ABSTRACT
This chapter considers service provision, and the evidence for the clinical and cost-effectiveness of neurorehabilitation programmes that aim to minimise the social handicap associated with neurobehavioural disability. The trend in acute management of traumatic brain injury in the UK and elsewhere has been towards developing centralised trauma services that deal with major and complex trauma that cover large geographical areas. The continuing increase in demand and competition from health services for scarce financial resources, alongside an increase in the prevalence of long-term health conditions, has led to greater emphasis upon assessment of cost-effectiveness rather than the effectiveness of treatment or rehabilitation alone. Despite the challenges, evidence for the clinical effectiveness of neurorehabilitation for neurobehavioural disability has been mounting, as has demonstration of the cost-effectiveness of rehabilitation programmes. The chapter reflects on different types of service, understanding to a certain extent, but the criteria for allocating individuals to the most appropriate rehabilitation service are not always implemented in practice.
