The National Institute for Health and Care Excellence (NICE) has published new guidance on rehabilitation for people with chronic neurological disorders. The new guideline, Rehabilitation of neurological disorders including acquired brain injury, provides both an inspiring vision and a practical, step-by-step guide to how rehabilitation should take place, in hospital and community settings, for people living with neurological disability after acquired brain injury (ABI) or spinal cord injury (SCI), or from acquired peripheral nerve disorder, functional neurological disorder (FND) or progressive neurological disease. What is rehabilitation? When we talk about rehabilitation after traumatic brain injury (TBI), spinal injury or major trauma, we are referring to treatments, interventions or support which will help reduce the injured person’s disability, restore their function and independence, optimise their ability to carry out everyday tasks and participate in education, work or leisure, and meaningful social and family relationships. Rehabilitation can involve working with the injured person to overcome health symptoms (such as pain management) or functional disability (such as physiotherapy). For many of our clients, it also involves adapting their home and environment, providing specialist aids and equipment, and teaching strategies or behaviours to increase their safety and independence. Timely, personalised rehabilitation maximises the injured person’s recovery and enhances their quality of life. Its wider benefits include reducing costs and pressure on the health and social care systems, and economic benefits from enabling neurologically-injured people to work or contribute to society. How should rehabilitation take place under the new rehabilitation guidelines? A single point of contact or case manager The new rehabilitation guideline centres an individual’s rehabilitation around coordinated case management overseen by a single point of contact. The guideline doesn’t mandate that the coordinator or lead contact for rehabilitation should always be a professional case manager, but recommends assigning a ‘complex case manager’ (rather than a key worker) where the injured person has severe, complex and long-term rehabilitation needs and impaired cognitive function, difficulties with communication or comorbidities (such as depression) which make it difficult for them to access or engage in rehabilitation or advocate for themselves. The guidance says that the single point of contact or case manager’s role is to help the injured person understand and navigate rehabilitation services, coordinate their rehabilitation plan, support them in accessing rehabilitation services and refer them to other services where needed. Having an accessible, named, case manager who works closely with the individual and their family and understands their needs, ensures that rehabilitation is fully coordinated across multiple NHS, social care, voluntary services or private organisations but is also personalised and responsive to changes in the individual’s health, circumstances or needs. The guidance recommends that the injured person’s need for rehabilitation should be identified and discussed with them and their family as early as possible after injury or diagnosis. At this stage, the individual and their GP should be given an initial contact for rehabilitation. A holistic rehabilitation needs assessment A holistic rehabilitation needs assessment should take place ‘without delay’. This assesses the person’s functioning, symptoms and impairment across a wide range of physical, mental, emotional and environmental needs, such as pain, physical activity and mobility, cognitive function, speech/language/communication, eating/drinking/swallowing, bladder and bowel function, and any equipment and environmental adaptations needed for independent living. The needs assessment should identify rehabilitation which maximises the individual’s ability to participate in every area of their life across various times and settings. A rehabilitation plan A personalised rehabilitation plan based on the individual’s needs and goals should be agreed with the individual and those who are important to their rehabilitation, such as family members, health and social care practitioners. The plan should focus on interventions to optimise or maintain the affected person's functioning and abilities, even if their prognosis or potential for improvement appears to be limited. It should be reviewed and updated when the individual’s needs or circumstances change, such as when they move from acute to longer-term rehabilitation. Children’s and young people’s severe, complex rehabilitation needs should form part of their education, health and care plan (EHCP). The guidance recommends that rehabilitation interventions take place in settings which are appropriate to the injured person’s rehabilitation goals and preferences, such as at home, school, work or in other community settings. The injured person must be provided with any urgent equipment, assistive technology or environmental adaptations that they need at home, to support their rehabilitation and prevent delays to discharge. With the overall structure for the injured person’s coordinated, communicated and fully case-managed rehabilitation in place, the guideline then sets out step-by-step recommendations for the rehabilitative management of many of the specific needs that may be covered by the plan, such as for pain management, speech and language, feeding and swallowing, equipment and independent living, education and vocational rehabilitation, social and leisure activities and relationships. What do the new guidelines mean for people with TBI or spinal cord injury? The new guideline, Rehabilitation of neurological disorders including acquired brain injury, is a must-read for all who are involved in the recovery, rehabilitation and restoration of people with severe and chronic neurological disability after traumatic brain injury (TBI), spinal cord injury (SCI) and major trauma. It sets a clear expectation for what people with chronic neurological disability and their families should be entitled to expect from a system that cares about their rehabilitation and recovery. It gives healthcare and social care providers a detailed model of what good rehabilitation looks like in practice, with step-by-step guidance as to how they can get there. As a head injury and major trauma specialist solicitor, and frequent navigator of existing NHS and social care rehabilitation services for severely injured clients, I welcome the new rehabilitation guideline wholeheartedly, in the hope that rehabilitation services for TBI, SCI and other neurological injury will one day consistently work that way. NICE acknowledges that implementation of the new recommendations will take time, and this will depend on well-planned design, workforce planning and training, joined-up coordination, multidisciplinary and multiorganizational communication, significant funding, resourcing and equitable implementation. Is rehabilitation accessible via a traumatic brain injury (TBI) or spinal cord injury (SCI) compensation claim? Where the person’s injury gives rise to a traumatic brain injury (TBI), spinal cord injury (SCI) or major trauma compensation claim, the scope and detail of the new recommendations for good rehabilitation practice make it all the more vital that the claimant’s solicitor has the proven expertise and experience to ensure that their rehabilitation is prioritised, coordinated and funded, and is integral to the management of the claim. The key to effective rehabilitation is timely, coordinated, personalised implementation. If our severely neurologically-injured clients are not receiving the required level of rehabilitation for their needs at the time that they need it, we are often able to obtain additional funding and specialist support through their claim to ensure that they receive rehabilitation in a way that is timely and properly coordinated. Our clients’ rehabilitation is backed by Rehabilitation Code and interim payment funding, and coordinated by professional case managers, with input from our medical and therapeutic rehabilitation experts and specialist legal, SEN, and deputyship teams. In practice, this means that we can usually secure direct funding from insurers to instruct a case manager to carry out an immediate needs assessment (INA) and then put in place the recommended rehabilitation. We take an active role in each client’s rehabilitation and recovery, collaborating with our client’s NHS clinicians to ensure that our client’s rehabilitation continues seamlessly on from their acute (trauma) care, facilitating and attending MDT meetings, overseeing the implementation and follow-up of individualised rehabilitation, and ensuring that the client receives the rehabilitation when they need it, with full compensation for their injury and provision for further rehabilitation if needed in the future. Find out about our approach to rehabilitation. Read some of our clients’ rehabilitation success stories, which demonstrate the difference that timely, personalised rehabilitation can make to even the most seriously injured person’s restoration and recovery. Specialist Brain Injury Rehabilitation After Catastrophic Car Accident Severe Head Injury Claim Secures £5.1M Settlement & £140K Rehab £7 million settlement after ‘car-surfing’ accident £1,825,000 settlement and £150,000 rehabilitation for pedestrian after speeding driver leaves him with brain injury £750,000 + funded rehabilitation for RTA brain injury victim Brain Injury Rehabilitation Success Stories – Jessica Related article: UKABIF’s ‘Right to Rehab’ Report Urges Statutory Support for Brain Injury Survivors If you have been seriously injured in a road collision, or accident at work, school or public facility, and you would like to find out more about funded rehabilitation or making a claim, you can talk to one of our experienced solicitors, free and confidentially, by contacting us.
