31 minute read
EXCEEDING EXPECTATIONS
Exceeding expectations - the impact of effective brain injury rehabilitation
After Abbie sustained a serious traumatic brain injury in a road accident aged only 19, her ambitions to continue with her studies and career aspirations took a severe knock-back - but through effective, collaboration rehabilitation, she was able to fulfil her ambitions and now leads an independent life.
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Here, brain injury rehabilitation specialist Reach reveals how its ‘light touch’ and early intervention - and key role in supporting the family within a rehabilitative process and working within a multi-disciplinary approach which included education and statutory services - delivered life-changing results
Through a rehabilitation process being made into a positive experience, with meaningful and achievable goals and the engagement of family and education providers, Abbie has been able to rebuild her life beyond what was initially thought possible. Having been struck by a car while Abbie was a pedestrian, the 19-year-old was forced to pause her studies in beauty therapy amidst the ongoing consequences of her traumatic brain injury. She struggled with fatigue, had difficulties with cognitive processing and verbal information, experienced a reduction in concentration and all in addition to hearing problems. But through the engagement of brain injury rehabilitation specialist Reach, who devised a bespoke home-based programme to support her rehabilitation goals and recovery, Abbie has been able to complete a Foundation Degree and start her own business.
Her talent has even seen her working on the hair and make-up in a video shoot for a well-known singer - a dream come true for Abbie, and something that seemed worlds away following her accident. But through Reach’s role in providing and teaching rehabilitation strategies to Abbie and her family, liaising with her college and later University, and working with her case manager in collaboration with the multi-disciplinary team, the outcome has been hugely positive and beyond expectations. And through less than four hours of input per month from Reach’s neuro occupational therapists, the nationally-renowned rehabilitation specialist is showing what can be achieved through quality engagement and carefully-planned and managed rehabilitation. “This was a great programme to be involved in, and we are delighted with the outcome for Abbie,” says Fiona, senior programme manager at Reach, which specialises in teaching and empowering people how to manage their own recovery. “Understanding the issues, collaborating with the family and client and listening to what they wanted was key. Being flexible and responsive is hugely important. “We were also able to play an effective role in collaborating with college and University and establishing a real therapeutic bond with the family. The family were fully invested in the rehabilitation and getting the best outcome for their daughter.” Reach initially met Abbie and her family three months after her injury, when the need for an effective home-based rehabilitation programme was identified by the case manager. Reach, which has supported brain injury survivors since 1995, identified an array of “significant yet subtle” difficulties, which would impact on her educational, vocational, social and leisure participation. Through the rehabilitation intervention of a personal programme assistant - who is dedicated to reinforcing the rehabilitation strategies within a programme - alongside the support of senior programme manager, and neuro occupational therapist, Fiona. Working closely with Abbie and her family, Fiona was able to work with the case manager to ensure the appropriate rehabilitation was provided, while being mindful of the impact on the client, and being sure the pressure of the situation, and the demands of the many medical and therapeutic appointments, did not become too much. Crucially, Fiona was able to play two critical roles - firstly, in ensuring co-operation and collaboration with the case manager between therapists, overseeing them working to functional goals while balancing the time spent with Abbie to enable her fatigue to be properly managed. And also, through working with Abbie’s college to ensure her educational and day-to-day needs were met, giving her the freedom to live her life as a student while making appropriate provision for rehabilitative approaches to be there if and when needed. Abbie went on to complete her Level 2 college course in beauty therapy, going on to complete a University Foundation Degree in hair and make-up design. She was able to travel to college using public transport and also enjoyed a spell living in University halls of residence, living independently and enjoying her life as a student to the full. As well as working on a video shoot, Abbie also had a parttime job in a prestigious makeup store for professionals, further demonstrating her talent and commitment in building and pursuing her career. She now works part-time in her own make-up business and is living the meaningful life Abbie and her family only dreamed may be possible, after the devastation of her injury. Abbie’s mother is fulsome in her praise for Fiona and Reach in her daughter’s recovery. "The rehabilitation work Reach provided for my daughter was exemplary,” she said. “The programme manager knew month to month exactly what my daughter needed and if it wasn’t within her remit she would find someone who could help. “I honestly believe I would not have got through these last years without her and my daughter would not be where she is today without Reach’s rehabilitation." Heather Batey, managing director of Reach who founded the business in 1995, said: “It was such a pleasure and a privilege to work with Abbie on her areas of deficit following her brain injury. “Building a great therapeutic relationship with both Abbie and her family, as well as educational processes, very early was a key element to the success of Abbie's reach rehab programme. “The fact that Abbie then progressed through education and ultimately onto independent living with minimal support is a huge testament to her drive and motivation and also to what reach Rehabilitation stands for and the optimal outcomes which we can achieve."
The role of remote rehab in tackling the global healthcare backlog
Dr Paul Rinne is CEO and co-founder of GripAble, a mobile assessment and training platform to enable home-based rehabilitation for people with a wide range of neurological and musculoskeletal conditions.
With the demands of delivering care during a pandemic leading to significant backlogs in healthcare across the world, Paul explains the urgent need for and - potential of – a hybrid, digitally driven, pathway of care, and the opportunity GripAble provides to therapists who need to engage their patients in rehab remotely.
Pandemic backlog
Patients with physical and cognitive impairments require guided therapy to improve their quality of life. Simply put, the more rehab they do and the more they adhere to professional guidance, the greater their chances of having better outcomes, with a wealth of evidence backing this up. However, due to resource costs and poor logistics, current health systems cannot deliver the amount of therapy needed, with significant backlogs, and few patients receiving anywhere near what they require to improve their quality of life. This is a common problem faced by hundreds of millions of patients around the world, with demand for treatment outstripping capacity even before Covid-19. Inefficient care pathways are not only costing health systems hundreds of billions of dollars every year but costing people the chance to live their lives to their full potential. Prior to the pandemic in the UK (February 2020), there were already 4.43 million people on a waiting list for care. At the start of the pandemic, the number of people joining waiting lists initially dropped, but has since been rising. The latest figures for February 2022 show a record of over 6.1 million people waiting for treatment.* This doesn’t include the growing ‘hidden backlog’ of people that require care but have either not yet presented, or who have had referrals cancelled. Indeed, the COVID-19 lockdowns resulted in many patients being isolated at home, unable to attend therapy appointments and some unable to access emergency treatment, increasing the risk of disability. Not only this, but the increased risk of stroke post-COVID and the need for physical rehabilitation amongst COVID survivors, means that a tsunami of disability could be coming, if digital pathways to support therapy are not implemented quickly enough.
Uptake of digital technology
The uptake of digital technology in healthcare, which has to date been very slow, has been forced to fast-track as a direct result of the pandemic. The world has moved on, driving changes in technology which will shape the delivery of healthcare in the UK. Significant advances have been made in areas such as telehealth and digital health to deliver immediate care to patients unable to attend inperson appointments. Mobile is driving the increased technology adoption we are seeing, with therapists now being able to use platforms like GripAble to translate their services and expertise to the home environment. This is a crucial development as, for many years, therapists have struggled to find the appropriate tools that can engage their patients in rehab, allow for greater efficiency in their workflow, and track outcomes remotely. However, if technology is developed without careful consideration of delivery and adoption, it can be difficult for therapists and patients to implement and adopt and present further hurdles. Technology for rehabilitation must fit in seamlessly with the clinical pathway, allow for truly independent use, and be scalable and accessible. For those returning home from hospital, technology that aids this transition is vital.
Facilitating remote rehab
There are currently six million people across the UK living with upper limb disability, and 384 million people worldwide. Physical rehabilitation is critical for people to restore quality of life after suffering a stroke, or the onset of many other neurological and orthopaedic conditions. Studies show that repetitive, task-directed exercises can improve long-term upper limb recovery, making this a key component of occupational therapy and physiotherapy following a stroke. However, as I have mentioned, this level of therapy can be difficult to implement and deliver due to resource constraints within healthcare settings, as well as the range of challenges faced by stroke survivors during their recovery. But the advent of remote and telerehab devices has created the opportunity for high volumes of gold-standard, efficient and personalised therapy to be delivered to patients across the world, from hospital to home, making outcomedriven care scalable and accessible to all. At the cutting edge of occupational and physical therapy, GripAble is a smart mobile assessment and training platform to help people work on their hand and arm movement and grip strength. At the heart of its design is turning the rehab grind into fun, by training core hand movements in an engaging, gamified way to help people along the journey of restored ability. Over the last seven years, GripAble has been tested and developed in partnership with thousands of occupational therapists and physiotherapists and patients across multiple clinical conditions and leading academic institutions including Imperial College London and within Imperial Healthcare NHS Trust. The platform is unique in the way it provides therapists, and patients of all ages, the ability and transparency to track and assess progress. GripAble’s unique handgrip captures data that allows for highly accurate monitoring for therapists when compared to more traditional devices such as hydraulic dynamometers, foam balls and putty. In a clinical trial of 30 patients, researchers from Imperial College London, the University of Southampton and Imperial College Healthcare NHS Trust found that GripAble enabled on average 104 upper limb repetitions per day whereas conventional therapy achieved 15 upper limb repetitions per day. The study, which was funded by NIHR Imperial Biomedical Research Centre (BRC) and published in Neurorehabilitation & Neural Repair, is the first to show that a digital rehabilitation platform – GripAble - can achieve significant increases in the amount of exercise patients do compared to supervised therapy only. The findings suggest that a significant proportion of stroke survivors may potentially benefit from GripAble alongside conventional therapy. This could improve patient outcomes as well as ease pressure on global healthcare systems in terms of infrastructure and resources.
Home-based clinic
As a full-stack solution, with bespoke-built mobile hardware, software and data services, GripAble provides a platform for further homebased technological advances. Add-ons are already in development for whole body rehabilitation, and we are working with big pharma to support drug development for people living with upper limb impairment. With investment backing, GripAble is ideally positioned to deliver end-to-end patient care and connect millions to their own personal home-based clinic. GripAble has the unique opportunity to be used by every single person coming into contact with the healthcare system globally, measuring and recording grip strength from early childhood until end-of-life care. By empowering patients and therapists through remote rehab, GripAble has the ability to not only change the face of physical rehabilitation, but also of the global healthcare sector in general, helping to tackle the backlog in care and allowing more people to access the therapy they need.
About GripAble
GripAble is a London based start-up digitising rehabilitation from hospital to home. GripAble’s digital platform, which includes bespoke hand-held sensors, mobile hardware, software, in-built gamification and data services, enables home-based rehabilitation, allowing more patients to access gold standard care from professional therapists for longer periods, driving improved outcomes while decreasing the burden on healthcare systems. GripAble is delivering a full range of services to nearly 1,000 customers, and has already achieved considerable neurological, musculoskeletal, and paediatric care provider adoption across NHS and private healthcare. As a result, GripAble has established itself as the leading technology in the upper limb remote-rehab space. For more information, visit: www.gripable.co
As AKA Case Management marks its 20th anniversary, the business - which prides itself on doing things differently - continues to do just that as it looks to the years ahead.
Looking to the future while staying true to its values
NR Times learns more about AKA’s values, its approach, and why its sector-leading adoption of the four-day working week is reaping rewards for staff and clients alike
Since its inception in 2002, AKA Case Management has grown to become one of the best known case management companies in the sector, with a reputation for supporting clients and their families to rebuild their lives after catastrophic injury, and investing in the development of its team to ensure their wellbeing and ability to deliver the best possible service. And as the business enters its third decade, marking its milestone 20th anniversary on June 19, these core values continue to remain central to all AKA does. While it changed hands last year in a management buyout (MBO), which saw founder Angela Kerr hand over the reins to directors Dawn Abernethy and Andrew Rose, there has been a distinct lack of seismic change - rather a commitment to carry on with developing the business in the client and staff-focused manner for which AKA is known.
Its recent anniversary celebration was indicative of that, with a fun day culminating with an It’s A Knockout-style event providing the forum for staff and clients alike to socialise and enjoy themselves together, further strengthening the relationships that exist. “We want to make sure that what we do is good and that what we do for everybody is good,” says Andrew. “We want to be a good place to work, which provides good quality services to our clients. “We're not focused on becoming the biggest case management company, because the biggest doesn't mean you're the best - we'll do what's right for us, our employees and our clients.” “It’s definitely about quality, trust and transparency, they are values at the heart of everything we do,” says Dawn. “One of the things we’ve learned is that we implicitly trust all of our team, and they truly trust us too. None of this could work without that.” Dominic Hobdell, who heads operations and finance at AKA, says: “I think our fun day really spoke volumes about what we’re about, people came along and just enjoyed themselves. “We all just had a great time together. It was about everybody, staff and clients, and people left saying what a brilliant day it had been. That’s our culture, it’s very inclusive, and we’re proud of that.” Andrew adds: “I think, going forward, it’s important that we remain at the forefront of innovation in the sector, and to model that. We are happy to lead the way, and if people want to watch us and follow, then that’s great.” One area in which AKA truly is leading the way is in its introduction of the four-day week for staff. Launched in its 20th anniversary month as part of a UK-wide trial encompassing businesses from a host of sectors, the four day week - which sees staff paid 100 per cent of their salary for 80 per cent working time - is seen as a particularly forward-l ooking approach. For Andrew and Dawn, given AKA’s commitment to staff and clients and to embracing positive change, its adoption was not a difficult decision, and its implementation is being done in co-operation with the whole team. “We genuinely want our people to be happy, and if they are, then our clients will get the best out of their life through getting the best out of us,” says Andrew. “Through the four-day week, it’s acknowledging that we need to look after ourselves, and taking the action to support that. “For so many years, we’ve all been attending events and training that talks about self care, but then most companies say ‘Yes, but you’ve got to be available for your clients’. But those two things don’t work in balance - how can you be available to your clients 24/7 and also find the time to look after yourself? “Case managers, as everyone does, need time to replenish themselves. Whether that’s doing yoga, reading a book, taking some time for them - whatever it means to them to take some time out, that’s what their day off every week is aimed at.” “We are committed to focusing on what's best for the client, or what's best for our staff, but also I think working a four-day week is quite an uncommon thing, especially for a company in the care industry,” says Dominic. “So as well as realising it was a great thing to do, I think the fact it was that bit different made us want to do it even more.” Dawn says: “Of course, some of our team did have concerns because they do try to be available for clients as much as possible, but we try and do things differently and find solutions to problems, so have been able to address this. “Over the weeks leading up to the four-day week trial, our team did a series of workshops and learned various techniques for productivity, such as giving people permission to turn off Teams while working on a task so they can focus, being less responsive to emails for periods, making sure they are only working on one thing at a time. “This is something we’ve all contributed to and have given people the freedom to choose what works for them.” “Everything we're doing is research and evidence-based,” continues Andrew. “What we are doing with working practices and wellbeing is all clinical best practice. ‘We're not corporate, we’re not driven by profit, we want to run a successful business which helps to reward our employees and treat them well. “And actually, if you look at the period our trial has covered so far - including the Jubilee Bank Holiday weekend and BABICM Conference - the figures so far are looking pretty good. “So if this makes good business sense, as well as ensuring the wellbeing of our staff and supporting the service we can offer to clients, then that’s great. “I think the only slightly scary part of it was when we heard the statistic that every six years, we'll have given someone a year off. That was quite eye-opening!” Going forward, Andrew and Dawn will continue to add new people to the business as part of its ongoing growth, but are adamant the foundations of AKA’s reputation and the values behind that will remain as they always have. “There isn’t a hierarchy here, it’s about everybody, everybody contributes and has their part to play - AKA isn’t Dawn and I, it’s all of us,” says Andrew. “What Angela achieved was great, and we are where we are because of that, but we are taking it forward and doing things the way Dawn and I do, without losing any of what makes us, and has always made us, AKA.” Dawn adds: “AKA is everybody, our team and our clients. Our celebration event showed that, we’re all in it together - and without the people doing everything they do, none of this would happen.”
Left-right: Director Andrew Rose, Director Dawn Abernethy, Operations & Finance Officer Dominic Hobdell
Mel Smith, who joined AKA almost 18 years ago
What are the positives about working at AKA? The company is well lead and very supportive. Due to the nature of our work, every day can be different. AKA’s vision and values are always adhered to throughout the company and we ensure clients needs are met.
Why do you think AKA stands out? AKA has a very friendly feel to it while maintaining professionalism, the people who work for AKA go above and beyond for the client. Nothing is too much trouble.
What about the service you deliver to clients? The service we deliver is to enable the client to regain as much of their independence as possible and to ensure that they have a fulfilled life. The case manager will lead the collaborative process of assessment, planning, facilitation and care coordination, while ensuring the clients’ needs are at the centre of the process.
Is the team well supported, as well as the clients? Absolutely, by management and colleagues.
How much of a positive is the four-day week for you and your life away from work? Working a four-day week has allowed me to focus on myself more, when working five days a week, from at least 9am to 5pm, there is not much time for you. I feel much happier in myself, less stressed and feel more focused.
" I just wanted to say how brilliant I thought the AKA event this week was.
As you know I was supporting a client and she seemed to thoroughly enjoy the event (especially the band who were brilliant). All of the client's family were singing the praises of AKA and how well done the entertainment etc was. I know how difficult a day like that can be to organise and I wasn't sure who to pass this on to, but I thought it was brilliant. Also good to see so many staff and families taking part in it's A Knockout!"
Jo Sims, who has been with AKA for almost nine years
What are the positives about working at AKA? There are so many! We’re a close team who truly care for each other, AKA has always had ‘family’ feel to it and working here has been a breath of fresh air for me. I’ve never stayed in a job role this long before. I can’t see me ever leaving AKA.
Why do you think AKA stands out? We are care for each other as well as we care for our clients.
What about the service you deliver to clients? We support our brain injured / catastrophic injured clients to reach their rehabilitation potential by working collaboratively with other rehabilitation professionals.
Is the team well supported, as well as the clients? Absolutely. I have never been so well supported in the workplace as I’ve been at AKA
How much of a positive is the four-day week for you and your life away from work? It feels like a dream to be honest! A full day just for me! AKA signing up to the four-day week has made us feel even more valued than we felt before.
"Thank you everyone for such a lovely day yesterday it was so nice and there was no pressure just a really lovely, good day, excellent fun seeing Claire and Mel going A over T on the inflatables and that the goodie bags were great – a big thanks to everyone." "Following an outstanding day and the huge success of your celebrations I just wanted to send you a quick note. What a joy to see everyone
joining in - clients, their families, AKA colleagues, their families
and all the wonderful entertainers, food vendors and support- the day had something for everyone . Lots of tired legs from the little ones who just didn’t stop running all day!! Again, thank you for inviting me to join you in your celebrations and I cannot wait to see all the images on social media and your newsletter. Here’s to the next 20 years - many congratulations again to you all."
Claire Rhodes-Andrews,
who has been with AKA
since 2009
What are the positives about working at AKA? The support network comprises directors to managers to support staff, AKA encourages me to face any fears and supports me through them, drives and motivates me to achieve my purpose and goals in life, AKA values me as a person as well as for my work. Why do you think AKA stands out? I believe AKA stands out for the support we provide to all our staff and clients to fulfil their goals and live their best life after a brain injury. AKA has fantastic visions and values which all our staff strive to maintain.
What about the service you deliver to clients? We provide the support and rehabilitation for our clients to live their life to the full. One example is a client in Portugal who has SP, we visited the dolphin park with another client who went swimming with the dolphins, due to my client's condition he was unable to swim with the dolphins so I asked the staff if he could stroke and touch the dolphins. We went backstage and I supported my client out of his wheelchair and he sat on the side of the pool, three dolphins can up to my client. He lay down at the side of the pool and stroked the dolphins, which he never thought would be possible. I have many more amazing stories but this one always stands out for what our clients can achieve with support and vision.
Is the team well supported, as well as the clients? Our teams are very well supported by management, we have regular supervisions between six and 12 weeks and we are alway only a phone call away.
How much of a positive is the four-day week for you and your life away from work? The trial is having a fantastic effect on my work/life balance and efforts to spend time with my family. All companies should try this for their workers, I'm more productive Monday to Thursday to ensure my clients still receive all support needed.
30 YEARS
of TRU Rehabilitation
For the past 30 years, TRU Rehabilitation has been supporting brain injury survivors to discover their hidden potential, achieving outcomes that often previously seemed impossible.
For more information call 01942 707000, email enquiries@trurehab.com or visit our website www.trurehab.com Having grown from a single site in 1992, TRU now has six rehabilitation units, delivering support for clients from around the country, ranging from those detained under the Mental Health Act through to those ready for community reintegration. Its units, all within a six-mile radius, offer the full support of TRU’s in-house brain injury specialist multi-disciplinary team - comprising neuropsychologists, neuropsychiatrists, physiotherapists, occupational therapists and speech and language therapists - as well as counsellors, nurses, rehab assistants and cognitive rehabilitation coaches. This is also supported by a community outreach pathway for people within a 50-mile radius of TRU’s St Helen’s headquarters, giving an opportunity to develop long-term support for service users in their own homes. Delivering specialist and effective acquired brain injury (ABI) support for three decades, TRU’s holistic approach to rehab, and combination of clinical support with vocational opportunities, have seen clients regularly surpass all expectations. And through TRU’s bespoke, person-centred approach to every client’s rehabilitation, and the ability for them to join at any stage of their journey - whether that is months or years post-injury - the difference they are making in unlocking unknown potential is vast. “We have a model, but we work on the basis of how that fits best for the person, rather than how the person fits into the model,” explains clinical psychologist Dr Leanne Daniels. “We approach patient goal-setting in a gradual, achievable way, with smart goals and a goal attainment scaling framework. “But it’s also about acknowledging that, if someone progresses through their programme and has achieved lots of goals and looks like they’re doing really well, there might be time when clinical expertise needs to come back in - this happens in life, and while there may be setbacks along the way, we will build on the potential and the gains the client has made and keep going.” And through the dedication of the team across TRU’s centres - its complex mental and physical support sites The Newton, The Willows and The Lowton; neurobehavioural pathway Lyme House, community integration pathway Chapel House and supported living environment Ashton Cross - the gains made by clients can be significant. Recently, one older client, who has been with TRU for many years, has rebuilt a relationship with his family that has been missing for 25 years. “This has been amazing for him. It’s about not accepting things are always going to be as they are,” says Dr Daniels. “It shows the support our team deliver and the impact our counsellors and family services specialists can have. It’s a ‘trickle, trickle’ effect sometimes, and you do get somewhere. “It shows you that you should never say never.” The progress seen in patients under the Mental Health Act can also be vast. “We've got plenty of examples of clients who may well have been stuck in that system lifelong,” says Dr Daniels. “There are people who have been in secure services in a locked ward for many, many years, who then work through a transitional pathway to living in a unit with some access.
“You see the family relationships developing, and they’ll build up to maybe a weekend at home every six weeks when haven't been home for 10 years. That kind of thing is huge.” And it is TRU’s holistic approach that lies at the root, says Dr Daniels, who has been with TRU for 12 years. “I think through working together as a holistic team of clinicians, rehab co-ordinators and coaches, all driving that forward, this can mean the client often becomes a driving force in that too,” she says. “We focus on coaching and developing that relationship with the client, the therapeutic relationship between coaches and clients is a really key ingredient in our progress. “We take things slowly, so that brain injury rehabilitation can truly be about absorbing those skills, strategies and processes and employing them in everyday life. “We have a really well-established pathway, which people can enter at any stage, but that’s why our assessment process is really important and very thorough. “You could have 10 clients in a room with very different needs, and that's why the coaching model is really important, alongside the individualised approach to the programme. “It’s about enabling people who aren't quite functioning as well - whether that's physically, cognitively or psychologically - or trying to bridge those gaps so that the person is facilitated to have the best session possible “If someone can only tolerate a 10-minute session, then that’s what we’ll do, and we will build on that. And that’s how we get the results. “I have one client who, prior to when I assessed him and he came to TRU, he was literally in a bed in a bedroom all day and had been for a very long time. “Now, he’s been here for a couple of years and is out in a social environment for approximately six-and-a-half hours a day. He chats to people who pass by, we’ve got him playing cards, it’s fantastic to see the progress he has made. “You’d never get him on a vocational placement, but at TRU, we realise everyone is different and everyone’s rehab is different.” The success of TRU’s vocational offering is well known, with its array of activities comprising everything from woodwork and art, to drama and education, with younger clients in particular being able to pursue college courses if they wish. “Our vocational opportunities are a really big part of the jigsaw,” says Dr Daniels. “Sometimes, clients may be 15 years down the line in the rehab process, they’ve done all the therapies, but there are still gains to be made. “You can develop a clinical programme that isn't experienced in that clinical kind of way and can really build upon those areas of functional, physical independence and the scale through the vocational work. “Through our vocational programme, this can help to give them that bit of experience, self esteem, confidence, self sense of mastery, to then start dipping their toe outside. “Through getting the ongoing positive feedback, and building up these skills, that can help them get back into the community, or perhaps go back to where they live. “We see some amazing talents, and I remember one client in a woodwork class bringing a birdhouse over to me, and it was more like a bird mansion! “The level of detail and the intricacy showed her capabilities, and this allowed her to be as creative as possible. We could make it individual and bespoke to her, which is the beauty of it.” Vocational activities are also flexible enough to give clients of all abilities the opportunities to participate, says Dr Daniels. “It can be offered to our clients at many different levels,” she says. “There are some clients who are so high functioning, you wouldn't have a clue that they had a brain injury, but they need to have a focus and the support that can't be achieved in the real world, but that environment can almost be ‘manufactured’ in this world. “But then, for all the people who make bird mansions and these amazing French polished tables and doors, you will have people who can only do the painting or a bit of sanding. “But it's not just about making something that's functional and nice, it’s integrating the therapies through vocational rehab. And this can have its own effect for everyone.” Community reintegration is the end goal for the vast majority of clients, with TRU’s pathway enabling a means for that to happen by progressing ultimately towards the return home. “Our community unit is in a lovely, quaint village and there’s a corner shop, an ice cream parlour, a park, a couple of bars, bus stops - many of the places you’d want to visit in living your life,” says Dr Daniels. “Practice in as many social environments as possible is important in this process. For some of our clients with frontal lobe difficulties and dysexecutive functioning problems, that can impinge on them fully reintegrating into society, because the niggles can eventually develop into bigger problems. “But while we’re promoting independence, we’re acknowledging that as human beings, we are interdependent. “Voluntary placements are also important and we have growing links with the local community and wider communities. We’ve done things like where a gentleman who really loved outdoors and needed lots of physical exercise was linked up with local canal service, and he would go out and work on the canals voluntarily. “We make everything as person-centred as we can wherever possible, and constantly develop what we do and what we can offer, and that will continue. “TRU is built on the core values and philosophy of rehab and doing the very best we can for each and every client, and that will always remain at the centre of what we do.”
