Mapping Rehabilitation Resources for Head Injury

Abstract

Several reports have pointed to the unevenness in the UK of services for rehabilitation after head injury. A study was conducted in the Eastern Region of England to define the key stages in recovery and rehabilitation, by an iterative process of questionnaire, interview and consensus conference. Findings were translated into a draft set of maps showing current availability of services which were revised after feedback. Working groups then developed a set of definitions and classification codes for each stage of rehabilitation which were likewise disseminated for feedback. The maps were then redrafted to correspond with the definitions together with a flowchart of potential head injury rehabilitation services. The definitions were piloted at a regional neurosurgery unit and a rehabilitation hospital. Core services for neurorehabilitation region-wide were found to be variable and uncoordinated with fragmented and inequitable allocation of resources. The definitions and mapping system that emerged from this study should facilitate the design of care pathways for patients and identify gaps in the services.

Acquired brain injury services in the Republic of Ireland: Experiences and perceptions of families and professionals

“…They call for services to foster partnerships between professionals, patients and families in order to ensure that all needs are met. In Ireland and internationally, such partnerships may be complicated by what has been termed the 'fragmented' allocation and distribution of resources [19,20]. Typically, in the Irish context, people with brain injury requiring prolonged supports will encounter multiple separate service providers along their care pathway.…”

Inappropriate acute neurosurgical bed occupancy and short falls in rehabilitation: implications for the National Service Framework

“…4 A number of different care pathways for patients in the post-acute phase of neurosurgical treatment have been identified. 5 Among these is the concept of 'rapid access' ('acute') rehabilitation, 6 which can provide multidisciplinary management of spasticity, contractures, nutrition, continence, pain, agitation, pressure areas and tracheostomies for those with physical impairments, and continuous intensive supervision in a secure environment for ambulant disorientated patients, who are still in period of posttraumatic amnesia. This early active management of non-life threatening complications, which do not require surgical intervention, intravenous therapy or ventilation, could optimally be provided in a dedicated unit adjacent to the neurosurgical ward.…”

“…The need for appropriate services for different groups of patients has not been formally quantified and, to facilitate this, definitions of rehabilitation needs of patients with neurological disability have been developed. 5 These allow the unmet need for each type of service to be easily documented and, hence, will inform discussions about how to develop appropriate rehabilitation services. This study documents the need for different rehabilitation facilities for inpatients occupying acute neurosurgical beds in a large tertiary referral centre.…”

Action research in developing knowledge networks

“…One of the main roles of the researcher was to map provision and act as the coordinator for the collection, analysis and reporting of information. Resulting from this comprehensive mapping [26] and description of processes, the next two phases of the project examined collaboration, to link the information and information systems for meaningful discussions about possible improvements. At the same time there was emphasis on communication and coordination for knowledge sharing.…”