Progress is promised by harnessing rehabilitation technology, including that enabled by ICT, for provision of evidenced-based interventions. For example, intervention delivered via robotic devices, exer-gaming and/or virtual reality can produce equivalent benefit to “hands-on” intervention from a specialist therapist. The promise is that technology-enabled therapy will: enable people to receive evidenced-based interventions in their own homes without a therapist physically present; receive feedback on their performance and progress; be empowered to take more control of their rehabilitation; and receive timely guidance from their specialist therapist either via tele- rehabilitation or a physical visit. However, not all technology may be suitable for people with brain injury as the sequelae are heterogeneous and disability is complex with combinations of problems including muscle weakness, attention deficit and/or memory disorder. In addition, as people are participating in rehabilitation in their own homes, space for specialized equipment is limited and they need to be able to use the technology on their own or with limited help from their informal caregiver/s.
Consequently, the next generation of technology needs to be designed iteratively with the users i.e. patients, their informal caregivers and therapists.
Another part of the required step-change in neurorehabilitation is to (a) enhance knowledge of the predictive markers of response to specific therapies and (b) develop objective measures of response to therapy that are more sensitive to change that those in routine use. In current clinical practice, most decisions about which intervention to provide for individuals are based on clinical experience rather than evidence, then judgement of whether the therapy is of benefit is made mostly via behavioural rather than physiological measures. It can be five or more days before it is clear whether a specific intervention is working. If three interventions are provided before the right one is found then three weeks of injury-induced, time-limited, neuroplasticity potential has been lost. Advances in neurorehabilitation need the development of predictive models for behavioural response and measures to detect its physiological mechanisms.
For advances in technology-aided interventions, predictive models of response and sensitive measures of response to be implemented into clinical practice policy makers, service managers and clinical therapists must be partners in neurorehabilitation research. Co-development and co-evaluation of proposed solutions for unmet need are crucial for the neurorehabilitation implementation framework. If rehabilitation technology or physiological measures of response cannot be used in clinical rehabilitation settings, mostly peoples’ homes, then they will not be implemented. Being user-friendly, user-pertinent, and effortless to maintain are vital.Most brain injuries are preventable. In the paediatric age group, falls and road accidents account for most head injuries. Falls in the elderly, particularly when accompanied by anticoagulant medication, are a major cause of head injuries. Such injuries cause considerable morbidity and have huge costs to society through failure to return to work, fractured family relationships, homelessness, imprisonment and requirement for care & support. The need for guidelines for the prevention, diagnosis and treatment of sports concussion has led to a surge in research activity worldwide that will be helpful to patients with other forms of brain injury.
Major trauma networks are ‘getting the right patient to the right place’. Progress has been made in identifying and treating, in timely fashion, secondary insults to the brain including hypoxia, hypotension, fits and intracranial haematomas. We have developed tools (e.g. www.goodSAMapp.org) that enable people trained in basic airway management, who happen to be within a few hundred metres of such incidents, to be alerted. The early detection of an intracranial haematoma would allow for focussing of the trauma pathway to the needs of the individual patient. For all these reasons, access to better monitoring at the roadside is required.