9 minute read
Supporting Brain Injury
Neuro occupational therapy consultant Ruvini Silva works with brain-injured clients to support them to maximise their independence and achieve their personal goals. Ruvini shares the work she does in this role and discusses the changes she had to implement throughout the pandemic
From a young age, I believe my initial interest and exposure were gained by observing my father carrying out his consultations as a physician. This is where I mastered and emulated the fundamentals of building patient rapport, bedside mannerisms, communication and listening skills. Professionally though, my journey as an occupational therapist started in 1996 in Perth, Australia where I worked for the Blind Association as a new graduate. The role involved assessing and treating patients with various visual impairments as well as neurological or longer-term conditions. I then returned to the UK in the late 1990s where the clinical and management experience I gained in some of the most prestigious hospitals in London has framed my current practices as a consultant neuro occupational therapist. I worked as a neuro OT in the Midlands and then Southend-on-Sea which exposed me to various neuropathologies from MS to Guillain Barre to myasthenia gravis. From here I went on to St Mary’s Hospital in Paddington, London to work in acute and rehabilitation with some excellent clinicians including allied health professionals and medics who were experts in their respective fields. This is where I learned and assimilated my clinical assessment skills and also gained exposure to evidence-based practice and research. In 2005, I then moved to Surrey with my young family and worked for Hampshire County Council as their county consultant until 2017. Now I work as an independent clinician and was instrumental in setting up a virtual service for brain-injured clients for a charity in Hampshire during the pandemic in early 2020. Brain injured clients in general are a more disadvantaged
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group in comparison to those living with other longterm conditions. The soft symptoms of poor memory, ability to plan, poor organisational skills, impulsivity, behavioural problems, increased levels of anxiety, and depression are not always visible to others. As a result, this leads to problems of fully understanding the brain-injured client as a person with an impairment or disability. Clients with a brain injury are more susceptible to experiencing mental health problems during some period of their lives. Some of the short- and long-term effects of brain injury are related to mental health and can include increased levels of anxiety, depression, aggression, and impulsivity. The consequences of brain injury are influenced by a multitude of factors, from the premorbid state of social function, financial and environmental state, life experiences in childhood, to young adult life. From my experience of working in brain injury, this client group are also pressured with loss of their previous status, social isolation, changes to family dynamics and roles. Additionally, the lack of coordinated care in the community with no routine services that are easily accessible, leaves a client with further issues to address. Some clients may seek the comfort of alcohol, recreational drugs, gambling and even turn to various unhealthy social relationships by joining gangs and other groups where they may feel a sense of belonging. For the purpose of discussion, I would like to give you an overview of my role as a part time independent OT consultant where the day begins with planning and a team meeting with rehabilitation assistants who are extremely dedicated to the service. As the clinician, I assess new clients and offer them appropriate sessions of remedial activities, therapeutic groups or one-to-one sessions, as deemed suitable for a client. The model of practice is an eclectic one. Tailoring to the individual needs of the client as well as matching them with peers who are at similar levels in function and interests. It is worthwhile noting that the majority of the clients may not have had access to rehabilitation post-injury. The clients on a stroke pathway may have had some input with an early supported discharge team for four to six weeks only. This was a similar state of service provision pre-pandemic. The service was previously providing day centre activities, but in 2020 with the start of the pandemic, the innovation of service delivery took place within weeks. I was instrumental in implementing these changes and working closely with rehabilitation assistants. First with the introduction of basic telephone calls with remote monitoring which were diarised weekly. I then developed a booklet for the rehabilitation assistants to follow to help maintain therapeutic conversations. The contact with the clients was extremely useful in maintaining some degree of structure to their day. Although a few clients found talking over the telephone difficult in the absence of the face-toface contact. But with persistency and ongoing input clients reported more confidence. Within weeks the new virtual platform of Zoom was experimented and again not without technical problems. With the successful sessions of zoom being embraced by most clients we were able to offer them face-to-face virtual meetings and a hybrid model of service. The main focus during the pandemic was maintaining the client’s psycho-social needs and preventing deterioration. As clinical lead/OT consultant in a part time role I am able to assess and tailor make their treatment to their needs, offering appropriate interventions, whether it be working on improving their memory or working with a programme on fatigue management.
The main focus during the pandemic was maintaining client’s psycho-social needs and preventing deterioration
I would like to stress that during this one-to-one consultation I always allow five to ten minutes to talk to my client on examining their sleep patterns, nutritional intake, general wellbeing check or even how they have been spending the last 48 hours. This provides a clear picture of their health and wellbeing as well as possible ongoing issues to address. This may also include identifying the need to signpost a client to another service.
The need to signpost clients to relevant services is a tricky one. As limitations remain in speech and language therapy, neuropsychological services and social work. As a result, some clients may seek private help or no service at all.
My role also involves discussion with GPs or other health professionals who can assist the client with any additional needs, such as monitoring their diabetes, consulting neurologists, psychiatrists, or referral to a falls clinic.
As for satisfaction from this role, the ability to work with a group of clients who may not have routine access to statutory brain-injured services locally, I am able to provide and develop the service to meet the client’s needs. As we know the landscape of services nationally for brain-injured clients is still limited. My perspective is providing the client with opportunity to better understand how the brain injury has affected them and helping the client adjust and find solutions to their new way of life. This may be at times going back to basics of occupational therapy and occupational science. The ability to view every client as an ‘occupational being’ is vital as every one of us needs to be able to pursue and orchestrate occupations, whether it be an activity of daily living, unpaid or paid work, or leisure activities. I strive to facilitate a person-centred approach. There is ample time for a client, without any immediacy for discharge. Self-exploration and working to a client’s own pace are encouraged. The most rewarding part of my job is experiencing progress whether that be physically, mentally or socially. Examples where a client may wish to then consider working, or a further studying option, or simply saying “I can express myself here” showing improved confidence and independence. I am always striving for clients to feel at ease and to provide the opportunity to explore new occupations and give them a purpose in life. This is the purpose of occupational therapy in its true sense, and I am proud to fly the flag for this profession.
Unmissable CPD courses for OTs
Two fascinating new online courses written by OTs for OTs have launched this year, by world-class training provider Sensory Integration Education (SIE). Here’s an overview of both courses.
Feeding is one of the most complex things we require our bodies to do because it involves every sensory system integrating information about our body and the world around us. Would you know how to recognise when sensory-based issues are impacting on your client’s feeding difficulties and which strategies to advise and which to avoid?
Supporting Individuals With Feeding Difficulties: Sensory Integration in Practice - A
Multidisciplinary Perspective is a 10-hour online course comprising videos, presentations, interactive quizzes, worksheets and clinical discussions between your highly experienced and engaging trainers Laura and Louisa. Laura Osman is a Highly Specialist Speech and Language Therapist, Advanced Sensory Integration Therapist, Feeding Therapist and Teacher. Louisa Hargett is a Highly Specialist Occupational Therapist, Advanced Sensory Integration Therapist, Feeding Therapist and Teacher.
This course will provide you with a multidisciplinary perspective to understanding the complexity of feeding and will provide strategies that will inform therapeutic and educational planning to support children with feeding difficulties to improve their relationship with food. It is great value at £65 , is CPD Accredited and includes free Affiliate Membership to SIE.
Search: bit.ly/FeedingCourse
Have you ever dreamed of designing your own Ayres’ Sensory Integration (ASI) space? Ever wondered how you could make a rented room work for your SI therapy? What equipment would you need if you decided to offer mobile SI-informed therapy in schools, homes and workplaces? This new course from SIE has all the answers for you.
Designing Your Own ASI Space
is an online course, packed with helpful and practice advice from Moyna Talcer - a Consultant Occupational Therapist with 20 years’ clinical experience, both in NHS and private practice, and an Advanced Practitioner in Ayres' Sensory Integration.
This course is a must-see if you are thinking of adding SI-informed therapy to your practice. It comprises 5 hours of content using slides with voice-over, captioned videos, worksheets, downloadable handouts and recommendations for further reading. All advice is linked back to the evidence base for ASI and maintaining fidelity for ASI interventions. The course also includes a bonus video of an interview with Mike Brooke of Southpaw UK, who discusses the precise requirements of the different kinds of suspension equipment that are suitable for owned or hired spaces and for mobile therapists.
If you want to be guided through the decision making process about designing an ASI space or a mobile ASI therapy service, then this is the course for you. Priced at only £45, it is CPD Accredited and also includes free Affiliate Membership to SIE.
Search: bit.ly/ASIspace
For more information on these courses, as well as SIE’s universityaccredited postgraduate SI Practitioner training, and live webinars on CPD topics, see:
www.sensoryintegration.org.uk
Wiltshire Farm Foods Turns 30 with Softer Foods Offer
This summer, Wiltshire Farm Foods is celebrating. It’s been 30 years since the company created its first ready meal and, all these years later, it’s celebrating with a Softer Foods offer for those with swallowing difficulties.
Also known as dysphagia, swallowing difficulties are brought about by a variety of medical issues and can be hugely problematic for those who cannot access appropriately textured meals. As a thank you to OTs and their patients who have supported Wiltshire Farm Foods over the years, the company has developed an exclusive Summer Menu Pack, which includes seven mains and five desserts – two of which are brand new to their renowned Level 4 Purée Petite range. This range has been created specifically for those with dysphagia, as dishes with this texture are puréed and smooth with a consistent texture, each one meeting with IDDSI Level 4 requirements. One of the new dishes is a delicious Puréed Honey Glaze Pork with Apple Sauce, which comes served with sage and onion sauté potatoes and green beans. And those of you with a sweet tooth will also enjoy their Puréed Summer Fruit Sponge and Custard; the perfect zesty finale to your meal, with a sweet and fruity tang. Featuring many of their classics from over the years, such as Purée Petite Omelette, Chips, and Beans and tasty Purée Classic Fish in Creamy Sauce, Wiltshire Farm Foods’ menu pack will surprise and delight your tastebuds, whilst complementing the summer sunshine and brightening your mealtimes. Join them in celebrating the best flavours of summer in a texture you can enjoy, for just £41.85. Just quote SF21 to receive your exclusive Summer Menu Pack. Time to get that freezer stocked and enjoy meals which are not only delicious, but also safe to eat. Visit wiltshirefarmfoods.com to find out more.
