Traumatic Brain Injury Rehabilitation: Services, treatments and outcomes

In 1986 the Trustees of the Nuffield Provincial Hospitals Trust decided to develop a major core programme of studies concerned with the organization, development and improvement of services for physically disabled and frail elderly people. This programme developed rapidly due to the enthusiastic response of those in the field; and by 1992 the total value of the programme was in excess of £2 million and currently totals over £3. 2 million. It comprised a cohesive matrix of grants commissioned throughout the United Kingdom for work in identified areas which, taken in conjunction with existing grants, formed a comprehensive programme of much-needed studies and research in this field. The whole was to be underpinned by a major study planned and financed by the Trust but conducted by the Royal College of Physicians to survey the existing services being provided by some 180 health authorities. This study, together with concern for the handicapped schoolleaver, information about the availability of disability services and the care of mild/moderate head-injured persons, formed the prime initial thrust of the programme. In the case of head injury, the Trust was particularly concerned that there was discontinuity of care for many patients and little evidence as to which treatments were effective. Once patients had stabilized in hospital they were discharged into the community under the care of their general practitioner often without a continuing responsibility from the hospital.