Expert Witness Journal Issue 64 December 2025 - Flipbook - Page 61
A holistic rehabilitation needs assessment
rehabilitation and restoration of people with severe
and chronic neurological disability after traumatic
brain injury (TBI), spinal cord injury (SCI) and
major trauma. It sets a clear expectation for what
people with chronic neurological disability and their
families should be entitled to expect from a system
that cares about their rehabilitation and recovery. It
gives healthcare and social care providers a detailed
model of what good rehabilitation looks like in
practice, with step-by-step guidance as to how they
can get there.
A holistic rehabilitation needs assessment should
take place ‘without delay’. This assesses the person’s
functioning, symptoms and impairment across
a wide range of physical, mental, emotional and
environmental needs, such as pain, physical activity
and mobility, cognitive function, speech/language/
communication,
eating/drinking/swallowing,
bladder and bowel function, and any equipment and
environmental adaptations needed for independent
living. The needs assessment should identify
rehabilitation which maximises the individual’s
ability to participate in every area of their life across
various times and settings.
As a head injury and major trauma specialist solicitor,
and frequent navigator of existing NHS and social
care rehabilitation services for severely injured
clients, I welcome the new rehabilitation guideline
wholeheartedly, in the hope that rehabilitation
services for TBI, SCI and other neurological injury
will one day consistently work that way.
A rehabilitation plan
A personalised rehabilitation plan based on the
individual’s needs and goals should be agreed with
the individual and those who are important to their
rehabilitation, such as family members, health and
social care practitioners. The plan should focus on
interventions to optimise or maintain the a昀昀ected
person’s functioning and abilities, even if their
prognosis or potential for improvement appears to
be limited. It should be reviewed and updated when
the individual’s needs or circumstances change,
such as when they move from acute to longer-term
rehabilitation. Children’s and young people’s severe,
complex rehabilitation needs should form part of
their education, health and care plan (EHCP).
NICE acknowledges that implementation of the new
recommendations will take time, and this will depend
on well-planned design, workforce planning and
training, joined-up coordination, multidisciplinary
and multiorganizational communication, signi昀椀cant
funding, resourcing and equitable implementation.
Is rehabilitation accessible via a traumatic
brain injury (TBI) or spinal cord injury (SCI)
compensation claim?
Where the person’s injury gives rise to a traumatic
brain injury (TBI), spinal cord injury (SCI) or major
trauma compensation claim, the scope and detail of
the new recommendations for good rehabilitation
practice make it all the more vital that the claimant’s
solicitor has the proven expertise and experience
to ensure that their rehabilitation is prioritised,
coordinated and funded, and is integral to the
management of the claim.
The guidance recommends that rehabilitation
interventions take place in settings which are
appropriate to the injured person’s rehabilitation
goals and preferences, such as at home, school,
work or in other community settings.
The
injured person must be provided with any urgent
equipment, assistive technology or environmental
adaptations that they need at home, to support
their rehabilitation and prevent delays to discharge.
The key to e昀昀ective rehabilitation is timely,
coordinated, personalised implementation. If our
severely neurologically-injured clients are not
receiving the required level of rehabilitation for
their needs at the time that they need it, we are often
able to obtain additional funding and specialist
support through their claim to ensure that they
receive rehabilitation in a way that is timely and
properly coordinated.
With the overall structure for the injured person’s
coordinated, communicated and fully casemanaged rehabilitation in place, the guideline
then sets out step-by-step recommendations for the
rehabilitative management of many of the speci昀椀c
needs that may be covered by the plan, such as for
pain management, speech and language, feeding
and swallowing, equipment and independent living,
education and vocational rehabilitation, social and
leisure activities and relationships.
Our clients’ rehabilitation is backed by Rehabilitation
Code and interim payment funding, and coordinated
by professional case managers, with input from our
medical and therapeutic rehabilitation experts and
specialist legal, SEN, and deputyship teams.
What do the new guidelines mean for
people with TBI or spinal cord injury?
The new guideline, Rehabilitation of neurological
disorders including acquired brain injury, is a
must-read for all who are involved in the recovery,
EXPERT WITNESS JOURNAL
In practice, this means that we can usually secure
direct funding from insurers to instruct a case
manager to carry out an immediate needs assessment
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DECEMBER/JANUARY 2025-2026
