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Rehabilitation 2019

A good referral can get rehab off to the best start

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Dr Gemma Hague

Consultant Clinical Psychologist & Head of Clinical Services, TRU Rehab

Acquired brain injury patients need access to specialist rehabilitation services. A thorough and transparent referral process is the best way to begin their rehab journey.

All patients’ rehabilitation journeys start with a referral process. To make sure they’re immediately put onto the right rehabilitation pathways and offered the best services for their needs, it’s vital that clinical facilities carry out referrals in a robust and transparent way.

This is particularly true for anyone needing specialist services following an acquired brain injury (ABI).

Dr Gemma Hague is Consultant Clinical Psychologist and Head of Clinical Services at TRU, a specialist acquired brain injury rehabilitation facility in St Helens, Merseyside. Patients are referred to TRU from all over the UK from various sources including hospitals, local authorities, health services and private referrals.

Rehabilitation services for different needs

“When a patient is newly referred to us, we’ll have limited information,” she says.

“That’s why it’s so important to carry out a thorough assessment with a multi-disciplinary team to pull together all available information about that person, review their needs, assess their goals, recommend the rehabilitation pathway that suits them best at that point, and signpost them to the right services.”

This might involve neuropsychology, neuropsychiatry, physiotherapy, speech and language therapy, occupational therapy and counselling.

If a newly referred patient with acquired brain injury is not able to convey information to clinicians, it is necessary to liaise with family members or other clinical professionals who know their case history well.

“We view a referral as a systemic, holistic assessment,” says Dr Hague. “Naturally, it’s important to work with the patient first and foremost and enable them to be part of the assessment; but, wherever possible, we speak to their family and professionals who are close to that person — and also the commissioners to make sure we can implement the most cost-effective and clinically effective rehabilitation programme for that person.”

This referral process is essential because types of brain injury and their severity differ greatly.

“For example, some individuals will need support with daily living inside and outside their home, or with getting back to work, and may need functional skills training,” says Dr Hague.

“Others may experience issues with their executive functions, particularly after a traumatic brain injury.”

Coaching patients to be more confident and able

Executive functions are higher level cognitive skills, such as organising and planning, making decisions and judgements, understanding that actions have consequences and managing impulses: vital if individuals are to live their lives independently, develop a social network and maintain jobs and relationships.

“A specialist rehabilitation coach, supported by a clinical team, can help these patients shape their ability to manage their own lives,” says Dr Hague.

“They work in a similar way to a football coach by motivating people, guiding them and challenging them to the point where they feel more confident and able and have increased skills to structure their own environments and decisions.”

One challenge for Dr Hague and her team is to manage the expectations of those who have no understanding of brain injury, or what rehabilitation is trying to achieve.

“People do have to be realistic,” she says. “For patients with very complex needs, it’s likely that the neurological impacts of their injury will remain. However, their rehabilitation will give them stability, optimise their function and get them to a good point in their journey.”

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