Improving the Rehabilitation of Individuals Admitted to England’s National Spinal Injuries Centre with Traumatic Brain Injury

Abstract Study Design: Mixed methods service improvement project. Retrospective analysis of clinical documentation and qualitative focus group with clinicians. Objectives Although traumatic brain injury (TBI) and spinal cord injury (SCI) often co-occur, many barriers have been found to identifying TBI in SCI rehabilitation and adapting treatment accordingly. This study aimed to compare the number of TBIs detected at the English National Spinal Injury Centre to figures found in previous research, and understand the barriers to adapting SCI rehabilitation in the presence of TBI. Setting: United Kingdom inpatient spinal cord injury rehabilitation unit. Methods This mixed methods study assessed the documentation at each stage of 88 patients’ treatment where a TBI could be detected and used to inform rehabilitation, and subsequently, a focus group was conducted with staff to explore the barriers to detecting TBI and adapting SCI rehabilitation. Results Results suggested that data related to TBI were inconsistently recorded, the number of TBIs at the Centre was lower than previous research, and several barriers were interpreted from the focus group. Conclusions TBI in SCI populations may be an invisible unmet need. Several barriers may exist which prevent clinicians from detecting TBI in this population and adapting rehabilitation accordingly. Findings have implications for rehabilitation for individuals with TBI and SCI admitted to the service.