Rehabilitation in practice: improving delivery of upper limb rehabilitation for children and young people with acquired brain injuries through the development and implementation of a clinical pathway

Abstract

Purpose

Decision making regarding upper limb assessment and management of children and young people (CYP) with acquired brain injury (ABI) is complex. This project aimed to standardise and improve upper limb provision in one residential rehabilitation unit for CYP with ABI.

Methods

Plan-do-study-act (PDSA) methodology was used. Available evidence was synthesised and recommendations for assessment and intervention of CYP who present at different functional levels were made. A multi-modal knowledge translation process was used for pathway implementation, with regular review and updates in each PDSA cycle. Audit and staff survey at one year and two years post implementation were conducted.

Results

A clinical pathway consisting of an assessment decision tree, intervention matrix and evidence based summaries was developed. Audit at one year demonstrated 70% of CYP had an appropriate assessment form, which increased to 82% at two years. Staff survey showed increased knowledge and use of the pathway, and decreased perceived training needs between years one and two.

Conclusions

Use of an upper limb pathway can standardise care in line with best available evidence, and increase staff confidence in this complex rehabilitation area. Several years of development and implementation were required to embed its use in practice.

Implications for rehabilitation

• Upper limb rehabilitation for CYP with ABI is complex, with no “one size fits all” assessment or intervention techniques available.

• Developing a pathway in which the evidence for assessment and management interventions for CYP of different functional levels, and recommendations for clinical practice can improve the consistency of assessment and intervention, and staff confidence with upper limb management.

• A multimodal strategy for implementation planned from the outset of pathway development can facilitate the translation of the pathway into routine clinical practice.

Keywords:

• Quality improvement
• plan-do-study-act
• knowledge translation
• clinical pathway
• upper limb
• rehabilitation

Acknowledgments

The authors would like to thank all the physiotherapists and occupational therapists at The Children’s Trust who have contributed to this project. They would also like to thank the quality improvement and research team for support. Finally, they would like to thank the expert reviewers of the pathway.

Disclosure statement

No potential conflict of interest was reported by the author(s).