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Characterising neuropsychological rehabilitation service users for service design

Fergus Gracey (Clinical Neuropsychologist and Practitioner Researcher, based at the Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services (NHS) Trust, Ely, UK)
Donna Malley (Occupational Therapist and Practitioner Researcher, based at the Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services (NHS) Trust, Ely, UK)
Adam P. Wagner (Research Associate (Statistician), based at Department of Psychiatry, University of Cambridge, Cambridge, UK)
Isabel Clare (Consultant Clinical & Forensic Psychologist, based at Department of Psychiatry, University of Cambridge, Cambridge, UK)

Social Care and Neurodisability

ISSN: 2042-0919

Article publication date: 4 February 2014

168

Abstract

Purpose

Needs of people following acquired brain injury vary over their life-course presenting challenges for community services, especially for those with “hidden” neuropsychological needs. Characterisation of subtypes of rehabilitation service user may help improve service design towards optimal targeting of resources. This paper aims to characterise a neuropsychologically complex group of service users.

Design/methodology/approach

Preliminary data from 35 participants accepted for a holistic neuropsychological rehabilitation day programme were subject to cluster analysis using self-ratings of mood, executive function and brain injury symptomatology.

Findings

Analysis identified three clusters significantly differentiated in terms of symptom severity (Cluster 1 least and Cluster 2 most severe), self-esteem (Clusters 2 and 3 low self-esteem) and mood (Cluster 2 more anxious and depressed). The three clusters were then compared on characteristics including age at injury, type of injury, chronicity of problems, presence of pre-injury problems and completion of rehabilitation. Cluster 2 were significantly younger at time of injury, and all had head injury.

Research limitations/implications

Results suggest different subgroups of neuropsychological rehabilitation service user, highlighting the importance of early identification and provision of rehabilitation to prevent deterioration, especially for those injured when young. Implications for design of, and research into, community rehabilitation service design for those with “hidden disability” are considered.

Originality/value

The paper findings suggests that innovative conceptual frameworks for understanding potentially complex longer term outcomes are required to enable development of tools for triaging and efficient allocation of community service resources.

Keywords

Acknowledgements

This paper presents independent research funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The authors would also like to acknowledge the invaluable contributions of Ania Piasecka, Anneli Cassel, Iona Macrae, the staff and service users at the Oliver Zangwill Centre and the NIHR CLAHRC-CP team.

Citation

Gracey, F., Malley, D., P. Wagner, A. and Clare, I. (2014), "Characterising neuropsychological rehabilitation service users for service design", Social Care and Neurodisability, Vol. 5 No. 1, pp. 16-28. https://doi.org/10.1108/SCN-09-2013-0034

Publisher

:

Emerald Group Publishing Limited

Copyright © 2014, Emerald Group Publishing Limited

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