Often there are open days to try new sports out.  Perhaps there may be something they had not previously considered which could become a new hobby?

 

There is no getting away from the fact that this is a really tough issue for young people with an ABI.  There is not always one easy solution, but sometimes return to sport or finding new activities post ABI can take some time, trial and error.

There is support out there and there should be opportunities for everyone- sometimes it may also take some investigating of knowing where to look but we are here to help or to sign post you in the right direction if you need.

As a final note, given the amazing well-being benefits, even for children who may not be as inclined as others to want to participate in physical activity, by scheduling in just 20 minutes of movement or physical activity a day, huge benefits can be reaped.  This small amount of time can act as part of rehab and recovery at home, and help alleviate some of the side effects we can see post ABI.

 

Thinking Point;

 

If the below side effects are common after an ABI, should we be encouraging (or even prescribing) physical activity as part of a child’s daily routine?  Whilst it may not completely eradicate a child’s difficulties, could it at least help to manage some of the challenging side effects of ABI?

 

https://www.accesssport.org.uk/listing/category/inclusive-club-network

https://www.activityalliance.org.uk/

https://www.sportengland.org/funds-and-campaigns/disability

https://www.sport.wales/partners/national-partners/disability-sport-wales/