Early Rehabilitation in Head Injury; Can We Improve the Outcomes?


Osborn Neurorehabilitation Unit, Northern General Hospital, UK



The quality of care after head injury is still very variable with a little coordination
between different specialties. Acute care dominates, often with little regard to
rehabilitation needs.

To improve the outcomes of all head injury admissions to hospital, including mild and
moderate, by creating a head injury team to supervise a rehabilitation clinical

Patients and Methods
A head injury team was established to manage the care of all non-neurosurgical
admissions with head injury to a large teaching hospital. Apart from inpatient care, the
team coordinates various services involved in the care of head injuries, arranged
suitable follow-ups, supported relatives and trained healthcare staff on general wards
in the treatment of head injured patients. Follow-up clinics at 6 weeks and 6 months
were arranged.

In the first three years, the team managed the care of 812 admissions. Mean age was
44.3 years (SD = 24.8) and mean length of hospital stay was 6.1 days (SD = 10.9). Of
these individuals, 674 attended for 6 month follow-up with 52.2% having a good outcome
on Extended Glasgow outcome score. Patients and their relatives' feedbacks were
excellent with an average score of 4.7/5 on overall satisfaction rating. Following
presentations at national meetings and elsewhere, other centers in the United Kingdom
are now setting up similar pathways.

A dedicated clinical pathway and head injury team can improve the quality of care for
all admissions with head injury and enhance the role for rehabilitation medicine input
at an early stage.