Livability Icanho
The Brain Injury Rehabilitation Service
GUIDELINES FOR REFERRAL
Please complete all sections of the referral form to avoid any delay while
information is sought. We would be grateful for as much medical and social
information as possible, including any discharge summary, if available.1
Livability Icanho provides a comprehensive community rehabilitation service
for people aged 18 or over with acquired brain injury including traumatic brain
injury, stroke and haemorrhage.
The service offers specialist comprehensive inter-disciplinary assessment,
identification of problems/goals and setting up of individually designed
rehabilitation programmes.
The clinical team comprises of Neuro Specialist Occupational Therapists,
Physiotherapists, Speech and Language Therapists, Social Worker,
Neurologist, Clinical Psychologists and Rehabilitation Assistants.
The
rehabilitation programmes may include attendance at Livability Icanho, work
within individuals’ homes or in the local community, and will be regularly
reviewed.
HOW TO REFER
Telephone enquiries are welcome but all referrals should be made in writing.
All Referral Forms should be sent to:
Post: Clinical Lead, Livability Icanho, Chilton Way, Stowmarket, Suffolk
IP14 1SZ
Fax:
01449 776100 (secure fax)
Email: enquiries.icanho@livability.org.uk (Please encrypt Referral
Form with a password before sending. Please send password via another medium
i.e. phone or fax)
For any other enquiries, please telephone (01449) 774161
1Livability
Icanho reserves the right to withhold/refuse treatment if essential
elements of referral information are not provided.
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LIVABILITY ICANHO – REFERRAL CRITERIA
Individuals referred to Livability Icanho should meet the following criteria:
Be medically stable and well enough to be able to benefit from community
rehabilitation.

Be aged 18 or over.

Have a Suffolk GP.

Have an acquired non-progressive brain injury, including trauma, stroke,
haemorrhage, infection or tumour. If individuals have multi-pathology, the brain injury
should be their primary diagnosis. Any secondary problems should not be so
significant that they exclude them from benefiting from brain injury rehabilitation.

For Stroke:- To be accepted following the acute episode when discharged from
hospital to home or a place of residence in the community. Time frame for
acceptance of referral is up to 6 months from the point of discharge.
For other Acquired Brain Injury including Sub-Arachnoid Haemorrhage:- To be
accepted following the acute episode when discharged to home or a place of
residence in the community. Time frame for acceptance of referral is up to 1 year
from the point of discharge.
In exceptional cases referrals may be considered for Icanho rehabilitation beyond
these time frames with CCG approval, for example late detection of
difficulties/disabilities.

Require an interdisciplinary approach with some or all of the different professional
groups working towards common goals, including Clinical Psychology, Occupational
Therapy, Physiotherapy, Social Work/family support, Speech and Language Therapy
and medical input from a Medical Consultant.

Require a highly specialist brain injury rehabilitation service that explores all areas
of difficulty including social, family, emotional, adjustment to disability, vocational,
physical, functional, communication, cognition and behaviour.

Have complex difficulties resulting from their brain injury, either with multiple
problems or a single problem of great complexity. For example, this would include
those people with complex physical needs or those with subtle cognitive and
emotional changes.

Have the potential to benefit from, and the willingness to participate in, the
rehabilitation process.
Those clients who have a primary mental health problem, or severe behavioural difficulties
that cannot be managed in the community with specialist support, may not be accepted to
this service. Every effort will be made to work in partnership with their families, or signpost
to, the most appropriate services.
Those individuals with particular needs (for example with access, transport, continence,
medication or meal-time needs) should be discussed with the Clinical Lead at the time of
the referral.
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Livability Icanho
Addendum to Referral Criteria
Indicators for referral of clients with complex difficulties to the specialist
service at Icanho:
Those with multiple complex problems following brain injury;
Or those with a single problem of high complexity.

Those with complex perceptual and/or cognitive problems.

Those with behavioural difficulties which require specialist advice and
management.

Those with complex cognitive difficulties combined with a communication
problem.

Those with complex tone/ abnormal gait pattern with potential for requiring
orthotic involvement.

Those with a realistic return to a productive role. (e.g. paid or un-paid work)

Those with any family or social issues that require a specialist acquired brain
injury social worker input.
The management/clinical team at Icanho would be available to discuss concerns re
suitability and/or visit to discuss referral criteria in general.
NB: Livability Icanho is NOT purely a service for those with cognitive
behavioural problems. However, these may be some of the indicators of the
need for a specialist acquired brain injury service.
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Referral date: (leave blank)
Icanho Service No: (leave
blank)
LIVABILITY ICANHO
REFERRAL FORM
Date discharged from hospital:
(leave blank)
NHS No:
PERSONAL DETAILS
Name
Address
(including
Post Code)
Tel No
Date of Birth
Ethnic Group
Religion/faith
Language(s)
Male / Female (please circle)
1st:
2nd:
If not at above address, please give current location:
Address
(including
Post Code)
Tel No.
NEXT OF KIN DETAILS
Name
Address
(including
Post Code)
Tel No.
Relationship
CARER DETAILS (if different to Next of Kin)
Name
Address
(including
Post Code)
Tel No.
GP DETAILS
Name
Address
(including
Post Code)
Tel No.
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Team Resources/Clinical
Icanho Service No: (leave blank)
MEDICAL DETAILS
Principal
diagnosis &
site of damage
(if known)
Icanho
classification
(leave blank)
Date of onset
Scan results
MRI
CT
Other
Glasgow Coma At incident
Score
(GCS)
On admission to A&E
Post-traumatic
Amnesia
Consultant(s)
involved
Neurosurgery
(details & date
if applicable)
On going
medical issues
Past medical
history
Current
medication
(name drugs &
dosage)
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Team Resources/Clinical
Icanho Service No: (leave blank)
REASON FOR REFERRAL
*Please continue on a separate sheet if necessary and attach any relevant
scans, test results and reports as necessary.
DOES THE PERSON REFERRED EXPERIENCE PROBLEMS IN
ANY OF THE FOLLOWING AREAS?

Please give details
Physical/mobility
Functional
Communication
Cognitive
Behavioural/Emotional
Social Interaction
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Team Resources/Clinical
Icanho Service No: (leave blank)
SOCIAL AND WORK SITUATION (e.g. type of property, lives alone,
family circumstances, work situation)
TRANSPORT NEEDS (if any)
OTHER AGENCIES INVOLVED OR REFERRED TO AT
DISCHARGE (include contact name and telephone no.)
IS THE INDIVIDUAL AWARE OF THE REFERRAL?
YES
NO
REFERRER INFORMATION
Name:
Discipline/relationship:
Address:
(including
Post Code)
Tel No:
Signed:
Date:
Please send completed form to:
Post:
Clinical Lead, Livability Icanho, Chilton Way,
Stowmarket, Suffolk IP14 1SZ
Fax:
01449 776100 (secure fax)
Email: enquiries.icanho@livability.org.uk (please encrypt Referral Form with a
password before sending. Please send password by another medium e.g
phone, fax)
For any other enquiries, please telephone (01449) 774161
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Team Resources/Clinical