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1 Introduction
1.1 THE NEED foR A GuIDElINE
Acquired brain injury (ABI) is a significant cause of morbidity and mortality in Scotland encompassing
damage to the brain’s physiology caused by an external force or pathophysical damage resulting from nondegenerative
disease states (see section 1.3). It is estimated that more than 100 out of every 100,000 people
have a traumatic brain injury (TBI) that results in difficulties that persist beyond one year post injury. 1 People
who have suffered a brain injury have a higher risk of death than people hospitalised for equal durations due
to other injuries or people from the general population. In a case control study which calculated mortality
rates following brain injury in Glasgow over a 13 year period, the death rate was more than twice that for
the general Scottish population (30.99 versus 13.85 per 1,000 per year). 2 Traumatic brain injuries challenge
entire family/social systems and cause stress and disruption to normal life. The subsequent constellation
of difficulties experienced by the person with the injury and their family or carers can have a longer term
impact on their ability to return to their previous level of function and quality of life. This includes their ability
to attain, or retain, employment or education.
Access to appropriate and timely specialist assessment and rehabilitation can have a positive impact on
outcome. Historically, however, services in Scotland for this patient group have been variable. Rehabilitation
to manage brain injuries can be provided by individual professionals or specialised teams across a range of
settings from primary to tertiary care but a national strategy to coordinate this care has yet to be developed.
1.2 REMIT of THE GuIDElINE
1.2.1 OVERALL OBjECTIVES
1 • Introduction
While SIGN 110, Early management of patients with a head injury, 3 focused on the management of the
patient in the first 72 hours following an acute injury, this SIGN guideline has been developed as a companion
document and covers the longer term rehabilitation of adults in the post-acute period. Other SIGN guidelines
will also assist practitioners in this area, eg SIGN 107, Diagnosis and management of headache in adults; 4
SIGN 118, Management of patients with stroke: rehabilitation, prevention and management of complications
and discharge planning; 5 and SIGN 119, Management of patients with stroke: identification and management
of dysphagia. 6
In some people with brain injuries there may be complications that impact on rehabilitation such as preexisting
cognitive impairments or epilepsy. Cognisance should be taken of these issues, however their
presence does not preclude the affected individual from rehabilitation. Management of epilepsy is covered
in SIGN 70. 7
The guideline will provide recommendations, where possible, about post-acute assessment for adults over
16 years of age with brain injuries and interventions for cognitive, communicative, emotional, behavioural
and physical rehabilitation. Furthermore, evidence will be presented on important questions relevant to
patient outcomes such as optimal models and settings of care, the benefits of discharge planning and the
applicability of telemedicine. While section 3 focuses specifically on the assessment and treatment of mild
traumatic brain injury, the remainder of the guideline is not limited to particular severities of injury.
Although this guideline focuses on the person with a brain injury, professionals working with this group
should be aware of the impact the injury and subsequent problems may have on the family and wider
social network, including children, siblings, partners and friends. 8 Children and siblings of the person with
the TBI may experience physical, psychological and emotional upheaval. This can have long term effects on
relationships within the family unit as well as their own cognitive and emotional development (see sections
6.1.1 and 10.2.4).
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