Inpatient Services

Referral information

Admission is by medical referral (referral form). Clinical and social details are required at the time of referral.

Admission

Admission to the Liverpool Brain Injury Rehabilitation Unit is based on the following criteria:

• Patients have sustained a significant traumatic brain injury. Priority is given to people who have sustained a traumatic brain injury, although others with acquired brain injury with similar needs will be considered.

• Patients are between 15 and 65 years of age.

• Patients must be medically stable and sufficiently recovered following their acute injury. Patients with tracheostomy and multiple orthopaedic injuries will be accepted.

• Patients are accepted from South West Sydney, Southern Sydney and Southern and South West NSW, as well as Canberra Hospital and the ACT. Priority is given to people within South West Sydney Area Health Service.

• Patients are resident or have a responsible family member resident in the South Western or Southern Sydney regions.

Services provided

The LBIRU Inpatient Unit is a 16-bed ward located in Liverpool Hospital’s grounds. The Unit is accredited as a training facility by the Faculty of Rehabilitation Medicine (Royal Australian College of Physicians) and is accredited by the Australian Council of Healthcare Standards.

The Unit can manage confused and disorientated patients. There are high dependency rooms close to the nurses' station for patients who require close monitoring. There are single and two bed rooms which are used according to the level of care required. Private beds are not available.

The Inpatient Team consists of the following staff and services: 

• Staff specialists in rehabilitation medicine
• Trainee registrar in rehabilitation medicine 
• Nursing
• Programme Co-ordinator
• Physiotherapy
• Occupational Therapy
• Speech Pathology
• Clinical Neuropsychology
• Social Work
• Diversional Therapy
• Other medical services available by consultation include ophthalmology, orthopaedic surgery, neurosurgery, neurology, psychiatry and dietician.

When a patient is first admitted to the Brain Injury Unit, assessments are carried out by therapists to determine what problems the patient has as a result of his injury. An appropriate therapy programme is then drawn up. Problems which are common after a head injury are:

• Behavioural - e.g. irritability, impulsiveness, behaving in an inappropriate way, emotional lability (inability to control crying/laughing).

• Cognitive - e.g. memory problems, slowed thinking, difficulty solving problems, unable to reason in a logical manner.

• Physical - e.g. a person may be unable to sit up without support or be unable to walk.

• Speech/language - e.g. a person might have slurred speech or they may have difficulties finding the correct words to express what they want to say.

If the patient is not in post-traumatic amnesia (P.T.A.), assessments will be carried out as soon as possible after admission, however, if the patient is in P.T.A. when he/she is admitted to the unit, formal assessments will be delayed until the person emerges from P.T.A.

After the assessments are completed a therapy programme is drawn up for the patient to work on problems. Each patient is different so some people will need more therapy than others. The therapy programme is designed to address cognitive, behavioural and language problems as well as physical problems. Some therapy will occur one-on-one with an individual therapist , whilst other therapy will occur in a group with other patients.

There are several reasons why group therapy is important:

• Most people spend a good deal of their lives interacting with groups of people (both at work and in social situations) rather than just dealing with one person at a time. After a brain injury some people lose their social skills and it is necessary to teach them how to relate in a group.

• Some problems only become obvious in a group setting. For example, a patient may be able to have a conversation with one person but may have difficulty following the conversation with a group of people.

• Some patients have trouble concentrating when there are other people around but it is important for them to learn to do this again because in real life situations we have to carry out tasks when there are other people around us, both at home and at work.

• Participating in groups also provides patients with support and encouragement from the others in the group and gives them some comfort knowing that others are experiencing some of the same problems.

Relatives and friends are not allowed to sit in on group therapy. This is to respect the privacy of the other patients. Moreover, patients with behaviour problems sometimes "show off" in front of relatives/friends.

Each person receives a copy of the group programme with a brief description of each activity. Also, the patient will be given an individualised timetable of therapy times that will be adjusted as therapy needs change. Individual counselling is also provided, if appropriate, to assist the patient to adjust to the changes in their lives which have arisen as a result of the injury.

Patients and families will receive progress reports throughout the admission on what goals have been set, achieved and still working toward. These reports will be provided formerly in Progress Meetings.

Discharge

Upon discharge from the Unit patients will be allocated a Community Team case manager. The case manager is the contact person at the Unit for any issues that may arise upon return home.