Rehabilitation Following Traumatic Brain Injury: Challenges and Opportunities

Background The principles underlying the rehabilitation needs for patients with head injury have been recognised since the Second World War. Since that time, numerous official reports have highlighted major deficiencies in service provision and make similar recommendations for an integrated service. However, recent national reports and a comprehensive survey in the Eastern Region have still found that whilst there are models of excellence, core service provision in the UK remains variable, inequitable and under-resourced. This is acknowledged and supported nationally by those with expertise in, and understanding of, the needs of brain injury survivors, their families and carers from across the spectrum of health and social services, and voluntary agencies. Traumatic brain injury is the leading cause of disability in people under 40 years of age, and severely disables 150200 people per million annually. It is now estimated that 200 300 per 100,000 of the population have a significant disability as a result of head injury. Survival rates following severe brain injury have improved dramatically in recent years due to advances in acute care, potentially increasing the requirement for rehabilitation. The majority of head injuries, however, are designated as minor and moderate and after initial management there is little or no follow up and support, yet recent studies show that a significant proportion of these may suffer persisting symptoms after what appears to be a minor injury. 10 The need for comprehensive and effective rehabilitation programmes for these individuals is therefore ever increasing. Moreover, these patients can suffer considerably and there can be a significant economic impact in terms of delayed return to work and normal activities. Rehabilitation medicine is a relatively new specialty, having been recognised as a separate discipline only in the past 20 years, and as yet there are relatively few trained rehabilitation specialists. Although it has traditionally been a low profile medical speciality, attitudes are changing and the importance of early rehabilitation intervention to optimise the long term outcomes of head injury is now increasingly recognised. There have been a number of recommendations for neurorehabilitation, and the process of developing guidelines is ongoing, the most recent being the national guidelines for rehabilitation following acquired brain injury which seek to address the complex and three-dimensional nature of rehabilitation. This review describes some of the challenges presented in planning and delivering effective rehabilitation services to head-injured patients and explores solutions and opportunities in the light of current development of the National Service Framework for Long-term Neurological Disabilities, which sets a national framework to enable local development, implementation and commissioning of services.