Neurorehabilitation provided by a Multi-Disciplinary Team (MDT) of therapists is considered best practice for individuals with acquired brain injury. However, real-world service evaluations remain limited.
Therefore, a team of psychologists at Richardson Care decided to complete a service evaluation to examine the outcomes of adults with Acquired Brain Injury (ABI).
It aimed to evaluate the effectiveness of the neurorehabilitation provided by the MDT at Richardson Care on the cognitive, behavioural and functional outcomes demonstrated by service users.
Why are service evaluations important?
Service evaluations play a critical role in determining whether health and social care services achieve their intended aims and meet accepted standards of good practice.
Unlike research, service evaluations use routinely collected data to inform local decision-making and service development and do not seek to generate generalisable knowledge1.
They help to increase transparency and accountability in complex care for vulnerable adults.
Notably, there have been increasing calls for services to publish high-quality evaluations to strengthen evidence-based practice in residential and community ABI care2.
This article provides an overview of the evaluation of the ABI neurorehabilitation service at Richardson Care.
To read it in full go to https://www.richardsoncares.co.uk/wp-content/uploads/2026/03/Richardson-Care-FINAL-Service-Evaluation-2025.pdf
Experiences of individuals with acquired brain injury
The experience at Richardson Care is that each person is unique and brain injuries affect people in different ways.
This is supported by contemporary evidence that continues to emphasise that ABI recovery is nonlinear, highly individualised and influenced by environmental and relational factors3.
However, there are some common traits amongst individuals with ABI: They frequently experience complex cognitive, emotional and neurobehavioural difficulties, including deficits in attention, memory, language, processing speed and executive functioning, as well as changes in mood and behavioural regulation4.
These difficulties can significantly disrupt independence, identity, community participation and psychosocial functioning. This highlights the need for coordinated and person-centred neurorehabilitation.
MDT approach
At Richardson Care there is an experienced MDT of neuro specialists who are available on-site to support service users.
The team comprises psychologists, assistant psychologists, an occupational therapist, speech and language therapist and neuro-physiotherapist, as well as a consultant neuropsychiatrist.
The MDT works with service users and home managers to develop, review and revise a care plan for each individual. The MDT provides a combination of therapies for each person depending on their needs and they are supported daily by specialist care staff.
This approach is widely recognised as the gold standard within ABI rehabilitation.
MDT models promote shared decision-making, integration of expertise and flexible adaptation to individual needs.
They have been associated with improved functional outcomes, emotional wellbeing and reduced long-term dependency following neurological injury5.
Recent systematic reviews further support that MDT neurorehabilitation improves goal attainment, community participation and cognitive functioning, particularly when therapy intensity is consistent and individually tailored6.
Participants in the service evaluation
Data were extracted from four adults aged 18 years or older, who had sustained an ABI and been involved in a rehabilitation pathway, including cognitive assessment, multidisciplinary therapy and collaborative goal setting.
Although the sample size was small due to specific inclusion criteria, it was still felt to be a valuable exercise.
Measuring outcomes
Outcome measurement is central to evaluating neurorehabilitation effectiveness and several measures are routinely used at Richardson Care.
Achieving goals
Goal Attainment Scaling (GAS) supports structured, collaborative goal setting and offers quantifiable, person-centred indicators of functional progress7.
GAS continues to be recommended in contemporary neurorehabilitation research for its sensitivity to change and its alignment with personalised care principles8.
Goal attainment scaling
All participants (denoted by SU1 – SU4) demonstrated measurable improvements in functional goal attainment. Across shared goals, all participants achieved +2 (“much better than expected”) on cooking ≥1/week and community access 5×/week, and 0 (“as expected”) on RehaCom® (computer-based cognitive rehab) 1×/week.
Cognitive functioning
Cognitive functioning is commonly assessed using the Addenbrooke’s Cognitive Examination–Third Version (ACE-III), which evaluates five cognitive domains: attention, memory, fluency, language, visuospatial.
It is validated across a range of neurological conditions9.
Updated evidence confirms that the ACE-III remains a clinically robust tool for monitoring cognitive change over time in ABI populations10.
The graph below shows changes in cognitive functioning scores for each domain.
Two participants (50 per cent) demonstrated measurable improvements in overall cognitive functioning, while two participants (50%) showed no improvements and/or decline with regards to overall cognitive functioning.
Changes were domain-specific, with some participants demonstrating improvements in fluency or visuospatial abilities despite a decline in overall ACE-III total score.
Behavioural risk
Behavioural risk and change can be monitored using the Overt Aggression Scale – Modified for Neurorehabilitation (OAS-MNR) and the St Andrew’s Sexual Behaviour Assessment (SASBA), which quantify challenging and sexually inappropriate behaviours, respectively11.
Behavioural Incidents
The graph below shows changes in the number of behavioural incidents for each service user matched across three-month periods. Note that higher values indicate more recorded behavioural incidents.
Behavioural outcomes showed variability, with 50 per cent of participants demonstrating a reduction in behaviours that can be described as challenging and 50 per cent showing an increase.
Increased recorded incidents for some participants may reflect enhanced reporting accuracy following the transition from paper-based to electronic incident recording.
Clinical Implications
Despite the limitations of the service evaluation, including the small sample size, several implications emerge:
- Person-centred goal setting appears to be a strong feature of the service and should continue to be prioritised.
- One-to-one enhanced support likely facilitates engagement and functional recovery and should be considered where clinically indicated.
- Behavioural reporting could be strengthened through continued staff training and fidelity monitoring.
- Scheduled cognitive reassessments may help differentiate between genuine cognitive change and situational variability.
Conclusion
Overall, the service evaluation suggests that multidisciplinary neurorehabilitation at Richardson Care is associated with functional gains and for some participants, improvements in cognitive and behavioural stability, although outcomes varied.
Findings reinforce the value of coordinated MDT involvement, structured routines, consistent relational support and personalised rehabilitation goals.
Future evaluations adopting mixed methods approaches and larger samples may further clarify the mechanisms through which MDT rehabilitation contributes to recovery following ABI.
Richardson Care is specialist provider of neuro rehab services for adults with acquired brain injury, or learning disabilities and complex needs.
An independent family business with a 37-year track record, it has six specialist homes in Northampton.
To find out more or arrange a visit, call 01604 791266, www.richardsoncares.co.uk.
References
- National Research Ethics Service, 2013; Twycross & Shorten, 2014
- Daniel et al., 2022; Wade, 2019
- Simpson & Tate, 2021
- Jorge et al., 2004; Planton et al., 2023
- Langhorne & Duncan, 2001; McKerral et al., 2020; Turner-Stokes, 2022.
- Covey et al., 2023
- Krasny-Pacini et al., 2013; Grant & Ponsford, 2014
- Ruff et al., 2023
- Hsieh et al., 2013
- Tan et al., 2024
- Alderman et al., 1997; Knight et al., 2008
