Neuro Rehab Times issue 30 by aspectpublishing

NEURO REHAB TIMES

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NR TIMES

Announcing Your Winners The NR Times Awards 2023

Celebrating 20 Years of Sleep Unlimited As one of the pillars of health, good sleep is vital for both successful rehabilitation and compliance with other therapies. Sleep Unlimited specialise in assessment of those with complex conditions using Actigraphy – and advice using Cognitive Behavioural Therapy for Insomnia (the NICE recommended guidelines for treating an insomnia disorder). Please email denise@sleepunlimited.co.uk for an information pack and free sleep screening questionnaire. We also run training for healthcare professionals – our highly acclaimed REST® Training Programme includes: a two day training course; option to sign up for a license to use the REST® resources; and group supervision sessions. Please email training@sleepunlimited.co.uk for a course flyer and booking form, or see our website www.sleepunlimited.co.uk

Sleep Unlimited Ltd PO 570, Gateshead NE8 9GF 0191 580 0008 for our website

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WELCOME

Editor's note For our interactive digital edition visit

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“I really struggle to take any compliments of any form. I don’t see what I have done as being anything different to what anyone else could have done. It’s no big deal” This quote from Sean Dolan, the hugely inspirational primary school teacher, charity fundraiser and brain injury survivor who we interview in this issue of NR Times, makes me smile. For him, and for so many other survivors, as well as those professionals who deliver such selfless and outstanding care and support, they believe they are doing nothing particularly special. To them, they’re just doing their job, or just getting on with their lives.

Send your stories and opinions to Deborah Johnson, Editor deborah@aspectpublishing.co.uk For advertising enquiries contact Gary Wilding, Head of Sales gary@aspectpublishing.co.uk Also on the NR Times team: Andrew Mernin, Founder / MD andrew@aspectpublishing.co.uk Sorina Mihaila, Designer Andrew Nealen, Contributor

But to the rest of us, what Sean and so many others across the world of brain injury and neuro-rehab are doing is amazing. Truly awe-inspiring and most certainly a “big deal”. For me, that quote sums up everything about the NR Times Awards, and why we wanted to shine a light on those whose efforts and achievements so often go under the radar. We are privileged in our roles at NR Times to interview survivors, professionals, fundraisers, volunteers and so many more people whose determination and commitment leaves us amazed. Neuro-rehab is not an easy area to work in - far from it - and those delivering the care, support, therapy and interventions which are changing lives regularly work long hours and hard shifts to change lives for the better. Outstanding dedication and the highest standards of neuro-rehab provision can truly change lives - and we wanted to recognise those who really are delivering this, those whose innovation and commitment are creating a more positive future. So in this issue, we are immensely proud to share with you the winners of the NR Times Awards 2023. From the scores of submissions came the shortlists; and from those lists of outstanding entries have come the winners, as well as others who are named as ‘highly commended’ and ‘commended’. Our judging panel readily admitted that in all 11 categories they judged - with one being a result of the public vote - they faced an unenviable task. “How am I supposed to pick a winner?!,” was a frequent remark, amidst so many genuinely excellent entries.

NR Times is produced by Aspect Publishing Ltd. Registered company in England and Wales (number 10109188 / registered office: 11 Lansdowne Terrace, Newcastle upon Tyne, NE3 1HN)

But for our winners and everyone who made the shortlists, most of whom will see their role as doing ‘nothing different’ to what anyone else would do, we are proud to highlight your contribution. Congratulations to everyone - and thank you for your efforts.

Collaborative content Sponsored features are created in partnership with our sector partners whose support ensures we can continue serving our readership.

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CONTENTS

06 N R T I M E S A W A R D S Unveiling the winners of the inaugural event 1 4 R E M OV I N G T H E PA I N The pharmacist simplifying the headaches for case managers 16 STRIKES AND THEIR I M PAC T The challenges facing patients and wider healthcare 20 MEET THE CASE MANAGER Introducing the team at VARSS 2 4 C R E AT I N G V I M H E A LT H Founder Tom Taverner reflects on the past year 26 AMIGUOUS LOSS How to deal with this form of grief 2 8 ' C R E AT E A L E V E L P L AY I N G F I E L D ' L eading adaptive athlete calls for parity 3 0 I N N O VAT I N G F O R T H E FUTURE How Richardson Care is embracing innovation 4

Contents 32 REBUILDING LIFE AFTER GBS The devastating impact of Guillain-Barre Syndrome 3 4 P O S I T I V E R I S K TA K I N G How to embrace this in neuro-rehab 38 BELIEVING IN THE DREAM How Sean Dolan returned to teaching after brain injury 42 MEETING THE PRESIDENT Making dreams come true for clients 44 INTRODUCING CHISLEHURST The latest addition to Active Care Group’s portfolio

48 TEN YEARS OF CHROMA Founder Daniel Thomas shares his journey so far 52 JOINT WORKING IN PERSONAL I N J U RY How an OT-led approach reaps rewards 56 TRANSFORMING REHAB Harnessing the power of rehab tech 58 PREDICTING THE U N P R E D I C TA B L E Learn more about the CCMS conference 60 NEUROMUSCULAR TRIAL Electrical stimulation in dysphagia 64 LEADING LEGAL LIGHTS Slater and Gordon hailed by Legal 500

CONTENTS

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78 STEPS IN SINGAPORE STEPS Rehabilitation and STEPS Prosthetics at RehabWeek

68 TRANSFORMING FUTURES The role of neuro-rehab in rebuilding lives 7 0 S LT A N D M E N TA L H E A LT H How speech and language therapy is a key rehab tool 74 R E C R U I T M E N T A N D R E T E N T I O N Supporting the care sector workforce 76 INTRODUCING THE GALILEO The latest innovation from Fourier Intelligence

8 2 F E S C YC L I N G Five benefits of elevating rehab and fitness 84 EXPERT WITNESS A leading expert explains what it entails 8 6 N AV I G AT I N G N E U R O - R E H A B Bespoke case management approaches

9 0 C M S U K AWA R D S Unveiling the winners of the 2023 case management awards 92 TRIPLE SUCCESS Unite Professionals are the big winners of the CMSUK Awards 9 4 S H O U L D E R PA I N Discussing approaches for prevention and relief

90 MAXIMISING INDEPENDENCE The role of compassionate care 5

C O V E R S T O RY

he first-ever NR Times Awards attracted scores of entries from individuals, teams and organisations around the world, from those united by one common goal changing lives and futures for those affected by neurological injury or illness. With judges hailing the response to the inaugural awards as “phenomenal”, each of the 12 categories received significant numbers of nominations - 11 of which were decided by a judging panel, and one solely on public votes. The extensive shortlists were reflective of the very high quality of the submissions, which were the basis for the judging process. Judges were asked to set aside any knowledge beyond what was in the nomination, and decide on the basis of what each entrant had presented. The NR Times Awards - sponsored by Elysium Healthcare - were created to recognise and celebrate outstanding practice across the field of neurorehab, and to shine a light on the dedication and commitment from so many professionals in delivering truly life-changing outcomes for patients. Eleven categories were judged by our independent expert panel, with the sponsor of each award also joining the panel for their specific category. The panel - within which anyone with a conflict of interest in a category

was exempt - were: John Davis, nationally-renowned neurotrauma specialist lawyer marking 40 years in the profession, and consultant principal lawyer at Slater and Gordon Vicki Gilman, chair of BABICM and founder of Social Return Case Management Luke Griggs, chief executive of Headway Chloe Hayward, executive director of UKABIF The Rehab Leader of the Year Award was chosen by votes, which came in droves from across the world across the five-week voting period for the 13-strong shortlist. The winners - as well as a number of highly commended and commended finalists - were revealed in an online awards ceremony, attended by all of the shortlisted entrants alongside the judges. Deborah Johnson, editor of NR Times, said: “Being able to share the stories of so many people and organisations in the world of neuro-rehab through writing for NR Times is a great privilege, and often my colleagues and I are left in awe by those we speak to. “The inspirational and amazing stories of dedication, selflessness, courage and achievement are too many to begin to recount - but that was the basis of the concept of the NR Times Awards; to shine a light on some of

the amazing work and outstanding practice that makes such a difference to the lives and futures of so many survivors and whole families. “Our first-ever NR Times Awards has been absolutely fantastic, and that is due to the incredible response and levels of support we have had in creating such a success. “Thank you to everyone who entered for their submissions; to our judges for spending so much time analysing the many entries and giving such thoughtful insight; and to our sponsors, without whom the NR Times Awards wouldn’t have been possible. “It was an absolute pleasure to announce our winners in the ceremony, and to acknowledge outstanding practice with ‘highly commended’ or ‘commended’ commendations, and we are very pleased to announce them more widely here. “Congratulations to everyone who won and was shortlisted - your work is truly helping to change lives and give hope, and that is something beyond any measure.” Elysium Healthcare said they are “delighted to sponsor the inaugural NR Times Awards in 2023. “The publication has been a fabulous platform for a wide range of neurological content, leading edge analysis and bringing human stories to life to give others hope for the future.”

C O V E R S T O RY

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BRAIN / SPINAL INJURY LAW FIRM OF THE YEAR sponsored by Chroma Winner - Stewarts Highly commended - Irwin Mitchell Commended - RWK Goodman Shortlisted Lavelle Partners Nash & Co Slater & Gordon

With six finalists all shortlisted in recognition of the quality of their legal work in often highly complex cases, as well as the levels of client support they demonstrate, judges praised the levels of commitment and excellent outcomes evidenced from each. However, the stand-out name in this category was Stewarts, in recognition of the impressive outcomes secured for clients, the creation of its Onward patient support service, and

efforts to support the wellbeing of its team. Daniel Thomas, managing director of category sponsor Chroma, said: “The quality of entries was very high, with some great examples of dedication to clients, but three really stood out. “I’m delighted that Stewarts Law has become the inaugural winner of the Law Firm of the Year. “By presenting them with this award, we

wanted to celebrate and recognise the importance of their approach to staff wellbeing and resilience; limiting solicitors to only ten to 12 cases at a time. We also wanted to highlight how they had an impressive average award per client despite or because of their wellbeing approach. “Finally, in their submission, Stewarts Law showed an impressive commitment to pro bono work, including their Onward service.”

INNOVATION IN NEURO-REHAB - sponsored by Iris Care Group Winner - Children's Trust Highly commended - Richardson Care Shortlisted BES Healthcare BIS Services BPM Rehab Genrobotics Lusio Rehab Neural Pathways Social Return Case Management

Nine organisations were shortlisted in recognition of their willingness to embrace innovation and embed forward-thinking and often sector-leading practices into their service, for the benefit of patients and families. Innovation was demonstrated in a variety of ways, comprising events, use of technology, new approaches to client work - making this a particularly varied category to judge.

However, the work of The Children’s Trust was deemed to be particularly innovative in the creation of its new Community Rehabilitation Service, which will support children and families after head injury. Janine Strange, group commercial director for category sponsor Iris Care Group, was among the judging panel. “It’s absolutely vital we all embrace innovation,

and there were some really great examples of how that is put into practice in these submissions,” she said. “The Children’s Trust clearly demonstrated that in their approach, and how they are bringing together digital information, virtual consultation and community rehabilitation to create a service that could easily become scaleable in the vital area of child head injury.”

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INSPIRATIONAL CONTRIBUTION - sponsored by TRU Rehab Winner - Darran, St Andrew’s Healthcare Highly commended - TBI OneLove Commended - Ian Pearce, NeuroProactive Shortlisted Professor Nick Alderman, Elysium Healthcare Dr Vincent Harding, St Andrew’s Healthcare Jennifer Rudd, JRCMS Social Return

This category was described as being particularly hard to judge, with an array of outstanding professional achievements alongside deeply personal motivations. Winner Darran has overcome huge challenges in his life, including the loss of

his son and a suicide attempt, and since his diagnosis of Huntington’s Disease, he works tirelessly to raise awareness of the condition and its impact. Suzie Kenyon-Tilley from category sponsor TRU Rehab was among the judges.

“This was such a difficult category to judge with so much dedication and truly outstanding impact seen in the entries - but Darran’s story and the contribution he makes to the lives of others is truly inspirational,” she said.

CHARITY OF THE YEAR - sponsored by Reach Winner - Child Brain Injury Trust Highly commended - Spinal Injuries Association Commended - Headway Derby and Headway Worcester Shortlisted Headway Salford Huntington’s Disease Association LEGS Natalie Kate Moss Trust Pink Concussions St Andrew’s Healthcare

Ten charities made the shortlist of this award, with judges highlighting the highly impressive contribution being made by each entrant, whatever scale they work on - be that locally, nationally or internationally. But it was the work of the Child Brain Injury Trust that really stood out, with the breadth of support, continual innovation and strong and developing relationships with stakeholders highlighted as being particularly important here.

The Spinal Injuries Association was also hailed for its clear goals and strategy behind achieving them, and two Headway groups were praised for the impact they make on the ground in their respective communities. Heather Batey, founder and managing director of Reach, was among the judging panel for this category. “Judging a category like this is a privilege, but also a very difficult task as every entrant is making such a positive difference to the lives

of individuals and their families - it was not an easy one to judge,” says Heather. “However, the four charities we have chosen for recognition are really excelling in provision both locally and on a wider scale. The Child Brain Injury Trust probably ticks every box you’d hope for in a charity - collaboration, education, training, innovation, engaging all stakeholders in fundraising, and always thinking outside the box to develop things further - and is a very worthy winner of NR Times Charity of the Year.”

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REMOTE REHAB INITIATIVE - sponsored by Think Therapy 1st Winner - Enable Therapy Services Highly commended - REHABILITY Commended - Children's Trust Shortlisted LEGS Lusio Rehab Reach

Six initiatives which embraced the power and potential of remote rehabilitation in a variety of different ways were shortlisted. Building on the opportunities created during the pandemic period in new levels of acceptance of home-based rehab, judges praised the entrants for the creative and engaging ways in which they delivered care and support remotely.

The standout name was deemed to be Enable Therapy Services and the application of its post-concussion assessment. Steph Fleet, head of service development and customer relationships at Think Therapy 1st, was one of the judges. “There has been a really positive move towards devising innovative methods to meet clients needs across neuro-rehab, and

this award is very important in showcasing some of the great work in achieving this,” she said. “The assessment programme delivered by Enable Therapy Services is very robust and comprehensive, and will undoubtedly enable so many more people to access rehab, and is a great example of what can be achieved remotely.”

PEOPLE’S CHOICE - REHAB LEADER OF THE YEAR - sponsored by Breakthrough Case Management WINNER - Zen Koh, Fourier Intelligence

This category was decided entirely by public vote, with judges selecting a 13-strong shortlist. Hundreds of votes were received and all 13 on the list received significant numbers of votes - but our winner was chosen by a clear margin. Zen Koh, as co-founder of Fourier Intelligence,

has become a globally-renowned name in rehab tech, devising some of the most innovative robotic devices available which are transforming the lives and rehab potential of patients around the world. Committed to improving patient outcomes, and in uniting the global rehab tech sector in doing so, Zen plays a central role in the

development of the industry internationally. As President of the International Industry Society in Advanced Rehabilitation Technology (IISART) and named among the Top 40 Under 40 Future Most Influential Leaders in MedTech, Zen’s global impact continues to be seen and felt by those working in rehab tech and throughout the world of neuro-rehab.

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CASE MANAGEMENT FIRM OF THE YEAR sponsored by Morrello Clinics Winner - West Country Case Management Highly commended - Corporé Commended - HCML Shortlisted Breakthrough Case Management Circle Case Management Emma Way Associates Enable Therapy Services Maia Rehabilitation

The eight-strong shortlist was drawn up in recognition of clear examples of commitment to clients and in enabling them to explore all possibilities in making the best possible recovery. The ability to work collaboratively in achieving this, for the benefit of the client and development of case management more widely, was also demonstrated. The stand-out name was Westcountry Case Management, in recognition of its clearly-

evidenced person-centred approach, which even enabled ten clients to go on holiday to destinations of their choice, showing the levels of dedication from the team in achieving this. Jakko Brouwers, director of Morrello Clinics, was the judge from the category sponsor. “It was stressful but a great experience to be asked to judge this category,” he said. “The quality of the entries was high and the nominations included very diverse aspects of

case management as well as good governance and staff welfare. It was a tight field with a few of the entries standing out above the rest. “The winner of this year’s award clearly demonstrated how they go the extra mile in support of their clients and their families. Their drive to involve clients in co-production of care and rehabilitation plans as well as finding ways to arrange family holidays really helped to transform the lives of many of their clients.”

RESEARCH PROJECT - sponsored by Askham Rehab Winner - Dr Adrian Parry-Jones, University of Manchester Commended - Dr Alyson Norman, Plymouth University Shortlisted St Andrew’s Healthcare Tisch MS Centre, New York

Four outstanding pieces of research were shortlisted for this award, all of which address key areas of neuro-rehab and patient need. Judges praised the personal commitment of the researchers in advancing knowledge and raising awareness in their specialist areas, which will in itself help to change the future. But it was the work of Dr Adrian Parry-Jones in the treatment of brain haemorrhage that

was deemed to be truly outstanding, with the launch of the ABC Care Bundle at Salford Royal Hospital reducing mortality at the one-month mark by ten per cent. Aliyyah-Begum Nasser, director of Askham Village Community - of which Askham Rehab is part - was part of the judging panel. “With so much innovation in the space, patients stand to benefit enormously from

pioneering ideas, equipment and approaches,” she said. “But it’s important that any innovation is supported by appropriate research to ensure it is not only safe but also effective for any user. “The work of Dr Parry-Jones shows good evidence-based practice, piloting in one area before scaling up once outcomes had been achieved.”

SPONSORED CARE PROVIDER OF THE YEAR - sponsored by Embrace HR Winner - BIS Services Commended - South West Yorkshire Partnership NHS Foundation Trust Shortlisted Cygnet Elysium Healthcare Kibblesworth Centre - part of Active Care Group Richardson Care

Six services were shortlisted for this award, in recognition of the quality and diversity of support delivered, to patients as well as families and staff. Judged praised the quality seen across the board, but one name emerged as being truly stand-out in terms of its service delivery and ongoing training and development of staff. BIS Services showed clear evidence of a highly-

skilled workforce, with ongoing opportunities for training and development, with a focus on the quality of support for clients. Its BIS Lodge, a ‘home from home’ for service users, was also highlighted as a key component in its offering. Cecily Lalloo, managing director of category sponsor Embrace HR and part of the judging panel for this award, said: “We are all well aware of the challenges in recruiting and

particularly retaining people in this field, so as well as the quality of the service, the focus on staff was also prioritised. “The focus from BIS Services on training and the wellbeing of their team was clearly demonstrated and outstanding in this category, and alongside clear evidence of client support, their holiday home is an excellent feature in their offering.”

THERAPY PROVIDER OF THE YEAR sponsored by Irwin Mitchell Winner - Clarity Psychology Highly commended - BIS Services Commended - CHD Rehab Shortlisted Ariya Neurocare Psychworks Associates Chroma Cognivate Enable Therapy Services East Coast Community Iris Care Group

The extensive shortlist in this category was reflective of the quality of submissions and the excellent practice being seen across all branches of therapy. While judges said there were a number of very high quality entries, three were singled out, with the top two being particularly strong. Clarity Psychology was judged to be the winner through its clearly-demonstrated commitment to person-centred support, with a focus on their own identity being at the heart of everything the team does.

Lynne Carrick-Leary, senior business development manager at Irwin Mitchell, was the category sponsor’s representative on the judging panel. “It was wonderful to see the high calibre of submissions and the many different support therapies available for the brain and spinal community. The wealth of knowledge and the innovative services showcased are truly inspiring,” she said. “The judging process was undoubtedly challenging, given the exceptional quality of

LIFETIME CONTRIBUTION - Prof Nick Alderman

measures for use in neurobehavioural rehab services, which have transformed the way in which outcomes are measured and compared, including the esteemed and widely used SASNOS measure. Prof Alderman holds professor roles at two UK universities, is clinical director of neurobehavioural rehabilitations services at Elysium Healthcare, and has also been awarded

Professor Alderman has worked in neurobehavioural rehabilitation for 40 years and is hailed by professional peers for his “unparalleled vision and unending determination” to advance best practice in this area of work. He has led the development of specific outcome 12

the submissions. However, Clarity Psychology stood out with their emphasis on the identity of their clients and how it informs their therapy. This client-centric approach evidently makes a significant difference in the therapy they provide. The client case studies presented by Clarity Psychology were particularly inspiring. “Being part of the judging panel for this category was a pleasure, as it highlighted the impact that targeted and innovative therapies can have on positive rehabilitation outcomes for clients.”

a Fellowship of the British Psychological Society in recognition of his contribution to this very specialist field. His impact across treatment innovation, service development, leadership, research, publications and teaching across the past four decades is described by colleagues as being “immense” making Prof Alderman the first recipient of the NR Times Lifetime Achievement Award.

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What’s the point of case managers?

his was genuinely the exact question I was asking myself 12 months ago when I left a career in Pharmacy, to join Ocean Healthcare; a provider of complex care services based in Newton Abbot, Devon, for people in their own homes across the South West. As a pharmacist, I was well versed (I thought) in how patients transferred from secondary to primary care and into community services. However I was also very naïve assuming that primary and secondary care was joined up enough to support service users who sadly found themselves with life changing medical or physical injuries or conditions who now needed not just constant expert medical care around the clock, but a whole raft of other supporting services. I guess I wrongly thought the support would just ‘be there’ from the NHS or other local authorities.

Re-educating myself I knew that at Ocean Healthcare, for the last 10 years, we provided a service across Devon and the South West which focused on quality and consistent care to the many service users who were already with us. But I quickly learned this was focused on local authorities who commissioned us. I knew we were able to step in and provide care to the most challenging of packages, especially when other providers stepped away or handed them back – I know this as the commissioners told us! They also told me, they were surprised more case managers didn’t use our services. What’s a “case manager?” I asked. I quickly learned that case managers were the people who actually were there at a patients point of greatest need, helping stitch back together all the elements of their life so that they could focus on recovery and then,

living the rest of their lives. “I need to learn more about this” I told myself. So having joined CMSUK I thew myself into online courses to learn about what a case manager does, and also attend the BABICM conference back in June….I was amazed! I felt like the mist had cleared and I understood how vital case managers were to not just healthcare, but society. However, I also learned, or at least had a tiny glimpse, into just how many conflicting priorities and pain points they had, particularly when it came to the medical needs of their clients. The pharmacist who invented pain relief for case managers I set about doing what I have been doing through my whole career – help to relieve other people’s pain! I wanted Ocean Healthcare to be the service case managers never knew they needed. So, we redesigned our our entire recruitment process,

invested in a whole stack of carer welfare benefits (including the best pay rates in Devon) and built a whole new training centre focused on providing a whole heap of accredited, nurse delivered, clinical skills to carers. Not just a class room, our state of the art training centre in Newton Abbot (just south of Exeter) is equipped with hoists, medical beds, ventilators, suction pumps, training dolls and a whole host of other advanced equipment and teaching aids. This was all designed to make sure we could recruit and train the highest calibre healthcare assistants in the South West. We also invested in various new software packages to managing clinical care plans, scheduling and communications which has transformed how we do business and crucially, communicate effectively with all stakeholders. We also now have an entire strategy devoted to happiness. We were shortlisted at the recent HSJ Awards for ‘Workplace Initiative of the Year’ for our Live Happy, Care Well philosophy. We actually employ a

full time Happiness Manager, part of who’s role is make care a happy and rewarding career. “Well Paul, that’s all lovely” I hear you ask, “but so what?” Well, for case managers, this means you don’t just need to not worry about how your clients will get reliable, consistent high quality healthcare, you wont even need to think about it! We will handle the whole lot, by a service run by advanced nurse practitioners, alongside a team of Care Team Managers with one dedicated to each service user – our own mini internal team of case managers!

"I wanted Ocean Healthcare to be the service case managers never knew they needed"

Do you want a consistent team of fully trained HCAs in place for your package? In less than 4 weeks? With a fully managed care plan, risk assessments and regular audits all signed off by a team of specialist nurses? Tailored reports and comms that tell you exactly what you need to know? All with a single point of contact? And a service with out of hours support? Well, you can have it. Any pain you have related to complex medical care needs of your users can be resolved by a simple call or email to us at Ocean Healthcare. An entire complex care service built to take care of your clients medical needs so you can focus on everything else. Or if you are in the Devon area, drop into our office. We always have the best coffee and cupcakes on hand so we are always ready to sit down and talk. Our office is located at 45 Devon Square, Newton Abott, TQ12 2HH

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Junior doctors' strikes, ambulance waiting times and the rise in medical negligence claims

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he medical field is constantly under pressure to maintain impeccable standards. With an increase in patient loads and varied complexities, the healthcare sector faces immense challenges. One of the recent pressures faced by healthcare providers is the strikes by junior doctors. Junior doctors, like many of us, are struggling to afford basics like food and heating. Not only that but they are struggling with deteriorating working conditions, and it is hoped that the industrial action will lead to a pay deal which will impact positively on motivation, rates of attrition, productivity and patient care. These strikes have however, raised serious concerns over patient safety and have subsequently led to a rise in medical negligence claims. Junior doctors and their strikes Junior doctors are the backbone of the medical industry, often being the first port of call for patients. However, there have been instances where these doctors have felt the need to voice their concerns through strikes. These strikes, primarily driven by issues such as working conditions, pay, and contract terms, have a direct and indirect impact on patient care. Impact on patient care When junior doctors strike, the immediate effect is a reduction in manpower. This means fewer doctors are available to attend to patients, leading to longer wait times and potential lapses in care. The flip side to striking junior doctors is a daunting reality where patient care is impacted, treatments are delayed, and the workload on existing medical staff amplifies. There is inevitably a link between strikes and a surge in medical negligence claims. Ambulances waiting outside Emergency Departments Another grave concern that has a direct correlation to medical negligence claims is the backlog of

ambulances waiting outside emergency departments. This issue is not isolated but intertwined with the above-discussed challenges. When emergency departments are overwhelmed, it's often a ripple effect from other factors like junior doctor strikes. The 10th October saw what may well be the first of many critical incidents declared by Derriford Hospital in Plymouth this winter period. There were 22 ambulances waiting outside the Emergency Department, and the Department itself had been overwhelmed with the attendance of almost 400 patients in one day. Whilst patients were being urged to seek medical assistance from local GP surgeries and pharmacies, it is becoming increasingly clear that the strain on the ambulance service is being worsened by difficulties in patients accessing their GP’s due to a lack of appointments, limited access to the eConsult service and a nationwide shortage of GP’s. With nowhere else to turn desperate patients are turning to the ambulance service. The Prevention of Future Deaths (PFD) Report A critical document highlighting

these concerns is the Prevention of Future Deaths Report by Andrew Cox, the Coroner. This report sheds light on the tragic deaths of patients who had to wait unduly long for an ambulance. Case studies The Prevention of Future Deaths report prepared by Andrew Cox wasn’t the first of this nature, and possibly won’t be the last. His report alone highlighted 4 cases where ambulance delays and hospital overcrowding had been an overwhelming factor in the cause of preventable deaths in his County. Mr Reedman sadly passed away as a result of stroke at the age of 54 years. He was an otherwise fit and healthy man. Following a stroke, standard first line treatment is thrombolysis which can only be administered within 4.5 hours of stroke onset. In Mr Reedman’s case thrombolysis was administered 4.5 hours after the onset of symptoms, which is at the extreme edge of the window for that form of treatment. The PFD Report noted that, “This delay in treatment was a direct consequence of ambulance delay”, which was caused by the fact that there was no

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available ambulance to respond because they had been detained in the Emergency Department car park due to an inability to offload patients. Another PFD Report was filed with the Department of Health and Social Care earlier this year, by Coroner Jacqueline Lake following the death of Lyn Brind who died of Congestive Cardiac Failure after being conveyed to hospital in an ambulance with an elevated NEWS2 score (the National Early Warning Score 2 is a system

"With reduced manpower, existing doctors and medical staff might be stretched thin, leading to mistakes, delayed treatment and miscommunication"

used by healthcare professionals to assess illness severity and risk of deterioration). She finally made it into the Emergency Department more than 4 hours after her arrival to the hospital, despite suffering from a deterioration in her condition. She sadly passed away 22 minutes after her admission. The rise in medical negligence claims A direct consequence of these difficulties within the NHS is an increase in medical negligence claims. With reduced manpower, existing doctors and medical staff might be stretched thin, leading to mistakes, delayed treatment and miscommunication. Strikes and industrial actions inevitably lead to a reduction in the workforce, stretching the remaining medical staff thin and potentially leading to oversights, delayed diagnoses, and treatment errors. The surge in medical negligence claims during and post-strike periods can be attributed to these factors, as

patients may experience suboptimal care, mismanagement, or encounter avoidable medical mishaps. Of course, addressing the root causes of industrial action, safeguarding the rights and wellbeing of junior doctors, and ensuring the unwavering provision of quality patient care are pivotal in navigating this complex landscape. The other issue which arises as a direct consequence of a reduction in manpower is a delay in treatment as a result of the inevitable cancellations which occur. The Covid-19 pandemic stretched the NHS to breaking point and most NHS Trusts are continuing their attempts to overcome their huge waiting lists. This, coupled with the Junior Doctor strikes has led to an ever increasing strain on the service. Furthermore, when ambulances are made to wait there are a multitude of consequences including delayed response times to critically ill patients, patient deterioration and an overcrowded Emergency Department which places its own strain on medical staff.

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During the winter period from 20222023, there were at times up to 13 NHS Trusts across the country declaring critical incidents, and the delays in care were said to be causing the deaths of as many as 500 patients every week. Whilst the needless death of any patient is unconscionable, we mustn’t forget that delays in treatment will also leave many with life changing injury. In conclusion While strikes by junior doctors and the backlog of ambulances are pressing issues, it's essential to see them in the broader spectrum of medical care. These challenges highlight the underlying structural and systemic issues in healthcare that need to be addressed. Quite how the NHS will seek to rectify these issues remains to be seen. Downing Street confirmed last winter that they

"While strikes by junior doctors and the backlog of ambulances are pressing issues, it's essential to see them in the broader spectrum of medical care"

were doing “everything possible” to increase the number of beds available. Whether that is borne out over the winter of 2023/24 is yet to be proven. Ensuring that medical staff are heard, their concerns addressed, and systemic inefficiencies ironed out will not only reduce medical negligence claims but also ensure a higher standard of patient care. What now? If you are concerned with the treatment that you or a loved one has had in hospital, please contact Rebecca Brisley, Associate Solicitor, from the Medical Negligence team at Nash & Co Solicitors in Plymouth. You can reach her on 01752 827027 or at rbrisley@nash.co.uk

Meet the case manager: Vocational Assessment and Rehabilitation Services Scotland (VARSS) Lynne Atkinson and Susanne Crichton from VARSS tell NR Times more about their offering and how they support individuals through vocational case management to rebuild lives and regain independence

How would you describe your services? VARSS provides vocational assessment and case management to support people with injury / ill health to remain in or return to some form of meaningful occupation. We advocate for early intervention, where possible, to maximise work readiness and can also support transitions into new

paid / unpaid roles including work and study options, where required. What is your background and route into vocational case management? Susanne – I qualified as an occupational therapist in 1990 and spent most of my career in NHS working in rehabilitation services. I moved into

vocational assessment and rehab in 2016 and have never looked back. Lynne – I graduated with a psychology degree in 1998 and began working within supported employment in the voluntary sector. Over the years, I have specialised in working with people with an acquired brain injury. I have delivered vocational rehabilitation and case management within the private, public and voluntary sectors and since 2021, I have provided expert witness reports within the medico-legal field. How vital a role does vocational case management play in the rehabilitation process? It’s well documented that being in good work is good for your health so it’s no surprise that supporting a client to return to some form of meaningful occupation is likely to have a knock on positive impact on the rest of their rehabilitation and recovery. The key to ‘good’ work is a supportive and safe working environment and therefore having a case manager who is confident and knowledgeable, not only with the clinical impacts of a case but also about the work environment and legislation who is skilled in articulating and advocating these is beneficial to everyone. What should someone look for in appointing a vocational case manager? Susanne – When I moved into vocational rehab and case management I found having a wide breadth and depth of clinical knowledge was helpful to build on because every case is so different to the next and a client rarely comes with just one specific issue. As the world of health and work is full of variety and complexity enhancing skills in the field, beyond your professional qualification, is always beneficial. For example, I have completed additional training in functional capacity evaluations, work place assessments,

"Working in collaboration with the key stakeholders involved in the case is vital to the success of the vocational rehabilitation plan" transferable skills and vocational profiling and workplace mediation. Having an additional accreditation such as Certified Disability Management Professional (CDMP) is also important, We can demonstrate our continuing professional development in the field of vocational case management by maintaining accreditation through annual revalidation process. Having excellent communication skills is also vital, being able to build a therapeutic relationship with the client at a time when they are feeling particularly vulnerable is so important. Being listened to and understood is the foundation of a successful working relationship. How would you describe your way of working and how you work collaboratively with other services? Working in collaboration with the key stakeholders involved in the case is vital to the success of the vocational rehabilitation plan; keeping everyone updated and ensuring they are clear about their roles and responsibilities and maintaining good communication is fundamental. Each client is provided with personalised work focused interventions which aims to focus on what a client can do rather than what they can’t. It often involves getting to really know the person and what are the important roles and values they have now and for the future. A vocational rehabilitation plan often involves engaging with other services and individuals e.g. employers, colleagues, healthcare providers, statutory

services like Access to Work3 etc to facilitate a sustainable work environment. . Collaboration can mean working together with others or on occasions it can involve the vocational case manager taking an advocacy role for the client especially if assertion of worker / equality rights is required. Can you share an example of a particularly successful outcome for a client? Return to work Ms D, 52 yrs old, is a full time administrator in IT company. Ms D suffered a sub arachnoid hemorrhage (SAH). Her rehabilitation progressed well and she was able to walk with a stick indoors and elbow crutches outdoors, she had some residual communication issues (word finding difficulties, slurred speech) reduced concentration and working memory and reduced power and grip in left hand. All symptoms exacerbated with fatigue which she was regularly experiencing. She was absent from work for eight months. Key challenges for return to work included: two bus commute to workplace, role involved lifting and carrying broken IT equipment between rooms, work IT systems had changed since absence, manager and colleagues did not understand the impacts of SAH. Vocational plan: assess function against the demands of role, identify need for adaptations to role, increase awareness of SAH in workplace, support client with symptom management, particularly around fatigue management, explore welfare benefits to support reduction in hours. Outcome: Client returned to work on a part time basis – income supported by benefits. Vocational case manager offered education sessions to employer and colleagues to increase awareness of SAH, the specific impacts on Ms D and suggested work adjustments. Ms D was allowed to work >>

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"One of the biggest challenges is supporting someone with a ‘hidden’ condition" predominantly from home – to reduce commute and manage fatigue, she was allowed additional time for integration back into work and use of new systems – to accommodate reduced concentration and memory, fatigue pacing. When in work she has been provided with a trolley to move broken IT equipment – support for mobility and reduce need to lift and carry with reduced grip. Can you share an example of how you have overcome a challenge with vocational rehabilitation? In our experience one of the biggest challenges is supporting someone with a ‘hidden’ condition or symptom like reduced cognitive function or fatigue. It can be so debilitating and require lots of workplace adjustments despite the person often “looking fine”. In these situations the focus is often about education for both the client, who has to appropriately manage their condition in a work environment, and the employer / colleagues who need to understand why the client requires adjustments and the potential negative impact of not providing these in the workplace. We offer training to colleagues and co-workers about hidden disabilities such as brain injury, this can be really beneficial in ensuring support strategies are understood and can minimise fears around doing or saying the “wrong thing”. It also helps everyone feel included in

the plan and can often improves communication within a team. Would you recommend a move into vocational case management? Is it suitable for anyone with a case management background? What specialist skills do you need? If you have a breadth and depth of clinical experience and want to work in a person centered solution focused environment, if you love variety and are willing to learn new things everyday then you are likely to enjoy vocational case management. We would recommend having some additional training in the specialty with CDMP as a minimum as the work environment brings with it lots of complexities which can be daunting to navigate without some background knowledge. Why would you recommend your service in particular? Having worked in vocational assessment and rehabilitation for many years it was becoming evident that vocational case management was not as readily available as it should be for those who needed it. Within the medico-legal field, we were making recommendations for vocational rehabilitation programmes and it became apparent that many professionals were not aware of what this service was or how it could positively impact the lives of their clients. Creating VARSS was an opportunity

to change that, to raise awareness of vocational case management and provide an accessible service across Scotland and beyond. VARSS is built on the skills, expertise and passion of its vocational case managers, we are not only good at what we do – we love doing it! Can you share a fun fact about yourself? Susanne – I volunteer as a trishaw pilot for Musselburgh Chapter of Cycling Without Age Scotland – providing rides around my local community to anyone with mobility difficulties. It clears the cobwebs, keeps me fit and I get some amazing chats along the way! Lynne – As a busy working mum of three (and a rescue pup!) I have an amazing ability to spin plates! Growing up in the Orkney Islands, I was an active member of the Young Farmers and won many national competitions for speechmaking and debating…I still love to talk and share knowledge and experience – perfect for being a vocational case manager!

To find out more, please visit https://www.varss.co.uk.

Salisbury

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NHS Foundation Trust

The UK’s leading provider of FES treatment, devices and clinician training Our aim is to provide and develop FES (Functional Electrical Stimulation) as a rehabilitation treatment for people with neurological conditions (MS, stroke, CP, SCI, HSP, PD, TBI) Functional Electrical Stimulation (FES) restores and improves movement to assist with walking, grasping, shoulder or bowel function leading to improvements in daily living activities, quality of life and reduced pain. A range of Odstock Medical Limited (OML) and partner clinics throughout the UK. NHS and private referrals accepted FES treatment is supported by extensive clinical research and guidelines: NICE IPG278 guidelines ACPIN Clinical Practice guidelines Royal College of Physicians for Stroke guidelines

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A year of Vim Health Interview with founder Tom Taverner V

im Health Neuro Rehab Centre officially opened in November of last year. Utilising cutting-edge technology and evidence-based practices, their multi-disciplinary team delivers their clients the best possible care. As the firstanniversary approaches for Vim Health opening, we speak to Founder Tom Taverner to hear his take on setting up a Neuro Rehab centre in today's industry. What was your background before setting up Vim Health? I studied physiotherapy at the University of Sheffield Hallam and completed my degree 12 years ago. I have always loved sports, so it felt like a natural path to take. At school, I played football and rugby. I don't have as much free time now, but I exercise regularly and appreciate the mental health benefits as much as the physical. Soon after finishing my degree, I began work at the Royal Free Hospital in London, where I specialised in Neurological

Physiotherapy. From there, I went on to work with Exoskeleton company Rex Bionics, as their Clinical Director. What inspired you to create VIM Health? To be honest, an accumulation of things: Disability Rights Activist Sophie Morgan is a long-standing childhood friend, so I had a snippet of insight into her world and the importance of accessibility from an early age. I'd also say my experience as a Neuro Physio and the knowledge gained whilst working with robotics in rehabilitation. Combining the above gave me an in-depth understanding of the challenges faced within the

"One of the things I love most about working at Vim Health is the changes we see in our clients"

healthcare industry, specifically, the underserved population of people dealing with neurological injuries and the serious health inequalities we continue to see in society. What is your role at Vim Health? So Vim Health was my brainchild, and with the help of some significant people, Jon Graham (PhysioFunction) and Crispin Simon (Prothea Technologies), we turned an idea into something tangible. Understanding the vital role exercise plays in our mental health, I wanted to create a welcoming space where people could feel confident to exercise independently and alongside their neurorehabilitation programs. Whilst we're still in our infancy, I spend a lot of time handson in the centre, and I have at least one session with nearly everyone who comes through the door. It's great to get to know our community and ensure we deliver the best possible service. We've created an

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accessible space that looks great and feels incredible —special thanks to MotionSpot for designing our accessible bathroom and changing room. Our focus will always be collaboration over competition because I think the more accessible spaces available to the disabled community, the better. What has been your most valuable life experience to date? Without a doubt, I'd have to say it was losing my mum at the age of 25. It made me realise how short life can be and how important it is to push through the challenges and not let fear hold you back. Losing her gave me a new thirst and drive for life. One of the things I love most about working at Vim Health is the changes we see in our clients. Whether emotional or physical, the model of care we have created, mixed with the expertise on site and technology, means we see a massive change in people. This is what it's all about.

Through setting up VIM Health, what has been the biggest challenge? When you create something innovative that disrupts industries, it is often met with resistance from some existing systems. So, things like getting services commissioned and expanding our reach are challenging. Fortunately, the model has been validated by the clients and our corporate partners, so the uptake has been significant. On a personal level, balancing work and family life has its challenges and finding time for myself.

grateful to have partnered with charitable trust The CiaO Foundation as part of our bursary scheme, enabling approved applicants to receive part of funding towards their rehabilitation programs, making them financially accessible.“I can now mention that we have cemented partnerships with two new charity foundations. Fletchers Foundation and Frenkel Topping Charitable Foundation will also be supporting successful bursary applicants through their rehabilitation process, so watch this space."

What advice would you give to anyone who is considering visiting our centre? Please do it. Book a free tour and come and check out the centre. The videos don't do it justice; it's such a welcoming environment. It's a feeling we've created. We have a lovely community of people regularly attending the gym and our weekly exercise classes, we would welcome you with open arms. We're incredibly

Vim Health is a neurorehabilitation centre with an accessible gym based in Hassocks, Mid Sussex. Their team of healthcare professionals deliver bespoke intensive rehab programs using state-ofthe-art upper and lower limb robotics in a non-clinical setting. They support people with a Spinal Cord Injury, Stroke, Multiple Sclerosis, Cerebral Palsy, Parkinson's Disease and other neurological conditions. For more information on the facilities, they have and the services they offer, head to www.vimhealthcare.co.uk.

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Dealing with ambiguous loss in rehab setting

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By Luke Cook, head of rehab and nursing at Askham Rehab In the world of specialist rehabilitation, we often find ourselves navigating the complex emotions associated with what is known as ‘ambiguous loss’. It's a term that doesn't roll off the tongue easily, yet its significance cannot be overstated. It refers to a type of loss where you've experienced a significant change in life, but you're left without a clear roadmap on how to cope with it. The impact of ambiguous loss Ambiguous loss is a unique and profoundly challenging experience for individuals and families, particularly following life changing accidents or illnesses. This emotional journey is one that necessitates understanding, validation, and a level of awareness that goes beyond the conventional grief. I've seen numerous families grapple with the profound sense of loss that accompanies a serious brain injury or similar traumas. Often, these individuals spend a significant portion of their lives projecting their futures with a loved one, only to have those dreams drastically altered. It's crucial to understand that the feeling of loss, even though the person is physically present, is normal and entirely valid. Many individuals found in a specialist rehabilitation setting are often around 50 years old, at a stage in life when they were expecting to embark on a new chapter, possibly without the responsibilities of raising children and with financial stability. This sudden shift in life expectations can be particularly challenging to accept. The crucial role of empathy The key to dealing with ambiguous loss is fostering empathy and compassion. It begins with acknowledging the emotions that

arise when you realise your loved one may never be the same again and it’s okay to grieve this loss, even though the person is still alive. Grief isn't reserved exclusively for when someone passes away, it can be a constant companion in a rehabilitation setting. By simply recognising the phenomenon, you can help justify someone's emotions and allow them to address the issue, rather than being shackled by the confusion associated with it. One of the hardest things for families experiencing ambiguous loss is not being in control. They, quite naturally, often seek to control outcomes when dealing with complex brain injuries, attempting to shape a future that is largely unpredictable, even for our specialist teams. This need for control can often present itself as anger when those outcomes remain beyond their reach. Unlike the fast-paced environment of a hospital immediately following an incident, the rehab setting provides families with the time to process the reality that their loved one won't be the same again. This is when ambiguous loss most typically surfaces, as they begin to come to terms with this painful truth. In the midst of such uncertainty, it's crucial to provide support, understanding, and the reassurance that they are not alone in their journey. The danger of the internet In today's digital age, the internet can be a double-edged sword, offering both information and misinformation. It can inadvertently fuel false hopes about patient outcomes, making it essential to understand that every case is unique. Each individual's path to recovery, or adaptation, is distinct. Seeking professional help is always a positive solution and psychologists, with their expertise in addressing complex emotional issues, can offer guidance, coping strategies, and emotional support dealing with ambiguous loss in the rehab setting. As with all mental health struggles,

"Grief isn't reserved exclusively for when someone passes away, it can be a constant companion in a rehabilitation setting" the earlier you open up about it and seek help, the quicker you can come to terms with it and learn to rewrite the future that you once projected with a loved one. In the context of rehab, the support of loved ones is often the key source of determination in our patients, so it’s important to process what has happened and focus on being a source of hope for the individual. The key is to recognise that it's totally normal to feel the way you do. Embracing ambiguous loss as a concept, supported by the assistance of mental health professionals, can help pave the way for emotional healing. * Luke Cook is head of rehab and nursing at Askham, who works with a team of experts specialising in intensive neurological rehabilitation, hands-on therapy, and robotic and sensor assisted rehabilitation technology to empower people to regain independence after lifechanging injury or illness.

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‘Give adaptive athletes a level playing field’ A former soldier who has become a world-leading adaptive athlete after being paralysed during a charity bike ride has called for greater fairness and transparency in adaptive sport, after a rule change in a recent tournament saw him robbed of first place. Tom Green won his category in the recent Wodcelona event, which attracts adaptive athletes from around the world, and follows his fourth-place finish in last year’s WheelWod Games - hailed as the pinnacle event globally for adaptive fitness. But although Tom won his Seated 2 Male category - a category medics argue he should not be in, due to his lack of hip function - low numbers in the equivalent female category meant the male and female results were combined. That meant Tom - a former physical training instructor (PTI) in the Royal

Regiment of Fusiliers - was awarded a second-place finish, and one of his fellow competitors, who finished third in the male category, was no longer entitled to a podium finish. In protest, Tom handed back his medal to Wodcelona organisers. While they have since assured him they have learnt from this situation, Tom believes that it must be seen to be an open and fair competition to encourage others into adaptive fitness. “Adaptive sport is a growing area and I really want to see more people compete - but I don’t think things like this will inspire them at all,” says Tom, who was paralysed from the waist down after being hit from behind by a truck during a 100-mile charity cycle ride. “I was in first place at Wodcelona and was watching the leaderboard all weekend, and I finished in first place. But because there were

only two competitors in the Seated 2 Female category, they decided to join it together with the male category. “Clearly, a female will have less points as they have different workouts and theirs is a totally different category - and then the results have a knock-on effect for everyone in the male category. Not just for me, but for my fellow competitor who finished third, but then was told he no longer had a podium finish. “They deserve their recognition; they have earned it. I handed back my medal for that reason, because they have worked hard for this, and it has been taken away. “Another competitor in my category is someone I train, and he has come on so much. He just missed out on a podium in the end - but for someone like him, who is so close to gettinga top three place, rule

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changes like what happened at Wodcelona are not going to motivate him at all. “If they are low on numbers, it would make more sense to combine the female Seated 1 and Seated 2 categories, rather than combine it with the male category. They should be kept completely separate.” Tom, who has been supported by Breakthrough Case Management since his spinal cord injury in summer 2020, was told he would never be able to walk again - but has continued to surpass all expectations, with his rehab team continually amazed at the progress he is making. “What happened with the placings at Wodcelona was clearly unfair,” says Annabelle Lofthouse, Tom’s case manager at Breakthrough. “However, I was unsurprised by Tom’s decision to hand back his medal. As well as being a completely dedicated

"Adaptive sport is a growing area and I really want to see more people compete"

athlete, Tom is an incredibly principled man, and this is just so characteristic of him. He really is raising the profile of adaptive fitness in every way he can.” His venture into adaptive sport has been hailed as “superhuman”, and Tom now has his sights set on the CrossFit Games 2024 in Texas, which combine both mainstream and adaptive competitions to name the world’s top athletes in their respective fields. “Next year, they’ve promised to try and get all the adaptive categories into the Games, so my focus has shifted to that. I’m not going to compete in anything else this year, I’m concentrating on the qualifying rounds and then hopefully the actual Games,” he says. “That is the biggest challenge there is, it’s the Mecca for me as an adaptive athlete, so that’s what my sights are set on.”

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"Innovation is in our DNA"

ichardson Care, a specialist provider of residential rehab services in Northampton, was a Highly Commended therapy provider in the NR Times Innovation in Neuro Rehab Award 2023. Laura Richardson-Cheater, Director at Richardson Care, talks about how innovation has always been at the heart of service provision at the company. Laura says: “We have six specialist

care homes: three for adults with acquired brain injury and three for adults with learning disabilities and complex needs. The business has evolved a lot since it was started by my parents in our family home in 1989. We have always been ahead of our time in providing a person-centred approach to care and rehabilitation because our first residents, who had learning disabilities, were treated like members of the family. And some of them are still in our care now.

“We had to be innovative in the early days, due to a lack of resources. As we’re still a familyowned and run business, we have the freedom to think outside the box to enable service users to fulfil their potential. Innovation is in our DNA." The Innovation in Neuro Rehab award looked for providers who embrace innovation to give new hope to secure beyond-expectation outcomes in neuro rehab. The

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The holistic approach has enabled Lynda to transform her life

judges were also looking for providers who help to create examples of best practice that can be followed by the wider sector. Laura continues: “We’re delighted to be finalists in the NR Times awards and to receive recognition for our services. It’s testament to the work of the whole care team and the outcomes that we have helped our service users to achieve.” Innovation in psychology provision Richardson Care’s core principles of enabling service users to engage in meaningful activities and be part of a community contribute to its aim of using psychological therapies and interventions to reduce the reliance on drug therapies. The psychology team at Richardson Care is led by Consultant Clinical Neuropsychologist Dr Pedro Grilo who is supported by four assistant psychologists – an unusually-large team to support up to 78 service users. The psychologists are based in offices at each home and have an ‘open-door’ policy, so in addition to their scheduled sessions, service users can access support whenever they need it. Richardson Care offers a wide range of psychological therapies including Cognitive Behavioural Therapy, EMDR, DBT, psychoeducation. relaxation sessions, positive behaviour support, drug and alcohol misuse work and computer-assisted cognitive rehabilitation therapy.

Video: Check out the computerassisted rehabilitation therapy at Richardson Care here.

She needed frequent prompting and encouragement with all aspects of daily living, such as personal care.

Computer-assisted cognitive rehabilitation therapy In 2020, Richardson Care was one of the first organisations in the UK to use RehaCom® computer-assisted rehabilitation technology. Although it has become the leading technology of its kind in Europe, it is used by very few companies in the UK.

She was also wheelchair-bound and had been told that it was unlikely she would be able to walk again.

This tool assists in the rehabilitation of cognitive difficulties that affect specific aspects of cognitive function: for example attention, concentration, memory, perception and other daily-living activities. This means that specific difficulties can be identified then targeted and specifically trained. The system is auto adaptive, meaning the activity will get harder or easier depending on the performance of the person. This enables them to progress steadily, and reduces frustration if they are finding some tasks difficult. Lynda’s story of cognitive rehabilitation Lynda suffered a hypoxic brain injury in 2010 and was in a coma for three months. She was admitted to Richardson Care in December 2014.

Lynda started using RehaCom® in 2021 and since then has recalled previously-lost childhood memories as well as improving her short-term memory. Her attention, concentration and other cognitive skills, including mental maths, have also made significant improvements. Improvements in all of these skills have had a positive impact on Lynda’s well-being. For example, something like remembering where she’s put her mobile phone can make her life a lot easier. The holistic approach by the whole multi-disciplinary team has enabled Lynda to transform her life. She is physically independent and walks well unaided. She enjoys swimming, going to bingo, shopping and out to cafes. She has a part-time admin job at Richardson Care, where she arrives on time and completes her duties with enthusiasm. She has learnt to manage her emotions, develop confidence and resilience. To find out more or to arrange a visit, go to richardsoncares.co.uk or call 01604 791266.

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Rebuilding my life after being paralysed by Guillain-Barre Syndrome N

eil has been a teacher of performing arts at a school in Croydon for about 16 years. He describes his experience of developing Guillain-Barre Syndrome and how it almost totally paralysed him, and his experience of therapy and care at QEF to help him rebuild his life. He is now living independently at home again. “Just after Christmas 2022 I started to feel unwell. I thought it was just the annual cold or flu as everyone in the department seemed to have it, but I just couldn’t shake it off. Then in early February I started to feel pins and needles in my feet and in my hands, and then it started to progress into my legs and I was

having difficulty walking, especially in the morning. I was still mobile, but it was becoming a struggle. Then in early March I woke up one morning and I couldn’t move my face – it was numb and tingly. My mouth was tense and I had blurred vision. I realised I had to go to the doctors. I got up to make myself a cup of coffee and my legs gave way and I collapsed. Thankfully they came back and I was able to get up. I called 111 who told me to get myself to A&E by taxi. But the taxi driver dropped me at the wrong entrance and as I was walking to A&E my legs gave way again and I was on the floor and this time I was unable to get up. Eventually

someone found me and they bought a wheelchair to take me to A&E. Over the next week I deteriorated. On the Sunday I could pick things up and eat, by Monday morning I couldn’t. It got worse and eventually it almost completely paralysed me. In four days I basically went from a well-functioning adult to a baby. They quickly diagnosed me as having Guillain-Barre Syndrome (GBS) which attacks all the nerve endings. Thankfully it didn’t go into my diaphragm as if that happens you have to be intubated in ICU. But they got it just in time. I was bed ridden for five-six weeks while I had a drug that aims to restart your immune system.

It can happen to anyone, so this is utter bad luck. I had to be fed, washed, bathed, toileted. I was almost completely paralysed and I had blurred vision for about three weeks so I had to wear an eye patch. I couldn’t pick anything up as I had no strength. The bit I hated most was that my eyelids wouldn’t close. So I had to have eye drops every hour and when I went to sleep I looked like the exorcist! I had five-six weeks in hospital in acute care to monitor whether it was going into my diaphragm, but thankfully my breathing was OK. When I got transferred to QEF it was a blessing – you can’t recover in hospital it’s so busy and I had to learn how to use my limbs again. It was great to be able to recover in your own space and sleep in our own room with the lovely grounds around you. I couldn’t have gone home as I needed 24h care – I needed to be hoisted into the bathroom and had to be washed. Everything had to be done for me. Swallowing was ok but all my food had to be mushy as I couldn’t chew anything. Its very nerve racking. At QEF there is always a sense of goal and achievement, but also reality and honesty. They say ‘we are here to support you, but you do the work and if you need help ask for it.’ You don’t realise how important the small goals are as they build to the next step. It doesn’t affect your brain so the goals sound little, but physically they are big as your limbs don’t respond like they used to. The one-to-one physio you get at QEF is absolutely essential to recovery from this. When you have lost use of your limbs the idea of getting back into the community is absolutely petrifying – what do I do if I fall? The work I did with the Occupational Team was so important for this. I went around Sainsburys using my walker and just having someone there to support you is so reassuring. I didn’t think I would be walking around Sainsburys’ with a walker until I was 80 but you just have to do it. The sensory part of therapy is also

really important, as it stimulates signals from your hands back to your brain. At the beginning my hands were hyper-sensitive so the smallest touch was agonising. But it activates the nerves and helps the physios find where you don’t have any feeling. When I got here the physio was using a gentle scrubbing brush on my finger and I couldn’t feel it! It’s a really emotional journey and there are days when you are miserable and sad. With a click of a finger it’s a complete life change. There is a lot of fear with that about what your life is going to look like. But you get support with that here. It’s not about getting better, it's about getting you to a position where you are an independent person – it might look a bit different – you might be on a walker or use a wheelchair but you are as independent as possible. That’s really important to me. It was such a big moment for me when I was able to take myself to the toilet – I actually cried when that happened. You are surrounded by people who have similar conditions and are either ahead of you or behind you. Someone here was three weeks ahead of me and I saw her have her hands back and seeing her progress is really lovely. There is privacy here so you have your own time, but there is a social side too – we went to the cinema the other day and there are activities that you’re encouraged to join. Some aid your recovery and some are just fun like the Eurovision song contest party. This room is probably the size of my flat. All the little touches like the TV and Alexa being able to close and open blinds for you, it’s one less thing to call the nurses for. It’s good to do whatever you can for yourself. Everything is all about developing your independence. When you are away from here you realise the importance of all the small things, like trying to put your socks on. That’s not easy. You don’t realise how important it is till its gone. I’ve made a lot of progression in a short time as my body reacted well to the physio.

"You don’t realise how important the small goals are"

In 10 weeks I’ve gone from bed ridden and hoisted to nearly complete independence. I make my own tea and coffee now and take myself to the bathroom. But 2.5 weeks ago I couldn’t do that – I couldn’t walk that far. It’s exciting and it’s nerve racking but I am looking forward to going home. Its bitter sweet to leave such a caring environment and friends. Do I like washing my clothes – no, but that’s not reality. You need a bubble when you recover, as your body has gone through a huge trauma. Last thing you need to worry about is small things like clean pants, you have bigger things to fix. Being able to go outside is a massive thing. I walk with a stick indoors and outdoors with the walker now I can’t go back to work just yet – not full time anyway my body won’t do five days a week yet. I have to accept realistic goals to avoid disappointment. Looking forward I will probably go part time at a new school as a learning assistant in a primary school, as I build up my strength and will go back to full time when I can. Something like this gives you time to reflect and prioritise what’s important.”

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Embracing positive risk-taking in neuro rehabilitation

By Natalie Mackenzie, director, BIS Services

injuries, and strategies to implement it effectively.

Rehabilitating individuals with acquired brain injuries is a multifaceted and challenging process. These injuries often bring profound physical, cognitive, and emotional changes to individuals' lives. In rehabilitation, a shift towards embracing positive risk-taking has proven to be a beneficial strategy for optimising the recovery process and enhancing the quality of life for ABI survivors. Multi-disciplinary teams must endeavour to explore the concept of positive risk-taking, the benefits it offers when working with individuals with acquired brain

Understanding positive risk-taking Rippon (2010) found that individuals desire more autonomy and control over their lives and the risks they choose to take. Despite potential risks in pursuing personal priorities and goals, the perceived benefits in terms of quality of life outweighed them. However, Mitchell et al. (2012) noted that there is widespread uncertainty and insufficient evidence on how professionals can effectively support various groups of service users in positive risk-taking. According to Morgan and Williamson (2014), the principles guiding

our language use include: • Positive risk-taking focuses on making well-informed decisions rather than relying on chance. • There is no such thing as a risk-free decision; even seemingly safe options come with their own risks • Evaluating risks involves weighing the positive benefits against the negative effects of risk avoidance. • Positive risk-taking is contextspecific and represents a clear statement of action and intent, unlike more general terms like "positive risk" and "positive risk management" that can be easily misinterpreted. Positive risk-taking involves calculated and reasoned decision-making, recognising that risk-free choices do

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not exist. It requires a balance between the benefits and consequences of risk, framed within individual contexts. Positive risk-taking is a therapeutic approach that acknowledges the importance of calculated and well-managed risks as part of the rehabilitation process. While safety remains a paramount concern, positive risk-taking encourages professionals to explore new strategies, interventions, and activities that may involve some level of risk but offer potential benefits in terms of progress and independence for ABI clients. The concept of positive risk-taking is rooted in the understanding that taking no risks at all can result in stagnation, limiting the opportunities for growth, recovery, and reintegration into everyday life. This can impact motivation and engagement in rehabilitation provision, having negative outcomes relating to goal attainment and potentially complex medio-legal process. By carefully weighing the potential benefits against the possible risks, rehabilitation professionals can guide clients in making informed choices, enabling them to explore their capabilities and regain a sense of control over their lives. Benefits of positive risk-taking in ABI rehabilitation Encouraging Independence and Self-Efficacy: Positive risk-taking empowers ABI survivors to take ownership of their recovery journey. When individuals are encouraged to take calculated risks, they often discover new abilities and regain a sense of control over their lives. This fosters a sense of self-efficacy, which is crucial for their motivation and wellbeing. As we all know, finding the ‘hooks’ to engage our clients with can be limited if we are not thinking outside the box and engaging in the positive risk-taking process. Facilitating cognitive rehabilitation: Brain injuries frequently result in

cognitive deficits, such as memory problems and reduced attention span. Positive risk-taking can involve challenging cognitive tasks that stimulate the brain and aid in cognitive rehabilitation. These tasks may help individuals regain lost skills and adapt to their difficulties and ongoing challenges. Seeing progress and goal attainment is crucial to long term engagement in rehabilitation as well as positive mental health.

"While safety remains a paramount concern, positive risk-taking encourages professionals to explore new strategies, interventions, and activities" Enhancing emotional resilience: Positive risk-taking can contribute to emotional resilience. By encouraging individuals to venture out of their comfort zones and take on new challenges, they learn to cope with anxiety and frustration. Overcoming these challenges builds emotional strength and can potentially reduce the risk of depression and anxiety. Promoting social reintegration: Acquired brain injuries often lead to social isolation, as individuals withdraw from social activities due to fear and uncertainty. Positive risk-taking can involve social reintegration strategies, such as joining support groups or participating in community activities. This fosters connections, reduces feelings of isolation, and improves overall quality of life. With support and encouragement to place themselves in environments which may, at times, be flagged as ‘risky’ and unwise’ clients can take great strides to forming new social relationships, in an assessed and safe manner. Clients may have increased vulnerability and the modern world can open the door to a great number of risks for our vulnerable clients, but we must not lose sight that this is often the case

for many individuals living without an injury. Enabling physical rehabilitation: Physical deficits, such as mobility issues, can be addressed through positive risk-taking. This may involve activities that require increased physical effort and balance, helping individuals regain physical independence and reduce the risk of secondary health issues. Adapting to new challenges: Positive risk-taking plays a crucial role in enabling ABI survivors to adapt to new challenges and various situations they may encounter in their daily lives. This preparation becomes even more essential for individuals who are striving to regain their independence. By embracing calculated risks and exploring unfamiliar territories, ABI survivors gradually gain resilience, confidence, and the necessary skills to navigate the complexities of their rehabilitation journey effectively. This process involves continuously pushing personal boundaries and embracing growth opportunities that promote both physical and emotional recovery. Through this proactive approach, survivors can acquire invaluable experiences and strategies that foster their progress towards regaining control over their lives. Increasing confidence: One of the many benefits of taking calculated risks is the substantial boost it provides to individuals' self-confidence. When individuals successfully navigate challenges and achieve positive outcomes, it instils a sense of belief in their abilities and increases their self-assurance. This newfound confidence has a profound impact on various aspects of their lives, motivating them to explore new opportunities and fostering growth. Strategies for implementing positive risk-taking As is standard and best practice in all work we undertake with our clients, we must start by conducting

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a thorough assessment of the client's abilities, challenges, and goals, in collaboration with the family where possible. Understanding their desires and interests, and identify areas where positive risk-taking can be beneficial. All too often our personal values and reluctance to engage in risk can form a barrier that needn’t be present. Personal reflection as to the impact on our own norms on client progress should and occur on a regular basis. Collaboration with the client, family and other important people in their lives, to set achievable and realistic goals should occur from the outset. These goals should challenge, but not overwhelm. Establish short-term and longterm objectives that are specific, measurable, and relevant to their rehabilitation journey, their sense of self and their longer-term aspirations. Educate the client about the potential benefits and risks associated with each proposed activity or intervention. Encourage them to make informed decisions and take an active role in their rehabilitation plan. Empowering

"A collaborative approach helps individuals stay motivated and resilient" clients to make decisions based on individualised education, whilst sometimes falling into the ‘unwise’ bracket is a positive process for all involved. Gradually introduce positive risktaking activities and interventions, starting with low-risk challenges and progressing to more complex ones. This approach allows individuals to build confidence and competence over time, whilst also allowing the MDT to gain evidence of processes and outcomes, both positive and negative to learn from. Indeed, those outcomes that may be deemed as ‘failures’ are the ones to learn most from. Continuously monitor the client's progress and provide constructive feedback, which can be a huge challenge when working with clients with reduced insight and awareness, and those that may lack capacity. Think of novel ways to present the feedback in

an engaging and joint-working manner. Celebrate their successes and support them when faced with setbacks. A collaborative approach helps individuals stay motivated and resilient. Develop interventions that are tailored to the individual's specific needs and interests. This personalisation enhances the client's engagement and motivation, increasing the likelihood of positive outcomes. This should be standard practice, and it goes without saying any program of rehabilitation should be individualised, but this is not always the case. Positive risk-taking is: “weighing up the potential benefits and harms of exercising one choice of action over another. Identifying the potential risks involved (i.e. good risk assessment), and developing plans and actions (i.e. good risk management) that reflect the positive potentials and stated priorities of the service user (i.e. a strengths approach). It involves using “available” resources and support to achieve the desired outcomes, and to minimise the potential harmful outcomes” (Morgan, 2013). In conclusion, embracing positive risk-taking in the rehabilitation of individuals with acquired brain injuries not only promotes recovery but also nurtures hope, resilience, and a sense of purpose in the face of adversity. By tailoring rehabilitation strategies to the individual's specific needs, abilities, and interests, remarkable progress and an improved quality of life can be achieved. Together, with a collaborative effort from the client, their caregivers, and the rehabilitation team, positive risktaking becomes a dynamic and valuable approach that empowers individuals to regain independence and rebuild their lives. To find out more, visit thebiss.co.uk.

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Always believe in the dream After brain injury forced Sean Dolan to give up the teaching job he had always wanted only weeks after it began, he resolved he would never give up on his ambition. Ten years later, he has returned to his role as a teacher and is preparing to mark the anniversary of that lifechanging moment with an extreme fitness challenge to raise money for the hospital that saved his life. NR Times speaks to the inspirational survivor, who discusses his journey, the impact of exercise, and why he struggles to acknowledge his recovery is ‘a big deal’ On October 25, 2013, Sean Dolan’s life changed forever. A newly-qualified teacher, having just completed his first half term in his new role, he was playing indoor five-a-side football when he fell into a wall. From playing football with friends as he had done countless times before, he was left unconscious, with a fractured skull and bleed on the brain. Sean was rushed to James Cook University Hospital on Teesside, placed in an induced coma and forced to undergo a craniectomy. One minute a 25-year-old man in the prime of his life, pursuing his dream career, and the next fighting for survival and facing a recovery where his parents were warned would probably see him lose the use of his left side, and he may not regain full independence. But from that utter devastation for him and his family has come a recovery his consultant at James Cook has described as a “miracle”.

Ten years on, Sean is a teacher at a Teesside primary school, having resumed the career he loved and always aspired to, through a sheer determination to never give up on his dream. And having become a prolific fundraiser for the intensive care and specialist neuro wards at James Cook - which he credits with saving and rebuilding his life - Sean is now about to embark on his toughest challenge yet. From the anniversary and for the following ten days, he will complete his Ten for Ten challenge - a series of gruelling physical challenges, from a marathon to a ten-hour football match, all of which have deep personal meaning attached to them. “Exercise has been really important for my recovery, for both my mental and physical health, and now it has given me a way of raising money for the hospital that enabled me to rebuild my life,” says Sean, from Billingham. “There has been a lot of proving myself worthy on this journey, both to myself and to the people who have helped me in my recovery - so fundraising gives me a way to give back, and show what I can do.”

“I felt almost like I owed it to the people who saved me to get a life that was worth of the recovery I had made"

The journey back into teaching For Sean, being a teacher was his dream. Having graduated from Durham University, he secured a job at a primary school in his native Teesside. After an enjoyable first half term made him realise this was the career for him, everything changed in an instant during a game of five-aside. Having been in a coma, and needing part of his skull replaced with a titanium plate, Sean spent 59 days in hospital in total - but while his recovery was only just beginning, he was desperate to defy the odds and return to the classroom. “In hospital, I was told that I may need to prepare for life where I might not work again,” recalls Sean. “And that was a really bad time. In my head, I was only prepared to accept that I had recovered successfully when I was teaching again. I had to go back to it. “But, as with recovery from brain injury in general, it has been a journey. It’s been very much backwards and forwards. It has been a big learning experience. “When I did feel ready to go back into school, I had to spend time as a teaching assistant, doing staggered periods of work. When I was cleared to go back into teaching, I took the first job possible, and it was too soon. “Then you have to take a step back - and you feel everything is going backwards. It has been a journey with some difficult times along the way.” However, having taken the step back he needed, Sean found himself ready to move forwards again - and took a role with his current school, where he has been for three years.

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“It took me six years to find the right school, but it’s all going well so far and I’m happy here,” he says. “Things aren’t always as straightforward and as you’d hoped they would be. But you have to keep going, and you can get there.” As well as returning to the career he loved and everything he had worked so hard for, Sean also sees his resumption of teaching as a debt of gratitude to those who saved his life and have supported him since. “I felt almost like I owed it to the people who saved me to get a life that was worth of the recovery I’d made, of the recovery they had helped me with,” says Sean. “There has been a lot of proving along the way, and a lot of proving that I’m worthy. I have suffered a lot with imposter syndrome over the years, and survivor guilt too. A lot of my fundraising is about proving myself worthy of my recovery, as well as the fact I am teaching again. “But although I am teaching, I’m still

not sure I can ever fully accept what happened. There are peaks and troughs. I look at the friends I had at the time of the accident, and where they are now compared to me. I do feel I have fallen behind everyone else.” Sean has now reached a point where he is comfortable in discussing his story, and in sharing it for the good of others - although he can never see a time where he is able to be seen as an ‘inspiration’. “I have been through times where I hated talking about what happened, but now I’m quite happy to share it, as hopefully it can be a positive for somebody else - but I’ll never volunteer myself to do that,” he says. “I don’t really view it as a big deal. I think that if I got through it, then most people could have done the same. It’s probably a defence mechanism, but I really struggle to take any compliments of any form. I don’t see what I have done as being anything different to what anyone

else could have done. “I do tend to play it down, but if it helps someone else, then I’m happy to discuss it. “I’m from a small community where everyone knows everyone else, which does bring its own problems because everyone knows what has happened to you already. But I have been lucky with the support I’ve had, particularly around the fundraising and people wanting to help with that. “When I’ve done fundraising events in the past, like a 24-hour football match I organised, there were probably 80 people taking part in that. I’ve got people from the community joining me in some of my latest challenges. “It does show that support is there, and that’s great to know.” Giving back and proving what’s possible - the Ten for Ten challenge Having organised four anniversary fundraising events in the ten years

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"There has been a lot of proving along the way, and a lot of proving that I’m worthy"

since his accident, and taken part in many more initiatives to raise money for South Tees Hospitals Charity collectively raising well in excess of £10,000 - Sean’s Ten for Ten fundraiser is a hugely ambitious tenday physical challenge to celebrate his recovery. All ten challenges, to be completed over ten consecutive days from October 25, have personal meanings to Sean. From the marathon - which covers the route the ambulance took from the site of the accident, to North Tees and then James Cook hospitals - to the 59k cycling challenge, which will take place ten years to the day of his injury in James Cook hospital

where fought for life, to two football matches to bring in his love of the game he was injured playing, everything is tailored specifically around the milestone anniversary. As the date falls within term time - often the half term holiday has begun by October 25, as it had in 2013 - children from Sean’s class and others within the school are being sponsored to take part in a Joe Wicks-a-thon. Other local schools are also set to join in. While delivering an ideal fundraising opportunity, the physical activity has been chosen to mark its significance in Sean’s ongoing recovery. “Pre-accident I was always sporty, but I’ve never been in the shape I’m

in now. It has been a journey, which has probably been as important for my mental health as for my physical health,” says Sean. “I was in hospital for 59 days and I lost muscle through being bedbound. Then I went home and adopted the approach of ‘Well, I did nearly die, so I will have that takeaway, I will have that chocolate bar’. But then I ballooned. “Exercise has been really important. The fundraising has been great, but when I entered my first Olympic length triathlon a year after the accident, it was probably as much to show that I could do it, having been warned a year earlier that I might lose the use of my left side.

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"It’s about showing what I can do, and knowing that I can do it" “That first triathlon was my way of proving that I could do it. And from there I started doing the Great North Run, which I’ve done every year since. It’s about showing what I can do, and knowing that I can do it. Exercise is something you can measure, and I like seeing improvement.” One of the sponsors of his ten for ten fundraiser is Tees Neuro Physiotherapy, a specialist neurophysio which supports patients in their recoveries across the North East, Teesside and North Yorkshire regions, combining expertise with the latest in technology and robotic equipment to deliver life-changing progress. Coincidentally, Sean’s physiotherapist from neuro Ward 26 at James Cook, Rahilla Pearson, now works at Tees Neuro Physiotherapy, giving a connection he never expected to find - and making the neurophysio practice an ideal partner for his challenge.

Rahilla will join Sean on the 10k leg of his triathlon, and physio Rosie Warnett is planning to join the marathon. “It’s fantastic I have met one of the people who taught me to walk again, and it comes back to that proving myself worthy of recovery and thanking those who helped me in that,” says Sean. “I remember being told off when I was in hospital by my physios for trying to be too active - I’ve always wanted to get back to a point where I was doing the things I wanted to, and now I feel I am there. Their support in those early days has enabled me to get here.” Victoria MacGregor, clinical director of Tees Neuro Physiotherapy, says: “Sean is so inspirational and shows what can be achieved, even when at times the outlook can seem really difficult. Returning to his job as a primary school teacher is such a massive achievement, and this Ten for Ten challenge is incredible.

“He has raised so much money over the years for James Cook, and this latest challenge is really taking that to the next level. It has taken so much organising and all of the events have such a personal reason behind them, and we are so pleased to be able to support him. “Sean is an example to our clients here, and to other brain injury survivors, of what can be possible. With the right rehab and the commitment to overcome the obstacles, it just shows what can be done.” To support Sean’s Ten for Ten challenge, visit here https://www. justgiving.com/page/sdtenforten

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Making dreams come true when Alex met the President

After telling his case manager of his ambition to meet the President of Ireland, Siobhan McSweeney resolved to make this possible for her client Alex. Here, Siobhan, CEO of MCS Case Management, tells us how this helps to show the lengths and effort she and the team will go to for their clients, to make the seemingly impossible possible

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hen Alex was asked what his ultimate goal was, he was certainly aiming high. “He said he wanted to meet the President of Ireland - I said 'You’re not looking for much',” says Siobhan McSweeney, CEO of MCS Case Management. “It was a big ask, but we’ll always do absolutely everything we can for our clients. “We knew what this would mean to Alex. And that’s what it’s about, making goals and ambitions come true.” Siobhan - whose business is one of the only case management companies in Ireland, and who is credited with blazing a trail for the profession in the country had not been working with 17-year-old Alex, who has autism, for long when he disclosed his ambition. Being tasked with supporting Alex and his family with the practicalities of living their lives to the full through her role as a case manager, Siobhan was determined to make this particular dream come true.

Writing to the office of Michael D. Higgins, President of Ireland, Siobhan explained Alex’s wishes and asked whether it may be possible to facilitate a meeting. “You hope, but you never really can be sure. It’s the President, after all, and I’m sure he receives so many requests every day,” says Siobhan. But following her appeal, Siobhan was delighted to receive a response inviting Alex to a Garden Party at Áras an Uachtaráin, the official residence of Michael D. Higgins and his wife Sabina. “He was absolutely thrilled, he and his family were delighted,” says Siobhan. “He went along with his mum and a friend, and I was also invited, which was absolutely fantastic. Alex was overwhelmed. It was one of the best days of his life, and it was for me too. It was amazing.” And while enjoying the sumptuous hospitality of the event in Dublin, Alex was also able to fulfil his wish of meeting the President

himself. “It was fantastic. We had a photo taken and I also asked the President for his autograph - I was told that was a breach of protocol, but it’s not every day you meet someone like that,” says Siobhan. The fact that Alex’s wish was able to come true, and was not discounted in favour of him naming something more achievable, is an indication of the ethos and determination of MCS Case Management in supporting their clients. “Nothing is impossible, things should never be seen as being impossible,” says Siobhan. “We want to make things happen for our clients. We are absolutely committed to them and to making their lives better wherever we can. “When Alex said he wanted to meet the President, rather than saying ‘Well what’s your achievable goal?’, we were determined to make it happen." To find out more, visit mcscasemanagement.ie.

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Introducing Chislehurst With huge and growing pressure on places for people in need of neuro-rehab, Active Care Group has added more beds to its national portfolio through the opening of its latest specialist centre, and is now accepting referrals. NR Times learns more about Chislehurst Neurological Rehabilitation Centre, created following extensive investment, and which delivers bespoke and impactful rehabilitation for people with neurological illness and injury

hrough the acquisition of a new site in London, Active Care Group is adding even more much needed neuro-rehab beds to its portfolio. The creation of Chislehurst Neurological Rehabilitation Centre, a 15-bed centre in South East London, offers specialist support to people needing post-acute rehabilitation, as well as those living with long-term neurological needs, and brings much-needed provision.

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Opened in August, the centre has a strong focus on holistic care and therapy - with a full in-house interdisciplinary therapy team - and in promoting empowerment among its residents. Currently, the centre is scaling up slowly, bringing in residents in stages to ensure each are safe and settled before being joined by others. Importantly, while being able to accept admissions from anywhere in the country depending on need, Chislehurst can be a step-down or interim option for patients at Blackheath Brain Injury Rehabilitation Centre, a nearby facility which is also part of Active Care Group. Chislehurst, formerly a residential care home, has been revamped into a neuro-rehab facility following significant investment, and offers a range of resources to create a happy and homely feel. With therapy rooms, communal living areas and a gym, the centre can cater for people at various stages of need. The average placement will probably be around six months, although adjusted intensity programmes are tailored to the specific rehab goals of each individual. For Jacqueline Henry-Carr, manager

at Chislehurst, the centre offers neuro-rehab opportunities in an environment where people can thrive. “This is a really positive environment, and one which is geared around therapy and rehabilitation,” she says. “We are quite flexible on how long that will take. We’ll have long-term patients, but then also individuals who will need support for a shorter amount of time. “Because we’re so close to Blackheath, which offers quite intense rehab, we can adopt a slower stream approach if we need it. “But it’s all dependent on the goals of the residents and the work they’re doing, what kind of prognosis they have versus what they can tolerate. There is flexibility in relation to their admission here, and that is regularly reviewed.” For those residents whose needs vary, and they may step down from Blackheath, or else move to Chislehurst for an interim period, the close working between the teams at both centres means their transition can be fully supported, says Jacqueline. “There will be individuals who wouldn’t be able to tolerate the intensity of the sessions in

Blackheath, and therefore could be considered for Chislehurst. The slower pace of rehabilitation at Chislehurst can help with an individual’s ability to engage in all their sessions while providing time for recovery.,” says Jacqueline, who previously worked as a physiotherapist at Blackheath Brain Injury Rehabilitation Centre for a number of years. “So for these residents who need a larger gap between sessions, while still having daily therapy input that they may not get in the community, Chislehurst is an ideal setting for them. “Because we’re all part of Active Care Group, and the teams know each other, the communication is very easy and the transition can besmooth when a resident moves from one centre to the other. We are all absolutely committed to helping them achieve what they want to, and addressing their needs in the best way we can.” One priority for the Chislehurst team is its delivery of holistic care, involving all partners in care from the family, to GPs and social workers, to the lawyer and case manager. “I have found this can be so important, and there is a lot to back up the importance of family >>

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involvement,” says Jacqueline. “It’s not just about them being on-site and visiting, but even just contacting them and keeping them in the loop, and giving the opportunity for them to be involved and identifying things we may not be aware of. They are vital to helping us to get a good idea of who a person is. “Hearing that familiar voice and seeing familiar faces can be so important, particularly during the admission phase. We are welcoming residents for the first time, so everything is new to them. And while our staff will become like a second family, initially they are strangers. So we’ll always look to involve the family. “But as well as the family, we will always try and involve the wider team, as their input is also very important

"Hearing that familiar voice and seeing familiar faces can be so important, particularly during the admission phase" to the resident themselves. We’ll always try and find opportunities for discussion around any changes that are happening, or maybe there’s a special event coming up in their life, like a wedding or birthday. “By engaging with everyone involved, we can ensure we are delivering the support they need at the right time.” The opening of Chislehurst and extensive renovations to make it into a specialist neuro-rehab unit are

geared around the quality of life of the residents, says Jacqueline. “As a smaller centre, everyone has their own en-suite, they have their own space they can decorate themselves. Food is cooked on-site, and residents are encouraged to use the communal areas. “We have a quiet lounge, which is a great place to chill out outside of therapy sessions, and the centre itself is in a really quiet area. It’s a very positive environment and one we are really pleased to be welcoming new residents into.” * Chislehurst is accepting new admissions. For more information or to make an enquiry, visit https:// activecaregroup.co.uk/location/ chislehurst-rehabilitation-centre/

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47 www.motomed.com

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A decade of changing lives through the creative arts therapies - the Chroma journey so far Since its foundation in 2013, Chroma has been a key name in the popularisation of the creative arts therapies - and particularly music therapy - in rehab settings, with its founder Daniel Thomas seen as one of the early pioneers. Here, we speak with Daniel as he reflects on Chroma’s tenth anniversary, the highs and lows along the way, and how the team he has built holds the key to Chroma’s future

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“When I heard about the concept of music therapy, I just knew that’s what I wanted to spend the rest of my life doing and pushing forward.” Despite having no prior experience in either music therapy or in running a business, a visit to the United States in the late 1990s - and a “random conversation” with a girl named Sarah - proved transformational for Daniel Thomas. At a time when music therapy was known in the US, but just beginning to emerge in the UK, Daniel immediately recognised his desire to become a music therapist. “I thought it sounded like such a brilliant way of bringing together music and psychology, which were two really important parts of my life and really resonated with who I was. So that’s what I did.” And from that initial conversation has come Chroma, the UK’s leading creative arts therapies provider which has a team of around 120 therapists working in hundreds of locations across the country, working with key providers in education and healthcare - STEPS Rehabilitation, The Remeo Hospital and the Portland and Wellington Hospitals being among its longstanding clients. And while music therapy - as well as the art and drama therapy now delivered by Chroma - have become recognised and respected as a highly effective intervention, and a key part of a multi-disciplinary team, Daniel’s role in reaching that point cannot be underestimated. “It does make me proud to see how the arts therapies have grown in standing and recognition, and to know Chroma has played its part in that,” says Daniel. “For me, it has always been about enabling the richness of experience, the outcomes and the possibility of lives being made better by the creativity and psychological support offered in therapy. “Music therapy has become a way to achieve that, and we are delivering that in schools and hospitals across

Daniel Thomas

"I am proud to see how the arts therapies have grown in standing and recognition" the UK, and to hundreds of clients." Celebrating its tenth anniversary on October 23, the business has grown significantly from starting life in Daniel’s spare bedroom, with him having trained as a music therapist, then launching this venture after some time running a sole trader music therapy business to see where the journey took him. “We’ve definitely come a long way from the bedroom business - and I often reflect on how random conversations can play such a big role in your future!” Building the UK’s leading arts therapies provider Back in 1999, music therapy was in its infancy in the UK. Having gained HCPC registered status only three years earlier, it was not in widespread use or felt to be in the mainstream of interventions regularly commissioned by healthcare professionals or litigators and case managers.

“It was very much a psychodynamic approach, much more psychotherapy with music. There was very little involving brain injury or neurorehab.” he recalls. “But at that time, I had no knowledge of it myself, so I started my training – and the story began.” Initially known as “Music@Work”, Daniel secured an EU grant for his logo and website, and started out as a sole trader. But as word spread about the impact he was making, demand grew. “Before long, I was working with six schools over five days, so I needed to bring someone in to help. And it started very organically, just delivering music therapy initially,” he says. “I had some other therapists working alongside me, with me doing therapy as well as the admin, finance and quality assurance. I was just trying to work it out, really.” Always keen to innovate, Daniel looked at what else the business 49

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"I wanted to create this amazing therapy brand with a real growth strategy" could offer, to deliver even more to clients who had shown such positive response to date from the delivery of music therapy. He decided a natural progression would be to deliver the suite of the creative arts therapies – music, art and drama – and the name Chroma was born. “I wanted to create this amazing therapy brand with a real growth strategy, so we could deliver this range of therapies with easily transferable skills in hospitals, schools and any other settings. “But what I really wanted to do was to deliver quality at scale. Quality is really easy, as you can just hire somebody brilliant, and scale is really easy, because you can take on hundreds of therapists; but quality and scale together is something totally different. “It’s like there was a moving target we tried to keep in the centre of, we still do even now, but it was always moving – and that’s why we never stand still.” Delivering music therapy in increasing numbers of settings, and becoming regarded as a central part of the multi-disciplinary team, among its many clients was the Wellington Hospital in London, a commission which held personal significance for Daniel after his mother spent her career working there as a clinical physicist. One key moment in the development of Chroma was the creation of the Adoption Support Fund, created by then-Education Secretary Michael Gove in 2014, which ringfenced £30million a year to provide therapy services to adopted children. Having been part of the pilot project

in Gloucestershire, Chroma was then ideally placed to scale nationally and deliver art, music and dramatherapy to young people in locations across the country. “This opportunity gave us the chance we had wanted to really increase things and to start investing behind the scenes. We were incredibly lucky in some ways, and it was very much ‘right place, right time’, but that was a massive moment for us,” says Daniel. “Suddenly we were flooded by referrals for adopted children so we were able to embark on a big therapist and office staff recruitment push too.” But alongside the major breakthroughs have come the truly difficult periods - and like for many other organisations, the onset of the COVID-19 pandemic proved to be a very trying time for Daniel and his team. “On March 23, the first day of lockdown when Boris Johnson was on television telling us all we must stay at home, the whole of what we did at Chroma was hosted in hospitals and schools. So as I watched that announcement, I realised that our entire turnover had effectively stopped,” recalls Daniel. “We had a few month’s reserves in the bank, and I’ve got to say that was a terrifying moment, because no-one knew what lay ahead. Would we have a business anymore? At that point, we had maybe one client who we worked with online, but that was all. We knew we had to act fast, but it was such a difficult few weeks.” True to the innovative nature of Chroma, Daniel and his directors

sprang into action, preparing online sessions, putting together safeguarding protocols, and totally redefining the business. “Within a month, we were delivering between 60 and 70 per cent of our work online. It was quite a turnaround, and has paved the way for where we are now with our use of technology, and where are looking at into the future.” Looking to the future - the next ten years and beyond Having achieved so much in its first decade, and not least being widely recognised as one of the main reasons why music therapy has the respect and reputation it now does in the UK, Chroma is now looking to the future with confidence. Its client group continues to grow, and the outcomes and progress it has delivered for clients since 2013 are too numerous to name; yet everyone remains deeply valued by Daniel and his team. Differentiating itself from competitors as a business - not a charity or a not-for-profit organisation - Chroma is able to be agile and take decisions quickly; something Daniel believes is fundamental to its ongoing success, and will continue to be important into the future. “We’re the only registered limited company in the field of the creative arts therapies, we’re a profit making business and we aren’t shy about saying that,” says Daniel. “We want our clients to be independent, to live without us and our therapy, and we also want to be independent ourselves. We are financially independent and not

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“We want our clients to be independent, to live without us and our therapy" reliant on a board of trustees to make a decision, or the next successful grant application, so we can be quick to react. “That isn’t common in this area of work, and there do seem to be some people who struggle with the fact that we are commercial, but I’m proud of the fact our profits are going back into making the business deliver even more for our clients.” Its willingness to embrace technology during the pandemic has given rise to a whole new dimension to Chroma, with the team now exploring a range of new mediums to support clients. “Part of the legacy of that time is the opportunities we now have,” says Daniel. “We have a lot of younger clients, so we’re looking at the delivery of therapy via WhatsApp. Younger people in particular respond very well to that as it’s something they’re familiar with, but we’re looking into the safety protocols around that.

Sarah, whose conversation began the Chroma journey

Back to his roots - Daniel and his father “We’re also pursuing our ambitions for the use of music-for-health apps to support our work, and we’re already underway with a pilot project. “There is a lot of interesting work happening there, and as a business only too keen to innovate and keep moving forward, there is a lot of opportunity here for us.” Having recently held a celebration event for the ten-year anniversary, bringing together members of the Chroma team from across the country, Daniel said it confirmed what a positive organisation the team has created - one placed ideally for the future. “There are around 120 people in the team now, from very experienced therapists through to those who are newly qualified, and that event brought home to me the sense of belonging, and a culture where people feel able to be themselves,” he says. “That is one of the most amazing things about what we have done at Chroma, and the ethos we have. That does make me feel quite emotional to reflect on that. “But I think also one of the things I’m

most proud of is that if I disappeared tomorrow, everything would go onwards and upwards without me. “While I am a figurehead for the business, we have the most brilliant team who could take things forward. I’ve always looked for the things I’m really bad at doing, and found someone who is really good at it, so that we are a true team. That approach has worked so well, and it does make me really proud to have got to this point. “I’m excited about what the future holds, and it has actually been really nice to reflect on how far we have come. It has been a journey and it’s great to be on it with such fantastic people.” To find out more, please visit wearechroma.com.

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Working together for the best client outcome

Stephanie Fleet, at Think Therapy 1st and Kirsty Mors at Bond Turner discuss joint working in personal injury claims and how the unique Occupational Therapy-led approach to rehab and commitment to joint working is delivering life-changing progress In a personal injury claim, the overarching aim of all sides is to rebuild a person’s life so they can be in the position they would have been had they not been injured. “It’s all about looking at what the injured person’s life was before the accident compared to now and what it would have looked like in the future vs now,” says Kirsty, serious injury lawyer at Bond Turner. “The main thing is to understand is your client’s injury and what it is going to mean for them. For example, a self-employed yoga

instructor with a wrist injury; to a naked eye they may look like they have fully recovered, yet when you delve in to how it has impacted them, it’s a completely different story and it has had a huge impact in their work and life in general.” In achieving this, often the injured person will need some form of treatment or rehabilitation. Submitting a claim can mean that your solicitor can ask the defendant’s insurers for an interim payment, or they may agree to fund rehabilitation under the Rehab Code. They may or may not agree to this, and it usually makes a difference whether they have or haven’t admitted fault, but this will vary from case to case. The claims process can be very stressful, intrusive and often really frustrating - but this is the

advantage of having a quality legal representative and rehabilitation lead in making the process as simple and straightforward as possible. Through establishing effective lines of communication and building a relationship that benefits all parties - the injured person, claimant and defendant solicitor and/or insurer - Kirsty and Stephanie discuss how their way of working is helping to overcome some of the traditional challenges. An OT-led Multi-Disciplinary Team While often the rehabilitation and multi-disciplinary team is led by a case manager, Think Therapy 1st are often able to occupy this role while involved and providing rehabilitation. An Occupational Therapy provider, the team specifically work in

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specialist rehabilitation for people severely or catastrophically injured - and its ambition to restore function and autonomy aligns perfectly with the goal of the claims process as a whole. “Occupational therapy has a very important role to play here,” says Stephanie, head of service development at Think Therapy 1st, who also runs her own OT caseload. “As a rehabilitative healthcare professional, you assess a person's ability to do all the things they want and need to do, then figure out how to get the person back to that using fun and everyday activities as the rehabilitation intervention. “The goal is to promote autonomy, wellbeing, and engagement in all parts of the person’s life.” Think Therapy 1st has become well known in the sector for its Specialist Rehabilitation Occupational Therapy (SROT) approach, which sees the team engaging clients in functional rehabilitation through practical means, which is enabling them to rebuild their lives. “We adopt what we call a functional restorative rehabilitation approach – this is where we focus on restoring the function,” says Steph. “If there is permanent and longterm damage, we then look to adapt the task or use strategies to overcome the difficulties. When that avenue is exhausted, we then look at how to compensate for the long -term impact with care packages or equipment and adaptations. “The unique thing that our OTs do is because they approach the injured person/client from the treating therapy perspective, they can provide both this element and the coordination of all other health and care needs as part of this role. “This will either reduce the input the case manager needs to have during the rehabilitation, if there

Kirsty Mors is a case manager; or if there isn’t one involved, this blended role can do both until therapy has ended.” And the outcomes speak for themselves - at the end of therapy, less than 10 per cent of Think Therapy 1st clients need ongoing case management or care, and over 80 per cent who were in work prior to injury and are still of working age return to employment. “Part of our approach will be to teach the person to manage their own long-term needs from the injury and this has a lasting impact. Clients can get back to living their life, their way, and know what to do,” says Stephanie. Revised ways of working Kirsty has found that working with Think Therapy 1st has enabled her to sometimes depart from the usual claims process, which involves obtaining medico-legal evidence from independent doctors, a process which clients can find very intrusive. “Whilst I would not advise someone to settle a claim without medico-legal evidence, which enables legal representatives to put an accurate value on a claim, for some clients they find the experience of going through the process too much for them,” says Kirsty. “With Think Therapy 1st’s unique approach, their monthly reports and all parties’ meetings, I have

Stephanie Fleet had the information to be able to identify possible future losses at an early stage without medico-legal evidence. This has enabled me to conclude claims without medico-legal evidence, whilst achieving excellent results for my clients to support them in the future with their ongoing recovery.” Furthermore, through a joint commitment by both Think Therapy 1st and Bond Turner to providing a voice for the client, effective communication and a comprehensive understanding of the process is helping all parties to work together for the best outcome for the client. Think Therapy 1st has developed a monthly update report to serve as the client's voice and provide a transparent and accurate account of the client's rehabilitation journey. The reports include goal attainment updates, progress in clinical measures and an overview of how the client is transferring all learnt strategies from all professions into their daily routine. Through the development of Kirsty and Stephanie working together and keeping the client central to the process at all times, they found opportunities to bring all parties together in regular meetings, which is hailed as being pivotal in enabling legal teams to make decisions and provide instruction. If the case is a joint instruction

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"The goal is to promote autonomy, wellbeing, and engagement in all parts of the person’s life"

under the Rehab Code, then the Insurer or their defendant solicitor will also attend meetings to agree funding and next steps. This can expedite the rehabilitation, progress and recovery of the client and often also brings the litigation to an end much earlier. However, a current pertinent issue in the industry is the question of cost recovery for solicitors attending multi-disciplinary meetings - an issue discussed in the recent case of Hadley v Przybylo [2023] EWHC 1392 (KB) . In this case, the claimant’s legal team argued that that the MDT attendance acted as a ‘live feed’ assisting in progressing the case. The defendant’s legal team argued the attendance at MDT meetings was non progressive. Ultimately, the judge agreed with the defendant. Think Therapy 1st invite both the claimant and defendant legal representatives to their MDT meetings. Attendance at these meetings provides both parties with a transparent insight into any issues as they have the opportunity to ask any specific questions to the treating team. This maximises the benefit to the litigation and supports and open and transparent relationships between the claimant and defendant representatives whereby they can have sensible discussions, for example regarding the necessity of interim payments, which is

clearly beneficial for the claimant. It also allows for a seamless approach to the rehab as funding can be discussed during the meetings. Kirsty is of the belief that attendance at these MDT meetings is beneficial to both parties in terms of the litigation as it enables them to value the claim earlier, and possibly settle earlier which reduces the length of time the injured client goes through the legal process. “Essentially, if the MDT meetings are progressive i.e. the claimant’s representative is not just there to take notes, then there is a good argument that the costs are recoverable,” says Kirsty. “With Think Therapy 1st’s approach to MDT meetings, these costs should be recoverable as the meetings are instrumental in updating and aligning all parties involved, bridging the gap between rehabilitation and the legal arena ensuring a seamless flow of information and collaboration and ultimately the best outcome for the claimant.” Personal approach and client commitment Underpinning everything, agree Kirsty and Stephanie, is the need for a very personal approach in supporting clients to get back to where we want to be. In coming to understand them, who

they are and their lives pre-injury, new levels of insight can be gained into where they want to be. “One recent client had sustained a mild TBI but was immediately back at work and juggling their parental role,” says Stephanie. “On the surface, this client had returned to all the things they wanted and needed to do and felt they had returned to all their roles. Yet, from the amount of effort the client was putting into these two roles, we recognised this stopped them from being able to do any of their other roles, such as social activities and hobbies. “These roles provided the client with downtime - and despite performing well in their employed role, their rest and play time was non-existent - and therefore, the client was not doing everything they were prior to their injury.” As a result, the rehabilitation was devised to focus on them returning to rest and play roles, without impacting on work capabilities. For Kirsty, this kind of very personcentred approach is vital to the whole process. This is what I love about my job; whilst I do not like what has happened to my clients, I enjoy being able to make their life better, in the short term, and also for the long term,” she adds. To find out more, please visit tt1st.co.uk.

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Transforming Rehabilitation: Harnessing the Power of Rehabilitation Technology

n the evolving world of healthcare, rehabilitation technology has emerged as a revolutionary force, reshaping the way we provide care, improve patient outcomes, and empower individuals on their journey to recovery. Rehabilitation technology offers remarkable advantages for both clinicians and patients. In this article, we will explore how rehabilitation technology is revolutionising the field of therapy, bridging the gap between current provision and best practice. Streamlining the rehabilitation processes Impairment in the upper extremity is a common symptom that affects

up to 80% of stroke survivors. The use of high-intensity upper limb exercise is associated with improved upper limb recovery, and stroke survivors need opportunities to participate in intensive exercise programs. A lack of resources and low rates of self-exercise present challenges for both clinicians and patients. Rehabilitation technologies offer a solution to these challenges. GripAble is a rehabilitation platform for rehabilitation of the upper limb, combining gamification with highly sensitive calibration, the device is designed to be accessible to those with weak grip or poor range of movement. The platform offers standardised grip testing as well

as games designed to promote high dose movement repetition along with control and precision of movement. Game parameters can be personalised to an individual's ability ensuring the just right challenge along their rehabilitation journey. GripAble simplifies and streamlines the processes and paperwork related to rehabilitation, enabling clinicians to focus more on patient care. It can help decrease the time that therapists spend on tracking and record keeping through realtime data capture, and report generation. This gives therapists the opportunity to prioritise other crucial aspects of patient well-being which require direct contact. The

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GripAble platform keeps records of all training activities done by a patient during a rehabilitation session, and over time. This supports clinical reasoning (facilitating self management / self directed training) and allows therapists to spend less time keeping those records, and more time engaged with their patients. Remote data-driven insights Recently updated National Clinical Guidelines for Stroke, recommends that stroke survivors should be able to access rehabilitation services as new goals or needs arise. To accomplish this, there is a focus on self-directed therapy, along with telerehabilitation as a means to supporting those who need additional input. Rehabilitation technology can support in this push towards remote and self-directed therapy by providing objective and accurate data This empowers healthcare professionals to collect, analyse, and interpret patient information more effectively and supports ongoing clinical reasoning. Gripable allows continuous monitoring of performance on grip strength and range of movement over time, along with engagement and adherence, supporting clinicians to augment treatment plans and goals accordingly. The ability to remotely monitor and adjust treatment plans based on real-time data can enhance the quality of care through delivering personalised solutions that are both efficient and impactful. The GripAble platform can be used by patients at home so that therapists can track patient progress remotely. This empowers therapists to gather more information about patient progress in the time between appointments. Recent clinical trials show that using GripAble in addition to conventional care increases the amount of repetitions ten fold and doubles the amount of upper limb arm training that stroke survivors engage in.

Gamification: an efficient and accessible tool in rehabilitation technology Gamification is highly effective in rehabilitation because it turns the often-challenging process of therapy into an engaging and enjoyable experience. Rehabilitation technology is able to use data to enhance gamification. By introducing game elements like rewards, challenges, and competition, patients are more motivated to participate actively in their rehabilitation. This increased engagement leads to greater adherence to therapy programs and ultimately, improved rehabilitation outcomes. GripAble offers patients the opportunity to carry out their rehabilitation by playing games. Studies have shown that this

approach helps motivate patients to do more repetitions while training. Serious fun for better recovery with rehabilitation technology The integration of rehabilitation technology into rehabilitation represents a transformative force. It is redefining the landscape of patient care, striking the perfect balance between effective rehabilitation and enjoyable engagement. The future of rehabilitation is here, and it's powered by rehabilitation technology—where serious fun meets the science of recovery. If you are interested in learning more about GripAble and how it can enhance your rehabilitation journey, please get in touch! www.gripable.co hello@gripable.co.

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Neuromuscular electrical stimulation trialled for dysphagia at Elysium Neurological 60

he Bridge Neurological Centre, part of Elysium Neurological, has begun a trial of neuromuscular electrical stimulation for a resident with dysphagia following a family request and numerous investigations on its suitability. The innovative treatment has previously been trialled in UK hospitals with promising results but this is one of the first uses in a residential setting as part of a comprehensive speech and language rehabilitation programme. In this EveryExpert article we speak with Mira Bou Akar, Lead Speech and Language Therapist at The Bridge Neurological Care Centre, in Middlesbrough, who has been leading the introduction of this ground breaking treatment. Mira talks us through how neuromuscular electrical stimulation is being used with Ampcare ESP, what initial progress has been seen and what this may mean for dysphagia treatment in the future.

Traditional dysphagia treatment Dysphagia, the difficulty moving material from the mouth to the stomach, also known as swallowing difficulties, can occur post-stroke, cancer, dementia or progressive neurological disease due to anatomical, physiological and neurological impairments. This is a painful condition, and in some complex cases swallowing is impossible, so there is significant negative impact on physical and mental wellbeing, both for the individuals suffering from dysphagia and their families. Therapeutic care for dysphagia has previously focused on management of symptoms, and rehabilitation of swallow function, with very few alternative treatment innovations yielding positive outcomes for patients. However, in response to the call from NICE 2014 for more robust research in this area, and the issue of the NICE 2018 guidelines, the use of neuromuscular electrical stimulation (NMES) in the

treatment of dysphagia is growing in research interest, clinical trials and clinical practice. Within the UK, clinicians from Sheffield Teaching Hospitals NHS Foundation Trust (2019) led a clinical study testing the efficacy of NMES using the Ampcare Effective Swallowing Programme (Ampcare ESP). In the study, (Martindale N, Stephenson J, Pownall S. (2019)) patients who experienced dysphagia with reduced laryngeal elevation completed a therapy program using NMES. Although further research is needed, the findings suggested that NMES was successful in reducing impairment in a subset of patients with dysphagia resulting from stroke and non-stroke aetiology. NMES at The Bridge Although the growing interest into the use of NMES means that it has become more common place within acute setting clinical practice, it is still not yet widely used within residential rehabilitation settings.

"This is a painful condition and, in some complex cases, swallowing is impossible, so there is significant negative impact on physical and mental wellbeing" 61

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There are varied reasons for this, such as lack of awareness, training and/or resources. Mira Bou Akar explains the remarkable way that NMES came to be trialled in a rehabilitation programme for the first time at The Bridge Neurological Care Centre. Mira explains: “Ampcare ESP was initially suggested by the family of one of our residents who has a complex aetiology and has had dysphagia for at least five years. When this individual arrived at The Bridge he began a comprehensive dysphagia programme with regular sessions, trialling different approaches and we worked closely with the family to understand his history and what might work best for him. “It was very important for us to work with the family, and gather extensive medical history from previous placements because there were many different factors to consider with this particular individual. For example, he has a history of cancer and radiation treatment, he also experienced a stroke and didn’t use his muscles for swallowing for

certain periods so functionality was lost. Plus, he has been on limited rehabilitation programmes at other services with no functional improvement for his swallow. We needed a bespoke solution for him and regularly explored other therapeutic approaches, as part of those discussions, the family suggested the possibility of Ampcare. "There's still a lot of research and audits needed on NMES to see how beneficial it is for different aetiology and patients especially in complex rehabilitation settings, and we, of course, must follow the national guidelines, but it is a therapy that shows great promise so I wanted to trial it.” Ampcare Effective Swallowing Programme Ampcare ESP was developed in the United States by a team of expert physiotherapists and speech and language therapists. It’s noninvasive and combines electrical stimulation parameters with resistive exercises. The programme

uses a dual-channel electrotherapy system with a pair of electrodes, placed submentally in order to stimulate the supralaryngeal muscles and/or with a facial placement to address oral deficits. Electrical stimulation is used in combination with simultaneous oral and/or laryngeal exercises, with the intended outcome of improved quality of muscle contraction and swallowing function. Mira Bou Akar undertook specialist training to be able to use Ampcare ESP as part of a rehabilitation programme and explains what that process was like. Mira says: “We wanted to trial the treatment as soon as possible so we chose the training that would enable that to happening – an online course with different modules, each one concludes with an exam and then certification, followed by a virtual meeting with Ampcare ESP US team. It’s a comprehensive course, you of course need to understand the product and how it works, you need to know your anatomy and where to place the electrodes.

“Most importantly you need to know the reasoning behind what you're doing so you can know how to amend the exercises and adjust it. It doesn’t suit all patients so you need to be able to personal the process and understand possible contraindications and how to best use it for the individuals you are treating.” Individually tailored sessions At the time of talking with EveryExpert, Mira had successfully completed five therapy sessions with Ampcare ESP. She explains how each session is a combination of NMES and traditional speech and language exercises according to the individual’s ability. Mira explains: “Ampcare ESP are 30 minute sessions of stimulation, and within that there are on and off times. During the ‘on’ times we use the machine to electrically target and stimulate the muscles. We started with submental placement of the electrodes initially and then introduced the facial placement as Ampcare ESP was well tolerated by the patient. Electrode placements and wiring were decided based upon our speech therapy assessments, with careful consideration of which side or muscles were weaker/stronger, and our therapy goals. “During the ‘off’ times, the muscles have a break from the electrical stimulation, but I still try to stimulate the patient’s swallow. This is tailored to the individual and their swallowing abilities and safety levels. Sometimes we use tasters to help with the swallows, to increase saliva production. “So the sessions are a combination between the stimulation of the device and speech and language exercises according to the patient's needs – and we adjust this according to the individual’s responses, tolerance and results obtained. The sessions were also scheduled around the patient’s needs, preferences, any visits/outings that he had planned and took into consideration his fatigue levels, other care or therapeutic interventions and the best times for optimal engagement. “A well-tailored exercise programme

was also formulated to complement the Ampcare therapy that the patient completes on his own, or with his family or other team members.” Collecting therapy data Mira and the Speech and Language service at The Bridge are one of the first services in the UK to be trialling Ampcare ESP and are collecting data from their therapy sessions. Mira has liaised with Sue Pownall and members of her team at Sheffield Teaching Hospitals NHS Foundation Trust who led their clinical trials and has been at the forefront of NMES research in the UK. Mira explains why it is important to collect data from her work. Mira says: “Research about Ampcare ESP and NMES is still being conducted, especially within a complex residential setting so all data from therapy is useful so that we can understand which patients respond well to treatment and why. I am implementing the adapted NICE clinical audit tool to Ampcare ESP within my therapeutic work. I collect baseline data for the patient, then after the treatment, plus I assess whether there were any risks using it. “I record the Ampcare parameters each session and outcome measures are gathered using varied instrumental and bedside dysphagia assessments, patient questionnaires plus qualitative and quantitative scales. I also review the patient’s and his family’s views on therapy progression as this feeds onto their quality of life. In addition, the patient’s tolerance, compliance and motivation is also recorded. During the Ampcare session, the patient’s vital signs including their oxygen levels are closely monitored along with any signs of discomfort, skin irritation, etc.” Future plans for NMES With initial positive results from the use of Ampcare, Mira is optimistic about its future use at the service. Mira says: “Well of course we need to see how it goes with this patient in particular, and we must take everything on a case by case basis, but I’m very optimistic about future use.

"I’m very excited to try it with other residents, where appropriate, to see how we can help them" The individuals we support at The Bridge have complex needs, complex aetiologies and a lot of comorbidities, so we need to know more about NMES and its impact longer term with complex patients before we can say anything more definitive. But in general I do have high hopes for NMES, because we're triggering varied muscles needed during a swallow function combined with rehabilitation exercises and program. It’s very targeted. “What is also good about Ampcare is that if you stimulate a muscle, because of the anatomical structure and swallow kinematics, it could pull other structures with it. The hyoid range of movement during Ampcare stimulation, for example, could impact tongue position. “I’m very excited to try it with other residents, where appropriate, to see how we can help them. Other speech and language therapists can also participate in the training and the therapy can be rolled out more widely, which I’m hopefully with benefit more individuals with dysphagia and their families. My hope for the future is to be able, with the audits and data collected at The Bridge, to contribute to the ongoing research for NMES.” Get the latest insights, blogs and news from Elysium Neurological over on their EveryExpert thought leadership hub: elysiumhealthcare. co.uk/neurological/every-expert/

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Legal 500 confirms Slater and Gordon as national leaders

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egal specialists at Slater and Gordon have been hailed as leaders in their field nationally by Legal 500, in recognition of the outcomes they secure for clients and the dedication they show in supporting them throughout the claim process. Slater and Gordon is again named as an eminent name in serious injury and clinical negligence work, with its team winning praise for their legal capability alongside the quality of service they deliver to clients. Legal 500 is an annual publication which ranks lawyers and law firms based on feedback from clients and professional peers, as well as analysis of the cases they work on and outcomes they secure. Slater and Gordon works nationally to support clients, and continues to grow through the expansion of its office network and strategic additions to its team to develop its service even further. Madelene Holdsworth, managing director of Slater and Gordon who herself was named as a key individual for her work in military claims - said: “Slater and Gordon’s standings in the Legal 500 are a testament to our exceptional lawyers and their hard work and dedication. “It is a privilege to represent our clients and we are so pleased to see so many of our teams and experts recognised by the guide.” SERIOUS INJURY Slater and Gordon is a stand-out name in the field of life-changing injury, acting in a wide breadth of cases, from highly specialist brain and spinal injury claims through to major high profile work such as acting for 11 families who suffered bereavement in the Manchester Arena bomb. Its capability in the most high value, complex work is repeatedly highlighted, with stand-out cases including a highly complex claim on liability involving an individual who

Tracey Benson

John Davis

sustained a series of rugby injuries over the course of two months, which eventually led to a catastrophic brain injury on the pitch. Legal 500 cites the team throughout Slater and Gordon’s national network as being “excellent…really easy to work with. They are friendly, down to earth and provide clear instructions”. Among the many key names in the law firm’s team are some of its leading individuals and rising stars. John Davis, a leading name in neurotrauma with more than 40 years’ experience of brain and spinal injury claims who is based in Newcastle, is named in the Legal 500 Hall of Fame in recognition of his longstanding and consistently high quality impact in this very specialist field of work. Angela Beric is named as a leading individual for her work in brain injury claims. Based in Cambridge, Angela is hailed by Legal 500 as being “a very experienced and competent litigator with much experience of claims of the utmost severity”. Head of serious injury in the South region, Tracey Benson, is cited as “a first-class lawyer; she combines technical prowess with passion and fights tooth and nail for her clients.

She regularly instructs on maximum severity cases and knows the pitfalls to avoid in order to achieve a significant outcome”. Kate Nicklin, already an established name in neurotrauma work in the North of England, is named as a rising star for her support of clients. Crystal Eaton is also named as a rising star, for her “huge commitment” to her clients’ cases throughout the duration of the claim. “She has an excellent manner with those who have suffered serious injury and makes complex concepts easy to understand. Clients really feel that their voices are being heard,” says Legal 500. “She is very pragmatic and organised on obtaining appropriate expert evidence. She is able to manage expectations whilst also achieving the best result for clients.” CLINICAL NEGLIGENCE Slater and Gordon builds further on its reputation in this area of work with yet more outstanding rankings and citations in the latest edition of Legal 500. The team, which works nationally, is highlighted for its ability to “work well l together and ensure that the client

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Emma Doughty is extremely well served”. There are a high number of “highly experienced and skilled individuals, who work together for the collective good. They are impressive in the number of high value and complex cases they attract,” says Legal 500. Further, it adds of the clinical negligence team: “Slater and Gordon are extremely well resourced and extremely professional. They listen carefully to clients and provide very sound tactical advice.” Lawyers across the practice area are recommended for their capability, with a number of both leading individuals and rising stars singled out for praise. Emma Doughty, based in London and national head of clinical negligence at Slater and Gordon, is named as a leader in her field and hailed as “a supremely talented lawyer. She has an impressive grasp of detail and a powerful intellect. “She is a trusted, effective and hardworking senior partner who is great at getting the right experts and in keeping the client at the forefront of her thinking”. Ben Gent, a key name in clinical negligence in the North of England, is also named as a leading individual and is praised for his “strong record” in litigation. He is “an excellent

Ben Gent

Slater and Gordon is a stand-out name in the field of life-changing injury, acting in a wide breadth of cases

Yvonne Agnew practitioner,” says Legal 500, “who brings sound judgement and realism to his work. “He cannot do enough for clients but has a clear understanding of when a claim should be pursued, and when it should be settled.” Yvonne Agnew, similarly a leading individual, is hailed as being “one of the foremost UK experts in birth injury cases”. Among Slater and Gordon’s rising stars in this area are Lara Bennett and Kelly Lloyd-Davies. Lara is praised as a “dedicated and skilful claimant lawyer” and Kelly wins recognition as being “a true claimant’s lawyer. She has a solid grasp of the issues in each case and can communicate complex issues to lay clients clearly and gently”. The recently-opened Newcastle office is also highlighted as ‘one to watch’ in this area of work, with the base building further on its longstanding reputation in the North East to be a local go-to advisor for claimants. To find out more, please visit slatergordon.co.uk.

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Totus Neurorehabilitation: Transforming lives and futures 68

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otus Neurorehabilitation was founded by Clinical Neuropsychologists Dr. Claire Bazen-Peters and Dr. Emma Hale on a dog walk in 2019. They reflected on how in the ever-evolving field of healthcare, one resounding truth remains constant: collaboration yields the most promising outcomes. Nowhere is this truer than in the realm of neurorehabilitation, where clients and their families face such daunting challenges. Claire and Emma envisioned a rehabilitation service that would break down the silos, unite expert practitioners from various disciplines, and prioritise the well-being of not only patients and their support networks, but also the dedicated professionals who support them. The Totus team have embarked on a mission fuelled by compassion and a keen understanding of the existing approaches and evidence base in neurorehabilitation. Since their founding, they have grown to a team of nearly 40 practitioners and span across the South West, and South Coast of England and Wales. The Totus Approach: Interdisciplinary Synergy At the heart of Totus Neurorehabilitation is the belief that rehabilitation is a collective effort and, therefore, that truly individualised rehabilitation requires a carefully curated team of practitioners that combine different specialisms in Neuropsychology, Occupational Therapy, Physiotherapy, Speech and Language Therapy and Dietetics. This joined-up service, although utilised within the NHS for decades, is somewhat inconsistent in the private sector. The Totus model of interdisciplinary working is effective, clear and efficient, it fosters wellbeing of the client and their support network, and research shows this approach delivers better rehabilitation outcomes. Claire and Emma passionately believe that client involvement is paramount and that the greatest resource for rehabilitation is the client themselves. A key focus in their approach is the

importance placed on clear, client led, goal setting, spanning across disciplines. This enables clear markers of progress for the client, but also for funders to access and evaluate. The merits of true interdisciplinary rehabilitation are manifold and underscore the mission of Totus Neurorehabilitation: 1. Holistic care: Brain injuries often have multifaceted consequences, affecting cognitive, physical, social, and emotional domains. The Totus team can holistically address these challenges collaboratively. 2. Improved outcomes: Interdisciplinary collaboration means that experts continuously share insights and optimise their input. Research evidence suggests this promotes better outcomes for the client. 3. Customised rehabilitation plans: Each client and their family are unique, and their rehabilitation journey should reflect that. Interdisciplinary teams can tailor treatment plans to the individual, offering a more effective and personalised approach. 4. Efficiency: Having a fully integrated team within one service limits the potential for duplication providing a cost saving benefit. 5. Sustainability: A crucial objective is for the rehabilitation supplied by Totus to be sustainable. That is, that treatment plans cater for long term need and not just short term outcomes. Claire and Emma emphasise the need for constant professional development and learning. Regular CPD for the team is provided and networks of peer supervision groups have been established to ensure up to date research and approaches inform the rehabilitation provided. Totus Neurorehabilitation's approach

is a statement to the potential that emerges when professionals from various fields unite with a common purpose. Their approach, founded on compassion and rooted in evidence based practice, serves as a beacon of hope for individuals and families navigating the challenging terrain of brain injury rehabilitation. Through recognising the value of interdisciplinary rehabilitation, legal professionals specialising in personal injury cases and case managers entrusted with patient affairs can ensure their clients receive neurorehabilitation that is multifaceted, coordinated and tailored to need. For any enquiries, contact info@ totusrehab.co.uk

A Client’s View – Simon E The initial main challenge was accepting I had had a brain injury. The physical challenges were hard to ignore, but I’d had no previous experience of a brain injury. All I knew were the words people were telling me. It inherently terrified me. After leaving hospital I thought “they’ve got this wrong”, I was in complete denial. There was a delay in starting my rehabilitation, and I was hugely sceptical. I understood what a Physiotherapist could do for me, I understood what an Occupational Therapist could do for me, but I thought “what on earth can a psychologist do for me?!” But six months on and the psychology sessions have had the most significant impact. I began to realise that not all my symptoms could be attributed to the physical injuries, accepting the brain injury helped me to start to make sense of it all. I remember the impact of those initial conversations, there was a lessening of fear. I gradually began to see that my life is different, but that doesn’t have to mean it is worse than it was. The sessions have helped me to understand myself and the impact of my injury, and what I can do to help myself.

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The role of speech and language therapy in unlocking new levels of mental health support

Through adoption of specialist SLT in a mental health setting, significant improvements can be made to behaviours which challenge, and a new understanding of these can be gained by both the patient and clinical team. Kim Ferrari, Lead Speech and Language Therapist at St Andrew’s Healthcare, discusses how the team’s innovative approach is delivering results While Speech and Language Therapy (SLT) is widely used and recognised in brain injury rehabilitation, in the very specialist

field of mental health work, its adoption remains more limited. But with statistics showing that around 80 per cent of people in mental health services live with some form of language impairment - and around 30 per cent also have difficulties with their swallow - SLT has vast potential in helping to support this population. Using SLT to engage with people with a mental health diagnosis in ways that are accessible and appropriate makes the multidisciplinary approach much more effective in helping to recognise and understand behaviours that

challenge and find a way forward. At St Andrew’s, SLT is integral to its specialist MDT approach. The mental health charity, based in Northampton, supports people with complex mental health difficulties to overcome their challenges and work towards living as independently as possible. And through the introduction of an innovative new approach to SLT, St Andrew’s is supporting patients to make new levels of progress. “As speech and language therapists, we’re uniquely trained to be able to identify communication needs and to be able to support people with

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communication difficulties to be actively involved in their care and treatment,” says Kim Ferrari, Lead SLT at St Andrew’s. “At St Andrew’s, we see a lot of behaviours that challenge - but we view behaviour as a form of communication. So, if a person can’t communicate through language, they tend to try to convey their message through behaviours. “By having SLT as part of the MDT here, we can help to unlock different ways for people to be able to communicate that isn’t going to cause harm to themselves or others - and we are seeing some positive progress in terms of achieving that.” The importance of SLT in mental health settings The use of SLT for people with a mental health diagnosis remains much less widely used than in a typical neuro setting, although its adoption is increasing. But at St Andrew’s, its use is longstanding, and the vital role it can play in delivering new levels of support to patients is something its therapy team are well versed in. “SLT in mental health is still quite a new concept, but there are clear links between speech, language and communication needs and mental health, which are complex and bi-directional,” says Kim. “People who have communication needs are more likely to experience mental health difficulties; but equally, people with mental health conditions are more likely to present with communication needs. “So we've got it working both ways, where our patients have either got a history of struggling to communicate, and maybe it has not been flagged at an earlier stage in life, leading to feelings of frustration if they can't express their emotions to other people, which has then led to mental health difficulties as a result. Or we've got people with diagnoses like schizophrenia, depression, anxiety, and all of these come with their own communication challenges.”

Many mental health therapies are delivered via verbal means, commonly known as ‘talking therapies’ - but in the delivery of this, naturally those impacted by a difficulty to communicate will struggle to engage effectively or may even be excluded. “If we look at the level of people in mental health services with some form of language impairment, it’s about 80 per cent, then it is going to affect their ability to engage in that therapy. This is then going to affect their ability to work along a rehab pathway,” says Kim. “You have a higher risk of readmissions if individuals haven’t engaged in therapy effectively - so it’s really important that we look at ways of providing therapy for people with communication needs in a way

The use of SLT for people with a mental health diagnosis remains much less widely used than in a typical neuro setting that is accessible, to enable them to effectively access the support and services, which will support their recovery.” Among the root causes for mental health issues is trauma, with people who have had a traumatic background from a young age often finding themselves in specialist settings in later life. Kim believes these circumstances should also be considered in the delivery of SLT, through the use of a traumainformed approach to therapy delivery. “We know that experiencing trauma from a really young age can affect how the brain develops, specifically in regions that are responsible for executive functioning, emotional regulation, and the ability to

process language,” says Kim. “While these individuals are not classed as having a brain injury, they have seen alterations to their brain development based on their history. “We do need more research in this area to advance our understanding, but trauma is another area in which we, as speech and language therapists, can support people to recognise their own communication profiles and provide them with new ways to communicate to the best of their ability, in an environment that creates safe opportunities to express themselves effectively.” Swallowing problems can also be acute in mental health settings, and is an area where SLT is key in the MDT’s clinical approach. “With around 30 per cent of the mental health population having difficulty swallowing as well, that is another role of SLT,” says Kim. “A lot of the medication people take for mental health conditions can affect the swallow mechanisms, and we also see behaviours around mealtimes that can increase the risk of choking. So SLTs are needed in mental health settings to be able to intervene in this area as well.” Adopting a life-changing new approach As a specialist mental health setting which can trace its roots back to 1838, when St Andrew’s opened as a hospital to offer ‘humane’ care to the mentally ill, the charity is always keen to find new ways to support its patients, and often leads the very latest in research and innovative approaches to support that. St Andrew’s is now helping to deliver new levels of specialist SLT support through doing things differently. The adoption of an arousal curve approach, which can help both patients and clinicians better understand how a patient’s level of mood and emotional arousal impacts on language, is having significant results.

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Building on a model by Dave Hewett which has been more widely used as a teaching method, the introduction of the arousal curve as a therapeutic tool is helping to get to the root of patterns around behaviours that challenge and changes to an individual’s language ability, informing the wider MDT with new ways of supporting people and ensuring the patients themselves know why their communication skills can vary so dramatically. “When we think of high arousal states, for example, if people are in a high stress situation, the brain floods with the stress hormone cortisol. This slows down neural connectivity, and therefore has an effect on how your brain is functioning. It can take 48 hours for the brain chemistry to return to normal.” says Kim. “Everyone has an optimal communication window, where we can communicate as we typically would when feeling calm and safe. As arousal levels increase and more cortisol enters our system, we leave this optimal communication window and we find that language processing is negatively affected as a result. “So by adopting a new therapeutic approach, we aim to highlight that when a person is still in their optimal

communication window, staff can be using verbal de-escalation skills, but if this is not implemented early enough and we see someone getting to a crisis point, it’s important for people to recognise that the individual is no longer able to communicate in the same way - they're not able to engage in those sorts of de-escalation conversations, they can’t process high level questions. “Using the arousal curve is enabling Speech and Language Therapy to take a more holistic look at the patient’s communication skills. We’re not just looking at them at a snapshot in time during one formal assessment - it enables us to look over a period of time and really try to build up a solid profile of the people we’re working with. “We work on these arousal curves directly with patients, as well as staff. It gives the patient a chance to take a step back and think maybe about a particular incident that has happened, and to break down how they were feeling at each stage, how they were communicating and how this changed over time. It can be confusing, so breaking it down can help to make more sense of it all. “We then encourage patients to think about how they want staff to

communicate with them at various stages of an incident, particularly at times when their processing is affected. Some people say that when they are showing signs of hyper arousal, for example, they do not want staff to repeat what they are saying, as it leads to too much information to process.” “By engaging in this way, and implementing changes based on what the patient suggests, we can reduce the risk of people getting to a crisis point, because we can recognise the signs and symptoms earlier as their communication starts to change. Or it can be used on reflection, as staff can think back about what happened and what could have been implemented to give more effective support earlier.” In the case of many patients at St Andrew’s, the arousal curve has enabled a better understanding of their communication profile. Whilst people in the mental health divisions may score quite highly on standard language assessments, many reflected that the assessment results did not reflect their abilities during challenging situations. Answering questions, remembering verbal information, expressing emotions and asking for help are some of the most frequently described skills that people can do well day to day but struggle with during a crisis. “So by using the arousal curve, it has given many patients an explanation as to why these changes might be happening and why they struggle to communicate at certain times and not others. It’s often something that hasn’t been identified for them before despite happening since childhood.” Incorporating the arousal curve into the therapeutic approach is a new initiative which is showing the opportunity for enhanced outcomes for patients and it is also proving valuable for staff in their ongoing learning.

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"Even if students do not move into a specialist mental health setting, a greater awareness of the speech, language and communication needs of those with mental health challenges can be invaluable in their career"

“As well as the positive impact on patients, we are using it as a teaching tool for staff, to show how communications might change over time,” says Kim. “Currently it is clinician-led, but longer-term, there is definitely scope to get partners in care involved. We try to make everything as personcentred as possible here, so we are looking at the potential for bringing in families and carers outside of St Andrew’s. “Longer term, I think there could be really significant potential for this.” Widening knowledge and best practice With a longstanding specialism in mental health, the team at St Andrew’s are committed to sharing their knowledge and skills wherever possible - particularly in the field of SLT, where mental health is not always as widely known and understood. “When I think back to being at university, we had very little teaching on mental health,” says Kim. “A lot of teaching is much more geared towards working with

children in schools or working in acute hospital settings. So newlyqualified speech and language therapists may well have very limited understanding or experience of specialist mental health work. “That is something we want to change, and a big part of what we're trying to do at St Andrews is to create student placement opportunities, so students can learn more about working in mental health. We’re trying to promote it as an area people can come straight out of university into. “It can seem very scary for some people, because it’s different and unknown, but we want to share our knowledge and open it up so students can get the experience so it’s not so intimidating. It’s an area of SLT where they can make a big difference.” Even if students do not move into a specialist mental health setting, a greater awareness of the speech, language and communication needs of those with mental health challenges can be invaluable in their career, says Kim. “We hope that on our placement

students can take their learning back to their universities and share more widely,” says Kim, who began her own career in SLT as a newlyqualified therapist at St Andrew’s. “And ultimately in their career, they may work in a stroke unit, for example - but someone could be admitted who has a mental health history. The skills they learned on placement here mean they can tap into them further down the line and use that learning with patients elsewhere. I think having that knowledge is valuable, regardless of where they end up working. “A trauma-informed approach is also something we hope our students will learn from us. If we can help embed that as part of everyday practice, then wherever they go afterwards, they can be utilising these skills so that the terms ‘patient-centred’ and ‘compassionate care’ aren’t just buzzwords - they’re actually used, and made more tangible in order to deliver the best possible care to the patient.”

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Redefining care - creating the conditions to help plug the workforce gap The workforce crisis in social care is putting huge pressure on the delivery of life-changing provision nationally - but through employers taking a positive approach to recruitment and retention, the foundations of change can be laid. Cecily Lalloo, MD of Embrace HR, independent HR specialists in private care sector support, discusses some steps organisations can take to address this. The challenges facing social care and its workforce are well-documented, but sadly they continue to grow. We are now at a stage where, in a sector which employs around 1.4million people, we are seeing a staff turnover rate of around 30 per cent. Currently, there are at least 150,000 vacancies. That is very troubling, and cannot ensure the quality or indeed quantity of care that so many people depend on across the country for the longterm. Yet against the backdrop of this workforce crisis, we do see many examples of very good practice by care operators, who are supporting their staff in their development and are investing in their wellbeing in what is a role very prone to burnout. As the sponsor of the Care Provider of the Year category of the NR Times Awards, I was privileged to judge entries from care operators nationally - and I was greatly encouraged by

the many examples of employers delivering the support their workers need and deserve. To see organisations taking a stand against the recruitment crisis, and helping to deliver solutions, is excellent. But for so many others, this appears a monumental task, and one where they are struggling to deliver the service clients need amidst the pressure on their resources. While by no means definitive measures, there are a number of areas employers can consider as they look at their staff recruitment, and particularly retention, in ensuring they are building careers for people for the long-term, and making working in social care a role they want to remain in. Here are some points for employers to consider: Create a positive recruitment process Bringing new people into your organisation, whether large or small, is a huge step to take, so decide what matters to you. Most likely their values and behaviours are very important, and must align with those you have as an organisation or even as a family for those who employ in their homes. Offer the opportunity to learn more about the role, perhaps by offering taster sessions or assessment days. Show that care presents an opportunity to develop social skills and positive interaction with clients and families, while benefitting from good working conditions.

Show the ethos of your operation from their first interaction with you, with visible leadership and structures in place for them to see the support that will be in place, alongside a path of development should they choose to pursue it. Communicate with applicants throughout the recruitment process, to build a positive relationship from the earliest stages and give information on timeframes and what they can expect. This will help to build a good impression of you as an employer and that each employee matters. Understand your workforce By getting to know your team and their needs, you are helping to foster a positive workplace culture, geared around those on the frontline whose roles are often very challenging. Encourage honest and open dialogue to get to the root of what staff want or need, as individuals and as teams. By developing this trust with workers, and offering opportunities to develop skills and interests, this can help to build loyalty. By getting to know individual employees and demonstrating they are important to you, this can help identify when they are feeling unsettled or unhappy. Consider holding feedback sessions or opportunities where staff can share their thoughts - it is important these are listened to and given due consideration.

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A career in social care, while undoubtedly rewarding, can come with huge demands and challenges for an individual

Of course people do leave and move on, but it can greatly help future recruitment and retention efforts if you can understand why that is. A leaver survey or exit interview can be important and can help to inform future approaches. Make wellbeing a priority A career in social care, while undoubtedly rewarding, can come with huge demands and challenges for an individual. Burnout is very common and support can be all too often absent. By creating a culture of wellbeing within your organisation, this can help prevent sickness absence and improve retention rates significantly. The mental and physical health of staff being tasked with delivering often life-changing care is paramount to them being able to do these vital roles effectively. Developing policies covering stress, burnout, workload and sickness which are the shared responsibility of HR, senior leaders and line managers - can be transformational for an organisation. It is very important that leaders in an organisation are visible, and there are clear lines of communication for an employee if they face challenges. By making time and space for them to talk and share what they face whether personal or professional problems - this can benefit their wellbeing enormously. By showing concern for your staff and the inevitably long hours they are facing, this will also help to demonstrate positive practices. Encourage employees to use benefits

and entitlements like annual leave for rest and recuperation, and help guard against potential issues before they arise. Offer careers rather than jobs Often, care is not regarded as a professional role, and as a job rather than a career. But this is entirely wrong, and care can be a very fulfilling, long-term career - indeed it is for many people across the country. Perceptions, however, are frequently rather more negative. By investing in staff training and development, this can help to lay the foundations for longevity. By giving the opportunity for employees to gain qualifications and accreditations, embarking on training to continually upskill them in the delivery of their role, this will create an ongoing desire to learn. Often, funding can be available for such opportunities. Development of clear career pathways are also vital to this. By demonstrating a route for progression and the setting of goals, employees will feel part of the organisation and invested in its future. While progression may look different for each person, the offer of flexible learning and development opportunities means they can get involved whatever their circumstances. Offering staff the opportunity to develop into other roles will assist retention - perhaps they are a care worker and may be interested in a team leader role or a role within a therapy team. Developing staff will also help to establish a longterm plan for individual people and teams, giving more certainty to your

future planning and provision. Recognise and reward Showing staff they are appreciated is crucial in retention. Care can be a difficult sector to work in, without question; but celebrating and recognising the achievement of those working within it can make a huge difference. Whether that takes the form of verbal or written praise, awards, bonus or financial or gift incentives, will depend on the organisation - but to have channels of appreciation in place is very important, for those working throughout the business. Sharing stories of excellent work or outstanding commitment with the wider world can also be important. Whether that is on social media or your own website, or through an external forum such as NR Times, publicly showing appreciation can be very important for the individuals involved, but can also reflect well on you as an organisation. Remember to ensure that people are comfortable with their stories or photos being shared. While the problems in recruitment and retention will not be solved overnight, and there is a long road ahead, by making positive steps to make workers feel valued in careers where they can develop and progress, we can make change that will benefit the sector today and into the years ahead. To discuss recruitment and retention policies and approaches in greater detail, contact the team at Embrace HR via www.embracehr.co.uk

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Introducing the MetaMotus™ Galileo The pioneering device is the latest innovation from Fourier Intelligence, bringing together rehabilitation with robotics to help advance the next generation of neuro-rehab even further. NR Times learns more

he MetaMotus™ Galileo, unveiled at RehabWeek 2023, is a biomechanics analysis and rehabilitation platform, which integrates both virtual reality (VR) and robotics. The Galileo system aims to be the most advanced rehabilitation system by integrating a 6-DoF Stewart platform, 6-component force plate, LED curved screen, dual-belt treadmill, dynamic weight support, motion capture system, rehabilitation robotics, exercise therapy equipment and humancomputer interaction software. It supports humanoid robot training, testing and assessment by creating a diverse yet controlled environment, both for rehabilitation and for research. Zen Koh, co-founder and global CEO of Fourier Intelligence, hailed the platform as a key step in its ongoing mission to change patients’ lives

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"The Galileo system represents our dedication to crafting a state-of-theart rehabilitation solution"

and outcomes through rehabilitation technology. “The MetaMotus™ Galileo stands as a testament to our unwavering commitment to the relentless pursuit of research, refinement, and innovation in the realm of healthcare platforms and devices, all dedicated to enhancing the wellbeing of our patients,” he said. “In line with our overarching vision of fostering an integrated rehabilitation ecosystem driven by cutting-edge technologies, we are propelling the evolution of Rehab 4.0. “The Galileo system represents our dedication to crafting a state-ofthe-art rehabilitation solution that empowers training, testing, and assessment within an inclusive, secure, and meticulously controlled environment."

which affect these experiences (and whether these factors are facilitators or barriers). The MetaMotus™ Galileo was developed to focus on the functionality of a person as a member of society, considering the functionality of an individual when performing their daily tasks. With its patient assessment capabilities, it can train patients for real-life scenarios. Helping them regain full independence upon leaving the healthcare facility and achieve functional independence, allowing them to reintegrate into society after life-changing injury or illness. Through the Galileo X Control &

Data Acquisition Hub, therapists and healthcare providers can assess and train patients' walking stability, posture, speed, and endurance using cutting-edge technologies such as the builtin 6-component force plates, motion capture, surface EMG, and telemetry electrocardiography. The MetaMotus™ Galileo also aims to provide full spectrum rehab training from early to later stages, allowing wheelchair, balance, and walking training. For more advanced users, multitasking and anti-interference training is available. To find out more, visit fourierintelligence.com.

ICF (International Classification of Functioning) in Rehabilitation with MetaMotus™ Galileo In the ICF, functioning and disability are multi-dimensional concepts relating to: the body functions and structures of people, and impairments the activities of people (functioning at the level of the individual) and the activity limitations they experience the participation or involvement of people in all areas of life and the participation restrictions they experience (functioning of a person as a member of society) the environmental factors

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STEPS Rehabilitation travel to Singapore to present at the 2023 leading global rehabilitation conference Representatives from STEPS Rehabilitation and STEPS Prosthetics travelled to Singapore at the end of September to attend and present at the world’s leading rehabilitation conference - ‘Rehab Week’. The weeklong biennial event, which launched in 2011 and moves location around the globe, attracts thousands of delegates and speakers. RehabWeek brings together engineers, clinical researchers, practicing clinicians and industry representatives to facilitate knowledge sharing across different disciplines to optimise the future development of technology in healthcare. It’s an opportunity to

showcase inspirational innovations in the field of neurorehabilitation and share the groundbreaking advancements in both clinical practice and technology that help transform the lives of individuals affected by lifechanging injury and illness. History of RehabWeek The IEEE International Conference on Rehabilitation Robotics (ICORR), the International Neurorehabilitation Symposium (INRS) and the International Conference on Virtual Rehabilitation (ICVR) joined forces in 2011 to launch the first Rehab Week. It took place in Zurich, Switzerland

and attracted over 650 attendees from all over the world. Since then, it has grown to become the largest flagship global rehabilitation conference of its kind, and the 2023 Rehab Week was the 7th such event. 2023 RehabWeek The programme for the week contained keynote lectures, presentations, workshops, poster sessions and panel discussions from internationally renowned speakers. The multidisciplinary approach to this conference was reflected in the programme with sessions delivered by physicians, therapists, rehabilitation

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engineers and neuroscientists. This year’s conference addressed the challenges and opportunities faced in the changing landscape of neurorehabilitation. Delegates were offered insights into the ongoing expansion of innovation and were presented with a comprehensive view of the challenges faced by healthcare providers and engineers in the postpandemic era. “One key issue that the organisers addressed was the lack of communication between those designing and building devices and those using them with patients” commented Jules Shiel-Boulger, one of STEPS Rehabilitation’s Founding Directors who attended the conference. “The most successful innovations are those driven by the need of the patients and their clinicians. RehabWeek provides a fantastic platform for all those working in the area of rehabilitation to come

together to exchange ideas, receive feedback, present and build new relationships.” The STEPS Workshop Fellow STEPS Rehabilitation Founding and Clinical Director, Toria Chan, along with Lucy Greensmith, Specialist Rehabilitation Occupational Therapist, and Kostas Falidas, Specialist Rehabilitation Physiotherapist delivered an engaging and interactive workshop, showcasing and demonstrating how advancing technologies compliment clinical practice in specialist residential facilities. The team also provided a comprehensive explanation of STEPS’ practical applications and protocol development. During the workshop, delegates had the opportunity to experience some of the Fourier Intelligence, and MindMaze technology. The session featured demonstrations of innovative devices, including

"The most successful innovations are those driven by the need of the patients and their clinicians"

the ExoMotus™, ArmMotus EMU™, MindMotion GO, Intento PRO and Izar. During the workshop, Colette Shaw, Founder and Prosthetist at STEPS Prosthetics demonstrated some of the latest commercially available upper limb prosthetic technology, including the pattern recognition control system from Coapt and a multi-grip powered hand from Taska Prosthetics.

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During her week in Singapore, Colette also had the opportunity to attend prosthetic focussed workshops and presentations from some of the world’s leading engineers, scientists, and manufacturers. “It was great to get a glimpse into the future direction of commercially available prosthetics including bidirectional control of bionic limbs, artificial intelligence and sensory feedback.” Lucy Greensmith, Specialist Rehabilitation Occupational Therapist: “RehabWeek 2023 provided me with a unique opportunity to directly feedback to engineers about what I am looking for in technology to help my clients. "The workshops were hugely practical, and I was able to work with new FES (Functional electrical stimulation) and trial technologies as well as. STEPS having the opportunity to share how we use technology and how adapt it to meet the needs of our clients. "One of my favourite sessions attended was the fireside discussion which brought together key players from industry to discuss alongside

"It was great to reconnect with colleagues I’d met at previous RehabWeeks to strengthen relationships and collaborations"

academics, clinical practitioners and most importantly patients about bridging the gap." Kostas Falidas, Specialist Rehabilitation Physiotherapist: “The final day was spent visiting the local healthcare institutions in Singapore, including the newly built Rehabilitation Research Institute of Singapore; which was a great opportunity to see how technology is very much inbuilt to nursing care homes and the community hospitals,

and how closely the research institute works alongside expert clinicians with technology development and evaluation. "A holistic healthcare approach is also key in Singapore, with building design focussed on incorporating the outside inside. "The community hospitals unique design ensures every patient has a window to enable views of the beautiful greenery surrounding the building, clean open spaces, and simple designs which all aid to the rehabilitation process, something I feel STEPS Rehabilitation is championing in the UK.” Toria Chan, Clinical Director at STEPS Rehabilitation: “It was great to reconnect with colleagues I’d met at previous RehabWeeks to strengthen relationships and collaborations. "We also made new connections which have led to discussions and opportunities to share our ideas and explore ways to engage in R & D projects across the globe. "It was a privilege to present alongside

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Technology Assisted Upper Limb Rehabilitation Therapy: Challenges and Opportunities’ and provide the perspective from our experience on integrating technologies in residential and day rehabilitation, bringing the client and clinician’s perspective to the forefront of discussion. STEPS prioritise working with forward thinking companies, who listen to feedback and embrace the implementation of further development and refinement of their products. "The last day was the clinic / lab visits which I was particularly looking forward to, having set up STEPS, it's fascinating to have the opportunity to gain some insight into the healthcare set up and approach in other countries. It was interesting to see technology used within all three care settings we visited including elderly care, and the climate in Singapore, enables beautiful green roof top gardens, and more outdoor rehabilitation. At the community hospital (Ng Teng Fong General Hospital) they had a fantastic set up outside (Mobility Park) with a sensory garden, ramps, pedestrian crossings, a decommissioned taxi for transfer practice, and even an exact replica of a bus and metro carriage for patients to practice on and rebuild confidence prior to discharge. (I was worried our OT may want to relocate to Singapore!). Not many people own their own vehicle in Singapore, so the ability to access public transport and taxis is crucial to their independence. "It was great to see how the Clinic for Advanced Rehabilitation Therapeutics (CART) and the RRIS integrated with each other and other health care settings to share knowledge and further advance their practice and use of technology. "One innovative approach the government has backed, is to fit the same accessible gym equipment that is used at CART, in multiple local gyms, to enable continuity for patients in the community." RehabWeek 2025 Looking ahead, the STEPS team will attend the next RehabWeek, which will be held in Chicago in 2025, in collaboration with the Shirley Ryan AbilityLab and Northwestern University.

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"FES bikes can provide a safe and effective way to exercise, even for individuals with limited mobility or other physical limitations"

learn, FES bikes can help to improve cardiovascular fitness, which can have a range of health benefits. Increased Range of Motion and Flexibility Through the contraction of muscles synchronised with the pedalling of the bike, the FES bikes are capable of preserving or augmenting the joint's range of motion and boosting flexibility. This proves particularly advantageous for individuals suffering from conditions like spinal cord injury, cerebral palsy or stroke, which often lead to muscle stiffness or spasticity. The lack of normal flexion and extension of legs due to being seated in a wheelchair can result in contractures and movement limitations, which, once established, pose a challenge to resolve. Regular use of anFES bike aids in maintaining the normal range of motion in the knees, hips, and ankles. For those without complete paralysis and with prospects to walk again FES bikes can enhance overall mobility, consequently facilitating daily activities. Promoting Cardiovascular Well-being One of the primary advantages of utilising FES bikes for rehabilitation and fitness is the enhancement of cardiovascular health for the long run. The FES bikes provide an exercise regime that is of low impact, leading to improved blood circulation and peripheral flow, consequently reducing the risk of heart ailments

and other cardiovascular disorders. Furthermore, FES bikes can bolster endurance and stamina, which can enhance overall fitness and the quality of life. Whether you are on the road to recovery from an injury or seeking to augment your fitness in spite of a chronic disease, FES bikes serve as an excellent tool to sustain or strengthen your cardiovascular well-being. Reduced Pain and Swelling A key advantage of utilising FES bikes in rehabilitation for certain users is the potential to lessenpain and swelling (oedema) in the limbs. By enhancing circulation, FES bikes can decrease inflammation and fluid build-up. This proves particularly beneficial for those recovering from injuries or surgical procedures, as it can expedite the healing process and lessen discomfort. Furthermore, as previously mentioned, FES bikes assist in improving joint mobility and flexibility, which can thereby contribute to alleviating muscle and joint stiffness and pain. Improved Mental Health In addition to the evidence-based, physical benefits, using FES bikes can also have a positive impact on mental health and well-being. Exercise has been shown to release endorphins, which are natural mood boosters that can help to reduce stress and anxiety. For individuals recovering from injuries or illnesses,

the ability to exercise and improve their physical health can also have a positive impact on their mental health and overall well-being. FES bikes can provide a safe and effective way to exercise, even for individuals with limited mobility or other physical limitations. The most important thing to understand about exercise is that we have to stick at it. It is something that we have to commit to for life, and should not be viewed as something which is a short term fix. All humans ideally need to exercise but this becomes even more important when an injury or condition forces us to adopt a more or less passive lifestyle. An FES Cycling system at home allows us a means of exercising safely and effectively despite our health condition. Anatomical Concepts UK Ltd have worked with FES Cycling systems for more then 15 years and have supported many users to work with this technology in homes, hospitals and clinics. They believe that overall, FES bikes represent a safe and effective way of exercising at home despite limb paralysis or weakness. Users see the benefit of preserving their health to the greatest degree so that potentially they may be better placed to take advantage of future breakthroughs in rehabilitation or curative steps that might arise. If you are interested in learning more about FES Cycling or the benefits of training with FES at home or in the clinic you can request a demo at https://www. anatomicalconcepts.com/fes-products

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Putting the expert in expert witness with complex care needs In conversation with Liz Ackroyd, Expert Witness Service Lead at Circle Case Management.

Circle Case Management are pioneers in training, relationship building and cross industry communication; so, we can all work together to achieve better outcomes for a person. Expert Witness Service Lead Liz Ackroyd is leading the conversation in how experts and legal teams can work seamlessly together to achieve better outcomes, improve working relationships and understand each other’s roles within the case. So, how can you be a better instructing solicitor and how can we provide a better service to you? Liz explains how… When receiving an Expert Witness Service enquiry, what information is key for your department to be able to triage correctly? The more information we can have, the easier it is for us to establish if we

have a suitable expert/s. We need to know what type of report is being sought, for example is it a breach of duty, causation or condition and prognosis report being asked for? Is it a screening report? Is there a fixed cost and, if so, what is it? Are there any deadlines we need to adhere to? There have been occasions where we have had to go back to the referrer to establish what discipline they are seeking - is it a nurse, a midwife or a specific therapy? We need some basic client specific information, in particular their age and their diagnosis. It would also be really helpful to know if a face to face or remote assessment is being requested. Providing us with their postcode makes costing our quotation much easier. We also need to establish if there may be any conflict of interest. A brief synopsis of the case is extremely useful as is knowing an approximate bundle size (which again makes quoting easier). How do you select the right Expert Witness for the enquiry? Our experts have very clear area of expertise and are well aware of the need to only take on reports dealing with their specific client group. We will offer the possible instruction to the team and will establish their timescales for the assessment and then completion of the report. We may go back to the instructing party at this stage if the expert has some questions they would like clarifying before being put forward. The most important thing we consider is that the expert we put forward is truly an expert and is credible.

There are times when we offer more than one expert to undertake the report if they have the relevant expertise.

"Our experts have clear area of expertise and are well aware of the need to only take on reports dealing with their specific client group"

Once the Expert Witness has been instructed, what further information might they need from the instructor? It is very rare, but sometimes we may be missing some of the bundle and will need to request the necessary documentation. We have asked the instructing solicitor to gain further information for us such as the sepsis policy or the dysphagia guidelines for the NHS Trust which was in place at the time of the index incident. There may also be occasions when we clarify precisely what is being asked of the expert in a particular question to ensure that we are meeting their needs. What can typically cause delays in delivering the report? Illness, family issues and other circumstances outside of our control may impact on our ability to meet the date we have set. However, we have a quality assurance system in place which means that our expert sends us the report

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approximately a week before the deadline. This allows us some time to make up for a short delay we may have had in receiving the report, whilst still allowing the quality assurance to be undertaken thoroughly. There are also occasions when further disclosure is made close to the deadline, which we understand is something beyond the control of the instructing party, but as our Experts are in clinical practice (which ensures they remain up to date) it may add a short delay to the solicitor receiving the report. What can the instructing party do to assist with delays? The most important thing, which

works both ways, is communication. Clear instructions which make it absolutely clear what the Expert is being asked to provide an opinion on. Make the bundle as easy to navigate as possible and logical, ideally chronologically and paginated. If further disclosure is made, sending it to us as soon as possible. If there are any changes in circumstance or new, vital information comes to light, the sooner we are made are aware the sooner we can amalgamate this information within our report and opinion. Circle Case Management are your one-stop-shop for all Expert Witness requirements, from reports to

rehab, pagination to medical record collation. For further information regarding our services see www. circlecasemanagement.com. To discuss your requirements, email expert@circlecm.com.

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Navigating bespoke case management services in neuro-rehab: Corporé’s approach How vital a role does case management play in neuro-rehab? Complex neurological injuries require a holistic, multi-disciplinary approach to achieve the best possible rehabilitation outcomes for the individual and their families. This is best achieved by utilising an appropriately qualified and experienced Case Manager to identify the overall goals, assemble the right multi-disciplinary team (MDT) and resources, co-ordinate and oversee performance, and support the individual and their family from the acute phase in hospital, through discharge and right to the end of their rehabilitation. Whilst there are many different clinical services available that can provide individual parts of this care pathway, it is our Case Managers who draw all this together to deliver the best outcomes. Our dynamic and bespoke service is able to adapt to changes in the pace of recovery and/or other external factors, whilst maintaining high clinical quality standards, to ensure individuals continue to receive the most appropriate care they need to achieve optimum and agreed rehabilitation outcomes. What are the main factors to consider when assessing clients? A good assessment is an essential first step in good case management and therefore good rehabilitation. So much of the process stems from excellent assessment skills. Corporé has a person-centred approach from assessment and throughout the rehabilitation journey. This means that the individual’s rehabilitation needs remain at the heart of the services we provide. This also ensures that the individual has ownership of their rehabilitation,

maximising their continued focus on, commitment to and trust in the process. The majority of clients are assessed in a home setting which enables us to involve family members and partners in the process from day one. This encourages involvement and commitment to the process, highlighting the key role family members have in supporting injured parties. Along with our Case Managers and the injured client, they’re also involved in the development and agreement of rehabilitation goals that will shape the case management journey. Gaining support and understanding for different rehabilitation decisions from family members / partners and making goals personal to every individual encourages adherence to the rehabilitation process. We conduct assessments as soon as possible following instruction from relevant parties to ensure we initiate rehabilitation therapies quickly, avoiding prolonged delays in accessing care which may cause further issues for a person’s injuries and recovery journey. Our assessments cover both psychological and physical considerations to determine both the type and extent of treatment and support needed in rehabilitation and when this should be provided in the process. Detailed knowledge and understanding of clinical conditions is considered and integrated into our assessment along with a wider understanding about the client’s life stage, relationships, family, spiritual beliefs, and social and economic factors. All of these considerations give us a better understanding of an individual’s health and wellbeing at the start of the rehabilitation journey and indicates what should continue

to be measured in the process. What assessment tools do your Case Managers use? Our Initial Needs Assessment (INA) involves the use of clinically validated questions about physical and psychological health. In addition, our Case Managers can deploy a wide range of assessment tools to build the most comprehensive picture of the individual client’s injury, its impact and their current state. It’s important to highlight that the Case Manager uses their clinical skills to determine which tools are most appropriate for each client. This in-depth assessment is taken at the client’s pace and typically lasts around three hours. Some of the assessment tools used include: • The Visual Analogue Scale (VAS) which measures pain in different areas of the body • Patient Health Questionnaire (PHQ-9) to measure depression • General Anxiety Disorder (GAD7) questionnaire to provide insight into a person's mental wellbeing and to determine the level of psychological support required, and when this should be offered in the rehabilitation process. • Brain injury checklists and the Rivermead Post Concussion Questionnaire • Chronic Pain Acceptance Questionnaire (CPAQ Assessment tools are also used as clinical prompts to ensure we have fully covered all areas impacted by the injury. This is useful where the client lacks insight into their difficulties or don’t always volunteer information regarding certain areas unless specifically prompted. These prompts can be helpful in assessing delicate issues such as sexual

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function or intimacy in relationships following an injury which, if not addressed, can have a devastating effect on clients. However, one of the key assessment tools a Case Manager has is observation. The ability to observe a client in their own environment is so valuable in looking at how they function and determine what motivates them. Other assessment tools include Functional Capacity Evaluations to understand an individual’s mobility, dexterity and ability to manage everyday activities and work activities. These in-depth assessments support our clinical reasoning in devising an appropriate rehabilitation plan that will secure the client’s commitment to the process. They can also provide baseline measures from which to gauge progress and/or validate a need to change treatment or therapy options to achieve the best possible outcomes. It is important for us that assessment is not something that only happens at the start of the case management process – assessment

"In a world of accelerating technological advancements, it would be foolish not to accept and welcome these developments as part of our clinical best practice" (and re-assessment) is ongoing throughout the process. As needs change, so too must our assessment of those needs. It is essential that we look at the work we are doing and seek to measure the impact of that input – if it’s not working, why not and what do we need to change? How do you coordinate multidisciplinary teams? Case Managers have extensive clinical experience and are adept at coordinating MDT. They draw on this experience to coordinate and liaise with therapy and treatment providers, ensuring input is delivered at the most appropriate time in the rehabilitation process. They remain in constant contact

with the client and hold regular meetings with the MDT team, where clients and families are involved to ensure continued commitment to the process. Updates on progress and discussion among the team determine any necessary changes needed on a collaborative and coordinated basis throughout, feeding back all information to all stakeholders, including instructing parties. In terms of treatment and therapy input, as well as using clinical reasoning, we can access specialist support through our sister company, The Treatment Network (TTN). TTN has a wide-ranging national network of specialists able to support many different treatment needs. By selecting specialists through TTN, we have easy access, and confidence in their robust clinical due diligence processes of every provider. This ensures that the services and treatments we provide clients are of the highest clinical quality. It is important that communication between all members of the team is on point, that every member

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of the team understands the overall rehabilitation goals and work in a coordinated manner to achieve those goals. How do you see assistive technology enhancing rehabilitation case management? In a world of accelerating technological and digital advancements, it would be foolish not to accept and welcome these developments as part of our clinical best practice. Governing bodies, including Health and Care Professions Council (HCPC), promote digital approaches in their standards of proficiency to better improve clinicians support of their clients. Now is the time for Case Managers to not only welcome new technological advancements, but actively seek out, learn and discover new systems that will support their practice. That’s why at Corporé, we’re constantly evaluating new technologies that will make us better at providing expert case management services. From advanced robotic limbs, to using big data and proprietary apps, these can help shape an injured party’s rehabilitation journey or warn of the threat of relapse. Providing more tailored 24/7 support, accessible online through the client’s own mobile device, we use the smartphone based musculoskeletal support application,

Phio. This tool can both recommend the most appropriate treatment pathways for motor accident related injuries from answers to a clinical ‘decision tree’ algorithm and provide clients with clinically validated and curated programmes of selfmanagement tools, including daily exercises and check-ins to support optimum recovery. The use of apps for memory prompts, diary entry or task planning for vulnerable clients are becoming a frequently used tool in providing round the clock support for clients in managing day-to-day life. We also see greater opportunities for client engagement and customer transparency through the use of client and customer portals to ensure increased accessibility to details of a case, providing key data in one robust and confidential system. Technology is changing and we are enthusiastically embracing those tools that enhance our personcentred approach to better shape our clients rehabilitation outcomes. With its growing profile and creation of the IRCM bringing new levels of professional accreditation to the profession, what do you think is the outlook for case management? I think the future has never looked brighter for case management. With the advent of Institute of Registered Case Managers (IRCM), case management has an elevated clinical backing from a professional

body. Members will be expected to maintain a high level of clinical quality in their practice, ensuring that they continue to expand their knowledge and development to improve their rehabilitative approaches. This is the most positive development in case management since it became part of the clinical approach in the UK. IRCM will provide access to support for Case Managers, allowing them the space to ask questions and seek advice when needed, whilst ensuring high clinical quality is maintained through rehabilitative practice. This means our clients, instructing customers and other clinical professionals will have even greater confidence in the service we, as Case Managers, provide. Coupled with their memberships of other professional bodies, such as Case Management Society UK (CMSUK) or the British Association of Brain Injury and Complex Case Management (BABICM), our Case Managers now not only have the support but also quality assurance for their focused specialisms whilst also being protected by a broader case management professional body. What does success in rehabilitation case management look like? Success at Corporé is different in every case and cannot be defined or described in one rigid format. Every case is personal to the client. Our objective is to provide the tools, adaptations, appropriate treatment or support to help our clients regain independence, control and agency in their lives. It’s about having clients who are safe, secure and happy. Clients that achieve their goals, whatever they may be, while ensuring those who refer to us are kept in the loop throughout, have open dialogue with us and are happy to continue to entrust their clients’ rehabilitation to us. Of course, the best person to answer this question is the client. If they feel their rehabilitation has been a success, then it has.

Celebrating 20 Years of Sleep Unlimited

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As one of the pillars of health, good sleep is vital for both successful rehabilitation and compliance with other therapies. Sleep Unlimited specialise in assessment of those with complex conditions using Actigraphy – and advice using Cognitive Behavioural Therapy for Insomnia (the NICE recommended guidelines for treating an insomnia disorder). Please email denise@sleepunlimited.co.uk for an information pack and free sleep screening questionnaire. We also run training for healthcare professionals – our highly acclaimed REST® Training Programme includes: a two day training course; option to sign up for a license to use the REST® resources; and group supervision sessions. Please email training@sleepunlimited.co.uk for a course flyer and booking form, or see our website www.sleepunlimited.co.uk

Sleep Unlimited Ltd PO 570, Gateshead NE8 9GF 0191 580 0008 for our website

www.sleepunlimited.co.uk 89

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Empowering U Complex Care: Maximising independence through compassionate care Empowering U was launched in 2014 by the Jakhu family following 30 years’ experience of working in the health and social care sector. Driven by a desire to establish a company that provides a highquality, compassionate service to individuals with complex needs, they have evolved to become a care provider that synonymous with excellence. Most recently, they have added a new ‘Case Management’ arm to the business, run by well-established and experienced practitioners. The company remains family owned and managed, and its foundations are firmly based on the principles of compassions

and unity. The ‘Complex Care’ arm of the business operates from three locations throughout the Midlands. The focus is on creating and delivering tailor-made care packages for individuals with complex medical needs and challenging behaviours. This includes providing live-in care solutions, nursing and personal care, as well as more unique services such as respite and occasion care. The Complex Care Team These services are all delivered by a team of managers and staff who have the correct relevant experience to support individuals

with their multiple needs. “It’s our team that really enables us to consistently deliver a high-quality service” explains Director of East Midlands branch, Gulshan Jakhu. “We work hard to recruit personnel who are fully equipped with the skills and know-how needed to deliver a superior service. Once they become part of the Empowering U family, we ensure that they are fully supported through training and continued professional development. There is a strong culture of mentoring and peer-to-peer support within the business. Our team don’t focus on what their clients can’t do; they focus on the life their clients want

to live and support them in making that happen.” Andrew Williams, who is Head of Operations at the Deby branch of Empowering U, believes that this working environment “builds confidence and improve communication skills amongst the team, giving them a sense of value. They take a unique and innovative approach to care services and through vision, stamina and a little humour, they offer exceptional care to those in need.” Empowering U offer a diverse range of homecare and complex care services to meet the wideranging needs of their clients. Complex and home care services • Person-centred community support packages for people with learning disabilities • Working with service users who struggle with challenging behaviours • Transition from children's services to adult services • Transition from hospital to home • Reablement • Personal Health Budgets • Nursing Care at home • Case Management for catastrophically injured claimants • Tracheostomy & Ventilated Care • Acquired Brain Injury Support • Spinal Injury support • Catheter, Bowel & Stoma Care • Complex Bowel Management • PEG (Percutaneous endoscopic gastrostomy) and JEJ (Jejjunostomy) • Suctioning Oral and Tracheal • Oxygen Therapy • Epilepsy Rescue Medication – Buccal midazolam & Rectal Diazepam • NG (Nasogastric) • Ileostomy (Stoma/Colostomy) • Cough Assist and Assisted Cough • CPAP (Continuous Positive Airway Pressure) • BPAP (Bilevel Positive Airway Pressure) • NIPPY (Non-Invasive Positive Pressure Ventilation)

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Young Person Nursing Care Case Study

- Empowering U don't use agency staff which she has experienced with care providers previously.

23-year-old *Clive has severe Cerebral Palsy and Epilepsy. He lives at home with his Grandmother (*Linda), his sister and his niece. He requires 24/7 support from two carers. Clive’s carers support his needs. Linda is able to maintain family life with the support of carers.

The Care Team There is a core team of main carers who have worked with Clive for many years. Linda says nothing is ever too much trouble for them, they do his washing, cleaning, attend appointments, liaise with the GP and accompany him when he is in hospital. The carers are familiar with Clive's needs and know how to respond to all situations, seeking out supervision from the Branch Nurse and attending ongoing training as required.

Interventions Administration of PEG feed and PEG medication, nebulisers, oral suctioning, pressure area care, personal care and companionship. Meeting Clive's needs Empowering U was recommended to Linda who was delighted by our timely response and prompt communication. Our Branch Nurse understood Clive’s health conditions, carried out the initial assessment and wrote a detailed care plan for the care team to follow. This was done in combination with Linda so all Clive's needs were met and personal preferences were included. Empowering U selected experienced carers who were complex care and epilepsy trained. Linda was impressed that there was a review after 6 weeks, weekly follow ups and visits from the Branch Nurse. She also appreciates visits from the office who are communicative and responsive, she gets to meet the team who deal with rotas and co-coordinating his package face-to-face. She was also pleased with Clive's continuity of care

The Outcome Clive is comfortable and well looked after. His physical care needs are met and also has mental stimulation and activities to maintain his psychological well-being, these include water play in the bath, singing or being read to and going to the local farm park or shopping round town. Linda is able to focus on other members of her family who need her and is able to take breaks away from home and go to her caravan knowing Clive is in safe hands. Working in Partnership with the NHS Clive has many other members of the multidisciplinary team which Empowering U work with including the Occupational Therapist, nutrition service and continuing health care who assessed Clive's needs. *names have been anonymised

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Congratulating the CMSUK Awards winners

he winners of the CMSUK Awards 2023 have been revealed. The annual awards were created to recognise and celebrate outstanding practice across case management and associated sectors in supporting people after life-changing injury or illness. With a theme of Exceeding Expectations for Clients, this year’s awards highlighted excellence in client service and commitment to delivering the best possible outcomes. Martin Hibbert, survivor of the Manchester Arena bomb and now a

passionate campaigner for people living with spinal cord injury, was the inspirational guest speaker at the event, held at the London Hilton Tower Bridge. Over 250 guests at the lunch were left in tears as he described his journey from that fateful night in May 2017, when he and his daughter Eve were the closest survivors to the suicide bomber. Both miraculously surviving, Martin’s spinal cord was severed and he is now paralysed, and Eve continues to defy all expectations in her recovery from serious brain injury.

Martin presented the winners of the CMSUK Awards – sponsored by Regen Physio – with their accolades, which were judged by experts from across the sector, including Deborah Johnson, editor of NR Times. The winners and runners-up were: Catastrophic case manager of the year Winner – Elaine Miller, Unite Professionals Jason Chidwick, HCML Shelley Westgate, Westgate Case Management

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Clinical case manager of the year Winner – Lisa Dunthorne, Unite Professionals Deborah Hathaway, Independence Works Nick Haycock, HCML Case management supporter (internal) of the year Winner – Alarna Benson-Green, Coastal Case Management Rebecca Johansen, Corporé Verity Clunies-Ross, Integrated Case Management Case management service provider (external) of the year Winner – PsychWorks Associates Cyber Spider Remedy Healthcare Partnership initiative of the year Winner – Corporé Major Incident Rehabilitation Service partnership H’s journey with Coastal Case Management, Irwin Mitchell, Dorset Orthopaedic and Relimb Independence Works, Addenbrooke’s Hospital, MTSP, Slater and Gordon, NFUM, STEPS Rehabilitation and STEPS Prosthetics

Rehabilitation Innovation of the Year Winner – RTW Plus – ‘Understanding the invisible emotional influences on the perception of pain’ Reach Personal Injury Services – Headlight head trauma triage service Unite Professionals – virtual rehabilitation clinic Case Management Company of the Year (Large) Winner – Unite Professionals HCML 3HUB

Case Management Company of the Year (Small) Winner – Emma Way Associates Sue Ford, chair of CMSUK, said: “I am genuinely delighted with the resounding success of the CMSUK Awards. “This event marks a pivotal milestone for our organisation, a moment when we unite to acknowledge and celebrate the remarkable achievements of those dedicated to the field of case management. “It stands as a testament to the unwavering commitment and hard work of our professionals, who consistently demonstrate their dedication to improving the lives of individuals in need, serving as a true source of inspiration. “The CMSUK Awards not only serve as a platform for recognising excellence but also provide an invaluable opportunity for networking and the exchange of best practices within our vibrant community. “I take immense pride in our collective accomplishments and eagerly anticipate the ongoing growth and innovation that our members contribute to the field of case management. “Congratulations to all the exceptional winners and nominees for their outstanding contributions.”

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Unite Professionals - the award-winning journey so far

Having won three awards at the CMSUK Awards 2023 - including Case Management Company of the Year the reputation of Unite Professionals Ltd as one of the leading firms in the sector was confirmed further still. Here, we speak with founder and managing director Jo Evans about the ongoing growth and development of the business As a well known professional within the world of neuro-rehab, Jo Evans is known both for her background in occupational therapy and her role as a case manager - the last 13 years of which have been spent as owner of Unite Professionals. Operating from its bases in Somerset and Merseyside, its team

of case managers - both associate and employed - as well as rehab coordinators, finance, BD and medical records professionals, work nationally in supporting clients after lifechanging, complex injury. Jo herself has built a strong reputation for her work in case management, and until recently was a director on the board of industry body CMSUK. Unite Professionals is no stranger to success, with its case managers having won several awards, and the business securing a number of prestigious endorsements. But after 13 years and counting, its success at the recent CMSUK Awards marks a new high for the business, with three award wins. Elaine Miller was named catastrophic

case manager of the year; Lisa Dunthorne won clinical case manager of the year; and Unite Professionals was named overall winner as Large Case Management Company of the Year. “It was such fantastic recognition. Our team are brilliant, I’m super proud of them. We’ve won CMSUK awards before for their amazing work, but to be named as Case Management Company of the Year was huge recognition of everyone’s hard work,” says Jo. “I’m not sure I’ve ever considered us a large case management company because we’ve grown organically over the years, and compared to the others on the shortlist we aren’t particularly large.

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“It was a great honour to be recognised by the judges as evidencing a service to customers and clients that met the high criteria specified for this category. It is always a privilege to gain such recognition from industry colleagues.” Jo’s journey into case management began when she was working as an OT, initially moving from a position as a clinical specialist in neurology within her NHS work to work in private practice. Having been instructed by case managers representing clients who had sustained traumatic brain injury she decided she would like to learn more about how case management could support this client group and went about this learning through the events team at CMSUK . “I was fascinated by the whole claim process and how case management worked alongside this being able to present clinical evidence representing the impact of the accident on the clients living and quality of life and then influence access to funded rehab pathways for the client,” says Jo. “In coordinating, monitoring, and guiding this process it seemed to pull everything together. It was like learning a new language in many ways, but I enjoyed learning the language and process and ensuring that as a company each of us, regardless of role, understood the client journey and wishes and the part we played in supporting that. “It really is a complex labyrinth working with clients and their needs, and putting together the solutions, ensuring funding is available to secure the way forward with a meaningful intensity of rehabilitation. But it’s a fantastic service to be part of.” Unite Professionals was born in 2010, and has seen the creation of a strong team of talent with several of its case managers being with the firm for the majority of its time in existence. The business is committed to funding the innovative work of both

Jo Evans managing director at Unite Professionals the clinical and admin teams in improving the case management service delivered. This has included running an annual conference, which has become a must-attend date in the calendar for professional development, as well as the chance to catch up, have fun, dance and learn. “Our case management approach has always focused on a strong ethos of peer support, regular training including reflection on relevant case law and engaging this approach has always kept us current ensuring we’re responsive and not reactive,” says Jo. “With the development of our outcome measure tool now in its 12th year, this provides great qualitative evidence of the efficacy of the rehabilitation approach taken by the case managers. “Our conferences focus on the fact that as case managers we are expected to understand the environment in which we work and challenge the status quo, we promote identifying evidence and advances in rehabilitation practice in order that we can deliver the ultimate service to clients and referring parties. “We’ve been delivering our conference for 11 years now, it’s really well attended, and we’ve had some great speakers, and that continues to grow too.” Despite the growth of Unite Professionals and its offering over the past 13 years, Jo continues to hold a caseload.

Jo explains: “For me, I love being part of each client’s journey and it is such a privilege to go into people’s homes and work so closely with them and their families to be part of the journey to map out a better future. “Understanding each person’s priorities is absolutely key, and being on this journey with them means you see it all - the happy points and sad points, backward steps and big steps forward. Some clients have been with us for nine or ten years, which is most of the time the company has been in existence.” Building and growing the coorperative of people at Unite Professionals, who share a vision to deliver a gold standard service, has been one of the personal highlights for Jo, and the process of adding to that continues. “It has been a joy to share training, teaching, supervision and buddying within our team. The journey continues for us all and our clinical team are an amazing group,” says Jo. “We’re always looking to add great new case managers to our national team. We currently have case managers with professional background in OT, physio and social work, but we would love to attract those with a nursing background too. “Our team are at the heart of what makes us who we are - and I’m so proud of what we are delivering to customers and clients. “Our strapline really is our team motto: “Your rehabilitation, our priority””

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Shoulder pain prevention and relief

o set the scene: many people who’ve had a stroke end up with mobility difficulties, and as a result come to depend on a wheelchair. 80% of these individuals develop shoulder subluxation as a result of muscle weakness creating shoulder joint destabilization, together with gravity pulling down on the head of the humerus bone (1). Linked to this, 29% of post-stroke patients suffer from shoulder pain (2). After traumatic brain injury, one report has shown that 84% of the patients developed contractures, and after just four weeks 23% of these contractures had become ‘fixed’ (3). In this article, we look at the preventative measures we can apply for wheelchair occupants to protect against, and relieve, upper extremity damage and pain. To control our hands we need to have control of our arms, and for that we need control of our shoulders. The shoulder is the most mobile joint in the body. It comprises a complex structure of bones, ligaments, and muscles that work together to keep it

Despite progress in many aspects of wheelchair development, an area that has had little attention to date has been the facilitation of the use and the preservation of function of our upper extremities

stable. However, because the shoulder is so mobile, it is also very susceptible to dislocation. Shoulder subluxation, a partial dislocation of the shoulder joint, is not uncommon. This occurs when the ball of the upper arm bone, the humerus, partly comes out of the glenoid socket in the shoulder. Complications of shoulder subluxation include: shoulder pain, loss of upper extremity function, tone increase, tendinitis of the rotator cuff tendons, and stiffening of the shoulder joint capsule. A shoulder subluxation is often the result of trauma, injury, neuromuscular disease, or a stroke (CVA) that weakens the arm muscles.

It is therefore critical that early intervention be applied, since this can prevent these problems developing. In addition, apart from the loss of function, these sudden onset mobility challenges frequently come with severe pain. Despite progress in many aspects of wheelchair development, an area that has had little attention to date has been the facilitation of the use and the preservation of function of our upper extremities. This function can be affected by back supports that are too high or too vertical, and thus restrict our shoulder blades from behind. On the other hand, chest or shoulder harnesses can heavily restrict movement to the front. Over and above avoiding restrictions to functional movement, what positive actions can we take? For day-to-day functionality, the use of our hands and upper extremities can be critical. Overall, we are trying to achieve the balance of postural management with facilitating functional activity. But what has been available to facilitate this?

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Arm supports, rests, or troughs? Most wheelchairs are supplied with an arm rest. However, most wheelchairs’ arm rests do little to prevent or alleviate the problems of reduced functionality and pain described above. Maybe this is because these parts of the chair are still often being referred to as arm rests, showing no recognition of their clinical importance? If we call them the ‘correct’ term of arm supports, maybe a better product might be prescribed. What are the challenges with common wheelchair arm supports? Just as foot supports should be adjustable to achieve the optimum distance for the lower leg from the seat cushion, arm supports should be finitely adjustable to get the forearm (and therefore the upper arm) at the right height, to sit comfortably in the shoulder socket. Further, the top of the arm support should support the forearm and wrist so that they do not fall off the support (Figure 1).

Figure 1 When the arm support is provided in the form of a standard ‘trough’, there are three problems with this design. One is that the trough restricts movement and thereby restricts both physical rehabilitation and also general function; secondly, the arm tends to be forced parallel with the seat frame, whereas the anatomically correct position is to allow the forearm to rotate medially by 1015 degrees; and thirdly, the hand tends to fall into a flattened pronated position and the fingers and wrist remain unsupported (Figure 2).

Figure 2

To have a perception of where the arm should rest: while seated, drop your arms down by your sides in a relaxed position. Then flex your arms at the elbows and see where your forearm and hand positions end up. This is the anatomically preferable resting position of the hand and forearm, and thence the upper arm and shoulder joint. A practical support So what do we need for an anatomically correct arm support? The answer is one that supports the elbow at the right height (supporting the elbow vertically in line with the shoulder joint will help prevent subluxation); one that supports the distal forearm in a medially rotated position (i.e. when it is across the body); one that permits dynamic movement of the forearm; one that supports the hand in the optimal position and with the thumb abducted; and one that allows hand movement, but can absorb unintended tone. Such a device is now available in the shape of the Bodypoint Dynamic Arm Support (DAS). This device was first invented by the Belgian physiotherapist and seating specialist Bart Van der Heyden (4) in 2009, and has since been developed and released by Bodypoint (5,6). The DAS supports the distal forearm in an anatomical resting position, as well as supporting the hand and fingers, thereby providing three points of support for the upper extremities. Positioning the hand so the thumbs are abducted and extended, with the fingers extended, provides a tone-inhibiting position. In the event that tone of the finger flexor muscles occurs, the dynamic finger section of the DAS will absorb tone, while a strap over the hand will control the hand position during extensor spasms. In addition, by allowing the elbow section to pivot, shoulder movement can remain, and even be trained, while the upper extremities are held in a safe anatomical position. The DAS also helps keep the hand in view, thereby reducing what is termed ‘neglect’ i.e. out-of-sight, out-of-mind.

The DAS offers unique adjustment where: • Gross lateral and rotational positioning can be accomplished through appropriate placement of the base plate • A pivot system allows for 60 degrees of total range of motion (ROM): 30 degrees of internal rotation and 30 degrees of external rotation at the shoulder, which in turn • Facilitates active ROM and proprioceptive exercise • Allows for optimal positioning that can be changed as needs change • Progressive position changes are possible over time • Each component can be individually adjusted for fit and function Applications The DAS is appropriate for the management of hypertonicity, resistance to passive movement, shoulder pain, and shoulder subluxation involving neurological involvement of the upper extremities arising from: •  Stroke (CVA) •  Brachial plexus injury •  Other progressive or traumatic neurological impacts on the upper extremity as may be seen in diagnoses such as spinal cord injury (SCI), traumatic brain injury (TBI), muscular dystrophies, multiple sclerosis and Parkinson’s. The ability to set up the device correctly, and the means for allowing movement in the right planes, are both critical for pain relief, for early physical rehabilitation, and for dynamic functionality. As ever, the earlier the intervention, the fewer the subsequent complications, and the faster the rehabilitation. References 1. Arya KN, et al. 2018 Rehabilitation methods for reducing shoulder subluxation in post-stroke hemiparesis: a systematic review. Topics in Stroke Rehabilitation 25, 68-81 2. Adey-Wakeling Z, et al. 2015 Incidence and Associations of Hemiplegic Shoulder Pain Poststroke: Prospective Population-Based Study. Archives of Physical Medicine and Rehabilitation 96, 241-247. 3. Mousa AS, et al. 2022 Assessment of Extremities Muscle Contracture for Critically BrainInjured Patients. International Journal of Novel Research in Healthcare and Nursing 9, 147-157 4. www.super-seating.com 5. modulararmsupports.com 6. besrehab.net/find-a-solution/by/brand/bodypoint/dynamicarm-support-/

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