Physical health

• Assessment of needs by internal / external Health Professionals
• Understanding and management of long term and chronic conditions
• Ensuring access to national screening programmes
• Pharmacological interventions including monitoring of efficacy and side effect profiles
• Nutrition and dietetics planning

Physical rehabilitation and management

• Gait, balance and mobility
• Spasticity & Muscle Tone
• Botulinum therapy
• Cardio vascular fitness
• Outdoor mobility
• Falls and manual handling
• Stairs assessments

Activities of daily living (ADLS)

• Personal ADLS
• Personal hygiene
• Toileting and continence
• Domestic activities of daily living
• Community skills
• Road safety
• Driving mobility support
• Spirituality
• Shopping
• Public transport
• Consideration of sexual needs

Psychological approaches

• Psychoeducational work aimed at understanding brain injury and associated issues
• Behavioural approaches including monitoring of positive behaviours and
challenging behaviour, functional analysis, neurobehavioural intervention and
positive behavioural support
• Neuropsychological assessment (to identify strengths and difficulties)
• Cognitive rehabilitation
• Psychosocial adjustment work considering identity, grief, mood, and mental health


• Social communication
• Reading and writing
• Hearing screening
• Receptive and expressive language

Discharge planning

• Home assessment and advice including coordination of specialist equipment
• Liaison with family and other support networks
• Liaison with ICB, Social Care and other stakeholders
• Plan for generalising skills to new environment
• Relapse prevention planning

Vocational Rehabilitation

• Return to work assessment and support
• Voluntary work skills support


• Eating and drinking
• Dysphagia

Family & Carer Support

• Financial support

Advanced care planning / end of life

• Gold standard framework in end of life care