Return to work after traumatic brain injury: recording, measuring and describing occupational therapy intervention

Low post-injury employment rates indicate that returning to work is difficult following traumatic brain injury (TBI). Occupational therapists assist people with TBI to return to work, but rarely is their intervention described. This has hindered research into vocational rehabilitation. As no existing tool was identified for recording intervention, a proforma was developed for this study. Using best practice guidelines and a consensus of expert opinion, 15 categories of the vocational rehabilitation process were identified. Time spent on each category was recorded in 10-minute units after each occupational therapy session. The records of 21 participants who received occupational therapy focused on vocational rehabilitation were analysed. The proforma was quick and simple to use. The analysis showed that assessment, work preparation, employer involvement, education and dealing with issues of immediate concern to participants accounted for almost 85% of face-to-face intervention. It also showed that for every 1 hour of face-to-face contact, an additional 2 hours was required for liaison and travel. This study showed that there is potential for using a proforma for quantifying and describing occupational therapy. This is the basis for further work to enable meaningful comparisons with other services and use in future studies

Atypical parkinsonism: Making the case for a neuropalliative rehabilitation approach

Background - Although atypical parkinsonism syndromes share some clinical features with the more common idiopathic Parkinson's disease, they also exhibit condition-specific symptoms, and have a shorter trajectory with a more consistent decline. There is an increasing awareness of the need for palliative care in non-cancer related diagnoses such as parkinsonism. A neuropalliative rehabilitation approach linking expertise in neurology, rehabilitation and palliative care in the proactive and collaborative management of long term neurological conditions, in particular those of shorter duration, is advocated, but appears difficult to achieve. Content - This article presents the main clinical features of the key atypical parkinsonism syndromes - multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration and dementia with Lewy bodies; identifies the ‘red flags’ that alert professionals to differentiate them from idiopathic Parkinson’s disease; and discusses their multidisciplinary management within the context of neuropalliative rehabilitation. Conclusion - Despite the publication of best practice guidelines, research highlights a marked lack of referral of people with atypical parkinsonism for palliative care. Earlier diagnosis and the timely employment of a neuropalliative rehabilitation approach is believed key to the successful management of the shorter and more steeply deteriorating trajectory of atypical parkinsonism syndromes

Mind the gap: rethinking community neurological rehabilitation services

Recognition that there was a lack of knowledge about what services existed for adults aged 18–65 years with an acquired neurological condition in North Cumbria, and how they were accessed and co-ordinated, led to a project to identify community rehabilitation provision and explore potential service models. Interviews were undertaken with service providers, and focus groups, interviews and a questionnaire were undertaken with services users and carers. The five areas of concern to emerge from a thematic analysis of the data related to service provision; respite care and day time occupation, transport and geography, co-ordination of services, and information. There were differences in perspectives and priorities. Having one point of contact for access to all services emerged as the preferred model, although this would not address the gaps in service provision. Despite the recognition that the National Service Framework for Long-term Conditions (Department of Health (DH), 2005b) has promoted service development for the target group, there is still a need to work towards greater coherence in service provision across a plurality of providers