This document summarizes Becky Williamson's occupational therapy fellowship in major trauma centers in the United States. The fellowship aimed to gain an international perspective on early OT rehabilitation for serious injuries, compare core OT skills between countries, and influence development of OT services in Nottinghamshire. Williamson found that American trauma centers promoted early mobilization and functional rehabilitation through joint OT-nursing care. OTs specialized in trauma and conducted assessments, splinting, positioning, and cognitive and functional rehabilitation in ICUs and hospital wards. Early OT intervention was shown to optimize outcomes and reduce long-term costs. Upon returning, Williamson recommended recruiting OTs specializing in trauma to the new regional trauma center to deliver best practices in early rehabilitation.

1. Major Trauma Centres
USA
Becky Williamson
Occupational Therapist

2. Early Occupational Therapy
rehabilitation within major trauma
centres of America

3. Introduction
• Major Trauma - serious multiple system injuries
• East Midlands Major Trauma Centre
• Queens Medical Centre - April 2012
• America Major Trauma Centres & Rehabilitation
• Much of the evidence from America
• Nottinghamshire Roosevelt Scholarship

6. Objectives
• Gain an international perspective
• Compare and contact the use of OT core skills
• Influence development of Major Trauma OT
services at NUH

7. Method
• Literature review of the existing evidence base
• Examination of current practice & services
• Identification of key contacts and visits in America
• Exploration of best practice, building knowledge &
understanding of services in American
• Dissemination of the scholarship findings to key
stakeholders

11. Discussion
• Joint therapy promoted early mobilisation & functional rehabilitation
• OT role
• assessment of levels of awareness & arousal
• splinting
• seating & positioning
• cognitive & early functional rehabilitation
• recommendations for managing behaviour
• support with emotional & psychological wellbeing
• Collaboration with bedside nurses facilitates 24 hour rehabilitation
• OTs completed senior rotations across the acute setting

12. Evidence
• Department of Health
• rehabilitation worst performing element of trauma pathway
• Rehabilitation can reduce “societal cost significantly” (DOH 2009)
• Rehabilitation prescriptions need to identify
• “an appropriate programme of rehabilitation to assist their recovery” NHS
Choices (2012).
• OT interventions needed in ICU stay to prevent deficits due to joint
contracture & initiate functional rehabilitation (Robinson et. al. 2006)
• Early OT rehabilitation optimises functional outcomes (Hedges et.
al. 2006)

13. Conclusion
• OTs need specialist expertise to deliver best practice in early
Major Trauma rehabilitation
• OT role recruited to in the regional Major Trauma Centre
• Opportunities for OT rehabilitation in ICU and HDU
• Highlight the need for and benefits of rehabilitation
• Save money in the long term
• Better patient outcomes

16. References
• Affordable Care Act (2010) Affordable Care Act Full Text [
http://www.healthcare.gov/law/full/index.html] Last Accessed: 31/04/2013 17:00
• Batalden P. B. & Davidoff F. (2007) What is “quality improvement” and how can it transform
healthcare? Quality and Safety in Health Care February 2007, 16(1): 2–3.
• Brahmbhatt N., Murugan R. & Milbrandt E. (2010): Early mobilisation improves functional
outcomes in critically ill patients Critical Care 2010, 12:321
• DOH – Department of Health (2009): Rehabilitation of major trauma patients QIPP - NHS
Evidence, 27 November 2009 - Publisher: Department of Health - Publication type: Quality and
Productivity Example [https://www.evidence.nhs.uk/qipp] Last Accessed: 31/04/2013 17:00
• Frances Report (2013): Final Report of the Independent Inquiry into Care Provided by Mid
Staffordshire NHS Foundation Trust [http://www.midstaffsinquiry.com/pressrelease.html] Last
Accessed: 31/04/2013 17:00

17. References
• Hedges J., Krog K., Megargee T., Porras-Monroe M., & Foisie Robinson E. (2006) Chapter 4 –
Early Rehabilitation Interventions Located in: Robinson L. (2006): Trauma Rehabilitation 1st
ed. Philadelphia PA, Lippincott Williams & Wilkins
• NHS Choices (2012): Major Trauma Services Reviewed by authors - 10/04/2012 [
http://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/Majortraum
] Last Accessed: 19/09/2012 17:00
• Nottinghamshire Roosevelt Travelling Scholarship (2012): [http://rooseveltscholarship.org/] Last
Accessed: 30/04/2013 17:00
• Robinson L. (2006): Trauma Rehabilitation 1st
ed. Philadelphia PA, Lippincott Williams & Wilkins
• Schweickert W.D., Pohlman M.C., Pohlman A.S., Nigos C., Pawlik A.J., Esbrook C.L., Spears L.,
Miller M., Franczyk M., Deprizio D., Schmidt G.A., Bowman A., Barr R., McCallister K.E., Hall
J.B. & Kress J.P. (2009): Early physical and occupational therapy in mechanically
ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009 May
30;373(9678):1874-82

18. Link to Report & Blog
• Report
http://www.rooseveltscholarship.org/resources/docu
ments/RooseveltReport-RebeccaWilliamson.pdf
• Blog
http://blog.travelpod.com/members/beckywilliamson

19. Becky Williamson - OT
rebecca.williamson@nuh.nhs.uk
@_beckyOT