Local Brain Injury Services
Minor HI: education
Patient description: Medically stable - requiring 24-48 h observation in acute A & E observation ward, prior to community rehabilitation (as necessary in a small minority), with low probability of acute neurological deterioration requiring neurosurgical advice/transfer. Description of rehabilitation input:Assessment and observation - education, emotional and social support. Planned discharge home or moves to Rapid access rehabilitation at 48 hours
Early supportive rehabilitation 1
Patient description: Medically unstable - requiring neurosurgical or clinical care. Description of rehabilitation input: Identifying and addressing early rehab goals before medically stable and transfer of care to rehab team
Early supportive rehabilitation 2
Patient description: Medically unstable - not requiring neurosurgical or critical care. Description of rehabilitation input: Identifying and addressing early rehab goals before medically stable and transfer of care to rehab team
Rapid access rehabilitation
Patient description: Medically stable - not (necessarily) able to actively participate due to PTA, confusion, rejection, low response or awareness. Description of rehabilitation input: Needs inpatient care due to physical dependency & requires continuous clinical assessment (nursing, medical, therapy) in order to facilitate optimal timing for rehab input and detect deterioration in clinical condition (in minority of patients). Immediate early rehab delivered, and judgement made on timing/ appropriateness of referral to next rehab sector.
Active participation inpatient rehabilitation
Patient description: Medically stable - able to actively participate with, and benefit from, therapy. Description of rehabilitation input: Needs in-patient care due to physical dependency, or need for specialist therapy equipment, safe environment, supervision or intensity of therapy which can not be provided in community
Behavioural rehabilitation
Patient description: Medically stable - but prolonged confusion, amnesia or behavioural difficulties, requiring specialist behavioural management, intensive supervision and secure environment. Description of rehabilitation input: Specialist behavioural management,including high staffing:patient ratio to ensure intensive supervision and secure environment. Access to neuropsychology and neuropsychiatry
Slow stream rehabilitation
Patient description: Medically stable - but low awareness or response persists beyond e.g. 3 weeks after sedation withdrawn, ICP corrected and medically stable. Able to benefit from medical and physical therapy to prevent complications and support recovery. Description of rehabilitation input: Assessment/active rehabilitation phase which needs to be distinguished from long term care, although planning care increasingly important aim after some (eg 6) months. Patients may go to active participation unit if they improve sufficiently.
Community rehabilitation - specialist regional teams
Patient description: Medically stable - able to actively participate with, and benefit from, therapy. Will include spectrum of initial severity of injury with a small minority derived from Minor HI category. Description of rehabilitation input: Interdisciplinary co-ordinated management therapy aimed at community re-integration/inclusion by enhancing independence, wellbeing, & assist return to work/education. In collaboration with Social Services, neuropsychiatry, voluntary and statutory services. Includes treatment of patients in residential care or with live-in carers
Community rehabilitation - local teams
Patient description: Medically stable - able to actively participate with, and benefit from, therapy. Will include spectrum of initial severity of injury with a small minority derived from Minor HI category. Description of rehabilitation input: Interdisciplinary co-ordinated management therapy aimed at community re-integration/inclusion by enhancing independence, wellbeing, & assist return to work/education. In collaboration with Social Services, neuropsychiatry, voluntary and statutory services. Includes treatment of patients in residential care or with live-in carers. Note that not all areas will have a Community Rehabilitation Team - where there is no such service, a link or links are given to the PCT concerned.
Intensive psychological rehabilitation
Patient description: Medically stable - independently mobile, primarily cognitive impairments likely to benefit from intensive neuropsychological therapy. Description of rehabilitation input: Aiming to return to work, studies or independent community life.
Specialist vocational rehabilitation
Patient description: Medically stable - living in community, aiming to enter/return to employment. Description of rehabilitation input: Aiming for return to work where this is influenced by physical or cognitive problems, or needs residential placement
Social, patient and carer support
Patient description: Carer support from initial injury; patient support when able to communicate. Description of rehabilitation input: Developing social skills, stamina, confidence, attention & leisure pursuits, sorting out benefits, day supervision & respite care. Specific attention paid to: Community involvement & integration (further education etc). Personal social development and empowerment. Structured daytime activity within the individual's competency framework. Information and guidance over a continuum. Family support and outreach. Advocacy
Residential Transitional Rehabilitation
Patient description: Medically stable - completed inpatient neurorehabilitation, but not yet ready to live in the home & community with a degree of independence. Also, family/carers not yet prepared for eventual return of survivor to home/community Description of rehabilitation input: support with day-to-day domestic tasks in a more home-like environment and introduction of community-based tasks. Assistance with learning/relearning skills, planning, budgeting, pursuing outside interests, etc. Liaison with community teams & social services prior to discharge. Also, help for family/carers in supporting the person in these roles, and with identifying possible statutory support needed.
Specialist ABI Nursing Homes
Patient description: Medically stable. Unable currently to live in the community. Description of rehabilitation input: provide comfortable and stimulating environment, with encouragement to pursue recreational activities and personal interests. Would include daily activity programme and outside visits. Rehabilitation facilities could possibly include cognitive and behavioural support. Experienced nursing and care staff available 24 hours a day. Support with diet & feeding where necessary. Family members involved and consulted.
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LEGAL INFORMATION
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