Head injury & Acquired Brain Injury (ABI)

Most cases of ABI are a result of trauma: traumatic brain injury or TBI. In addition to TBI acquired brain injury arises from other conditions such as young strokes, brain infarctions, brain tumours and toxic damage. 

In a study of all admissions to Glasgow hospitals with traumatic brain injury (TBI) in the period of one year (3000 in all) approximately 500 remained in hospital for 48 hours or longer (160 transferred to neurosurgery) and of these 400 had associated problems. 54% of those admitted more than 48 hours were discharged in a week or less; 16% were admitted for more than 4 weeks. Less than 10% of cases admitted for more than 48 hours were aged over 70. More than 40% of cases (estimated 1400 people) were disabled one year after injury (including more than 40% of minor brain injuries). Despite the high and persisting incidence of disability only 47% of disabled survivors received hospital follow up and a minority (28%) had rehabilitation or contact from Social Services (15%).

For more than half a century we have been reminded about the severe shortcomings in service provision for acquired brain injury (ABI). The NIH Consensus Development Panel (National Institutes of Health 1999) noted shortcomings of current rehabilitation in the US, which are relevant in the UK. These include the narrow focus of medical restoration approaches and the need to emphasise environmental modification to create enabling conditions, the needs of high risk groups are under-represented (eg infants, adolescents and the elderly), the need for rehabilitation over a lifetime, difficulties in accessing rehabilitation, involvement of the brain injured person and their families in decision making.

The typical patient with traumatic brain injury is a young (mean age 25) adult male, social class III-V, whose injury is associated with a road traffic accident and alcohol or drugs. In Greater Glasgow, assault and falls, often associated with alcohol and drugs are the most common causes. There are two small peaks in terms of incidence for children and older adults (often falls). Teasdale considered all people aged 14-98; hence the mean age in his cohort was older (38), and cause was most commonly a fall or an assault.

Post Acute Rehabilitation Facility (community hub)

The community ‘hub’ (post-acute rehabilitation facility) for people with acquired brain injury (ABI) is now fully staffed and opened to patients in April 2003. The premises are in the Twomax building in Gorbals, and provide short-term, goal-orientated therapies. It is important that all patients with suspected ABI have a functional assessment and that those who may benefit from rehabilitation in the community are referred to the ‘Hub’. A database is therefore being developed to help ensure that as high a proportion of patients as possible receive the treatment they need. The ‘database’ will also be used to assess the effectiveness of different interventions and to inform service development.

Also essential to the treatment of people with ABI are specialist observation/assessment facilities in hospital, including short-stay (<48 hours) beds in accident and emergency departments, and in-patient facilities for short-term rehabilitation. Discussions on the development of short-term rehabilitation at Glasgow Royal Infirmary and the Southern General Hospital have been in progress for some time. However negotiations with the respective Trusts are proving difficult – not least because of the very substantial costs associated with the proposed developments.

Acquired Brain Injury

Young Adults with Acquired Brain Injury in Nursing Homes in Glasgow

A REHABILITATION AND CARE SERVICE FOR YOUNG ADULTS WITH ACQUIRED BRAIN DAMAGE IN GREATER GLASGOW

Headway