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Please see the "Urgent Care: general" section on G-care for SWAST's guidance on Requesting Ambulance Transport (999 or Urgent).
Causes of loss of consciousness that can lead to falls and secondary head trauma include:
In patients with more severe signs or symptoms, assess using the Glasgow Coma Scale- (GCS) which provides a practical method for assessment of impairment of conscious level in response to defined stimuli.
Consider referral for adult (16 years or over) patients with Acquired Brain Injury (ABI) that embraces acute (rapid onset) non-degenerative brain injury of any cause, including:
The remit does not include stroke as stroke is covered by a separate stroke service in Gloucestershire. Please see the Stroke Pathway for further information.
The Brain Injury Team is a multidisciplinary therapy team (i.e. no medical input) based at Gloucestershire Royal Hospital. They offer in and outpatient assessment and therapy for adults (16 years+) who have had an acquired brain injury and who are a resident in Gloucestershire with a Gloucestershire GP. The team offers intensive acute therapy immediately post injury, through community rehabilitation and outpatient follow up, sometimes years after the brain injury. They cover the spectrum of mild to severe brain injuries.
The team is based at Gloucestershire Royal Hospital but is a countywide service. The team is able to offer specialist assessment of patients in possible low arousal states using the Sensory Modality Assessment and Rehabilitation Technique (SMART) assessment tool.
The team provides outpatient services in patient’s homes, residential accommodations, nursing homes etc. The specific therapies within the team are detailed below. The therapists are supported by Brain Injury Therapy Technicians.
The team work between the hours of 8:30 and 4:30pm Monday to Friday. Referrals can be made by telephoning 0300 422 5138 or 0300 422 5139.
Written referrals can be made to: Brain Injury Team, Ground Floor, Beacon House, Gloucestershire Royal Hospital, Gloucester, GL1 3NN.
This clinic is run by the Brain Injury Team and is suitable for everyone who attends the Emergency Department or has a brief inpatient stay following a head injury, and has residual problems. The aim is to offer them at least one appointment at the ‘mild head injury clinic’ within a few weeks of their discharge.
GPs can also refer directly to this clinic for patients who have had a mild head injury. This may be associated with a brief loss of consciousness and/or a period of time for which the patient has no recollection. Scans may have detected no abnormalities as yet.
For many people there can be a range of unsettling symptoms including fatigue, headaches, dizziness, word finding difficulties, irritability and memory problems, which can persist for some time after the injury. There is evidence from two randomised controlled studies that an early brief intervention can reduce the severity of such symptoms several months later. The initial appointment includes information provision about the common consequences of head injury and subsequent recovery, and suggestions about reducing their impact. Such suggestions range from fatigue management and advice about returning to work and other activities, to specific strategies relating to concentration and memory difficulties. For many people the duration and impact of the head injury symptoms are exacerbated by understandable anxiety and frustration relating to these unfamiliar symptoms, and addressing such concerns can be an important element of early intervention.
In addition to the mild head injury clinic providing follow-up for patients who attend hospital, it can be a useful first contact for people even years after their head injury, as it can provide a brief assessment and inform subsequent referrals to appropriate head injury specialists when required.
The mild head injury clinic is run by the GHNHSFT Brain Injury Team’s clinical neuropsychologist. There is also a clinic once a month run by the physiotherapist and the psychologist. Patients are seen by the physiotherapist to address difficulties primarily with balance and dizziness. A common consequence of a brain injury is dizziness, feelings of vertigo and poor balance. The team’s physiotherapist runs a clinic specialising in the identification of the source of the symptoms and the development of treatment programs to reduce patient’s difficulties (vestibular rehabilitation). Dizziness may also be assessed as part of a wider brain injury assessment in specific physiotherapy sessions.
Clinic appointments are held at the Outpatients Department at Gloucestershire Royal Hospital.
Please refer to:
Brain Injury Team (Mild Head Injury Clinic)
Gloucestershire Royal Hospital
Gloucester GL1 3NN
Tel: - 0300 422 5139
Fax: - 0300 422 5133
The Gloucestershire Neurology Service aims to provide a patient-centred service to those with acute and chronic neurological illness, in both inpatient and outpatient settings. The team consists of medical, nursing and support staff, based at Gloucestershire Royal Hospital with outreach, where possible, to the entire Gloucestershire community.
Please follow the resource link below for contact information and useful information for GP's on Shared Care and Aids to Diagnosis.
While discussion of individual cases is often required, there is a precedent for mental health services to be able to manage anxiety and/or depression in the months following brain injury in the absence of any evidence neuropsychological constraints (e.g. cognition, communication, behaviour). Similarly, if anxiety and/or depression unrelated to the brain injury occurs a long time after the brain injury event there may be no need for specialist brain injury input in the absence of neuropsychological constraints. If the neuropsychological constraints are mild enough that they do not hamper a more standardised approach then the patient may be able to engage with general mental health services, which may be advantageous to the patient where the onset of emotional difficulties is not related to brain injury.
If there is significant substance misuse which limits the patient’s ability to engage in rehabilitation, referral to substance misuse services for advice/intervention in the first instance may be more appropriate.
Referral to psychiatric services for mental health assessments should be made via 2G contact centre. Contact details and referral advice can be found here.
Headway Gloucestershire was established to respond to the needs of acquired brain injury survivors, who are aged 18 or over and their families/carers in Gloucestershire.
The service does not offer any clinical services but provides long term therapeutic care in the years following a brain injury by delivering the following services:
GPs can refer using this referral form, self-referral is also accepted from acute brain injury (ABI) survivors and carers via email or phone:
Great Western Road,
Telephone: 01452 312713
Fax: 01452 310728
Please see the Headway website for further information.
Please follow the resource link below for Gloucestershire’s Rehabilitation Commissioning Pathway for adults with ABI.
All drivers are required by law to report any condition that may affect their ability to drive to the DVLA. Failure to do so can result in a £1,000 fine, invalidate their insurance and lead to possible prosecution if the person is involved in an accident. GP's have a vital role to play in ensuring that patients adhere to these rules.
If you have any reason at all to suspect that the injury will affect a patient's ability to drive you should tell them this and provide the number for the DVLA Drivers Medical Group. Please see the Headway Driving after Brain Injury information leaflet.
Further information can be found on the DVLA website: https://www.gov.uk/head-injury-and-driving.