Neuro-Rehabilitation: Patient Categorisation
Specialised Neurorehabilitation Service Standards categorise rehabilitation needs as follows:
Patients with Category A rehabilitation needs
Patient goals for rehabilitation may include:
• Improved physical, cognitive, social and psychological function / independence in activities in and around the
• Participation in societal roles (eg work / parenting / relationships);
• Disability management eg to maintain existing function; manage unwanted behaviours / facilitate adjustment to
• Improved quality of life and living including symptom management, complex care planning, support for family
and carers, including neuropalliative rehabilitation
Patients have complex or profound disabilities e.g. severe physical, cognitive communicative disabilities or challenging behaviours.
Patients have highly complex rehabilitation needs and require specialised facilities and a higher level of input from
more skilled staff than provided in the local specialist rehabilitation unit. In particular rehabilitation will usually include one or more of the following:
• intensive, co-ordinated interdisciplinary intervention from 4 or more therapy* disciplines, in addition to specialist
rehabilitation medicine/nursing care in a rehabilitative environment
• medium length to long term rehabilitation programme required to achieve rehabilitation goals – typically 2-4
months, but up 6 months or more, providing this can be justified by measurable outcomes
• very high intensity staffing ratios e.g. 24 hour 1:1 nurse “specialling”, or individual patient therapy sessions
involving 2-3 trained therapists at any one time
• highest level facilities /equipment e.g. bespoke assistive technology / seating systems, orthotics, environmental
control systems/computers or communication aids, ventilators.
• complex vocational rehabilitation including inter-disciplinary assessment / multi-agency intervention to support
return to work, vocational retraining, or withdrawal from work / financial planning as appropriate
Patients may also require:
• Highly specialist clinical input e.g. for tracheostomy weaning, cognitive and/or behavioural management, low
awareness states, or dealing with families in extreme distress
• ongoing investigation / treatment of complex / unstable medical problems in the context of an acute hospital
• neuro-psychiatric care including: risk management, treatment under sections of the Mental Health Act,
• support for medicolegal matters including mental capacity and consent issues
Patients are treated in a specialised rehabilitation unit (i.e. a Level l unit).
Patients may on occasion be treated in a Level 2 unit depending on the availability of expert staff and specialist
facilities as well as appropriate staffing ratios.
Patients with Category B rehabilitation needs
Patient goals for rehabilitation may be as for category A patients
Patients have moderate to severe physical, cognitive and/or communicative disabilities which may include mild-moderate behavioural problems
Patients require rehabilitation from expert staff in a dedicated rehabilitation unit with appropriate specialist facilities.
In particular rehabilitation will usually include one or more of the following:
• Intensive co-ordinated interdisciplinary intervention from 2-4 therapy disciplines in addition to specialist rehabilitation medicine/nursing care in a rehabilitative environment
• medium length rehabilitation programme required to achieve rehabilitation goals – typically 1-3 months, but up to a maximum of 6 months, providing this can be justified by measurable outcomes
• special facilities/ equipment (e.g. specialist mobility/ training aids, orthotics, assistive technology) or interventions (e.g. spasticity management with botulinum toxin or intrathecal baclofen)
• interventions to support goals such as return to work, or resumption of other extended activities of daily living, eg
home-making, managing personal finances etc
Patients may also have medical problems requiring ongoing investigation/treatment
Patients are treated in a local specialist rehabilitation unit (i.e. a Level 2 unit).
Patients with Category C rehabilitation needs
Patient goals are typically focused in restoration of function / independence and co-ordinated discharge planning with a view to continuing rehabilitation in the community
Patients require rehabilitation in the context of their specialist treatment as part of a specific diagnostic group (e.g.
Patients may be medically unstable or require specialist medical investigation / procedures for the specific condition
Patients usually require less intensive rehabilitation intervention from 1-3 therapy disciplines in relatively short
rehabilitation programmes (i.e. up to 6 weeks)
Patients are treated by a local specialist team (i.e. Level 3a service) which may be led by consultants in specialties
other than Rehabilitative Medicine (e.g. neurology / stroke medicine) and staffed by therapy and nursing teams with
specialist expertise in the target condition.
Patients with Category D rehabilitation needs
Patient goals are typically focused in restoration of function / independence and co-ordinated discharge planning with a view to continuing rehabilitation in the community if necessary
Patients have a wide range of conditions but are usually medically stable
Patients require less intensive rehabilitation intervention from 1-3 therapy disciplines in relatively short rehabilitation programmes (i.e. 6-12 weeks)
Patients receive an in-patient local non-specialist rehabilitation service (i.e. Level 3b) which is led by non-medical