Rehabilitation following acquired brain injury
National Clinical Guidelines
PDF Available
These guidelines have been developed by a multidisciplinary working party, convened
by the British Society of Rehabilitaion Medicine and supported by the Clinical Effectiveness
and Evaluation Unit of the Royal College of Physicians. It includes contributions
from other organisations involved in the care and rehabilitation of patients with
brain injury.
These timely national clinical guidelines provide a comprehensive framework for
the management of adults with aquired brain injury. They set out the standards required
for post-acute rehabilitation and longer-term care which are crucial to reducing
morbidity, restoring function and improving participation of brain injured patients,
and so improving the quality of life and that of their families.
The guidelines complement those on head injury published by NICE in June 2003. These
focused on the first 48 hours after brain injury which are crucial in the management
of the pathology. The two sets of guidelines will thus set the standards for the
entire spectrum of care following brain injury.
The present guidelines are evidence based, covering not only clinical care but also
service provision, and will make a significant contribution to the development of
rehabilitation services over the next decade. They have been produced specifically
to inform the forthcoming National Service Framework on Long-Term Conditions.
Contents
The process of guideline development
Background
The guidelines
- Principles and organisation of services
- Approaches to rehabilitation
- Carers and families
- Early discharge and transition to rehabilitation services
- Inpatient clinical care - preventing secondary complications in severe brain injury
- Rehabilitation setting and transition phases
- Rehabilitation interventions
- Continuing care and support
The need for further research
Algorithm for early discharge into the community and referral to rehabilitation
Long-term neurological conditions:management at the interface between
neurology, rehabilitation and palliative care
National Guidelines
PDF Available
Long-term neurological conditions (LTNCs) comprise a diverse set of conditions resulting
from injury or disease of the nervous system that will affect an individual for
life. Some 10 million people in the UK are living with a neurological condition
which has a significant impact on their lives, and they make up 19% of hospital
admissions. These guidelines build on the Quality Requirements in the National Service
Framework for Long-term (Neurological) Conditions to explore the interaction between
specialist neurology, rehabilitation and palliative care services, and how they
may best work together to provide long-term support for people with LTNCs and the
family members who care for them. The guidelines also provide some practical advice
for other clinicians when caring for someone with an LTNC, and outline indications
for specialist referral.
Traumatic Brain Injury in Adults
Standards
NHS Scotland
The Scottish Needs Assessment Programme report of 2000 indicated that the provision
of services for brain injured people in Scotland needed to reach standards which
are laid out this booklet. It is available from their website,
Traumatic Brain Injury in Adults - Standards
Concise Guide to Good Practice
Use of antidepressant medication in adults undergoing recovery and rehabilitation
following acquired brain injury
National Guidelines
PDF Available
Depression is increasingly recognised as a common sequel to acquired brain injury
and the use of antidepressant medication in this context has increased markedly
over recent years. However, these drugs are not without side effects – some
of them serious – and they should not be used without proper evaluation and
monitoring. This set of concise guidance was developed jointly by the British Society
of Rehabilitation Medicine, the British Geriatrics Society and the Royal College
of Physicians, to guide clinicians working with people who have brain injury of
any cause (ie stroke, trauma, anoxia, infection etc). The guidance covers (a) screening
and assessment of depression in the context of brain injury, (b) issues to consider
and discuss with the patient and family/carer before starting treatment, and (c)
proper treatment planning and evaluation – including planned withdrawal at
the end of treatment.
Vocational assessment and rehabilitation after acquired brain injury
Inter-agency guidelines
PDF Available
Return to employment or alternative occupation is a primary goal and a critical
factor in the restoration of quality of life for people with acquired brain injury.
Currently, many people with acquired brain injury are unable to access, return to
or remain in previous or alternative employment. This has major economic implications
as well as far-reaching consequences for the individual and their family. Those
unable to return to paid employment are often not provided with the advice, opportunity
and support to enable them to find alternative occupation appropriate to their needs.
There is, however, consistent evidence that specialist vocational rehabilitation
services assist people with acquired brain injury in securing sustainable employment
or alternative occupation.
An Inter-Agency Advisory Group on Vocational Rehabilitation after Brain Injury was
formed in April 2003, comprising members of the NHS, Jobcentre Plus, social services
and independent vocational providers. The group was set up initially to recommend
guidelines on vocational assessment and rehabilitation to a working party convened
by the British Society of Rehabilitation Medicine, which was developing national
clinical guidelines on rehabilitation following acquired brain injury.1
The Advisory Group agreed that there was a wider need to produce detailed guidelines
and an inter-agency framework on vocational assessment and rehabilitation after
brain injury across the NHS, Jobcentre Plus, social services and independent vocational
providers. It was agreed that staff in these agencies need guidance in working together
to facilitate access to appropriate existing services for people with brain injury.
The inter-agency guidelines and framework focus on traumatic brain injury, for which
there is a substantial research base, but are relevant to other forms of acquired
brain injury.
Royal College
of Physicians website
Last modified 8 August 2008