Improving the rehabilitation of individuals admitted to England's National Spinal Injuries Centre with traumatic brain injury.

Study design: Mixed methods service improvement project. Retrospective analysis of clinical documentation and qualitative focus group with clinicians.

Objectives: Although traumatic brain injury (TBI) and spinal cord injury (SCI) often co-occur, many barriers have been found to identifying TBI in SCI rehabilitation and adapting treatment accordingly. This study aimed to compare the number of individuals with a TBI detected at England's National Spinal Injuries Centre to figures found in previous research and understand the barriers to adapting SCI rehabilitation in the presence of TBI.

Setting: England's National Spinal Injuries Centre at Stoke Mandeville Hospital.

Methods: This mixed methods study assessed the documentation at each stage of 88 patients' treatment where a TBI could be detected and used to inform rehabilitation, and subsequently, a focus group was conducted with staff to explore the barriers to detecting TBI and adapting SCI rehabilitation.

Results: Results suggested that data related to TBI were inconsistently recorded, the number of individuals recorded as having a TBI at the centre was lower than a recent study, and several barriers were interpreted from the focus group.

Conclusions: TBI in SCI populations may be an invisible unmet need. Several barriers may exist which prevent clinicians from detecting TBI in this population and adapting rehabilitation accordingly. Findings have implications for rehabilitation for individuals with TBI and SCI admitted to the service.