Evaluation of a multidisciplinary community intervention following acquired
brain injury: A case series exploring community integration
Clare Thomas1,2Student (Doctorate in Clinical Communication Science) clarethomas@homerton.nhs.uk
Supervisors: Prof Jane Maxim1 and Dr Carol Sacchett1
1
University College London, UK
2 Homerton University Hospital Foundation Trust
Case Example:
Introduction:
Intervention:
History
This study is a case series, exploring community integration in a group of
adults who have returned to living at home following a severe acquired
brain injury (ABI). The poster presents the background, development of the
intervention and proposed study design.
There is significant research evidence to support the benefits of
multidisciplinary rehabilitation following ABI. 1 Historically research has
focussed on the benefits of inpatient rehabilitation but more recent research
has demonstrated the benefits of community rehabilitation. 2 This is line with
current healthcare policy which advocates provision of care closer to home
and offering choice about healthcare decisions. 3
In neurological rehabilitation this has led to the following trends:
• Shorter stays in hospital
• Increase in community rehabilitation provision
• Increased choice about long term care and home environment
• Increase in number of people choosing to live in the community following
severe ABI
• Increased focus on community integration as the ultimate goal of
rehabilitation
23 year old man with a hypoxic injury secondary to
assault and cardiac arrest
Received 12 months of inpatient rehabilitation before
being discharged to live in his own flat, near to family
with live-in paid carer
On discharge:
• Complex physical disability requiring specialist
wheelchair and daily stretching and positioning
programme
• Assistance from two carers for all care/ transfers
• Severe dysarthria and reduced speech intelligibility
• Cognitive impairment, characterised by impaired
planning, attention and executive function
60
Goal Attainment
Scores Pre and Post
Therapy
48.49
50
GAS T Score
Pilot of support programme for clients with complex/ severe disability
following ABI living on their own in the community
31.9
30
20
10
Team review of progress to goals
0
Feedback from clients and close family members
Pre therapy Post therapy
• My carers will understand my needs
(communication, stretches, positioning,
medication, planning day)
• I will be able to get from lying to sitting with
assistance of 1 carer
• I will be able to shower in a chair 4 times per week
• I will have a less supportive wheelchair
• I will feed myself using adapted cutlery
• I will use a written timetable and computer to
support communication
• I will join the gym and play football
• I will attend a day centre for younger people
• I will write my own rap lyrics using the computer
The service is an established community multi-disciplinary
neurorehabilitation team in Hackney, London, comprising:
• Speech and Language Therapists
• Physiotherapists
• Occupational Therapists
• Clinical and Neuropsychologists
• Rehabilitation Assistants
• Support form a Consultant Neurologist.
References:
1. Turner Stokes L. Evidence for the effectiveness of multidisciplinary rehabilitation following acquired brain injury: A synthesis of two
systematic approaches. In Journal of Rehabilitation Medicine 2008: 40, 691 – 701
2. Geutsen GJ, Van Heugten CM, Martina JD and Geurts AC (2010) Comprehensive rehabilitation programmes in the chronic phase after severe brain
injury: a systematic review. Journal of Rehabilitation Medicine. February: 42 (2): 97-110
3. Department of Health (2005) The National Service Framework for Long Term Conditions. Accessed at: www.doh.gov.uk/publications
Intervention 2
Core goals
Prepare for discharge:
• Inpatient team to prepare detailed guidelines
for care staff and family
• Determine equipment requirements
• Detailed handover between inpatient and
community teams
Maximise independence in the home:
• Ensure all equipment is in place
• Ensure care staff receive training and
support in all areas, e.g. communication,
positioning, daily exercises
• Identify activities that the client wants to
participate in and explore options for
community access
Maximise community integration:
• Explore barriers to accessing activities and
social interaction in the community
• Identify supports available to access
community
• Provide graded support to access activities
• Encourage independent access to
community with family and carers.
• I will telephone friends and family
• I spend time playing on the floor with my son
• I will visit family locally
Successes of intervention
Team reflection on process and identification of and challenges to
successful support
Intervention 1
Goals
40
Developing an intervention focussing on community
integration :
Stage of intervention
Pre discharge from hospital
Study Design:
Challenges/ lessons learned
Remained living in flat and gained
increased independence. Including
improvements to function beyond
those predicted on discharge
Accessed local Sure Start Centre,
Ability Gym, No Limits sports club
and Headway Young People’s Group
Length of time taken to train carers
and supply all necessary equipment
– identified need to prepare more
during inpatient placement
Changes in care staff led to difficulty
providing training – identified need
to work closely with the care
agencies to achieve this
Increased access to community,
Home set up and carer training
family interaction and range of social essential to facilitate goals of
activities
community access and integration
Acknowledgements:
The author’s Doctorate in Clinical Communication Sciences is supported by the Adult Community Rehabilitation Team, Homerton University Hospital
Foundation Trust
The study is a case series design based on repeated measures:
• Participants: 6- 8 clients returning home to live after severe ABI.
• Intervention: the intervention will be delivered by the multidisciplinary team in
participants' homes and in the community. Each participant’s close relative will
also participate in an interview to collect additional information about the
intervention.
• Outcome Measures:
• Northwick Park Dependency Score
• Brain Injury Community Rehabilitation Outcome Measure
• Community Integration Measure