Regional Hyperacute Rehabilitation Unit (RHRU)

The Regional Hyperacute Rehabilitation Unit (RHRU) is a Level 1 complex specialised rehabilitation service commissioned by NHS England and situated within the NHS London region. 

It comprises of a fully integrated facility of 24 beds primarily for patients with severe complex physical disability, including those with tracheostomy, low awareness state (prolonged disorders of consciousness, PDOC).

We regularly admit patients from major trauma centres, hyper-acute stroke units, neurosciences centres as well as district general hospitals in London, Eastern (Bedfordshire, Hertfordshire and Essex) and Southern (Berkshire) regions.

The typical length of stay is around four to six weeks for assessments, and an average length of stay of 3 months for complex specialist rehabilitation or highly complex disability management. For patients requiring specialist rehabilitation, they need to be able to engage in intensive rehabilitation activities and the service is often more suited to patients in the younger age range.

Rehabilitation is underpinned by evidence based practice, with support from Clinical Specialists and an active research team based at the RRU and King’s College London.

Scope of the Service

The overall aims of the service are:    

  1. To provide an effective and high quality service for people with severe and complex disability, who require assessment and / or intensive interdisciplinary rehabilitation in a level 1 service, and whose needs cannot adequately be met by their local rehabilitation service

  2. To involve patients as fully as they are able in their own rehabilitation process, with due regard to their physical, emotional and cultural needs

  3. To optimise recovery of function in terms of physical, communication, cognitive and psychosocial abilities

  4. To facilitate the patient and family’s adaptation to residual disability and maximise independent function

  5. To modify environmental factors where possible and identify the need for specialist equipment to help maximise function

  6. To plan discharge in close liaison with local rehabilitation teams, referring physicians, GPs, local Social Services and any other agencies involved in the person’s ongoing care

  7. To provide support and advice to local teams immediately following discharge to ensure smooth transition between hospital and home and to ensure (where possible) that rehabilitation continues after discharge from the RHRU

  8. To provide advice to referrers on alternative rehabilitation and/or management options if admission to the RHRU service is inappropriate

  9. To be a regional, national and international focus for rehabilitation research across all professions

  10. To provide advice on service developments for other rehabilitation facilities nationwide

  11. To provide a service outside the unit to:
  • assess patients in other hospitals, private homes, Residential and Nursing Homes as appropriate
  • provide advice, support and recommendations to hospital and care staff regarding the care of people with complex needs, including advice on ongoing care packages.

Areas of expertise

  • Acquired brain injury of any cause, including stroke, trauma, anoxia, encephalitis, meningitis, vasculitis, toxic causes, etc

  • Partial spinal cord injuries, especially non-traumatic in origin

  • Peripheral neuromuscular disease e.g. Guillain Barre Syndrome, critical illness neuropathy, polymyositis etc

  • And, where the service is appropriate to meet the individual’s needs:  
    • Some progressive conditions e.g Multiple Sclerosis etc  
    • Other conditions e.g. medically unexplained conditions. 

Other areas of expertise include: 

  • Complex nutritional management including feeding gastrostomy, specialist dietetic input with direct access to St Mark’s Hospital, a national referral centre for intestinal and colorectal disorders

  • Complex spasticity management requiring holistic inter-disciplinary intervention and provision of botulinum toxin intervention, tendon releases, serial casting/splinting

  • Managing complex tracheostomy patients, including assessing for weaning and decannulation alongside ENT and planning for patients who need long-term tracheostomies.

  • Severe cognitive, communicative and/or behavioural problems in the context of severe physical disability

  • Assessment of patients in a Prolonged Disorder of Consciousness, PDOC) using standardised tools such as the Sensory Modality Assessment And Rehabilitation Technique (SMART), Coma Recovery Scale (CRS-R) and the Wessex Head Injury Matrix (WHIM)
  • Neuro-palliative care

  • Vocational assessment and return to work

  • Symptom management including Depression and Hemiplegic shoulder pain

  • Specialist facilities including Electronic Assistive Technology (EAT), Alternative and Augmentative Communication (ACC) specialist wheelchair and seating, Harness treadmill training and Hydrotherapy.

Exclusions include:

  • Very severe behavioural problems or severe cognitive problems without physical disability

  • Patients treated under section of the Mental Health Act

  • Patients for whom achievable rehabilitation goals cannot be identified

Northwick Park and St Mark's Hospitals

The Regional Hyperacute Rehabilitation Unit is situated at Ward Block, Level 6, Northwick Park Hospital.


Lead Secretary, 020 8869 2801 (Monday - Friday 8.30 - 4.30)

Ward Administrative Assistant, 020 8869 2811 (Monday - Friday 8.30 - 4.30)

Senior Management Team:

Professor Lynne Turner-Stokes, Director/Consultant in Rehabilitation

Dr Charlie Nyein, Consultant in Rehabilitation (Outreach)

Dr Andrew Thu, Consultant in Rehabilitation (in-patient Service)

Hilary Rose, Head of Therapy Services

Dr Stephen Ashford, Consultant Physiotherapist and Clinical Lecturer

Chris Dungca, Clinical  Nurse/Service Manager


Heads of Service:

Dr. Patrick McKnight, Consultant Clinical Neuropsychologist

Rita Santhirarajah, Clinical Nurse Manager

Katrina Clarkson, Principal Speech and Language Therapist

Aideen Steed, Principal Physiotherapist

Chantelle Pieterse, Principal Occupational Therapist

Fiona Zinger, Specialist Social Worker 

Useful links

Headway - The brain injury association
The charity that works to improve life after brain injury. Provides information, support and services to people affected by brain injury, their family and carers.

Stroke Association
The UK's stroke charity.They support stroke survivors, families and carers. And they fund research into the prevention and treatment of stroke.

Different Strokes
A registered charity providing a unique, free service to younger stroke survivors throughout the United Kingdom. 

The Encephalitis Society 
The Encephalitis Society is a registered charity providing support to individuals and families who are living with encephalitis. They also offer comprehensive information about the signs, symptoms and causes of encephalitis in children and adults to people affected and medical professionals, also leading research into encephalitis.

Upcoming Training Courses on the RHRU:

2018 Courses

Goal Attainment Scaling
Friday 2 February 2018
Cost: £150

RCS, Nursing & Therapy Dependency (Outcome Measures)

Friday 9 March 2018
Cost: £150

FIM+FAM Training Day

Friday 11 May 2018
Cost: £150

Prolonged Disorders of Consciousness

27 September 2018: A pragmatic approach in assessment and management from acute to the community

28 September 2018: Practical WHIM & CRS training
(Applications for WHIM & CRS training can only be accepted for those who have attended Day 1 or previous PDOC training days)

Cost: £75 per day

For enquiries about any of our courses or to be added to our course mailing list please contact Elica Ming-Brown, Therapy Assistant on 020 8869 2808 or elica.ming-brown@nhs.net