JCPSLP
Volume 16, Number 1 2014
7
Translating research into practice
Kerrin Watter
(top) and Paula
Addis
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
KEYWORDS
BRAIN INJURY
SPEECH
PATHOLOGY
SUB-ACUTE
REHABILITATION
SERVICE
DELIVERY
Speech pathology clinical
practice in sub-acute brain
injury rehabilitation
Kerrin Watter, Paula Addis, Anna Copley and Emma Finch
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
and equipment, policies and procedures, quality
management activities (Australasian Faculty of
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).
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).
