Title : An Assessment and Rehabilitation Model for Post-concussion Syndrome (PCS) in Adults
Introduction 
Definition of PCS  –  “ A syndrome that occurs following head trauma (usually sufficiently severe to result in loss of consciousness) and includes a number of disparate symptoms such as headache, dizziness, fatigue, irritability, difficulty in concentrating and performing mental tasks, impairment of memory, insomnia, and reduced tolerance to stress, emotional excitement, or alcohol” (WHO, 2010).
Diagnosis of PCS is symptom-based, as conventional neuro-imaging techniques do not always show evidence of injury. Symptoms are often longer term resulting in loss of relationship and loss of employment.
For 5 years |reach| (our company) have been carrying out assessments and short targeted home-based rehabilitation programs for adults identified as most likely to be suffering from PCS and gaining excellent results.
Assessment Process
Our unique assessment is evidence-based and carried out by a Neuro-occupational therapist. It comprises of a semi-structured interview, observations and a range of standardised assessment tools which are selected for their relevance to the client and their situation. 
The interview and observations are used to establish current situation and abilities, and any changes post-injury in the following areas:
•	Self-maintenance
•	Daily routines
•	Cognitive status
•	Physical / sensory
•	Sleep and fatigue
•	Behaviour and mood
•	Social dimension
•	Occupational performance
The standardised assessments include a range of tools to establish awareness, mood, fatigue and cognitive failures, as well as outcome scales to indicate the rehabilitation potential.
A report provides the outcome of the assessment and recommendations for rehabilitation where appropriate.
Rehabilitation Model
|reach| rehabilitation programmes are individually tailored to need, but in general consist of 8 sessions and a review. An educational approach is used, along with introduction of compensatory strategies and technology to promote independence, whilst working towards individual goals. The plan is to provide a tool box of strategies to ensure continued progression.  A rehabilitation programme typically includes:
•	Fatigue Management and sleep hygiene
•	Attention
•	Memory
•	Planning and organisation
•	Mood 
•	Anxiety
•	Vocational considerations
Outcomes and Discussions
Reach developed this approach to meet a clinical need which is usually not available through UK statutory services. Over the past 5 years our outcomes have shown all clients returned to employment/education/voluntary work and have been able to sustain such activity. 
Using standardised assessments, enables us to chart progress and identify barriers for continued progression. Many patients use their tool box of strategies on a long term basis, allowing them to optimise their rehabilitation potential and re-engage with pre-PCS activities. 
We are keen to share our working experience and outcome data with colleagues as this client group and the demand on UK statutory services is ever increasing.  Currently, we are developing a similar service for paediatrics and adolescents, based on evidence-based practice.