What happens after neurorehabilitation?
Whilst professionals working in the field of neurorehabilitation always strive to help individuals achieve their maximum physical, psychological, cognitive and social potential to maximise their quality of life, there are sometimes limitations to what can be achieved. This can be for a variety of reasons including the complexity of other injuries sustained at the time of the neurological insult or the pre-morbid health conditions people have. Neurorehabilitation services and professionals work towards an individual’s goals and use a set of nationally/internationally recognised outcome measures to help everyone see the progress being made and when progress has slowed, plateaued or all the goals have been achieved.
An outcome measure is a tool to measure or quantify the changes that occur that may be attributed, to some degree, to the intervention that has been provided. All therapies have a number of discipline specific outcome measures available to them in order to measure all aspects of their interventions and several may be needed to provide comprehensive relevant information for each individual. In addition there are measures available that are global measures that look at overall functional progress.
Many outcome measures are standardised which means that they have a set procedure to use when administering and scoring the measure. Standardised tests have known levels of reliability, validity, and utility, which ensure that therapists can select and use them appropriately and with confidence in the results.
The UK Rehabilitation Outcomes Collaborative (UKROC) has determined a set of outcome measures to be used within the different levels of specialist rehabilitation units who administer them at set intervals e.g. on admission and at discharge. UKROC collates case episodes for inpatient rehabilitation, including outcomes data, from all specialist neurorehabilitation services across the UK. This is used to provide the commissioning dataset for specialist neurorehabilitation services and national benchmarking. Many independent providers use some, or all, of the outcome measures as required by UKROC. However the amount of data required by UKROC is not cost effective for independent providers to collate ans therefore many do not submit (isn’t is level 1 only and therefore most independent providers are not at this level?)
Discharging from Inpatient and residential Settings
A patient is discharged home when they are deemed to have reached their goals or have reached a level which will not improve further at this point in time. It may also take place if funding is being ended; for which there are many reasons why this may be. Alternatively it may be that the next part of the neurorehabilitation can take place in another community based setting or actually back in an individual’s own home.
Most services will undertake a pre admission assessment and during this there will be a preliminary discussion about possible discharge destinations. Once admitted to the unit, ideally a formal discharge planning meeting should take place well in advance of a person’s estimated discharge date. The meeting should be attended by social services or continuing healthcare representative, other community based support networks (e.g. community mental health team, Community ABI Team) and the family or other personal significant representative. The meeting should consider whether the patient has any physical, cognitive, emotional and behavioural difficulties. It will also be important to determine if the patient needs adaptations to the home in order to be safe. Other issues which need to be discussed include continuing management of the patient, medication, ongoing rehabilitation needs that may be met in the community for which referrals need to be made to ensure consistency of treatment and support.
A patient may have a rehabilitation prescription which should outline their ongoing needs. The patient should have a copy and a copy will also be sent to the .
Community support varies around the country and cannot be compared equally across counties event, so it is important to find out what is available in your specific area and what information needed to help individuals with their ongoing treatment and support. Often INPA members are a good source of information for the services and support available in the areas they work in. Alternatively consulting Headway, UKABIF etc…are other mechanisms to find out what is available and where.
In addition to clinical support the patient and their family may need social support. Regional groups and branches of charities can be helpful.