Rehabilitation medicine (RM) consultants work with specialist multidisciplinary rehabilitation teams. Consultants have responsibility for inpatients in neurological rehabilitation and spinal cord injury units, but also provide input to stroke rehabilitation (usually for spasticity management). Those involved in the rehabilitation of limb loss provide pre-amputation advice and counselling. Increasingly, RM is involved in acute care, providing specialist advice for patients on critical care units in neuroscience centres (neurosurgery, spinal surgery and neurology). Patients receive ongoing care in outpatient and community settings, which are often multidisciplinary. RM has important relationships with major trauma, orthopaedics, neurology, neurosurgery, vascular surgery, acute medicine and palliative medicine.
There are discrepancies in access to specialist rehabilitation across the UK. Implementation of major trauma networks in England in 2012 has revealed these inequities through peer review. Survivors of major trauma often have difficulty accessing early/acute specialist rehabilitation and can wait many months for post-acute rehabilitation. Access to RM services is inequitable for early (hyperacute), post-acute and community-based rehabilitation. There are few regions where a networked approach has been successfully implemented. Recently, both the critical care and the trauma care clinical reference groups have re-emphasised the importance of early specialist rehabilitation to minimise long-term disability and care costs.
Patients are referred to specialist rehabilitation services via varying routes:
- spinal cord injury rehabilitation to supraregional centres
- specialist neurological rehabilitation centres, which accept complex patients; some provide assessment and rehabilitation for those in prolonged disorders of consciousness (vegetative and minimally conscious states)
- referral of patients with challenging behaviours is often to non-NHS providers, but RM consultants can facilitate onward referrals, as they will know local NHS provision and how to approach commissioners
- services for patients with limb loss are in specialist centres, which provide outreach to hospitals within their region for pre-amputation advice, and management of traumatic amputation and congenital limb deformities
- major trauma centres are mandated to have planned coordination of rehabilitation, with assessment of rehabilitation need by a consultant in RM within 3 days of injury
- referral to outpatient RM clinics and to specialist community rehabilitation services.