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!