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10.2 CoMMuNITy REHABIlITATIoN
10.2.1 INTRODUCTION
Post-acute inpatient rehabilitation is not available comprehensively throughout Scotland and in many
areas community rehabilitation services of variable composition are providing both short and long term
rehabilitation support to patients with traumatic brain injuries. 169
While there is limited research comparing the outcomes of community rehabilitation with other or no
rehabilitation, there is evidence of beneficial outcomes for patients with TBI who have access to the following
features of community rehabilitation services:
y interdisciplinary rehabilitation170-173 y planned transfer of patient care from hospital to community services169,170 y ongoing family and carers support170 y neuropsychology rehabilitation programmes171 y community rehabilitation many years post injury172,173 There is no consistency in current studies regarding the definition and make up of optimal community
rehabilitation services nor of specific rehabilitation programmes, however common themes emerge which
are outlined in the following sections.
10.2.2 INTERDISCIPLINARy COMMUNITy REHABILITATION
Patients who have access to services providing interdisciplinary rehabilitation in their community demonstrate
benefits that outlive the treatment period in comparison to those who have ‘usual care’.
A case control study compared a group receiving multidisciplinary outpatient rehabilitation with a group
receiving no rehabilitation. 174 Patients who participated in the multidisciplinary rehabilitation programme
achieved greater improvement on the community integration questionnaire outcome measure than controls.
However, there was no significant improvement in community socialisation outcome or work or school status.
The small sample size and lack of randomisation limits its application to other areas.
Community rehabilitation services for patients with brain injuries should include a wide range of
disciplines working within a co-ordinated interdisciplinary model/framework and direct access to
generic services through patient pathways.
Each patient should have a named worker.
10 • Service delivery
A guideline from the British Society of Rehabilitation Medicine and Royal College of Physicians recommends
that, as a minimum, a community specialist service to support people with brain injuries should include: 175
y specialist brain injury nurses
y physiotherapists
y occupational therapists
y speech and language therapists
y clinical psychologists
y specialist social workers
y dietitians
y technical instructors
y generic assistants
y consultants in rehabilitation medicine
y with access to other relevant services such as neurology, neurosurgery, neuropsychology, neuropsychiatry
and mental health services as required.
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