Recovering at home: A stroke client’s journey with Cavendish Homecare

At Cavendish Homecare, we recognise that the recovery journey following a stroke is unique and care must be tailored accordingly. Many stroke clients choose the option of receiving care at home, as it allows them to remain in a familiar environment with access to caregivers, family, and friends. This case study describes the discharge from rehabilitation unit following a stroke, highlighting how Cavendish Homecare’s client management facilitated this transition and recovery.

Our client’s journey

The client in her 80s suffered a left middle cerebral artery (MCA) infarct, which resulted in impaired communication, perception, and voluntary movements. The client experienced contralateral hemiplegia, loss of sensation on the right side, neglect of the right visual field, and global aphasia. The client was admitted to Accident & Emergency and then taken to an acute stroke unit where they were managed for 12 weeks, followed by four weeks of intensive rehabilitation. Initially, the client faced several challenges adjusting to being at home after the stroke. These included eating and drinking difficulties, immobility, sleep apnea, poor vision in one eye, double incontinence, and challenges in communication.

Our involvement and approach

From the outset of the enquiry, our specialist neurological nurse manager played a vital role. Using her knowledge and experience in the field of neurological injuries, she developed a care package that involved a dedicated team of highly skilled carers that provided round-the-clock care. The client’s self-motivation and interaction with carers, family and friends, combined with the implementation of a high standard of medical support, enhanced the stroke recovery. The comprehensive care package took a holistic approach and addressed the following areas: management of motor deficits and physical fitness, communication and sight, support with personal care, continence care, eating and drinking, social, recreation and leisure activities.

Collaboration with the multidisciplinary team

Our team collaborated closely with the client’s multidisciplinary team, to ensure a comprehensive and integrated approach was implemented. The team consisted of a range of healthcare professionals including: dietician, speech and language therapist (SLT), neuro-rehabilitation physiotherapist, neuro-rehabilitation occupational therapist, wheelchair services team, district nurses, podiatrist, nutrition team and pharmacist.

Management of motor deficits and physical fitness

Our carers played a crucial role in assisting with all movement and handling needs, including using a full-body sling for hoisting during personal care and transitioning to and from bed.

Communication and sight

The client experienced hearing difficulties, receptive aphasia, and short-term memory challenges following the stroke. Our carers engaged in full conversations with the client, being mindful of the client's vision impairment and hearing loss due to right-side neglect from the stroke. Being aware of the adaptations required, this improved the emotional and mental well-being of the client.

Support with personal care

As part of our comprehensive support, our carers supported the client with personal care, including activities such as combing their hair and brushing their teeth. Our approach prioritised empowering the client to maintain their personal routines while receiving the necessary support.

Continence care

We provided support to the client who experienced challenges with bladder and bowel control, leading to difficulties in recognising and interpreting continence signals. To address this, the nurse manager implemented a continence rehabilitation programme aimed at regaining control.

Eating and drinking

Through consultation with carers, the nurse manager and the client’s family, the team developed a dietary plan in line with guidelines which was prepared by the speech and language therapist (SALT). The client showed significant progress in eating and drinking, leading to a reduction in PEG feed and successful management of three meals a day with oral fluids. In addition, our nurse manager facilitated PEG feed theory training for the carers, followed by practical training conducted in the client’s home by the nutrition team. This ensured that the carers were equipped with the necessary knowledge and skills to confidently and safely handle PEG feeding.

Social recreation and leisure activities

The client had a daily activity plan which our carers worked on in conjunction with the family. It was important to also take advice from family to develop a schedule that supported the interests and hobbies of our client. This included:

-trips to the supermarket

-involvement in helping them to choose food for their meals

-daily exercise plan using exercises that were recommended by the rehabilitation centre

-watering plants

-going for walks in the nearby park

-sitting in the garden

Since discharge from the rehabilitation centre, the client settled back into the comfort of their home surrounded by a loving family, friends and carers. Through seamless collaboration with the multidisciplinary team and close monitoring of the client’s progress, our team successfully managed and coordinated the client’s care, alleviating stress for both the client and their family. As a result, our client continues to make a good recovery, benefitting from the expertise and support provided by our dedicated team.

To find out more about our services, contact us and speak with a nurse manager who can guide you through the process to achieve care at home for your family or friends.

Email info@cavendishhomecare.com or visit cavendishhomecare.com. Tel: +4402030085210.

Ongoing development of an esteemed neuro-rehab provider

Murdostoun Brain Injury Rehabilitation and Neurological Care Centre has built a reputation for supporting patients across Scotland with specialist neuro-rehab and care. With the appointment of Dr Ales Praznikar as medical director, the ongoing development of both the centre’s services and team is set to advance further still. NR Times learns more.

Beforejoining Murdostoun as its medical director, Dr Ales Praznikar served as the clinical lead for the neurorehabilitation unit at Queen Elizabeth University Hospital in Glasgow. With Queen Elizabeth University Hospital being one of Murdostoun’s main referrers, Dr Praznikar was already familiar with the facility and had engaged with the team there on numerous occasions before his transfer.

The level of interaction between the Murdostoun team and the neurorehab team at Queen Elizabeth University hospital, as well as the preparation from both teams, enabled numerous patients to successfully transfer from an acute to a residential setting. The incredible care delivered in the residential setting at Murdostoun was an important factor in Dr Praznikar’s decision to join their team.

“We referred quite a lot of patients to Murdostoun, and I also visited the facility, because I wanted to see where the patients were being referred to,” says Dr Praznikar. “It was a very good team. They would send me a report of every patient that we referred, and they were very nicely done.

“I was familiar with the quality of the facility well before I came here. It is a well-run centre, and I am really pleased to have joined the team here at Murdostoun as medical director.”

Dr Praznikar has a highly respected track record for his clinical work, including his previous role as the director of the International Alliance for ALS/MND and membership to the European Academy of Neurology Scientific Panels for neurorehabilitation and neuropathic pain. Aside from his experience, he is a renowned leader, committed to service and staff development alike. The addition of Dr Praznikar to Murdostoun’s neuro-rehab team shows Active Care Group’s dedication and investment to further develop and improve their services.

As such, plans are being looked at for the expansion of Active Care Groupowned Murdostoun - both in terms of capacity and new provision for certain conditions, as well as involving the team in research projects. This will support the further development of the capability and reputation of this specialist 46bed North Lanarkshire site, which supports people with neurological injuries and illnesses from across the West of Scotland and the wider country.

Committed to achieving best outcomes

For many years, Murdostoun has had a reputation as a key provider of neuro-rehab and neurological care for patients primarily from the Greater Glasgow and Clyde NHS area, but across the wider country too. Set in a rural location with expansive gardens, Murdostoun comprises a brain injury rehab unit - which supports survivors as soon as they are medically stable and are able to work with complex patients, such as prolonged disorders of consciousness, functional neurological disorder and those who have a neurological condition requiring a tracheostomy. There is also a neurological care unit - which provides both longterm, including slow-stream rehab provision. Both sites can provide respite and complex needs care. For all patients and their unique needs, the Murdostoun team is committed to delivering the best possible outcomes, whatever the circumstances.

One patient, 47-year-old Scott, was admitted to Murdostoun for long-term care after sustaining brain injury in an assault in 2010. He also has a history of drug and alcohol misuse. He had seen the breakdown of many relationships and people losing faith in him, causing Scott to feel “stuck in life”.

Although he often finds social situations very challenging, the Murdostoun team were determined to help him manage that as much as possible, as well as helping him achieve his long-held ambition of working in hospitality.

Through working with him over the course of many months and years, the right rehab and support has seen huge progress for Scott. Having secured a place on the Social Inclusion Project - an initiative dedicated to creating a diverse society where people have opportunities for inclusion - Scott also secured his dream job in the process. Since October 2022, Scott works one morning each week in a local coffee shop, with duties including serving customers and food preparation. Scott has thrived since taking on the position, making new friends at the coffee shop and relishing his newfound independence. He even joined the staff Christmas lunch last year, something his rehab team say was previously beyond all expectations for Scott.

“I finally feel like I have some purpose,” says Scott. “I have found my passion working in the food industry.”

Scott’s case helps to articulate the Murdostoun team’s commitment to help patients achieve their ambitions - and clearly shows the efficacy of the goal setting process, says Dr Praznikar.

“We work with patients to set goals, but this process depends on the individual and what goals are set based on their rate of improvement,” he says.

“The set goals must be felt as achievable by the patient, their families and friends, and the team. This case is a good example of what can be delivered and achieved.”

Service development

With an in-house rehab team, and specialism in a host of complex needs, including spasticity management; PEG feeds and skin integrity problems, Murdostoun has the capability to support patients with a wide range of neurological needs.

With Dr Praznikar’s long-standing specialty in more complex cases,

Murdostoun is looking to potentially develop and introduce support programmes for patients with particularly challenging needs, to build on the centre’s and its staff work even further.

“We have some sub-specialty programmes for especially complex patients,” says Dr Praznikar.

“Such as patients with prolonged disorders of consciousness (PDOC), patients with tracheostomy, complex stroke patients and those with spinal cord pathology.

“In some of the programmes, like PDOC, there have been a lot of advancements recently in basic science and clinical science, which means it needs to be looked at as almost a sub-specialty clinical approach.”

The Murdostoun team have developed their patient support systems in both the brain injury rehab and neurological care disciplines over many years. While they are already accustomed to dealing with the most complex cases - an area that could be developed further still - the principles of engaging each patient in rehab and support are the same, says Dr Praznikar.

“We take any patient with neurological dysfunction, and that is what neurorehabilitation is all about. At Murdostoun it is our goal to treat all patients with these conditions,” he says.

“The basic concepts are the same for everyone. We admit patients when we believe that the team’s approach can improve a patient's functioning in any of the domains, be that physical, cognitive, emotional, or social.

“It might be the particularities of treatment might be different, perhaps additional treatments like pharmacology, but the basic concept is the same - we want to support people with a neurological dysfunction or dysfunctions in order to improve their lives.”

Team development

The team at Murdostoun is well known for their capability and commitment, which attracted Dr Praznikar to the site prior to joining. Now, he is keen to use his extensive experience in leadership and development to help support the progress of team members.

“I think the team is excellent and has potential for further development and they are committed to participate in developing their skills,” he says. While training and skills development remain a key part of Active Care Group’s ethos and commitment to their staff, Dr Praznikar would particularly like to focus on and advance their involvement in research.

“We would like to start several research projects, which would really help the team to develop,” he says. “They have experience in this already, especially within the neuropsychology programme, where there has been some research going on.

“I have started to make it more structured and [an] almost a regular part of the clinical work. It will be organised as part of this, we will be clear about how to manage and achieve the outcomes.

“I believe that research and the data can contribute to the treasury of knowledge, in a way that is necessary to the inherent part of clinical work.

“It’s a team effort and an area we can involve the team for their development, and for the development of our service.”

To find out more, please visit activecaregroup.co.uk.

Fourier Intelligence has developed an innovative upper extremity rehabilitation device called the ArmMotus™ EMU. This cuttingedge technology, resulting from collaborating with Fourier's University of Melbourne Joint Laboratory, has garnered significant recognition and is poised to revolutionise therapy for various medical conditions.

Here are seven key things you need to know about the ArmMotus™ EMU.

Award-winning design

The ArmMotus™ EMU has earned numerous prestigious accolades, including the IERA 2023 Winner, Medical Design Excellence Award, Good Design Award 2022, iF Design Award 2022, and the Red Dot Award 2022. These recognitions highlight the device's exceptional design and potential to transform rehabilitation practices.

Iterative prototyping and optimisation

Before its final design, the ArmMotus™ EMU underwent rigorous internal prototyping and 17 product design iterations. This meticulous process focused on optimising manufacturability, serviceability, installation, and clinical usability, ensuring a high-quality and userfriendly device.

Versatile therapy for various conditions:

Explicitly designed for upper limb rehabilitation, the ArmMotus™ EMU offers therapy for a wide range of medical conditions. It effectively addresses impairments caused by stroke, traumatic brain injuries, spinal cord injuries, multiple sclerosis, orthopaedic disorders, and other neurological disorders affecting the upper extremities.

Innovative cable-driven mechanism

The device incorporates an innovative cable-driven mechanism featuring a dual aluminium capstan with carbon fibre rods. This unique design allows for a rotatable chassis and motorised elevating column, enabling effortless training setup for individuals with different arm lengths and accommodating both sitting and standing positions.

Enhanced device manageability and patient comfort

Recognising the importance of device manageability and patient comfort, the ArmMotus™ EMU utilises gravity compensation technology to reduce the arm's weight during therapy. This feature benefits patients prone to shoulder subluxation, commonly observed after injuries like stroke.

Immersive therapy with haptic feedback

The ArmMotus™ EMU offers haptic feedback, facilitating communication between therapists and patients. This interactive feature creates an immersive therapeutic environment and ensures patient safety. Additionally, the device supports various training setups, allowing for task-specific exercises such as motor coordination and bilateral movement training.

Group therapy capabilities

Promoting a collaborative and engaging rehabilitation experience, the ArmMotus™ EMU enables group therapy sessions. Multiple devices can be linked, allowing patients to challenge one another through gamified therapy activities. This approach enhances stimulation, motivation, and patient engagement, leading to more effective rehabilitation outcomes.

The ArmMotus™ EMU, developed under Zen KOH's leadership at Fourier Intelligence, represents a remarkable advancement in upper extremity rehabilitation. Its award-winning design, versatility across various medical conditions, and focus on patient comfort and engagement set it apart as a transformative device. With the ArmMotus™ EMU, the future of rehabilitation holds great promise in achieving improved patient outcomes and enhancing the overall quality of care.

To find out more, please visit fourierintelligence.com.