Development and Testing of a Digital Vocational Rehabilitation Programme for Working-age Adults with Acquired Brain Injury

Rewire is an app and class 1 UKCA marked medical device that delivers personalised neurorehabilitation. The app uses a video-guided assessment of upper limb and lower limb function to generate a dynamic exercise programme with weekly activity goals. Two NHS Trusts are using Rewire to treat acute stroke patients, some of whom are averaging around 120 minutes of activity each week in addition to therapy that is provided: equivalent to three additional physio- or occupational therapy sessions. In addition to addressing the deficit in therapy provision, Rewire helps to manage the psychological component of stroke. The app tracks mood, fatigue and pain; with mindfulness techniques to aid management. It is the first digital health therapeutic whose exercise recommendations take into account physical deficit and psychological wellbeing. Rewire is proven in its operational environment: funding from SBRI Healthcare is supporting a project to evaluate Rewire s impact on the carbon footprint of a community stroke rehabilitation service at Doncaster and Bassetlaw NHS Trust (DBTH), with an economic analysis. Innovate UK funding has been used to achieve MHRA and DTAC compliance. This project builds on early traction seen in stroke by developing and determining the acceptability of a vocational rehabilitation programme for working-age adults with acquired brain injury. Every year some 50,000 people in the UK aged 15-64 are admitted to hospital with a traumatic brain injury and a further 15,000 adults under 60 suffer a stroke1,2. The economic cost of traumatic brain injury alone is estimated at £15 billion annually3. A randomised controlled trial demonstrated that participants with mild-to-moderate traumatic brain injury who received cognitive and vocational rehabilitation were far more likely to have stable employment at 3 months in comparison to a group receiving usual care: 81% vs 60% (P = 0.02)4. Despite this, vocational rehabilitation is a service that is lacking nationally5. Rewire was conceived on an Acute Stroke Unit, where a prototype was developed in an iterative process with patients and clinicians. The theme that emerged from over 100 patient interviews was that progress is often slow and difficult to perceive, with a consensus that a greater intensity of therapy is required. Our iterative approach to development is integral to this project also, beginning with a needs-finding phase in work package (WP) 1 that culminates in a software requirements specification. Two focus groups will be conducted with individuals from Headway Tyneside and County Durham support groups. From these, two group members will be selected as Lived Experience Co-investigators who will shape and review new content. Mini-games that challenge verbal memory, executive functioning and develop processing speed will be created with an occupational therapist, while a neuropsychologist will construct a video-based CBT programme (WP2). A scalable vocational rehabilitation programme needs to be clinician-independent and nuanced enough to meet the needs of a heterogenous patient population. Rewire aims to achieve this by gradually increasing the cognitive load, equipping patients with psychological management techniques and creating a portal for employers enabling them to play an active role in the recovery process.