Brain Injury Service

The Brain Injury Service encompasses two clinical pathways: Complex Rehabilitation and Prolonged Disorders of Consciousness (PDOC) assessment and disability management

The primary commissioner for Level 1/2a rehabilitation and PDOC assessment to the Brain Injury Service is NHS England. Depending on capacity we can also accept referrals from other sources.

We provide comprehensive screening assessment prior to admission. Our goal is to ensure a smooth and efficient admission process, and prioritise meeting with the patient and their family whenever it is possible. While we may be able to accommodate several patients with tracheostomies, please note that we are unable to accept individuals who are medically unstable or require one-on-one nursing care.

Patients with one-to-one behavioural needs may be referred to our Neuro-behavioural service.

Supporting the complex needs of our patients

Most of our patients will have ongoing and sometimes complex needs at the time of discharge. This requires early planning and regular team and family meetings to discuss progress and plans.

We measure the success of our service first and foremost via feedback from our patients and their families. We also submit our statistics of rehabilitation outcomes to the United Kingdom Rehabilitation Outcomes Collaborative (UKROC).

Complex rehabilitation pathway

Our BIS wards provide values-based, goal-orientated rehab for people following severe brain injury.

Our Complex Rehabilitation programme is patient-centred and endeavours to work on self-directed goals where the patient is able. Where support is needed, goal setting is completed with family members based on patient values.

The multidisciplinary therapy team comprises occupational therapy, physiotherapy, speech and language therapy, clinical neuro-psychology, social work and dieticians as well as nurses, health care assistants and rehab medicine consultants. In addition to this, patients may have group sessions in occupational therapeutic art or music therapy.

They follow a 24 hour-rehab approach with the whole team providing opportunities for independence and optimisation of independence throughout the day.

Prolonged Disorders of Consciousness (PDOC) and Disability Management Pathway

Prolonged Disorders of Consciousness (PDOC) include conditions such as the Vegetative State (VS) and the Minimally Conscious State (MCS). This occurs due to damage to the brain and robust assessment of awareness is required to determine an individual ability to respond to their environment. Patients with a disorder of consciousness need a comprehensive assessment conducted by a multidisciplinary team of experts.

PDOC assessment
Patients with PDOC following sudden onset brain injury undergo assessment using a variety of lowawareness tools. Our approach is values based and personalised to the individual. We collaborate closely with families, providing support and enhancing their understanding of conditions and implications. Central to our programme is how we manage complex posture and seating challenges. Assessments may include Sensory Modality Assessment (SMART), the Wessex Head Injury Matrix (WHIM), and the Coma Recovery Scale (CRS), alongside expert clinical observation, management, and treatment.

Comprehensive support for relatives
Throughout this process, we offer continuous support and education to families and other invested people. Managing complex posture and seating challenges is central to our programmes. We address long-term challenges through collaboration with family members, friends, and external agencies.

Complex Care and Assessment
We provide complex care and assessments for individuals who have emerged from PDOC but still experience severe cognitive and communication impairments that affect their daily functioning.

The RHN has one of the largest groups of PDOC patients compared to similar settings across the UK.


If you would like to refer a patient for Level 1/2a rehabilitation services, please use BadgerNet to submit the referral. Where this is not possible, please use this form.

Please note, referrals must be supported by a medical professional (GP, consultant or community therapy team) and patients must meet pre-determined admission criteria.

If you have any questions about a referral to the Brain Injury Service, please contact the Admissions Office at 020 8780 4513
or email