Improving the rehabilitation of individuals admitted to England’s National Spinal Injuries Centre with traumatic brain injury

Spinal Cord Series and Cases, 2024 · DOI: https://doi.org/10.1038/s41394-024-00690-x · Published: November 27, 2024

Spinal Cord Injury Rehabilitation Brain Injury

Simple Explanation

Traumatic Brain Injury (TBI) commonly co-occurs with Spinal Cord Injury (SCI), yet TBI is often missed in SCI rehabilitation, hindering proper treatment adaptation. This study compares TBI detection rates at England's National Spinal Injuries Centre (NSIC) against previous research and explores barriers preventing tailored SCI rehabilitation in the presence of TBI. The project assesses documentation across 88 patient treatments and conducts a focus group with clinicians to understand challenges in detecting TBI and modifying SCI rehabilitation accordingly.

Study Duration

Between June 2020 and July 2021

Participants

88 patients with SCI, 65 male, 23 female, ages 18-83; 5 clinicians

Evidence Level

Mixed methods service improvement project

Key Findings

1
Data related to TBI were inconsistently recorded, and the number of individuals recorded as having a TBI at the center was lower than a recent study.
2
Barriers exist which prevent clinicians from detecting TBI in SCI populations and adapting rehabilitation accordingly.
3
TBI in SCI populations may be an invisible unmet need.

Research Summary

This project aimed to compare the incidence of TBI at the NSIC to ﬁgures found in previous research and to understand the barriers to identifying and considering TBI during rehabilitation at the NSIC. The results from phase one of the project suggested that the proportion of TBIs in the NSIC sample was signiﬁcantly lower than even the lowest proportions identiﬁed in previous research. The results from phase two suggested that there may be several factors involved in detecting TBI at the NSIC and tailoring patients’ treatment accordingly.

Practical Implications

Improved TBI Screening and Documentation

Standardize TBI screening and documentation across all stages of SCI rehabilitation to ensure consistent recording of relevant information.

Enhanced Clinician Education

Provide team-level education to increase clinicians' knowledge of TBI presentation in SCI patients and equip them to address rehabilitation challenges.

Early Interdisciplinary Discussion

Create dedicated time for interdisciplinary discussions early in the patient journey to address TBI impact, necessary adjustments, risks, and discharge planning.

Study Limitations

1
TBI identification relied on patient records, potentially misrepresenting clinical activity.
2
The COVID-19 pandemic may have impacted service delivery and patient characteristics.
3
Small focus group sample may not represent all MDT perspectives.

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