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Applying the SABIN guidelines to
in-patient rehabilitation
Aims
• Comparison of SABIN guidelines with Glasgow RHC neuro-rehab service
• Future Developments
• Case Study
Glasgow Neuro-Rehab Team
• Referral Pathway at
RHC
RHC Acceptance Criteria
Acceptance criteria
• Child age 0 - 16 years.
• Significant functional deficit as a result of acquired brain injury, acquired spinal injury or other diagnosed neurological condition.
• Requiring inter-disciplinary treatment (>2 disciplines).
• Medically stable.
• No longer requiring regular input from acute medical or surgical teams.
• Clear functional goals identified.
• Likely to benefit from programme of care.
• Parents/patient consent to participation in programme of neuro-rehabilitation.
Exclusion criteria
• Age > 16 years
• Too medically unstable to benefit from neuro-rehabilitation therapy
• Failure of parent/patient to consent to participation in neuro-rehabilitation programme
• Appropriate specialist interdisciplinary assessment indicates that the patient is unable to benefit from a neuro-rehabilitation programme
• Timescales for
Assessment
Rehabilitation Programmes
• Are goal-directed and evidence-based.
• Address the developmental stage and needs of the child.
• Address physical, emotional, behavioural and cognitive rehabilitation needs of the child.
• Are individualised and tailored to the needs of the child and their family/ carers.
• Directly involve “hands-on” and shared participation from parents, guardians and other family members.
• Provide information for and encourage participation from the individual, family, education, charity and third sector organisations and care/social work.
• Invite feedback and service user involvement from children, young people and families.
Goal Attainment Scaling
• SMART Goal
If the patient achieves the expected level, they score 0.
+1 (a little more) or
+2 (a lot more)
-1 (a little less) or
-2 (a lot less) i.e. baseline
Care Environment
• Photos of hospital
environment
Neuropsychology
• Ready access to neuropsychology service
– Assessment prior to discharge and at follow
up
– Advice and management strategies for family,
therapy team, all relevant agencies including
education
– Support with therapy adherence
• Access to psychiatric liaison services
– Mental health nurse within team
Discharge Planning
• Coordinated by neurology nurse specialist
• Regular meetings arranged throughout in-patient stay
• Community health colleagues and education invited
• Aiming to develop RHC discharge plan checklist
• Developing GIRFEC paperwork
Follow Up
• Children reviewed by
lead neurologist and
neurology nurse 6 weeks
post discharge
• Therapists not currently
involved at this stage
• Continued review by
neurologist and
neurology nurse including
advice to education and
3rd sector as required
Future Developments RHC
• Develop service feedback paperwork
• Discharge planning checklist
• Ensure paperwork GIRFEC friendly
• Audit service against SABIN standards
Case Study – John Paul
• Admitted to ward 6/7 hx vomiting and disorientation.
Transferred to PICU 5/7 later with increasing lethargy,
seizure and decerebrate posturing. Extubated after 8
days.
• MRI scan: changes in caudate nucleus and putamen
bilaterally
• Diagnosis: ?Flu A encephalopathy ?osmotic
demyelinosis due to recent acute shifts in sodium
• PMH: Prune belly syndrome, congenital hydronephrosis,
renal transplant (Dad, 2014) PEG and fundoplication,
suprapubic catheter
Presentation
• On discharge from PICU, alert but unable
to follow commands
• 4 limb hypertonia LL>ULs with brisk
reflexes
• Inconsistent fix and follow
• Tone meds: clonidine and baclofen
Problems
• 4 limb hypertonia
• Hypokinetic Hyperkinetic Movement
• Inconsistent fix/follow
• Reduced mobility
• Dependent for all personal care
• Global weakness
• Incoordination
• Impaired communication
• Unsafe swallow
Agreed Therapy Goals
• JP will be able to floor sit independently
and use hand to assist page turning of a
book within 6 weeks
• JP will be able to stand with minimal
supervision to shower on ward within 6
weeks
• JP will be able to communicate simple
responses using an ipad within 4 weeks
Therapy Intervention
PEDI Scores
0
10
20
30
40
50
60
70
Self Care Mobility Social Function
Admission
Midway
Discharge
Rehabilitation Complexity Scale Scores
02468
101214161820
Care
Nurs
ing
Med
ical
Ther
apy Disciplines
Ther
apy In
tens
ity
Equ
ipm
ent
Tota
l Sco
re
Rehab Needs
Co
mp
lexit
y L
evel
Admission
Midway
Discharge
Thank You!