Understanding Barriers to Neurorehabilitation After Traumatic Brain Injury.

Traumatic brain injury (TBI) often results in persistent cognitive, emotional, physical and functional difficulties, yet access to community neurorehabilitation remains inconsistent. This paper integrates a systematic review of patient-reported barriers to accessing and sustaining engagement with community neurorehabilitation following TBI, alongside an empirical qualitative study exploring Clinical Psychologists’ perspectives on both the barriers and potential solutions to improving access. Together, these studies examine barriers to accessing to community neurorehabilitation services for individuals who have sustained a TBI.

The systematic review, conducted in line with PRISMA guidelines and a registered PROSPERO protocol, synthesised qualitative research published between 2005 and 2025. Fifteen studies met inclusion criteria and were analysed using thematic synthesis. Four themes captured patient experiences: the need for self‑advocacy, limited recognition of TBI by professionals, fragmented and insufficient services, and inflexible systems that do not accommodate the symptoms of TBI.

The empirical study used a qualitative design. Reflexive Thematic Analysis was conducted on semi‑structured interviews with 13 UK Clinical Psychologists working in community neurorehabilitation services. Five themes were generated, highlighting how pre‑injury factors, inconsistent referral pathways and rehabilitation models designed around an “ideal” patient contribute to gaps in provision. Psychologists emphasised the importance of referrer education, culturally responsive practice, greater service flexibility and more integrated working across health and social care.

Across both studies, findings indicate that access to community neurorehabilitation is shaped by intersecting individual and organisational factors. Improving professional understanding of TBI, clarifying referral routes and developing more flexible, inclusive and coordinated rehabilitation models may enhance engagement and ensure more equitable access for individuals with TBI.