The team offers intensive acute therapy immediately post-injury, through community rehabilitation and outpatient follow-up, sometimes years after the brain injury. They cover the spectrum of severe to mild brain injuries and are based at Gloucestershire Royal Hospital but provide a countywide service accepting referrals from Consultants, GPs, Therapists and the brain injury association, Headway. They work between the hours of 8.30am and 4.30 pm Monday to Friday.

The physiotherapists help patients to:

• maintain joint movement and muscle strength
• improve their balance and coordination
• improve mobility by providing walking aids if appropriate

Occupational therapists help patients by:

• assessing postural management, providing seating, bed positioning and splints if applicable
• assessing and supporting them with returning to activities of daily living
• assessing and supporting them with returning to work
• providing a Fatigue Management Service

The speech and language therapists help patients with:

• eating and swallowing difficulties
• communication
• speech
• reading and writing

The therapy technicians help by:

• supporting the team therapists
• carrying out therapy intervention in a support capacity
• liaising with Headway Gloucestershire

Mild Head Injury Clinic

The Mild Head Injury Clinic is a non-medical outpatient clinic for people who have sustained a mild head injury. The clinic offers specialist assessment and advice. Typical referrals are for people who may have attended their GP surgery or the Emergency Department (A&E) following a head injury. Professions that are involved in the Mild Head Injury clinic include Clinical Psychology and Physiotherapy.

Patients are seen by the physiotherapist to address difficulties, primarily with balance and dizziness, commonly seen post mild head injury.

Many people experience a range of other unsettling symptoms including fatigue, headaches, word-finding difficulties, irritability and memory problems, which can persist for some time after mild head injury. There is evidence that an early brief intervention can reduce the severity of such symptoms several months later.

• Everyone who attends the Emergency Department or has a brief inpatient stay following a head injury will be referred to the Mild Head Injury Clinic. They will be provided with written information and advice about mild head injury, the common symptoms to expect and the things they can do to support resolution of these symptoms. They will receive a telephone triage appointment two weeks after receiving the written advice and recommendations. For some people, the triage appointment will establish that they do not require any further input and they will then be discharged. Others may find that their symptoms don’t seem to be improving or that they are impacting considerably on daily life. The triage appointment will establish whether they would likely benefit from further assessment and understanding of their symptoms, to inform specific recommendations.
• If this is agreed between the person and the clinician, then they will be offered up-to three, 45-minute individual sessions for this. The suggestions and recommendations made can range from fatigue management and advice about returning to work and other activities, to specific strategies relating to concentration and memory difficulties. For many people, the duration and impact of the head injury symptoms are exacerbated by understandable anxiety and frustration relating to these unfamiliar symptoms. Addressing such concerns can be an important element of early intervention. This part of the service is run by Clinical Psychologists who specialise in Neuropsychology, with appointments usually being carried out over the telephone. Face-to-face appointments at Gloucestershire Royal Hospital can be accommodated as required.

The Brain Injury Group

The Brain Injury Group is an educational group primarily concentrating on cognitive difficulties after head injury. The format includes general education on normal cognitive functioning and strategies for managing some of the common consequences of brain injury.

The group is facilitated by a Clinical Psychologist and an Occupational Therapist. Attendees need to be aged 16 or over with an acquired brain injury. The content of the sessions is aimed towards people whose main ongoing symptoms are cognitive and are impacting upon activities of daily living such as work. Attendees will need to have the ability to engage in group discussions and participate actively with tasks.

The group runs over six sessions (each lasting approximately two hours including breaks) and topics covered include:

• Week 1: Introduction to Brain Injury - Managing Fatigue
• Week 2: Attention/Concentration
• Week 3: Memory
• Week 4: Goal setting
• Week 5: Thoughts and Feelings - Executive function
• Week 6: Future Plans - including returning to work.

This session is run alongside the Back To Work Co-ordinator for Gloucestershire.

Quantitative and qualitative outcome measures are incorporated and past results have indicated improved understanding of brain injury, improved awareness of support services available and increased understanding of strategies to help manage ongoing difficulties.

Information for GPs

Community or external referrals should be made in writing to:

Brain Injury Team, Ground Floor, Beacon House, Gloucestershire Royal Hospital, Gloucester GL1 3NN

A pathway for Brain Injury is available on the G-Care website.

Early discharge programme

The Early Discharge Programme is suitable for any in-patient who is currently receiving team input who would benefit from high intensity, continued therapy within their home environment, or a patient who is currently receiving therapy at an out of county unit, whose therapy goals would be better met within their home environment. Patients will need to be reviewed by the team to ensure that their condition falls within the remit of the team and that they would benefit from a community based rehabilitation service.

Patient Inclusion Criteria

• Medically stable and tracheostomy out (unless permanent stoma)
• Out of Post Traumatic Amnesia
• No risk to self or others. At low level on head injury risk assessment or manageable at a higher level, or unlikely to change with further inpatient stay
• To be able to transfer with assistance of one
• Appropriate feeding regime in situ
• Appropriate support available at setting discharged to, e.g. family, care package
• Requires specialist brain injury therapy input

Exclusion Criteria

• Patients with pre-existing conditions which would prevent them from engaging in the intensity of specialist rehabilitation provided by this service or whose needs are already being met by appropriate services.
• Stroke

Staff consultancy

In addition to direct clinical work with in-patients and out-patients who have had an acquired brain injury, the Brain Injury Team also:

• Develop and deliver specialist teaching on all aspects of brain injury to other health professionals
• Provide specialist advice and act as an expert resource in the field of brain injury
• Provide second opinions to colleagues in the field of brain injury
• Translate national initiatives such as NICE guidelines and National Service Frameworks (NSFs), taking into account the implications for brain injured patients
• Write medico-legal reports as required

Out of County Rehabilitation

Following a period of acute in-patient rehabilitation with the Brain Injury Team, a patient may benefit from a further period of post-acute rehabilitation. This may be in a variety of different settings depending on the specialist needs of the patient. When ever possible patients will stay in County but on some occasions referral to an out of County rehabilitation unit will be required.

For all patients receiving rehabilitation out of county the team allocates a therapy link to facilitate liaison whilst the patient is out of county and a smooth transition back into county. The therapy link responsibilities are as follows: -

• To attend meetings in the out of county unit as appropriate
• To liaise with the allocated social worker
• To Inform the patient and relatives who the therapy link is and how to contact them
• To liaise with the Out of County Unit regarding patient goals to be completed upon discharge
• To send out a leaflet and follow up with phone call to the family to introduce the Brain Injury Team and the services available
• To link with the patients GP as soon as possible.

Vestibular Rehabilitation Following Mild ABI

A common consequence of a brain injury is dizziness, feelings of vertigo and poor balance. The team’s physiotherapist runs a clinic specialising in the identification of the source of the symptoms and the development of treatment programs to reduce patient’s difficulties. Dizziness may also be assessed as part of a wider Brain Injury assessment in specific Physiotherapy sessions.

If you would like to make a referral please contact:

Kate Batchelor, Gloucestershire Brain Injury Team, Ground Floor Beacon House, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN

Tel 0300 422 5139

Fax 0300 422 5133

Contact

For general enquiries please contact: -

Email: ghn-tr.brain.injury@nhs.net

Tel: 0300 422 5139, 0300 422 5138

Fax: 0300 422 5133

Ground Floor Beacon House, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN