JCPSLP Vol 16 Issue 1 2014

Translating research into practice

Speech pathology clinical practice in sub-acute brain injury rehabilitation Kerrin Watter, Paula Addis, Anna Copley and Emma Finch

There is limited research regarding the clinical practice of speech-language pathologists (SLPs) within sub-acute brain injury rehabilitation. This constrains the ability of SLPs to provide services based on high levels of evidence, with evidence from similar populations utilised to guide clinical practice instead. This article reports the results of a survey investigating the clinical practice and service delivery of SLPs working in Australian Brain Injury Rehabilitation Units (BIRUs). SLPs across eight BIRUs participated. Wide variation was found in staffing levels across the services, impacting service delivery and therapy intensity. Similarities were demonstrated in many areas of therapy provision, with patterns seen in prioritisation and service intensity. A variety of services and interventions were provided to meet the wide range of client goals and needs, in line with international guidelines. Ongoing research into sub-acute rehabilitation is warranted. Introduction The effectiveness of multidisciplinary rehabilitation for adults with acquired brain injury (ABI) and the efficacy of ABI rehabilitation have been investigated via a number of systematic reviews of the literature. Findings indicate that early, coordinated sub-acute multidisciplinary rehabilitation results in earlier functional gains and reduced length of stay, and improves patient outcomes after brain injury; and that patients receiving specialised ABI inpatient rehabilitation make significant functional gains (Turner-Stokes, Nair, Sedki, Disler & Wade, 2005; Turner-Stokes, 2008). Additionally, such rehabilitation positively influences patients later in the recovery process, and has been found to significantly improve functional outcomes, social cognition and return to work for patients with brain injuries (Cullen, Meyer, Aubut, Bayley & Teasell, 2011).

Sub-acute rehabilitation services for adults recovering from ABI or traumatic brain injury (TBI) are recognised internationally as “specialised” services (Kelly, 1992; Royal College of Physicians and British Society of Rehabilitation Medicine [RCP BSRM], 2003), and are often referred to as a “BIRU” (Brain Injury Rehabilitation Unit). BIRU services provide complex, specialised rehabilitation to a range of clients including people with severe brain injury, low awareness states, challenging behaviour and/or concurrent complex medical needs (British Society of Rehabilitation Medicine [BSRM], 2009). Within Australia, BIRU services are provided as part of a continuum of care for adults with ABI/TBI, are located within metropolitan areas and provide a specialised “statewide” service to adults of broad working age. With an estimated 2.2% of the Australian population (1 in 45 people) having an ABI with associated disability, and almost 75% of these aged under 65 years (O’Rance & Fortune, 2007), demand for services is high. There are, however, only a small number of dedicated BIRUs across Australia, and not all states and territories have a dedicated BIRU service. Differences exist at a state, regional and district level regarding models of care, admission criteria, funding models for services, and availability of services for adults with ABI/TBI, including acute, sub-acute, transition and community/outpatient facilities. Service delivery within Australian BIRUs Clinical practice within Australian BIRUs is governed by a range of formal documents, which influence practice from a broad service level to the level of direct patient care. National and international guidelines and standards provide a framework for delivering sub-acute brain injury rehabilitation services as a whole. These include recommendations regarding governance, staffing, facilities Rehabilitation Medicine [AFRM], 2011), and aspects of service delivery including staffing, areas for intervention and timing of interventions (BSRM, 2009; Colorado Department of Labor and Employment [CDLE], 2005; RCP BSRM, 2003). and equipment, policies and procedures, quality management activities (Australasian Faculty of

THIS ARTICLE HAS BEEN PEER- REVIEWED PATHOLOGY SUB-ACUTE REHABILITATION SERVICE DELIVERY KEYWORDS BRAIN INJURY SPEECH

Kerrin Watter (top) and Paula Addis

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JCPSLP Volume 16, Number 1 2014

www.speechpathologyaustralia.org.au