Rehabilitation for chronic neurological disorders including acquired brain injury

Context

A significant number of people live with long-term, often life-long consequences of neurological disease and disorders. Rehabilitation needs may be progressive or fluctuating. Chronic (or long-term) neurological disorders covered in this guideline refer to a large group of conditions that affect the brain, spine or peripheral nerves. These are:

For a detailed list of the diseases, disorders and injuries that are included and excluded see the section on inclusions and exclusions.

Rehabilitation is defined by the World Health Organisation as 'a set of interventions designed to optimise functioning and reduce disability in individuals with health conditions in interaction with their environment'. Functioning and disability are broad terms which are further conceptualised in the International Classification of Functioning, Disability and Health. This framework highlights the relationships and interplay between the following domains:

Rehabilitation is an overall process composed of individual interventions. These interventions range from the relatively simple, acting at one or a few domains, to complex interventions that may act across several domains. Rehabilitation is not a 'one size fits all' process and aims and goals should be identified and agreed with each person to fully inform personalised treatment and therapy programmes.

Rehabilitation can reduce demand on the most costly and intensive parts of the health and social care system. It also supports people and their families and carers to participate economically in society.

Given the large number of diagnostic categories, age groups and healthcare settings, there is wide variation in the delivery of rehabilitation interventions to people with these long-term conditions.

Inpatient rehabilitation for chronic neurological conditions is delivered through a range of services based within the NHS, the private sector and the voluntary sector. Referral criteria for these services are often specific for disease or condition, symptoms, locality or age group.

In the longer term, rehabilitation may be delivered through hospital or community services, including education-based services. It may also be provided by the private or voluntary sectors. Rehabilitation can involve impairment-focused approaches, for example to improve mobility, and activity or participation approaches focused on functional goals (such as managing personal care or preparing a meal). Referral criteria may include diagnosis, age, or time since injury, or may depend on the purpose or setting of the intervention (for example, vocational rehabilitation). Referral criteria often inform decisions about people's access to specialist rehabilitation services. There are significant variations in service provision and care pathways depending on the condition or injury.