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Brain Injury Rehabilitation Service Hypertonicity Clinic (State-wide Service)

Useful management information

The Hypertonicity Clinic is a state-wide service, which is a specialised medical and allied health run clinic created to assist inpatients and outpatients post brain injury, who experience hypertonicity as a major limitation to functional recovery, cause of carer burden or pain. The clinic provides comprehensive physiotherapy, occupational therapy and medical assessment and will refer patients onto other services as necessary.

The Hypertonicity Clinic:

  • Assesses adult patients, typically aged between 16 – 70 years, with adult onset non-progressive Acquired Brain Injury (including CVA/Stroke) or Traumatic Brain Injury (TBI) from QLD and Northern New South Wales.
  • Accepts appropriate referrals from a specialist consultant, GP, or Allied Health staff.
  • Sees any patient deemed appropriate at the triage consultation.
  • Assesses any patients with hypertonicity as major cause of functional limitation, pain, or carer burden.
  • Requires patients to have suitable follow-up (medical and allied health) post intervention, but this is not necessary for the initial consultation.

Time frame:

The clinic runs every Wednesday and Friday afternoon, and Thursday morning. The initial consultation is with a Physiotherapist and an Occupational Therapist.

Objectives of the Service:

  • Comprehensive assessment and consultation by a specialist multidisciplinary medical and allied health team to limit spasticity / hypertonicity as a cause of functional limitation in people with a brain injury
  • Provide assessment, recommendations, and rehabilitation intervention where appropriate
  • Improve continuity of care for community patients with few other available resources for the ongoing management of spasticity / hypertonicity
  • Improve communication between service providers
  • Improve links with community rehabilitation services
  • Provide equity of access for metropolitan, regional, and rural patients
  • Provide comprehensive education of families and carers
  • Provide education to other occupational and physio therapists, and equip them with the skills to manage patients with spasticity / hypertonicity

Other Useful Information:

For progressive ABI or other neurological conditions causing spasticity / hypertonicity not eligible for the Brain Injury Rehabilitation Hypertonicity Service (EG: Adults with Cerebral palsy), refer to Local public hospital general rehabilitation outpatient service

Minimum referral criteria (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Must have the following to be eligible for this service:

  • Receiving or able to be referred to Allied health for relevant input
  • Motivated to participate / carer support
  • Identified goals

AND

  • Hypertonicity impacting on (one or more of the following):
    • Daily function
    • Increasing number of falls / reduced mobility
    • Imacting on hygiene
    • Skin integrity / breakdown
    • Impacting on participation in therapy
    • Pain
    • Difficulty with orthosis / splints

Category 1
(appointment within 30 calendar days)

  • Currently an inpatient and receiving daily / regular Allied Health input.
  • Pain / hypertonicity interfering with participation in therapy
  • Hypertonicity currently impacting on hygiene / skin integrity
  • Active / Passive goals
  • Motivated to participate
Category 2
(appointment within 90 calendar days)
  • Receiving outpatient intervention from Allied health
  • Previously assessed / injected and compliant with recommendations / maintained gains
  • Some active goals
  • Passive goals that can reduce carer burden
Category 3
(appointment within 365 calendar days)
  • Nursing Home resident
  • Minimal access to Allied Health input
  • Passive goals
  • Minimal family / carer support

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If you still need to refer your patient:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

 

Essential referral information for Brain Injury Rehabilitation Service Hypertonicity Clinic (State-wide Service) referrals (Referral will be returned without this)

  • Relevant medical history
  • Current medications
  • Current social situation / Functional status / Support services / Allied Health services
  • Hypertonicity related problems (limbs affected, pain, hygiene, skin breakdown, passive care needs, previous hypertonicity management)
  • Patient / Carer goals

NB: Only patients with an acquired brain injury (Includes CVA/Stroke) or a traumatic brain injury can be seen

Additional referral information for Brain Injury Rehabilitation Service Hypertonicity Clinic (State-wide Service) referrals

Nil.

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service.  If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 5 December 2023