Upfront and enabling : delivering specialist multidisciplinary neurological rehabilitation

Aims: In the acute hospital setting, rehabilitation issues arising from neurological complications in patients on the medical and surgical wards are common. This article describes the work of one multidisciplinary, highly expert neurological rehabilitation team, which is available to advise and treat patients in a large teaching hospital in the UK, during one calendar year.

Methods: The development of the service, its staff and the interventions that the team employs are described. A review of the data from medical records of all patients referred to the team in the period 1st January to 31st December 2006 is then presented. These data were anonymised and extracted from patient notes using a standardized proforma, and include information on referral, initial diagnosis, rehabilitation interventions and subsequent discharge/transfer.

Findings: Sixty-one patients were seen. Their age ranged from 15 to 87 years with equal gender distribution. The dominant users of the team were surgery, respiratory medicine, intensive care and infectious diseases. Fifteen patients presented with new neurological conditions and 17 patients developed neurological conditions during their inpatient stay (stroke, critical care illness and other rare diagnoses). Twenty-nine patients had established neurological disabilities, and the enforced inactivity of admission threatened their precarious independence.

Conclusions: The team was instrumental in addressing key quality requirements of the UK National Service Framework for people with Long Term Neurological Conditions. Their contribution to better discharges, earlier discharges and the patients’ ‘quality of life’ was viewed by staff involved with the patients as significant. Further rigorous research is required to quantify these improvements further.