Appendix 1: Glossary

Activities

The processes or actions that use inputs to produce the desired outputs, and ultimately outcomes, that is ‘what we do’.

Brain injury specialist rehabilitation

Brain injury specialist rehabilitation implies rehabilitation for people who have:

• an injury to the brain
• damage to multiple areas of the brain
• multiple cognitive impairments
• significant impacts in their life
• a non-progressive brain injury, e.g. not a degenerative disease
• ability to actively engage in the rehabilitation process
• the likelihood that rehabilitation can make a positive difference to their future life.

Brain injury specialist rehabilitation implies rehabilitation for this specific group of clients who are a subset of people who have experienced an acquired brain injury ABI, of which those with TBI are the core group.

Client

The term client is used throughout this document to describe the person receiving the rehabilitation intervention, however resident, client, individual or participant may be substituted in different contexts.

Family-centred care

Family-centred care is ‘grounded in collaboration among patients, families, physicians, nurses, and other professionals for the planning, delivery, and evaluation of health care as well as in the education of health care professionals’.¹⁵

Foundational activities⁴⁰

Combined with the foundational inputs, foundational activities make rehabilitation service delivery possible.

Foundational inputs⁴⁰

Foundational inputs are the building blocks of the rehabilitation program. These are the preliminary requirements, which need to be in place before implementing a rehabilitation program.

Glasgow Coma Scale

The impact of the injury on the brain determines severity and ranges from concussion to persistent vegetative states and is typically classified from mild to very severe, according to the duration of unconsciousness (coma) as measured by the Glasgow Coma Scale.

Table 6: Glasgow Coma Scale

Injury severity category	Initial Glasgow Coma Scale
Mild	12-15
Moderate	9-11
Severe	3-8
Very severe	less than 3

Impacts

Impacts are the results of achieving specific outcomes, usually longer term and may take years to achieve. These are the consequences once the person achieves their outcomes and may be desirable or undesirable, anticipated or unanticipated. They are the changes that occur beyond the specific program targets.

Inputs

Inputs describe the ‘what’ and ‘who’ is used to do the work. It includes all the resources that contribute to the production and delivery of outputs or what we use to do the work.

Key stakeholders

A stakeholder is anyone who can affect or is affected by the program. They may be recipients, providers and internal or external. Key stakeholders are those who can influence the direction or priorities of the program, including participants and program sponsors.

Outcomes

Outcomes are the changes that come about through inputs and activities. They may be quantifiable. They are the medium-term results for specific beneficiaries that are the consequence of achieving specific outputs or what we wish to achieve.

Outputs

The final products, goods and services produced for delivery. Outputs are usually quantifiable and measurable or what we produce or deliver.

Post-traumatic amnesia

Not everyone with a brain injury, however, experiences a loss of consciousness or confusion as the immediate result of a TBI. Some people with a penetrating injury may initially be conscious following the injury. Some people have a hit on the head and get confused without ever losing consciousness. A football player after a heavy tackle may be confused or unsteady on their feet over a few minutes (this would be classified as a mild TBI and often in sport referred to as a concussion).⁵²

A critical indicator of severity for TBI is the length of post-traumatic amnesia (evidenced by a period during which the person is disorientated, unable to learn, unaware of time, place and person (self). They may display behaviours quite different than usual, being disinhibited, irritable or agitated.

Table 7: Post-traumatic amnesia categories

Injury severity category	Duration of post-traumatic amnesia
Mild	Less than 24 hours
Moderate	1-7 days
Severe	1-4 weeks
Very severe	More than 4 weeks

The primary group admitted to BIRP have severe or very severe PTA duration. Additional categories had been introduced into the BIRD state data collection for reporting and research purposes. By consensus of the 15 BIRP directors and managers in 2019, it was agreed to retain these categories for clinical purposes.

Table 8: Additional post-traumatic amnesia categories for BIRD data collection

Injury severity category	Duration of post-traumatic amnesia
Very severe	28 days to 3 months
Extremely severe	3-6 months
Chronic amnestic	More than 6 months

Principles

Principles are fundamental truths or propositions that serve as the foundation for a system of belief or behaviour or for a chain of reasoning. Principles here are the foundational propositions for effective brain injury rehabilitation.

Rehabilitation settings

These are the care settings or environments in which rehabilitation programs are delivered. The setting in which rehabilitation occurs is principally defined by the person’s changing needs over time and service availability.

Resources

Resources refer to both material and human resources.

Self-efficacy

An individual’s belief in their capability to succeed in a certain situation or accomplish a task. Self-efficacy influences how people set their health goals.

Sense of self

How an individual regards themselves, including an understanding of their qualities, strengths and personal attributes, all of which can be impacted by disability.

Traumatic brain injury

Mild

Mild TBI is also referred to as concussion. Recovery times vary greatly.

• Some people's symptoms subside within 48 hours. Others have symptoms persisting greater than a couple of weeks and these require careful assessment and reassessment.
• Some people's symptoms last months (post-concussion syndrome).
• The majority of people with post-concussion syndrome recover completely in three to six months.
• Some people do not fully recover and have lifetime impairments.

Mild traumatic brain injury (complicated)

Refers to people whose symptoms and impairments from a mild TBI have not resolved within three to six months.

Severe traumatic brain injury

Includes severe TBI and very severe TBI unless otherwise noted.

Values

Values are the beliefs that determine the attitudes and behaviours of the people who deliver rehabilitation services. Collectively these values inform the planning of rehabilitation services and how those services operate.

Acronyms

Acronym	Term
ABI	Acquired Brain Injury
ACI	Agency for Clinical Innovation
BIRD	Brain Injury rehabilitation Directorate, an ACI network
BIRP	The NSW Brain Injury Rehabilitation Program
CHN	Children’s Healthcare Network
GP	General Practitioner
LHDs	Local Health Districts
PCANS	Paediatric care and needs scale
PTA	Post traumatic amnesia
RPNSW	Regional Paediatrics NSW
NDIS/NDIA	National Disability Insurance Scheme/Agency
TBI	Traumatic brain injury
TLP	Transitional living program