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Brain injury rehabilitation in adults
Annex 1
key questions used to develop the guideline
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This guideline is based on a series of structured key questions that define the target population, the
intervention, diagnostic test, or exposure under investigation, the comparison(s) used and the outcomes used
to measure efficacy, effectiveness, or risk. These questions form the basis of the systematic literature search.
Key question See guideline section
1. In patients who have had a mild/minor brain injury and later present (in
primary care) what assessment/questions can be asked/applied to facilitate
triage to the appropriate service?
3.1-3.3
2. What evidence is there that the following interventions in patients with
brain injuries improve measurable components of physical function (see
below)?
y daily/repetitive specific physiotherapy (early/late)
y daily/repetitive specific occupational therapy (early/late)
y daily/repetitive practice of remedial activities (early/late)
~ computer based exercise rehabilitation/virtual reality rehabilitation
~ Nintendo Wii
~ physical games, eg basketball, racquet games etc
y daily/repetitive practice of functional activities (early/late)
y constraint induced therapy.
3. What is the evidence for the effectiveness of the following interventions
in the management of spasticity and muscle tone in patients with brain
injuries:
y exercise
y splinting
y electrostimulation /functional electrical stimulation
y anti-spasticity drugs (baclofen, tizanidine, dantrolene and diazepam)
y botulinum toxin
y surgery
y physiotherapy (early/late)
y occupational therapy (early/late)
y optimum seating and positioning including specialist equipment?
4. In patients with brain injuries and continence problems, which of the
following interventions are effective in improving continence:
y timed voiding/bladder retraining
y oestrogen
y anticholinergics, eg oxybutynin
y biofeedback
y anticholinergics
y duloxetine
y catheterisation?
4.3
4.1.5
4.2
4.4