Head injury rehabilitation: the role of a neurotrauma clinic

Abstract

Survivors of head injury are often left with varying degrees of disability and complex and varied needs, necessitating prolonged periods of rehabilitation and continuing care. Advances have been made in the acute management of these patients, but continuing management in terms of rehabilitation remains deficient with lack of specialist resources and a fragmented service. For head-injured patients, lack of access to appropriate ongoing rehabilitation may have profound effects on outcome and social re-integration. There are also considerable economic implications for planning and provision of services. The aims of this paper are to describe, review and evaluate the role of a Neurotrauma clinic within the Head Injury Service at Addenbrooke's Hospital, Cambridge. The multidisciplinary Neurotrauma clinic commenced in June 2003 following an extensive collaborative research programme to assess current regional head injury service provision and address deficiencies and management issues. Patients of all ages with ongoing problems following varying severity of head injury are followed up at 2 months + post-injury for as long as appropriate. Patients complete an SF-36 and GOSE questionnaire at each clinic appointment and this self-reported data is complemented by neuropsychological assessments, and demographic data entered on a database. The clinic acts as a 'gateway' to access appropriate ongoing rehabilitation and a source of information and support. The routine collection of outcome data enables tracking of individual patient progress and outcome and provides an information resource for further research. The findings highlight deficiencies in rehabilitation both in general service provision and specific patient need. Evidence in support of demand, need and effectiveness of rehabilitation for head injury is particularly relevant within the limited resources of the NHS. Early indications show that a specialist clinic can assist in providing continuity of patient care, in improving coordination of services, and act as a resource for further research on epidemiology, outcome and impact of rehabilitation.

Health-related Quality of Life 12 months after severe traumatic brain injury: A prospective nationwide cohort study

“…Global functioning, as evaluated by GOSE scores at 3 months and 12 months, was a significant predictor of HRQL in the current study. In addition, significant improvements in GOSE scores from 3 to 12 months post-injury were found, suggesting that disability following TBI is not static (38). Significant associations between recovery and QOLIBRI scores have been shown in other studies on TBI populations of all severities (21,24).…”

“…Moreover, recent recommendations made by the Norwegian Health Authorities (http://www.helsedirektoratet.no/IS-1279) resulted in the improvements to rehabilitation protocols available to these patients, as well as in more seamless chains of treatment. Improved care and rehabilitation efforts might contribute to less uncertainty with respect to the current and future situation and contribute to the HRQL (38).…”

Service use following attendance at an emergency department with an head injury: a 6-month survey

“…Additional relevant information was also gathered from the Cambridge Head Injury Database (CHID) for any referral to the specialist neurotrauma clinic (NTRC). 9 CHID contains comprehensive data on HI attendance at Addenbrooke's Hospital and is a resource for research to inform clinical practice and service planning.…”

“…Two of these were for neuropsychological assessment, nine to general neurosurgical clinics, and 28 to the NTRC. 9 Twenty-four of these 28 had been inpatients, and four had attended the ED and been discharged with HI advice. In terms of severity of injury, based on the GCS score at time of injury, 11 were mild, eight were moderate, and nine were severe.…”

The epidemiology of a specialist neurorehabilitation clinic: Implications for clinical practice and regional service development

“…Its aim was to triage patients to access appropriate further stages of an ongoing individually tailored rehabilitation and follow-up process to ensure best possible outcome; this may involve providing support, detecting post-injury complications and determining specific problems (cognitive, emotional, behavioural, physical). This study follows on from an earlier study which described the development of the clinic and evaluated the clinic model and its role within the service 5 years after its introduction [13]. This study now reviews the service at 9 years from its inception, examining the epidemiology of referrals to the clinic and its ongoing development, with the aims of exploring and highlighting issues and implications for clinical practice and further service development.…”