Rehabilitation for chronic neurological disorders including acquired brain injury

As soon as possible after suspecting or diagnosing a chronic neurological disorder in a child or young person, inform their nursery, school or college.

Provide the nursery, school or college with information about the child's or young person's condition, their prognosis and rehabilitation needs.

Discuss and agree the support, equipment, adaptations (including environmental adaptations) or adjustments needed to facilitate the child's or young person's rehabilitation and participation in education.

Ensure there is:

• a named rehabilitation practitioner that education practitioners can contact if they are concerned about the rehabilitation needs of the child or young person

• two-way communication and information sharing between rehabilitation and education practitioners, including during periods of transition, for example, when the child or young person moves to a different nursey, school or college, or their teachers change.

Discuss at regular intervals whether the nursery, school or college is still suitable for the child or young person or whether a different education setting is needed.

Regularly review education, health and care plans if they include rehabilitation provision, especially if the child or young person has a chronic neurological disorder that is progressive or fluctuating.

When assessing the person's ability to remain in, or return to work, take into account:

• their retained skills, strengths and motivations

• whether their rehabilitation needs are likely to increase or decrease.

If the person is unable to remain in, or return to, a specific work role, provide support to enable them to leave work or change their role.

Discuss remaining in, or returning to, work with the person and their employer as early as possible and:

• consider undertaking a work capacity evaluation, and

• help set expectations, and identify and solve any barriers that could prevent the person remaining in, or returning to work, and

• collaborate with specific professions in the workplace as needed, for example, occupational health, human resources and legal teams.

When planning return to work follow recommendation 1.16.4 in NICE's guideline on stroke rehabilitation in adults, which is applicable to people with other forms of chronic neurological disorder.

For an employer carrying out a workplace assessment with the person, identify potential barriers to effective working and develop solutions and strategies to overcome them.

Ask the person if and how they want any workplace adjustments (for example, the provision of a support worker or time to access rehabilitation) or changes to their role to be explained to their work colleagues and what information should remain confidential.

When undertaking vocational rehabilitation, use the most appropriate environment to assess rehabilitation needs and deliver rehabilitation interventions. This may be in the workplace, a hospital clinic, community setting or the person's home.

Check the effectiveness of workplace adjustments and review vocational rehabilitation whenever rehabilitation needs that might impact on work are being reassessed.

The employer should discuss and agree any workplace adjustments for addressing future rehabilitation needs with the person and seek advice from rehabilitation practitioners as needed.

Talk to the person about any barriers preventing them from achieving their social participation goals and work together to overcome these barriers. Barriers could relate to:

• the need for support, which may be practical, physical, emotional or cognitive

• the impact of other people's attitudes and behaviours

• cultural, social or socioeconomic factors

• availability of suitable facilities.

Recognise that social participation goals may involve simple, everyday social activities, for example, coffee with a friend or attending play groups.

Help the person to identify social clubs and activities in their local community that might address their social participation goals.

Help with any risk assessments and form filling required to enable participation in social and leisure activities, if needed.

Support the person to explain to organisers of social or leisure clubs or activities, including faith-based activities, any adjustments and adaptations needed to enable them to access the venue or activity.

When planning travel, social and leisure activities, take into account toileting needs and availability of accessible public toilets.

Consider online options for social activities if in-person activities are scarce, for example, in rural areas, or if travel is challenging.

Offer the person the opportunity to discuss rehabilitation needs and set rehabilitation goals connected with family life and friendships, including relationships at school and home for children and young people, and parenting and caring relationships.

Identify any physical, cognitive, communication, emotional or social barriers to family life and friendships as part of rehabilitation assessment, goal setting rehabilitation and planning.

If the person needs support to maintain and develop parenting and caring relationships:

• discuss how they feel about these relationships in the context of their rehabilitation needs

• address any physical, cognitive, communication, emotional or social barriers to parenting and caring responsibilities

• help them to access parental support services, if needed

• provide targeted rehabilitation interventions, for example, to address specific impairments that impact on caring for another person.

Provide information about intimate or sexual relationships and sex. This might involve having:

• information clearly displayed in healthcare settings

• sex aids or equipment available to show and discuss.

Offer the person the opportunity to discuss rehabilitation needs and set rehabilitation goals connected with intimate or sexual relationships and sex.

Rehabilitation practitioners should seek advice and support to ensure they are competent and confident discussing rehabilitation needs connected with intimate or sexual relationships and sex.

Rehabilitation practitioners should know when and how to signpost to other services for specialist advice and support about intimate or sexual relationships and sex, for example, psychosexual or couples counselling, or continence management. See also the section on interventions for emotional health and wellbeing.

Rehabilitation practitioners should seek specialist advice, or signpost to a specialist service, if potential safeguarding or consent issues are raised in connection with intimate or sexual relationships and sex.

When discussing, assessing and providing interventions connected with intimate or sexual relationships and sex, take into account the person's gender identity, sexual orientation, and any religious and cultural beliefs.

Identify and address any physical, cognitive, communication, emotional or social barriers to intimate or sexual relationships and sex.

Use appropriate methods to gather initial information about intimate or sexual relationship and sex, for example, by asking the person to complete a questionnaire in their own time.

Ask the person how they might talk about intimacy, sex and sexual functioning with partners and potential partners and provide support with this, for example, advice on sharing relevant personal medical information.

Address rehabilitation needs connected with intimate or sexual relationships and sex through:

• targeted rehabilitation of specific impairments or disabilities

• provision of information

• training for carers or potential sexual partners

• provision of, or signposting to, sex aids or equipment.

Address any barriers within health and social care settings that may restrict rehabilitation in relation to the person's rehabilitation goals around sex and intimacy. For example, provide door locks where it is safe and appropriate to do so, remove restrictions on internet access, and do not use restrictive clothing and splints.