Acquired Brain Injury Neuro Rehabilitation at QEF
Clients with an acquired brain injury (ABI) often come to QEF once medically stable and ready for discharge from an acute hospital setting. The therapy each person receives depends on how recent their injury is and the level of therapy they can tolerate.
Depending on where they are in their rehabilitation journey, they may benefit from a period of intense neuro rehabilitation or slower stream neuro rehabilitation over several months.
Intense neuro rehabilitation
Each client’s needs and potential therapy goals are assessed within the first few days of arriving at our Care and Rehabilitation Centre and a personalised therapy timetable is developed to help them achieve their goals e.g. to get out of bed independently, walk unaided, dress themselves, make a meal for themselves or return to work. This is supported by a personalised care plan.
A therapy timetable is then developed, reflecting the needs of each client. For example, some people may require more support from Psychology and Speech and Language teams than others. Therapy sessions are complemented by Therapy Support Workers who continue the work set by therapists outside formal sessions, as well as group work.
Progress towards SMART* goals is closely monitored and discussed each week in the multidisciplinary team meetings, throughout an average 12 week placement.
Clients’ medical needs are reviewed by the care and nursing teams and the GP and medical consultant in the ward rounds each Tuesday. Funding is usually via the NHS, case managers or occasionally self-funded.
Slow Stream neuro rehabilitation
After the initial acute phase which may have taken place somewhere else, a person may not yet be ready for their longer-term placement and need a longer period of rehabilitation in order to get themselves ready for permanent onward care. Or they simply may not be able to cope with an intensive amount of therapy sessions each day.
Slow stream is therefore a gentler and slower approach involving several sessions of each therapy a week, plus group work. It is often needed by clients with more complex requirements and provides more time for each person to maximise their potential. Clients’ medical needs are reviewed by the care and nursing teams regularly and the GP and medical consultant on the ward rounds each Tuesday. Funding is usually via the NHS or case managers as a result of litigation payments.
What to expect when you arrive
Within 48 hours of arrival each person is assessed by:
- a Physiotherapist to see how much independent movement they may have,
- a Speech and Language Therapist to determine their ability to swallow and what type of food they will be able to eat, and
- an Occupational Therapist who will determine their seating requirements.
- A manual handling risk assessment is also completed so the care teams know how best to manage moving each person.
During the next few days, the client will further assessed by:
- an Occupational Therapist to determine what support they require for personal care and feeding;
- a Speech and Language Therapist who will do further assessment around their communication needs, and
- a Clinical Psychologist who will assess their capacity to give consent, as well as their mood and cognitive abilities.
We then create guidelines for the care team (positioning, swallowing, behavioural, personal care etc), so there is a clear understanding of each person’s needs and abilities and a therapy timetable is developed based on individual needs. We aim to provide stroke clients with four to five sessions of Physiotherapy and Occupational therapy every week, whilst Speech and Language and Psychology are provided dependent on need.
Each person is allocated a keyworker who is the main point of contact for families, as well as responsible for coordinating the current and onward care needs of the client.
Second week onwards
Therapists work with each person to establish what it is that they want to achieve from their rehabilitation programme, as they will then be motivated to work towards these goals. Therapists then set SMART* goals for therapy sessions that help each individual to achieve their aspirations.
The Multidisciplinary team meets every week to assess how each person is progressing towards their goals, and a medical ward round takes place every Tuesday with a GP and Rehabilitation consultant.
We also provide art, music activities and other therapy led groups which each person can join in with, such as gardening, cooking ,relaxation and mindfulness. A dietitian is also available if needed to look at what food and supplements a person may require.
For clients receiving intensive neuro rehabilitation discussions about onward care and discharge start early so that it isn’t rushed. This involves talking to families and the client about what they want to happen when they leave QEF, establish whether going home is realistic, how much community rehabilitation they will need or whether an onward referral for continued rehabilitation is more appropriate, either with us or at another centre.
The Occupational Therapy team will conduct a home visit with the client to assess what equipment might be needed for the person to be safe at home, whether they may need a bedroom setting up downstairs for example and whether living at home is viable or not. Following this visit, the Occupational therapist will make recommendations around what equipment is required for a safe discharge home.
QEF’s social worker can support families and the client with planning onward care.
(* Specific Measurable Achievable Realistic Timely)