Types of injury

There is a range of injuries to the nerves (roots, trunks or divisions) that can be produces by traction.

                                              A.  Minimally stretched with no structural damage (neuraplexia).
                                              In this injury the sensitive nerve fibres temporarily stop working but will rapidly recover                                                without surgery. 
                                              B.  Stretched but remains intact.  
                                              In this injury the nerve has been damaged but not torn apart. The nerves may recover to
                                              a variable degree on their own over a period of months and may not require surgical                                                      treatment
                                              C.  Nerve Rupture.  
                                              In this type of injury, the nerve has been stretched to breaking point and has been
                                              snapped or torn  (similar to an overstretched elastic band).  Ruptures will not heal
                                              without surgery.
                                              D.  Nerve Root Avulsion.  
                                              In this injury, the nerves are torn away from the spinal cord and cannot be re-joined to                                                  the cord.  Some function of the arm will be permanently lost.  At surgery, nerves may be
                                              transferred from other areas to improve function.
 
     How do we establish what type of injury has occurred?

Initially you will be examined carefully to assess the movement and sensation you have in your arm.  We may perform x-rays and scans (MRI scan, CT Scan) to help in the diagnosis and to exclude other injuries that are associated with brachial plexus injuries.  Whilst these tests are useful to aid diagnosis, often the true extent of the injury may only finally be determined by performing an exploratory operation.

     What treatment will I receive after the assessment?

A member of the team will discuss the results of all of the investigations with you and whether an operation is
necessary.  If the injury to the brachial plexus is mild, and recovery is expected without surgery, then you will be seen  in an outpatient clinic to help you with any problems that you may encounter with your arm, and to review your  progress.

If it is clear that rupture or avulsion of the brachial plexus has occurred, then surgical exploration and repair of these nerves may be offered.  If you have other more serious injuries, then the brachial plexus surgery may have to be delayed until these injuries are stabilised.

      How are nerves repaired?

In clean cut injuries of nerves, each raw end of the nerve may be repaired (with the aid of an operating microscope) by re-attaching it to the other cut surface of the nerve.  This end-to-end repair is usually not possible in the case of brachial plexus injuries, partly because the injury produces weakness at the shoulder muscles, which in turn allows the shoulder to droop consequently pulling the nerve ends apart.  However, in the commonest injuries, the nerves are torn or stretched and the damaged segment of nerve either side of the rupture must be removed and repaired using grafts of nerves from the legs.

When nerves have been repaired, the nerve fibres then have to grow through the repair and out into the arm to the muscle or area of skin that they supply.  These nerves grow very slowly and maximum recovery after nerve repair is lengthy.  Furthermore, no nerve repair achieves complete recovery because of the impossibility of each individual microscopic nerve fibre reaching precisely and accurately the area it is best suited to supply.

      What happens if I need surgery?

If you are not already on the plastic surgery ward, you will be given a date to come into hospital.  When you arrive, you will be seen by the nursing staff, medical staff and anaesthetist.  They will assess your health and this will also give you an opportunity to ask further questions.

The doctors will explain the operation again and will ask you to sign a form to say that you are willing for the operation for proceed.  They may also draw a mark on the arm which is to be operated on.

You will not be allowed to eat or drink from the evening of the day before your operation.  This is to prevent you being sick when you go to sleep during a general anaesthetic.

On the morning of the operation, you will be given a gown to wear and you may have some medicine to make you feel drowsy before a nurse and porter take you to theatre.  In the theatre, you will be met by the nursing staff and the anaesthetist.

      The Operation

All surgery is performed under general anaesthetic.  The surgeon will examine the nerves to establish the extent of the damage and whether repair is possible.  If they find that the nerves have been ruptured (separated) then the gap between the nerves will be bridged by a nerve graft.  These grafts may be taken from less important sensory nerves on the back of the legs (sural nerves) or from nerves in the injured arm.  These nerve grafts will act as guides through which new nerve fibres can grow and cross the gap caused by the injury, to reach the muscles and sensory receptors of the shoulder, arm and hand.

If the nerves have been avulsed, it is impossible at present to re-attach the nerves to the spinal cord (although research into this area continues).  To try and regain function within the arm, intact nerves nearby doing less valuable jobs can be transferred to parts of the brachial plexus.  The transferred nerves no longer allow their original, less important, movements but the signals they carry can be used to make the more important muscles of the shoulder and arm work.  

Commonly transferred nerves include the nerve that normally shrugs the shoulder (accessory nerve) and nerves from the chest that supply the muscles between the ribs (intercostal nerves) which are transferred to muscles involved in stabilising the shoulder and moving the elbow.  

When these nerves start to recover, you will need to work very hard at retraining these nerves to move your arm and initially you may have to do different movements to make your arm work.

      What will I be like when I return from theatre?

. You will feel tired until the effects of the anaesthetic wear off.
. If you have any pain after your operation, it is important that you let the nurses know so that they may give you
   medication to help ease any pain.
. You will have stitches or surgical clips on your neck and the back of your legs (if sural nerve grafts are used).
  These will be covered with dressings.
. You will have your arm strapped to your side or in a sling and this must stay in place for four weeks.  It is
   extremely important that you do not remove this tape or sling as even a brief movement of your arm away from
   your body can damage the repair to your nerves.
. You may have a drain in place to remove fluid from around the wound.  This will usually be taken out after a few
   days

     

      How long will I have to stay in hospital?

Following your brachial plexus surgery, you should only stay on the ward for a few days.  This is dependent upon any other injuries you may have sustained at the time of your accident.

      What follow up will I have?

One week following your operation;

.  You will attend the dressing clinic and have your tape changed. at this stage any stitches that you have may be
    removed and your wound, arm and armpit cleaned.
.  We will re-tape your arm.

Four weeks following your operation;

.  You will be seen in the dressing clinic four weeks after your surgery to have the strapping or sling removed.
.  You will see the physiotherapist to start passive exercises on your arm.
.  You may see the occupational therapist to assess how you are managing with activities of daily living (ADL).

Three months following your operation;

. You will be seen in a multi-disciplinary team clinic. This will allow you to discuss with the team how you are
  managing following your injury.  Following this, your progress will be monitored regularly in a brachial plexus
  practitioner clinic, by a specialist physiotherapist.  There may be a need to have an additional operation in the
  future and this will be discussed with your consultant at this stage.

     Can I have a bath or shower?

If you have not had nerve grafts taken from your legs, then as long as you do not get the dressing wet on your arm, you can have a shallow bath.

      What happens if my dressings get wet?

If your dressings get wet then please phone either the dressing clinic (08:30-16:30 Monday to Friday), or the ward (16:30-08:30 Monday to Friday and weekends). (This applies to Leeds General Hospital).  They will be able to advise you on what to do.

      What happens if I am worried about my wound?

If you are concerned about your wounds, then please phone either the dressing clinic (08:30-16:30 Monday to Friday) or the ward (16:30-08:30 Monday to Friday and weekends).   (This applies to Leeds General Hospital) They will be able to advise you on what to do.

      When can I return to work?

This depends on your job and also on the extent of your injury, and you will need to discuss this with any of the brachial plexus team.  After the strapping is removed at four weeks, you are unlikely to do any harm to your plexus or to the surgery that has been performed.  However, the movement and sensation of your arm will be the same as it was immediately before the operation.  This is a result of the length of time it takes for the nerves to grow.

If you are unable to return to your previous job, of your employer is unable to provide alternative work, there are a number of supportive organisations that you can contact, which are listed under Other Organisations below.

      When can I return to sports and hobbies?

This will depend on your injury and also the sport or hobby you wish to return to.  You will need to discuss this with a member of the medical team.

      How long will it take for nerves to recover?

New nerves have to grow from the neck, down the brachial plexus, past the injury site and through the nerves into the upper limb in order to reach the muscles and sensory receptors.  Nerves grow at an average of 1mm per day but will take longer to grow through the nerve grafts and across the sites of repair.

As the nerve starts to recover, you will initially get a twitch of your muscle.  At this stage, you will be informed of how to strengthen this muscle by the physiotherapists.  Recovery of your nerves and the rehabilitation of your arm can take from several months to several years.
      Occupational Therapy

Following your injury, you may see an Occupational Therapist.  Occupational therapy will help you to improve the way you do day to day tasks.  They will start by asking you about any difficulties you have with daily activities, such as washing and dressing, and look at how you do these tasks.

      Where will I see them?

There are a variety of times during your rehabilitation that you may see an Occupational Therapist.

. You may be referred by the doctors, nursing staff or physiotherapists whilst on the ward.
. You may attend the Occupational Therapy Department after you have left the hospital, at a time which suits you.
. When you return to see the doctor or physiotherapist in clinic.

      What does Occupational Therapy involve?

The Occupational Therapist may be involved at different stages of your recovery.  This may include:

. Teaching you different ways of doing daily activities, e.g. making a hot drink, dressing yourself.
. Teaching you how to do things with one hand.
. Advise you on any adaptations or equipment that you may need to help you with these activities.
. Assess your ability to participate in work and leisure activities.
. Provide information on services available in your local area.
. Making a splint for your arm

If at any time you feel that Occupational Therapy may help you then please ask to speak to anyone involved with your care.
This comprehensive overview of BPI's comes thanks to the team at Leeds General Hospital and covers every aspect of a Brachial Plexus Injury, what it is through to how to live with it. Our thanks to the team at Leeds for allowing us to reproduce their work. Please keep in mind that the procedure for physio etc, listed below, relates to the Leeds General Hospital and that there may be some variations in technique in other Hospitals. Always consult your own physio about which exercises are suitable for your particular injury. Opening hours also relate to Leeds General and not other hospitals. Click on the headings below to go direct to each section.

What is a BPI?
Types of injury, how they are treated and recovery
Occupational Therapy
Physiotherapy
Pain Management
Clinical Psychology
Useful Links
Glossary of terms
The roots join to form three trunks – the upper, middle and lower trunk.   Each trunk then divides into an anterior and posterior division.  The divisions then join to form three cords - lateral, posterior and medial, before finally splitting to form the major nerves of the arm.  These nerves enable the signals that allow movement and sensation to reach the arm. If any part of the path of the nerve is injured, then signals from the brain will not reach the individual muscles in your arm and those muscles will not work. 





 

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F.A.Q.'s
    What is the Brachial Plexus?

The brachial plexus (Plexus: Latin ‘braid’) is a network of nerves in the neck and shoulder region.  They pass from the spinal cord in the neck, under the clavicle (collar bone) into the upper arm. These nerves carry electrical signals from the brain and the spinal cord, to the muscles and skin of the shoulder, arm and hand to provide movement and sensation (feeling) in your arm.

     How does the injury occur?

In adults the commonest cause of injury is traction (stretching) of the brachial plexus, usually sustained during a road traffic accident (RTA), mainly in motorcyclists.  Occasionally damage occurs to the major blood vessels that carry blood to and from the arm (subclavian artery and vein).

The plexus is formed by 5 nerve roots which exit the spinal column in the neck, four named after the lower cervical (C) vertebrae (C5, C6, C7 and C8), and the fifth root from the first thoracic (T) vertebra (T1).
       Physiotherapy

Physiotherapy uses a combination of exercises to maintain joint movement and strengthen muscles.  The physiotherapist will teach you exercises that you need to continue with at home.

        When will I see them?

Physiotherapy may be involved at various stages of your rehabilitation from soon after your injury to further on in your recovery.  The aim at all stages is to help your recovery and to improve your overall function based on your individual needs.  We will review your progress regularly.

         Where will I see them?

There are times that the physiotherapist may get involved I your rehabilitation:

. As an inpatient on the ward.
. In the out-patient department when you return to see your doctor or the brachial plexus practitioner.
. In the physiotherapy department after you have left hospital.  They may arrange this at the hospital or at a local
  physiotherapy department after discussion with you.

         What does Physiotherapy involve?

The physiotherapist will use various techniques depending on your stage of rehabilitation.  These may include

. Teaching you or your family exercises to keep joints of your arm and hand supple.
. Teaching you and your family how to look after your arm if there are areas where you have poor sensation.
. Advising you on your posture and how to lift and handle objects.
. Teaching exercises to encourage and strengthen movement when your nerves start to recover.
. Teaching ways of improving sensation when your nerves start to recover.
. Provide any general advice and information that you require on your injury.
. Assess and advise you on returning to work and leisure activities.
. Communicate regularly with local physiotherapy teams, doctors and yourself about your progress.

        Physiotherapy Exercises

Following your injury, your physiotherapist will teach you a number of exercises designed to regain / maintain the passive movement at all joints of your injured arm.  These exercises are important to ensure that your joints are supple and able to work or and when your nerves and muscle function improve.  They may be taught immediately after your injury or on removal of your sling after an operation.  Do not perform these exercised until you have been shown by your physiotherapist.

As each injury is different, your physiotherapist will instruct you or your carer on which exercises to perform, and the correct way to do them.  The following diagrams show you some of the exercises that you may be taught.

It is extremely important that you perform these exercises regularly at home as you are the person responsible for maintaining and improving the movement in your arm.

Unless otherwise directed by your physiotherapist, each exercise should be

. Initially performed at least three times a day.
. Performed slowly and gently.
. Held for 5 seconds at the end of each exercise.
. Repeated 10 times.

All exercises must be taken as far as your joint will let you go.
You should not experience any pain with these exercises.  If you do, please contact your physiotherapist.

        Shoulder exercises

The following shoulder exercises should be performed lying on your back.

1.  Elevation

             
Gently hold your forearm and lift your arm up above your head.  
Keep your arm close to the side of your head. 

 

 
2.  Lateral Rotation


You may need help from somebody else to do this exercise correctly. 
Using your other arm, bend your injured elbow 90° whilst keeping the 
elbow in at the side. Rotate the arm out towards the side.

 

 
3.  Abduction

             
Grab your forearm and bend your elbow to 90°.  Take your arm out to the 
side until your arm is at right angles to your body.  You may need assistance 
from somebody else for this exercise.

 

        Elbow exercises

All of the following exercised can be done in any position - lying, sitting or standing.

4.  Flexion / Extension


Grasp your forearm with your other hand and gently bend and straighten 
your arm fully.

 

5.  Rotation


Bend your elbow to 90° (you can support your forearm on a table), using your 
other hand to help, turn your palm up to face you ad then down towards your 
feet. It is important that you keep your elbow bent at 90°.



        Wrist exercises

6.  Extension


Hold onto your hand and take your wrist backwards.



             Finger exercises

7.  Flexion / Extension


Using your other hand bend each of your 
knuckle joints down and then straighten them.  
Start with the largest joint and then perform 
the same exercise on the middle joint and 
then the end joint. Repeat this exercise on all
of your fingers and finally using your other 
hand push your fingers down into a fist.



8.  Web exercises

             

Clasp your hands and stretch the spaces between each finger.




             Thumb exercises

9.  Web exercises

              
Keeping your hand flat on a table with your palm facing down, grasp your 
thumb and take it up and out so the side.

 

 

10.  Flexion exercise


Grasp your thumb and bend it across the palm of your hand towards the base 
of your little finger.




        It is extremely important that you do not attempt to perform these exercised until you have been
       instructed by a physiotherapist as they will inform you of which exercises are appropriate for you.
           
        Pain Management

Brachial plexus injuries can be very painful.  This pain can be divided into two stages depending on how long it lasts.

Acute pain    
The initial pain that you feel immediately after your injury.  Usually this will last for a few weeks.

Chronic pain      
Pain that lasts for longer than three months.

You may feel pain both in your neck and down into your arm.  The severity and type of damage that you have suffered often determines the amount of paIn that you experience.  The damage to the nerves may cause them to ‘misfire’ and send out pain signals.  This sort of pain is often called Neuropathic Pain.

These nerves may also cause areas of your skin to feel very sensitive.  Normal touch, such as the brushing of clothing against your skin, can feel extremely painful.  This is call allodynia.

With this type of injury, pain can often develop into a long-term problem and can be difficult to manage.  Your treatment may depend on which type of pain you feel and the length of time that it may last.

Management of your pain whilst you are in hospital is very important.  A detailed information leaflet called ‘Pain Relief after your Operation’ is available in each ward area (applies to Leeds General Hospital).  This describes a variety of methods that can be used to manage the type of pain that you may experience after an operation / injury.  If your pain is difficult to manage, the Acute Pain Team may be called to visit you whilst you are in hospital.  They may suggest different types of drugs or treatments to help you manage your pain.

If your pain remains a persistent problem, you may then be referred as an outpatient to either the Leeds Chronic Pain Management Service or your local chronic pain service.

        
       Leeds Chronic Pain Management Service

The team has many different professionals including consultants, nurses, pharmacists, psychologists and physiotherapists.  They are all specialists in pain management and will work together to provide a full assessment of your pain and develop an appropriate treatment plan.


        What treatments could I expect?

Please Note: The following treatments are given as a guide only.  Your own pain treatment may depend on the nature of your particular injury and clinical pain.

        Medication

Neuropathic pain often responds better to special medicines, which have different actions from normal pain killers.  However, normal pain killers are still used and can be effective in many cases (i.e. Co-codamol, paracetamol or ibuprofen).

        Gabapentin

Gabapentin is used to treat neuropathic pain.  Gabapentin was originally used in epilepsy but was found to help in neuropathic pain.  Gabapentin works by helping to reduce nerve excitability, which in turn helps to reduce pain signals being produced by the damaged nerves.
Unlike many pain control medicines, Gabapentin may take several weeks to start working and needs to be increased slowly to help reduce side-effects.

        Amitriptyline

Amitriptyline may also be used in managing your pain.  Amitriptyline was originally used as an anti-depressant but was found to be helpful in pain control in lower doses.  Amitriptyline is usually taken at night, usually two hours before you sleep.  It can make you drowsy and the dose needs to be adjusted to minimise this effect.

        Injections or Nerve Blocks

An injection or nerve block in the affected area may be beneficial in some people. 
Usually a mixture of local anaesthetic and steroid is injected near the damaged nerves where is numbs the area helping to block pain signals.  Injections or nerve blocks can last between several hours and several months.  Unfortunately, in some cases, this is not an effective treatment.

        Managing daily activity

In some cases it is not always possible to completely eradicate the pain resulting from a brachial plexus injury; however, it can often be reduced to a level which is better to manage.
As well as using medicines and treatments, adjusting your daily activities and strategies can help you cope better with your pain.  Important techniques in managing pain include pacing activity, relaxation, exercise and goal setting.


Further information on any of these techniques can be obtained by contacting one of the pain support groups listed below.

Action on Pain!  
20 Necton Road,  Little Dunham,  PE32 2DN     Ph. 0845 603 159             www.action-on-pain.co.uk

Pain Concern     
PO Box 13256, Haddington, EH41 4YD              Ph.  01620 822572           www.painconcern.org.uk

Neuropathy Trust    
PO Box 26, Nantwich, Cheshire, CW5 5FP        Ph.  01270 611828           www.neurocentre.com                                      

        Other Organisations

The organisations listed below can help you deal with any specific problems you are having as a result of your injury. Most of these organisations are in the Leeds local area, but if you need to find one nearer to you, please phone your local social services.

Neither Leeds teaching Hospitals trust nor the TBPI Group are responsible for the contents or reliability of external websites and does not necessarily endorse the views, products or services expressed within them.  Whilst every effort is made to keep this information up to date, contact numbers and web details may alter over time.

        William Merritt
        
The Disabled Living Centre – 0113 305 5332 – Advice on equipment and adaptations.
The Mobility Centre – 0113 305 5288 – Provides advice for people who wish to learn to drive, or return to driving after injury.

        Purchasing Equipment / Small gadgets
         
Yorkshire Care Equipment.
6 Ovens Lane, Rawdon, LEEDS, LS19 6DY – 0113 250 3250
131 High Street, Starbeck, HARROGATE, HG2 7LL – 01423 880399

Clarks Independent Centre (Mail order)
71 New Road Side, Horsforth, LEEDS, LS18 4JX – 0113 258 8888

Promedics (Mail order)
Moorgate Street, BLACKBURN, Lancashire, BB2 4PB – 01254 619000

‘Anything Left Handed Shop’
18 Avenue Road, BELMONT, Surrey – 0208 773 3722 
e-Mail enquiries@anythingleft-handed.co.uk  (www.anythingleft-handed.co.uk)

        Leeds Disability Helpline
Telephone 0113 214 3630 Monday to Friday 10:00-15:30
For information and advice you need on any aspect of disability, for example:

. Benefits and income.
. Holidays, leisure and sport.
. Legislation and rights
. Self help groups

        Driving

It is essential that you contact the DVLA to notify them of your injury before you plan to drive again.  Failure to do this can result in a fine.

Drivers Medical Group
DVLA
SWANSEA
SA99 1TU
Telephone 0870 600 0301 (Monday to Friday 08:15-16:30) or visit www.dvla.gov.uk 

        Driving Aids for Disabled

Adaptacar                                                                 Carmobility
Telephone 01769 572785                                         Telephone 01404 44470
Website www.adaptacar.co.uk                                Website www.carmobility.co.uk 

 
Brian Page Controls                                                  Steering Developments Limited
Telephone 01784 435850                                         Telephone 01442 212918
Website www.brianpagecontrols.co.uk                   Website www.steeringdevelopments.co.uk 

            
               Many more links to useful websites can be found in the 'Contacts and Links' section of this website

       Glossary of Terms

A variety of terms and acronyms are used by medical staff.  This glossary aims to help you understand this language

 
ADL
Activities of Daily Living – Things that you do on a day-to-day basis e.g. washing your face
 
Allodynia
Over-sensitivity of a painful area.  Normal touch such as clothing may feel painful or unpleasant
 
Anterior
The front of the body or part
 
Avulsion injury
Nerve is pulled out from the spinal cord.  Surgery cannot re-attach this nerve to the spinal cord and is therefore aimed at nerve transfers
 
Brachial plexus
Network of nerves that provide the movement and feeling to the arm
 
C5, C6, C7, C8, T1
Names given to the different levels of your spine which your nerves leave from.  C refers to the cervical (neck) bones and the T refers to the thoracic (chest) bones.  The numbers relate to the level that the nerve leaves from.
 
Cervical vertebrae
Bony parts of your neck
 
Chronic pain
Persistent pain that lasts longer than three months
 
CT
Computerised Tomography – a specialised scan that will give detailed pictures of the plexus
 
Distal
Any point of the body furthest from the head – e.g. the hand is distal to the elbow
 
Horner’s Syndrome
This is characterised by drooping of the eyelid and a small pupil on the same side as the injured arm.  This occurs following damage of the T1 area
 
Lateral
Towards the side of the body
 
Medial
Situated towards the midline of the body
 
MRI
Magnetic Resonance Imaging – a specialised imaging technique using a magnet and radio waves to create detailed pictures of the plexus
 
Multi-Disciplinary Team (MDT)
A group of people which will include clinicians from different areas – such as doctors, nurses, physiotherapists, occupational therapists, clinical psychologists
 
Nerve grafts
A nerve is taken out from somewhere else in the body (e.g. the sural nerve from your leg) and re-attached to bridge the gap between the damaged nerves in your arm
 
Nerve transfers
A nerve is re-directed from elsewhere in your body to the healthy distal part of your nerve e.g. intercostal nerves (from your chest) to musculocutaneous nerve (in your arm) that supplies the biceps muscle
 
Neuropathic pain
Pain caused by damage to the nerves
 
Neurapraxia
The nerve is damaged but intact and heals without surgery
 
OPD
Outpatients Department
 
PDC
Plastics Dressing Clinic
 
Posterior
The back of the body or part
 
Proximal
Any point of the body nearest to the head e.g. the elbow is proximal to the hand
 
Rupture
The nerve is completely torn in the neck and can be operated on by means of nerve grafts
Our thanks to 
for the above information
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        Clinical Psychology

During the course of your treatment, you may meet one of the Clinical Psychologists.  Brachial plexus injuries can have a huge impact on people’s lives and you may go through a range of emotional and physical reactions after sustaining this type of injury.  The psychologists in the team are all used to seeing people who have sustained a brachial plexus injury and understand that it takes time to adjust.

       When will I see them?

This may be on the ward or as an outpatient, and could be at any stage of your care as needed, from soon after your accident to much later on in your recovery.  Sometimes another member of the team may suggest that a referral to them would be helpful, or you could request to see them yourself.

       Some of the reasons why patients see one of the psychologists:
         
. Having difficulty coming to terms with the loss of arm function and the impact of this.
. Finding the change in appearance difficult.
. Having to think about surgical options at a time when it may be difficult to make decisions.
. Feeling anxious about undergoing surgery.
. Effects on relationships with partner, family and friends.
. For support through the course of recovery.
. Having difficulty coming to terms with the accident.

Sometimes after an accident people experience some of the following:

. Flashbacks (thoughts, pictures, dreams or feelings) of the accident.
. Feeling sad or upset or unable to cope.
. Feeling numb or withdrawn or staying away from reminders.
. Having difficulty sleeping or concentrating.
. Feeling irritable or angry.
. Feeling nervous or frightened.

These kinds of symptoms are very common after an accident and a natural part of the recovery process, and usually improve with time.  However, if things don’t seem to be falling into place, then the psychologists can usually help with specific techniques aimed to help with the symptoms.

       What does seeing the clinical psychologist involve?
        
. You will usually see the psychologist for about an hour, but this may be shorter if you are an inpatient and have         other treatments to fit in.
. You will always see the same psychologist and you may be offered a series of appointments depending on what
  you decide with your psycologist.      
. The content of each session will depend on the reason for your referral.  Whatever the circumstances, your
  psycologist will want to listen to what you have to say, and to understand the difficulties that you are
  experiencing. They will discuss the possible next steps with you.  They might suggest gathering more information
  to get a clearer picture of your situation or to offer you help with your problems (e.g. this may involve filling out         some questionnaires) Your views are important. Your psycologist will ask you for your consent before doing
  anything more. Your psycologist will also give you information about confidentiality at your appointment.

  
If you are not sure whether you need to see a psychologist, talking to another member of the team may help you decide, or you could see one of the psychologists for a discussion about appointments and what they may involve.