Neuro Rehab Times issue 29 by aspectpublishing

NR TIMES

Did you make the shortlist?

See the contenders for this year's awards inside

NEURO REHAB TIMES /29

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

www.sleepunlimited.co.uk for our website

Editor's note

For our interactive digital edition visit nrtimes.co.uk

Celebrating achievement

When we launched our first-ever NR Times Awards, we did so with the ambition of shining a light on the inspirational and often life-changing work being done throughout the field of neuro-rehab.

We hoped we would hear from some of those whose dedication, commitment and innovation is helping to changing the future for patients both now and in years to come.

And, truthfully, we have been overwhelmed by the entries we have received. The numbers, and quality of submissions, have been beyond all expectations.

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

The ambitions we had for the inaugural NR Times Awards have certainly become reality, and thanks to all those who have made that possible. From our sponsors - particularly headline sponsor Elysium Healthcare - through to those who have made nominations, we are so grateful for your support.

Today, we are delighted to unveil the shortlists in all 12 categories. Eleven will now be judged by our panel of judges and category sponsors, with one - Rehab Leader of the Year - now open to a public vote.

Judging such fantastic shortlists will be a hard task indeed; and while only one can win each category, we look forward to celebrating the achievements of many more, whose contributions are making such a positive difference.

This issue has many other stories of achievement, in a number of ways. We have the fantastic stories of Lawrence and Aidan, both of whom have overcome such adversity and so many challenges to now enjoy life and look to a positive future.

We also have the progress of major names in neuro-rehab, and we are delighted to celebrate their ongoing growth and development. From Circle Case Management’s sector-leading franchising opportunities, through to Slater and Gordon’s new office opening and the pioneering project into dementia care planning by St Andrew’s, the continuing innovation from those working in this sector is fantastic to see.

We hope you enjoy this issue, and will join us in congratulating everyone who has made the shortlist of the NR Times Awards.

As ever, if we can support your organisation in celebrating your own success, please do get in touch with any of the team. We’re always delighted to hear from you.

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)

Collaborative content

Here, we unveil the shortlists of the inaugural NR Times Awards.

After receiving entries from individuals, businesses and organisations around the world, we can now reveal who has made the final few in each category.

The amount of submissions received exceeded all expectations, and the quality of entries has meant that the numbers on each shortlist varies greatly - in many categories, it was too difficult to discount many of the outstanding entries at the shortlisting stage.

The NR Times Awards, sponsored by Elysium Healthcare, were launched this year for the first time to recognise and celebrate the outstanding practice, innovation and dedication from those working across the field of neuro-rehab in changing the lives of patients, both now and into the future.

Across 12 categories, the Awards will highlight the inspirational work being done by teams and individuals in

supporting patients and families, and often helping to transform the practice area they work in and the wider neurorehab sector.

Judging will now take place over the coming weeks, with the awards ceremony being held online on October 26, when the winners will be revealed. Categories will be judged by a representative of each sponsor, and by our independent panel of judges:

- John Davis, renowned neurotrauma specialist and consultant principal lawyer at Slater and Gordon

- Vicki Gilman, chair of BABICM and founder of Social Return Luke Griggs, chief executive of Headway

- Chloe Hayward, chief executive of UKABIF

Judges will be exempt from judging any category in which there is a conflict of interest.

Deborah Johnson, editor of NR Times, says: “We have been absolutely thrilled and taken aback with the response to our first awards, and from the support we have had from our entrants, judges and sponsors. Thank you to everyone, on behalf of the whole team, in making this such a success so far.

“The quality and breadth of entries has been of the highest calibre, and putting the shortlists together was no easy task. Some of the shortlists have many more names on there than we initially intended - but we genuinely felt we could not discount such excellent entries at this stage, so will pass to our judging panel for their insight ahead of them choosing a winner.

“We are very excited to reveal the winners next month, but for now, congratulations to everyone who has made the shortlist. Please be very proud of your achievements and for the amazing work you are doing.”

Fixed-term contractswhat you need to know

SPONSORED

The use of fixed-term contracts can give clarity and certainty to employers and employees alike - but for employers, they must ensure they are meeting their legal requirements towards those working for fixed-term periods.

Cecily Lalloo, managing director of Embrace HR, independent HR specialists in private care sector support, discusses the key points of which employers must be aware. Fixed-term contracts can be a useful way for employers to cover positions for a defined period of time, giving assurance that there is enough resource for particularly busy periods or certain projects, while also

affording flexibility. For employees too, being contracted to work for a fixed period can give clarity around the nature and duration of their role, and what is expected of them during that time.

In such a fast-changing sector as healthcare, where resources may suddenly be particularly under pressure, the option of a fixed-term contract can be an effective tool to bring in people for a defined period. For example, to cover an absence on maternity leave or a long-term sickness absence.

There are four main types of fixedterm contract:

*Pure fixed-term contracts – these expire automatically, at the end of the term, without the need for notice. These are quite inflexible as there is no option to terminate the contract early

*Contracts with a notice clause providing for early termination – if notice is not given, the contract will expire automatically at the end of the term

* Contracts stated to be for an initial term, during which notice may not be served – the contract terminates on notice after the initial fixed term has expired

* Evergreen contracts – these renew automatically for another fixed term, unless one of the parties gives notice of termination.

Fixed-term employees are protected by legislation through the FixedTerm Employees (Prevention of Less Favourable Treatment) Regulations 2002.

This states that employees on fixed-term contracts are treated no less favourably than permanent employees - so in terms of aspects like pensions or defined benefits, they are comparable. During their period of employment, employers should review the contractual terms and benefits offered to fixed-term employees and look for any differences from those offered to permanent staff.

Longevity also counts in an employee’s favour, particularly at the point at which a contract expires, which is regarded as a dismissal. Throughout their period of employment, they are entitled to be informed of any permanent roles. Fixed-term workers will have unfair dismissal rights after being employed for two years, and for those who have been continuously employed for four years or more on a series of successive fixed-term contracts, they will legally - and unless there is justification for the use of consecutive temporary contractsbe treated as a permanent employee. But in the case of unfair dismissal, fixed-term employees are awarded greater protection, and there are circumstances in which they will be deemed to have been automatically unfairly dismissed.

There is no requirement to have two years of service to bring this claim. For a dismissal to be fair, it must be for one of the potentially fair reasons set out in legislation, which are:

• Capability

• Conduct

• Redundancy

• Contravention of a statutory obligation

• Some other substantial reason.

In this situation, employers will need to establish which reason they seek to rely on, and follow a fair procedure. Each case will be based on the circumstances at the time. The use of fixed-term contracts can be beneficial for both sides - but employers must ensure they are adhering to the legal rights afforded to fixed-term employees, and the fact these may increase after two and four years.

For advice or guidance in this area, please contact Embrace HR at www. embracehr.co.uk

What is Freezing of Gait and can NexStride help?

Freezing of gait (FOG) is a common motor disorder in Parkinson’s disease (PD).

It is characterised by sudden, unanticipated interruptions in gait, lasting from seconds to minutes, in which people feel that their feet are stuck to the floor and unable to move forward despite trying hard. FOG episodes can occur in other neurological diseases too. The phenomenon is particularly debilitating and often requires physical support from another person to get unstuck and start walking again.

Treatment strategies developed for managing gait disorders and freezing include medications, deep brain stimulation (DBS), physical therapy interventions and external visual cues.

The classic presentation of gait freezing is sudden and dramatic stops and starts while walking, but

some patients describe that they feel like their feet are glued to the floor with an inability to take the next step. These episodes often occur when crossing doorways, turning around, or approaching an obstacle. The severity is very variable from person to person with some experiencing only occasional episodes and rarely, some individuals will experience almost continuous FOG preventing useful ambulation.

Freezing of Gait obviously impairs mobility but also increases the risk of, and causes, falls and significantly reduces quality of life. Gait disorders, including freezing, affect 60–80% of PD patients, often presenting in the later stages of the disease.

Several factors can cause or worsen the freezing of gait, including fatigue, distraction, anxiety, stress, visual clutter, transitions from

one walking surface to another, and narrow spaces. Patients who have freezing of gait also tend to experience more severe postural instability and other motor symptoms of the disease. Studies have shown that more advanced PD patients who show primarily a freezing of gait phenotype tend to have less benefit from dopaminergic medication and have more potential side effects, including motor fluctuations. Thus, there is a growing clinical focus on novel therapeutic interventions, not only for FOG but working on the significant nondopaminergic pathology that exists in the primary progressive freezing gait syndrome. Physical therapy, particularly a program that involves balance and gait training, is an essential non- pharmacological intervention to improve gait freezing and associated motor symptoms.

Standardised gait questionnaires and structured physical activity programmes have been used to assess patients' motor and cognitive function, providing a baseline to evaluate this and guide clinical intervention.

Visual cues are known to be an effective method for improving freezing episodes. The presence of sensory feedback may be useful for overcoming a "motor block" and promoting movement.

Various external visual cues, such as laser lines, stripes on the floor, or footstep rhythms, can be an effective way to overcome freezing, providing the patient with a predictable sequence to follow.

Additionally, tasks such as mental imaging and rhythmic audio cues can also effectively trigger gait initiation in PD patients.

Anatomical Concepts offers a neat product called NexStride that uses

cueing technology to help overcome the freezing of gait.

The NexStride product combines both visual and rhythmic audio cues, and makes them adjustable and adaptable to different types of walking aids.

The device can be attached discreetly to any walking cane or frame with a laser line adjusted to a distance that suits the individual user. A metronome can also provide an audio cue with the volume control at your fingertips. Fundamentally by using the visual and/or auditory cueing you are able to bypass the blocked neural pathway that is causing the freezing of gait. The NexStride can effectively trigger gait initiation in many persons who have difficulty with FOG.

You can find out more or purchase the NexStride at https://www.anatomicalconcepts.com/nexstride or contact them for more information.

Chroma, supporting therapists’ resilience

By Rachel Smith, music therapist, Chroma

SPONSORED

Chroma is leading the way in ensuring creative arts therapists receive the tools they need to develop resilience in the work they are carrying out each day.

Therapists work with a variety of clients, all of whom have their unique issues, of which Chroma therapists provide unwavering support to help them overcome these and move forward positively.

But as is the case with talking therapies, it can take its toll on the mental health of the therapists. And, Chroma, established by practicing arts therapists, understand all too well the mental burnout and fatigue that can occur as a result of the job. This is why they have ensured their therapists receive the very best support, in-house, that can help prevent stress and promote self-care.

All HCPC registered creative arts therapists need to access their clinical supervision, but the clinical team at Chroma offer additional management supervision. This support can occur weekly if the case is particularly difficult or stressful, but typically every eight weeks. If the case the therapist is working

on is particularly challenging, support can even be provided daily – so therapists never feel alone and always feel heard and supported in their role. During these sessions, the clinical management team will find out how the therapists’ case is going and what needs further exploration – supporting therapists to think about their goal setting.

Chroma also provides an on-going monthly CPD programme offering training on all aspects such as report writing, working with families, short-term work, dealing with funding, autism etc.

This helps therapists, especially new therapists, hone in their thinking about the work they are doing and understand the importance behind what they are doing, whilst receiving guidance on the support they are providing clients – they’re not alone to fend for themselves – Chroma is always on hand to help. No one is left to struggle, and with that level of support therapists build their resilience towards the work they do every day and to better support their wellbeing at work and, outside of it.

To find out more, visit wearechroma.com.

27 SPONSORED

"No one is left to struggle"

Dementia care planning and co-production

Through a pioneering new research project, people with dementia and their loved ones will play a greater role in their care than ever before - and care professionals will be supported to make this happen.

NR Times finds out more from project lead Dr Inga Stewart, who discusses her ambitions for a person-centred approach to become commonplace in healthcare

“We want to get to a point where you just couldn't imagine writing a care plan without involving the person it's about, and the people who are supporting them in their care” That commitment to the highest standard of person-centred dementia care lies at the heart of pioneering new research, which aims to create a new approach to care planning which could change the current face of healthcare.

Led by Dr Inga Stewart, consultant clinical psychologist, clinical research fellow and head of co-production at St Andrew’s Healthcare, the project will shine a light on the need to put the patient and their partners in care at the heart of care planning - a process in which they all too often feel sidelined.

With the support of the Alzheimer’s Society, the research will inform the

development of a toolkit to help care teams actively involve those directly affected by dementia, working in equal partnership to create a care plan that takes in all perspectives on care and is as person-centred as it is possible to be.

The research project - The coproduction of the care planning process with people with dementia - brings together experts in dementia through their academic, clinical or lived experience, creating a steering group with a comprehensive, 360-degree knowledge of dementia and current practices to help inform how effective change can be made. The main issue challenged through the project - the sidelining of people

with dementia in their own care - is something that is sadly quite commonplace in care settings, says Dr Stewart. But with care planning covering every aspect of their life - from what support they need with particular tasks, through to which shampoo they prefer - it is essential it is tackled.

“We can see some really good practice, where the person with dementia is involved in their care plan, as are their families or care partners. But then there will be some practice where care plans are written about people, and they’re not involved at all,” says Dr Stewart.

“And I think, sadly, the latter is probably more the norm. I don’t think it necessarily comes from a bad place; I think it’s more often a lack of understanding about co-production, how you engage and involve people to really work together to create a care plan.

“Often, people think you just can’t do that with somebody with dementia. “It might be that a person doesn't

SPONSORED

Dr Inga Stewart, consultant clinical psychologist and head of co-production

"There will be some practice where care plans are written about people, and they're not involved at all"

really know where they are, they don’t know what a care plan is. But that doesn’t mean you can’t coproduce their care - they will know what they like and what they don’t like, they will know what their hopes and wishes are.

“And you can adapt your way of working and communicating with somebody to ensure that coproduction can happen.”

Co-production is a term at the heart of everything Dr Stewart and St Andrew’s are seeking to do, ensuring the person is the focal point throughout their care. And for Dr Stewart, this lies at the heart of the research, and is key to changing the future for dementia patients.

“Co-production really is a set of values, it’s about respect and genuinely listening to and taking on board what somebody else thinks,” says Dr Stewart.

“Often people think it has to be about agreement, but actually it’s about everybody having a voice. When you create these coproduction opportunities, everybody comes with their own experience. “So you might have people who come with their experience from their professional background, whose learning will have been done academically; but their experience will be different to the lived experience of those who have

dementia, or are living alongside people with the condition.

“For me, I have worked with lots of people with dementia, I've worked with lots of care partners and family and friends, but I have not lived with dementia, and I have not lived alongside somebody with dementia. So I don't know what those experiences are really like.

“If we all bring all of that to the table, and we genuinely take on board all of these experiences, knowledge and ideas, then what we can co-create is really exciting. And it's so much more than any of us could do individually.

“We’ve got to think of it in terms of levels, and what often happens is that people are co-producing but they don't even know they're doing it.

“So it might be that whilst you're supporting somebody with their personal care, perhaps they're having a shower, and you're chatting

away to them about the things that they like.

“You could be talking about their family and you find out that they have a gorgeous garden back at home, and they love to potter in the garden and they know about flowers. So then you end up speaking to the rest of the team and saying, ‘I found out something new about this person’. And that comes out in the care plan.

“So it can be happening in many forms already, but what we want is for everybody to have the opportunity to co-produce to the fullest extent they can.”

By bringing together a steering group with wide-ranging experience of dementia and living with dementia - nurse and social worker Julie Hayden; ex-football referee

Peter Jones and ambassador for the Alzheimer’s Society; independent pharmacist and local Alzheimer’s Society ambassador Emma Wood; Niccola Hutchinson-Pascal, head of the co-production collective at UCL; and Professor Jacqueline Parkes, specialist in applied mental health at University of Northampton - all approaches to dementia can be analysed.

The project has created a number of practice standard statements to help guide the focus on the patient in the creation of care plans:

"Often people think it has to be about agreement, but actually it's about everybody having a voice. When you create these co-production opportunities, everybody comes with their own experience"

Practice standard statements

> I am an equal partner in planning my care

> I am at the heart of decision making

> I have had a conversation about care planning and I feel ready to start

> The language and approach is understandable to me

> People significant to me could be invited to be involved in planning my care where appropriate and acceptable to me

> I am the expert in my own experience. My knowledge and my care partners’ knowledge is respected and included

> The steps that we are going to take together to attain my aims are clear and achievable.

> We can review my care plan together at any time

“There is always room for improvement in dementia care, and through this research project, we want to bridge the gap. We want people to realise what they’re doing that is really good, but also how they can overcome some of the barriers,” says Dr Stewart. “The practice standard statements are really fundamental, they are the basis of all of the work that we've done.

“We drew on what was already out there in terms of literature, and we drew on people's lived experience, and also their professional experience, to think about what are the foundations of co-produced care planning?

“By creating this toolkit, we want to support the staff tasked with writing care plans to co-produce them with the person and their care partners. That is our focus.

“The actual toolkit itself is dementia-friendly, and could be used by care partners as well. There are hints and tips in there to help. It also has a checklist, which can be used as a self-assessment or audit tool on a broader level, to look at people’s care plans across the service.

A pilot of the toolkit is currently underway at St Andrew’s, building further on the care provider’s existing commitment to co-production.

“There is already a lot of working going on in co-production, and we’re currently working on our co-production framework, which is really exciting,” says Dr Stewart.

“I think this toolkit fits very nicely into

our dementia services, and this will be one of our outcome measures - we’ll be able to show just how co-produced our care plans are by using the checklist as an audit tool.

“I feel really confident about the toolkit. A lot of work has gone into it, and I hope it will help to make the cultural change we all want to achieve.”

Beyond the St Andrew’s pilot, interest is building from care settings around the country, which is informing the next stage of research.

“Right from the beginning, we have had a huge amount of interest externally, from care homes and hospital settings,” says Dr Stewart.

“We hope they will be involved in the second stage of the research, which is the multi-site research. I hope this can be an opportunity to influence practice and to influence and challenge thinking and assumptions that are out there.

“While people working in care may be innocently assuming that you cannot co-produce care planning with people with dementia, we want to show them that is wrong and how you can do things differently and better.

“By supporting them in this, and showing them and guiding them through the process, we can make change, and that is what we really hope to do.”

To get involved in the consultation, contact Dr Stewart and the team at research@stah.org.uk

Rebuilding lives and creating futures

We provide person-centred, holistic therapy and care and work closely with the NHS, case managers, families and everyone involved with an individual’s neuro rehabilitation.

Tel: Email: Web:

01372 84 1111 neurorehab@qef.org.uk www.qef.org.uk/CRC professionals

QEF’s Care and Rehabilitation Centre provides expert neuro rehabilitation and 24/7 nursing care; supporting people to rebuild core skills after an acquired brain injury, stroke, incomplete spinal injury or neurological illness. Watch our virtual tour

and

the

meet

team at qef.org.uk/CRC virtualtour

Using computer-assisted technology in brain injury rehab

RichardsonCare is one of the first organisations in the UK to use RehaCom® cognitive therapy to improve outcomes for people with acquired brain injury. After introducing RehaCom in 2020, alongside other therapies such as Cognitive Behavioural Therapy, Dialectical Behaviour Therapy, relaxation and psychoeducation, service users at Richardson Care have experienced a range of benefits. These include:

-improved short-term memory

-recalling previously-lost childhood memories

-better attention skills and ability to divide attention

-increased concentration

-improved cognitive skills

-improved reaction times

-improved higher executive functions

The RehaCom® technology assists in the rehabilitation of cognitive difficulties that affect specific aspects of attention, concentration, memory, perception and activities of daily living. This means that difficulties can be 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 ensures steady progression, increasing motivation and reducing frustration for the client. RehaCom® also offers a number of screening modules to detect impairments and recommend corresponding cognitive training modules. Regular screening can also help show progression and provide detailed reporting. Check out our video to see RehaCom® in use here.

Case study

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. She needed frequent prompting and encouragement with all aspects of daily living, such as personal care. She was also wheelchair-bound and had been told that it was unlikely she would be able to walk again.

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. She reports improvement in her selfesteem.

The holistic approach by the whole multi-disciplinary team has enabled Lynda to transform her life. She is physically independent and can walk well unaided. She enjoys swimming, going to bingo, going shopping and out to cafes. She has a part-time admin job assisting the Admissions Team 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. Read Lynda’s case study in full here. Richardson Care has six specialist residential services in Northampton: three for adults with acquired brain injury and three for adults with learning disabilities and complex needs. All service users are supported by a multi-disciplinary team of therapists and dedicated care staff who provide person-centred care.

For more information call 01604 792166 or visit www.richardsoncares.co.uk

Therapies in actionthe importance of multi-disciplinary working

NR Times learns more about the role of speech and language therapy and physiotherapy combining to support patients at Nottingham Brain Injury Rehabilitation Centre to exceed expectations, regain independence and rebuild their lives

In supporting a person to rebuild their life after brain injury, or in the event of neurological illness, the input from the multi-disciplinary team and their specialism across a breadth of aspects of neurorehabilitation is vital.

Two of those disciplines, physiotherapy and speech and language therapy (SLT), can work particularly closely, supporting each other to restore some of the independence in communication and movement which can make such a huge difference to a person’s life.

At Nottingham Brain Injury Rehabilitation Centre, SLT and physio work together on a daily basis with clients across its residential, slow stream rehab and high dependency units, supporting them from the very earliest stages of recovery to secure outcomes often beyond all expectations.

The impact of the individual disciplines can be powerfully felt within the wider rehab picture - both as inpatients within the centre, and as outpatients, with the re-launch of its specialist outpatient service - enabling clients to establish the

channels of communication and movement which will allow them to move forward.

“We work with a very complex client group and are dealing with cognitive impairment. It’s essential that from the start we establish communication in whatever way we can,” says Eden Akiatan, a senior neurophysiotherapist at the 59-bed centre, owned by Active Care Group.

“For this reason, we work hand in hand together with SLT. Once we have that communication, then we can engage with them.”

“It’s building that relationship and building the trust,” says speech and language therapist Nicholas Sobieraj.

“The more we can work together as an MDT, the more we can support them in their recovery.

“Often our patients come to us and they can tolerate five minutes of something, sometimes not even that. So by working on different aspects of therapy you can build the tolerance. Over time, you suddenly realise they can now do something for half an hour, even an hour. And it’s about giving the support for them to get to that point.”

Eden adds: “We want our patients to live their lives, that’s what we want to help them achieve. I always tell them ‘Let go and just live’. Live your life and do what you love.

“That’s our aim, to help them to get there, and working together we can help them to do that.”

‘We never give up, however long it takes’

Sarah* arrived at the centre in a minimally conscious state after a left-side stroke which left medics fearing for her future. After discharge from hospital, Sarah, who is in her 50s, was unable to communicate and had severely limited movement on her right side. She also had a tracheostomy in place.

Progress was slow, with no major improvement for over a year. But while Sarah’s rehab potential may have been questioned by some, for Eden, Nicholas and the Nottingham team, they resolved to continue rehab and wait as long as it may take to support Sarah in achieving the long-awaited breakthrough.

“Even during the time we were seeing no progress, we continued to work,” says Eden.

Committed to person-centred therapy

Working across the three units at the centre - Millwood, which specialises in slow stream rehab; high dependency service Fernwood;

Franchising - an exciting new initiative in case management

Richard Thorp, managing director of Circle Case Management, discusses how they are offering others a sector-leading route into starting their own business

Along with my partners, Pippa Bird and Yvonne Spijkerman, two of the most highly respected case managers within the industry, we have owned and managed a case management company for nearly ten years. Managing a mixture of employed case managers and freelance associates, alongside our expert witness and Mental Capacity Assessment services.

Case managers often enter the industry without any experience. With most case managers transferring from clinical settings, Circle Case Management provide training and high levels of admin, clinical and supervisory support, whilst working to create manageable significant caseloads. We pride ourselves on our case manager retention, with many case managers developing their skills and moving into supervisory and service lead positions.

We understand that as clinicians grow, they may want the opportunity to start their own business, as we did, making their own mark within the industry.

Case management is a personal service; case managers develop a close working relationship with a client (P) and their family, we understand that reallocating a case to a different case manager may not be the best option for P. Disruption to P can have an impact on their recovery and wellbeing and with this in mind, we have created a new route for case managers that would overcome this issue and still give them the pathway to becoming a business owner.

The progression from clinician to

business owner can seem like a scary jump to make, especially if the case manager has no business experience. The management of all aspects of case management, business procedures and clinical policies can be a lot for many to manage efficiently, especially with the advent of CQC registration and the growing requirements of instructing solicitors and Insurance companies making sole practice increasingly more demanding. Knowing what decisions to make in the best interests of your business can be difficult when starting a new company. Without experience and a deep understanding of the case management and the medio legal industries, costly mistakes can happen with processes which effects the level of service delivered to P.

As an established business, we are able to reflect on case managers that have previously left our team to create their own businesses and ask “How can we assist case managers to reach their goals whilst retaining assets within the team that we have invested in?”

Introducing Empowering U Case Management (EUCM)

The Jakhu family have owned and operated several care providers in England and Wales for the past 30 years.

After continued success in the sector, Empowering U Complex Care was launched in 2014 to provide complex care to individuals who require support at home and in the community. The organisation has gone from strength to strength across the Midlands.

Empowering U Case Management (EUCM) was born out of a requirement to build a case

management firm that delivers a client-first, collaborative approach to case management. By sitting under the wider Empowering U umbrella, EUCM have access to a vast amount of expertise and experience gained in the health and social care sector and use this to deliver a unique service, putting the client first in everything they do.

EUCM is led by Barry Lehane, Head of Case Management and Rehabilitation and Jenny Mitchell, Head of Business Operations. Together they hold over 24 years experience within in the field of Case Management.

EUCM have a team of 10 Case Managers, which include Physiotherapists, Registered General Nurses, Registered Mental Health Nurse and Occupational Therapists, who are geographically distributed over the country to enable us to cover each county. They ensure their case managers have the appropriate skill set as well as the experience of working within a multi-disciplinary team and the ability to advocate for the client. To underpin all this, they follow EUCM person-centred approach. Through their comprehensive induction and ongoing support and governance,

Empowerment at the core

One of the defining features of EUCM is an unwavering commitment to empower clients and their families on their journey to recovery or improved quality of life. Their person-centred approach helps clients navigate complex healthcare systems, making

informed decisions about their care and making their voices heard. They strive to equip clients and their families with the confidence to actively participate in their care. Their blend of care coordination, detailed knowledge of the healthcare landscape, and an absolute focus on empowering individuals with complex needs offers a life-changing service to clients and their families. Through their remarkable work, EUCM continually pushes the boundaries of what is possible in case management, contributing significantly to better outcomes for clients and their families in the UK. While the journey to recovery or adjustment can often seem daunting, providers like EUCM underscore the fact that with the right support, collaboration, and unyielding motivation, the path ahead can be navigated with dignity, respect, and empowerment.

Governance

EUCM are committed to continuously improving the quality of our services and safe-guarding the high standards of case management which they offer. They ensure that the stakeholders are in good hands and that the team are functioning at their highest potential.

All of their case managers are registered with their individual professional bodies, which is checked on a regular basis during audits. On top of their professional body, they are registered with BABICM and/or CMSUK. They all work to the codes of conduct released by BABICM and CMSUK. EUCM are up to date with the status of the IRCM. EUCM provide a robust and indepth induction to all their case managers, even if they have been in case management for several years. Regular clinical supervisions, training and team days are held to ensure that EUCM uphold their high standard of clinical governance.

Fourier Intelligence opens landmark centre

Occupational therapiststhe move from disillusion to empowerment

Think Therapy 1st discuss fulfilling the full scope of practice through working as an occupational therapist

As a career, occupational therapists (OTs) typically signed up for the holistic approach of empowering individuals to participate in meaningful activities despite injuries and health conditions. Nonetheless, a growing number of OTs grapple with disillusionment arising from the phrase “not within your scope of practice,” created by a health system that attempts to

compartmentalise treatment and therapy into separate departments with separate practitioners from separate organisations. Imagine a system turned on its head, where the occupational therapists are able to treat clients as they were trained, moving through the rehab model of restoring function, then adapting and finally compensating for loss of function when it can't be overcome. While also coordinating with the client across the multi-disciplinary team (MDT) to ensure the best treatments at the right time, rather than the restricted occupational therapy treatments offered by limited-scope roles.

Instead, the occupational therapists get to use their specialist knowledge, their ability and wellplaced opportunity to coordinate the wider MDT to manage the client's full recovery across all disciplines and areas of their lives. Can you imagine the outcomes? We don’t have to; we are seeing them.

Ten years into the unique model of Specialist Rehabilitation Occupational Therapy that is offered exclusively by Think Therapy 1st, where OTs not only gain job satisfaction and career fulfilment , they’re also alongside their clients while they make such remarkable gains.

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The latest audits of clients who completed their full therapy achieved the following:

> 91 per cent of their personal goals – remaining goals were either discontinued or had contingency plans in place to complete after therapy input

> 97 per cent of their therapy goals focused on enabling clients to return to activities they want and need to do

> 90 per cent improvement in selfcare activities, such as washing, dressing, eating, and sleeping

> 84 per cent improvement in productivity activities, including school, work, household tasks and using transport

> 97 per cent improvement in participating in leisure activities, including hobbies, sports, and socialising.

Even clients who only completed part of their therapy, for instance, less than half of what was recommended, made significant gains:

> 67 per cent achieved of their personal goals

> 68 per cent achieved of therapy goals

> 66 per cent improvement in selfcare abilities

> 47 per cent improvement in productivity activities

> 41 per cent improvement in leisure activities.

Hear directly from one of our associates below:

“After working in statutory services for many years the idea of stepping into independent practice felt quite daunting, but the team at TT1st are so supportive and knowledgeable it made the process much easier.

“The TT1st model appealed to me straight away with a clear focus on activity and empowering the client to reach their full potential. I found it really refreshing that the goals are so individual to the client, this makes the role really varied and also so rewarding.

“The company is forward thinking and the operational processes are really efficient which means

high standards are maintained and clinical time is productive and focussed which in my experience promotes greater job satisfaction.”

Air Ambulance. I understood that this was therapy and was getting me better in other ways not just physically”

Rachel

Stott,

Associate Specialist Rehabilitation Occupational Therapist

And hear from our clients: “Life is fantastic…I think I'm near enough back to normal…If it wasn’t for you, I think I would still be shut up indoors. You saved my life, and I'm really thankful I had you” “20 months after my accident, I went on to do my sponsored walk. I walked three miles and raised over £4,000 for the Essex

If you are an OT brimming with potential and want to explore fulfilling your full scope of practice, think about joining us we’re nationwide.

TT1st providing a platform for OTs to amplify their impact and reignite their passion for the profession. Visit our website for more information and to be part of this community of practice join our Facebook group: TT1st National OT Network for Functional Rehab.

Slater and Gordon on the move into Newcastle

NR Times visits its latest opening, having relocated its office in Newcastle, and speaks to the team about its commitment to the region, building its existing reputation further, and how its wide-ranging capability can prove crucial for clients in accessing the support they need

As a well-known and trusted name nationally, Slater and Gordon’s expansion into growing numbers of localities across the country is bringing the expertise of its lawyers even closer to those who need their support. The firm has always had

a presence in Newcastle but has recently relocated to the new and improved premises.

Regarded as a leader in its field in serious injury work - particularly in life-changing brain and spinal cord injury claims - and in supporting clients through distressing cases of clinical negligence, Slater and Gordon’s expansion is seeing it become even more accessible on a local level.

With an ethos of client-centred service, and a commitment to building the strongest possible relationships with both clients and fellow professionals, the growth

of its office network gives greater opportunities for in-person contact with its team of experts. Alongside this, clients are able to tap into the expertise of lawyers based elsewhere in the Slater and Gordon network, many of whom are national leaders in their field.

The latest relocation in Newcastle, builds on a long track record of success for Slater and Gordon in the city and wider North East. With years of trust amassed from its work in industrial disease,enabling countless clients from across the once heavily industrialised region to access life-changing support, the

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Through a series of new office openings, law firm Slater and Gordon is investing in widening access to its expertise for people across the country.

Ben Gent, specialist medical negligence lawyer

new office concentrates on industrial disease, serious injury and clinical negligence work.

Responding to the growing demand for its services from across the region, its team - which continues to recruitis building on its existing client base and relationships with professionals and support organisations, to offer the best possible service from its new home in central Newcastle.

Key names in the team include John Davis, a well-known figure nationally who this year marks 40 years in law, who is hailed in independent legal publication Chambers and Partners as “probably the leading lawyer in the North East on neurological trauma”; ‘rising star’ neurotrauma lawyer Kate Nickin; and Ben Gent, a specialist medical negligence lawyer top-rated by Legal 500 and Chambers and Partners.

And through its new presence on the ground in Newcastle, Slater and Gordon is keen to build its footprint in the North East even further.

“We already have a strong reputation in this region, and we have always had work from the North East, but I think being local and present in the area is very important for everyone,” says John Lowther, a clinical negligence lawyer with over 10 years’ experience of working in the North East.

“We have a strong network, which we are keen to grow even further, and have built relationships with some really key organisations which can be of benefit to our clients. Charities like Heel and Toe, organisations like Healthwatch - I am chair of Healthwatch South Tyneside - are great local resources, and add to the relationships we have nationally too.”

“There is such a deep vein of expertise running through the firm, both locally and nationally, which is so important for our clients,” says John Davis, one of only a handful of lawyers nationally to be accredited in both brain and spinal injury work.

“Our opening in Newcastle shows our commitment to this region, and the fact we are there for our clients. But importantly, we can offer access to exceptional people within the Slater and Gordon network for advice, in addition to the expertise of our team locally.”

“It’s important when acting for clients in a particular area that you know the local experts, so which therapists you’d go to, where to signpost people, where is best to find the support they need,” says Josephine Hall, who previously worked in Slater and Gordon’s London office before returning to her native North East. “It’s also easier to see clients, which we know they really value, and to see the circumstances they face. You can disguise a certain amount on video calls, but when you see them in their own surroundings, you get a much better idea of their situation. There are things they may not tell you, but when you see it with your own eyes, you better understand how you can help them and get a fuller picture of their needs.

distressing event.”

While locally the networks may be different, the commitment to supporting clients is consistent throughout the Slater and Gordon group. With a reputation for fighting hard for its clients, in cases that can routinely take many years, its North East team share the determination of their colleagues around the country in delivering the best possible outcomes. “There is a genuine commitment to putting the client at the centre of everything, which is something you hear a lot, but Slater and Gordon really do,” says John Davis.

“Our ethos is absolutely uncompromising on this and we’ll do everything we can to get the best outcome for our client and their particular circumstances, however long that takes.”

“Our priority is to do absolutely everything we can to support our clients, and to find every way we can to make their lives better after a

With a track record of securing significant settlements for claimants in both serious injury and clinical negligence work - and, crucially, in enabling people to rebuild their lives through accessing bespoke support and securing justice - the team’s expertise can be a key factor in determining the end result.

"It's absolutely vital that you go to a lawyer who is a specialist in their

Through its new presence on the ground in Newcastle, Slater and Gordon is keen to build its footprint in the North East

Kate Nickin, neurotrauma lawyer

their respective field, you’ve got to be really careful about that,” says John Lowther.

“There was one case which came to me, where previously it was being looked at in the region of £5,000, but the previous lawyer wasn’t a clinical negligence specialist. With proper investigation and after establishing the full circumstances, we actually settled for over £1million.

“We will leave no stone unturned in investigating a claim, to ensure our clients get the support and the justice they deserve. We will unpick everything and give them the answers they need and so they can access what they are entitled to.

“For many clients, it is very important to them that they are making a claim to make sure positive change happens, that procedures are changed as a result of what has happened to them. That is something we are very pleased to support with - mistakes do happen, and that is very unfortunate, but it is important that lessons are learned and preventative measures are taken that could stop the same thing happening to someone else.”

“The fact we are part of a national network adds so much more, too, and enables us to offer a holistic service,” says Josephine.

“We have a specialist midwifery and nursing team, who are such a

valuable resource. We also have specialists who offer advice on welfare benefits, which is a service not everyone offers but which can be a lifeline for many clients.

“For those who unfortunately may not have claims, our in-house expertise means we can signpost them to the right places, we’ll always do everything we can.”

To find out more, please visit www.slatergordon.co.uk.

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John Davis, specialist neurotrauma lawyer

over 200 experts

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We are the largest provider of HP expert witnesses in the UK, renowned and respected in the field

Occupational Therapists and Case Managers play a key role acting as expert witnesses in clinical negligence and personal litigation.

We require experienced Occupational Therapists and Case Managers specialising in all clinical areas, especially those working in the fields of neurology, stroke, brain injury, spinal injury and cauda equina syndrome, who are confident, have excellent communication skills (verbal and written), enjoy a challenge, are intrigued by the forensic nature of this work, and above all are keen to learn new skills.

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Elysium Neurological holds its first clinical advisory panel

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Elysium Neurological has held its first Clinical Advisory Panel (CAP), to assist clinical teams in the provision of care for individuals with complex and challenging needs. The panel is comprised of leading experts within neurological rehabilitation and treatment and will provide advice and recommendations for three cases per meeting, following presentations made by the teams involved in the individual’s daily care.

Convened to support teams at service level, the panel will draw on the wealth of specialist knowledge and experience that is present across the five different neurological pathways within Elysium, but is not always accessible to regional teams on a day-to-day basis. Paul Mooney, Clinical Director for Service Development & Improvement, Elysium Neurological Services, was instrumental in the development of the CAP and explains the reasons behind its launch.

Paul says: “We recognised that, collectively as a division, we have a huge amount of expertise across our five clinical pathways, and we wanted to ensure that there was a mechanism to be able to use this effectively to enhance patient care. The various clinicians within our services can now benefit from the ability to draw on each other’s knowledge and experience through the CAP, which is a formal panel that sits externally to a given service and that can be approached for advice around particularly challenging cases.

“On the balance of probability, every in-patient service will deal with complex and challenging individuals, and that can be a difficult and sometimes lonely place for clinicians. Sometimes we can feel that we have tried everything that we can

think of to support a person, so it’s helpful then to get a fresh pair of eyes, to link in with peers from other professions, from other services, even other pathways, to think about different ways of doing things.

“By drawing on the most skilled clinicians available across our services, we can ensure best practice that helps the individuals who use our services to get the best level of care possible.”

Elysium Neurological operates five neurological pathways across 10 services throughout England. The pathways (Neuroprogressive Conditions, Complex Physical Conditions, Complex Dementias, Neurorehabilitation, Neurobehavioural Rehabilitation) provide specialist neurological treatment, care and rehabilitation for individuals with a variety of different complex needs. For Paul Mooney, the CAP was a natural step in formalising how clinicians already support each other.

Paul says: “There are similarities in how services operate in neurological care but within each of those pathways, clinicians may approach people and problems in a different way. So, if there is a particular case where one approach is not yielding the best outcomes, it is good practice to reach out to others to reflect on a possible solution. Therefore, the development of CAP was actually a very logical move, it felt like an evolution of our overarching teambased philosophy of care.”

Louise Smith is Registered Manager and Executive Hospital Director at Badby Park Care Centre, and although she is a panel member for CAP, she joined the first meeting along with members of her team, to present and discuss a complex case. Here, Louise shares her motivation for participating in CAP and why she felt the process was beneficial not only to the resident, but also to herself.

Louise says: “I'm a mental health nurse, but I've always worked in neurological services since I qualified

25 years ago. So, I've developed quite a lot of knowledge and skills over that period of time with regards to challenging cases and individuals with complex needs. However, when you're faced with a challenging situation each day, all of the time, sometimes you can’t find the answer, you don’t necessarily think outside of the box.

“Whereas a clinician with a more objective view, who is a step back from the everyday care, can offer advice and suggestions from a new perspective. Drawing on expertise from multiple clinicians is a continuation of what we do at service level, but CAP is about broadening that access and extending it across all our services, to bring in that additional knowledge and experience.

“I asked my clinical team, who work with this particular resident on a day-to-day basis to come and present her case, receive feedback and then implement recommendations. They felt very positive about the experience and really took the feedback onboard. They’ve started

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"The various clinicians within our services can now benefit from the ability to draw on each other’s knowledge and experience through the CAP panel"

to implement some of the things that were advised, for example, they’ve been speaking to the dietitian and asking new questions. We’ve also been liaising with our visiting consultant, in regards to making some medication changes and he is now reviewing those.”

Louise and her team have already started thinking ahead to the next CAP and considering ways to develop

them further.

Louise continues: “My team found it really beneficial, they enjoyed it and they're already starting to think about other cases that they can potentially use CAP for. If possible I would like to involve the resident’s family more. Unfortunately for the case we reviewed most recently, we were not able to engage with the family prior to the meeting. We do

have families who are very actively involved and present at the site on a regular basis, and I would definitely encourage them to participate if this was in regards to their family member. They are part of the team that's providing care and support and their input is invaluable to that resident every day. They know them best, they know their history, what's been tried before and what hasn't. Understanding that history is really important when working with challenging needs.”

Shona Anderson, Regional Director of Nursing for Elysium Neurological Services, believes that CAP plays a vital role in ensuring quality of life for individuals with complex needs, and is an important learning opportunity for everyone who takes part.

Shona says: “For me there are two main reasons why CAP is so important. The first is continuing to ensure the utmost quality of life possible for the people that we support. We know that everyone who attends CAP wants the absolute best for those they care for, and that’s why they are asking for advice from the panel. Participating in CAP is a proactive way of ensuring that the individuals that use our services receive the most personalised and effective care and support that can be provided as a team.

Navigating cognitive rehabilitation: a review of the updated INCOG 2.0 guidelines

By Natalie Mackenzie, director and cognitive rehabilitation therapist at BIS Services

BISServices have provided specialist cognitive rehabilitation assistants for nearly 17 years, to provide support and rehabilitation to individuals living with brain injury and neurological conditions. As a cognitive rehabilitation therapist, I am often asked what my role is, and how it sits apart from other therapist or clinicians.

A cognitive rehabilitation therapist plays a crucial role in helping individuals who have experienced cognitive impairment due to injury, illness, or chronic conditions. We implement targeted therapeutic strategies designed to improve or restore cognitive functions such as memory, attention, language, and problem-solving. We conduct comprehensive cognitive assessments, create personalised rehabilitation plans, and facilitate cognitive exercises.

Our role is to track progress, adjust therapeutic interventions as necessary, and work closely with other healthcare professionals to ensure comprehensive input. The role also involves providing education and support to clients and their families, helping them understand the nature of cognitive impairments and strategies for managing them in day-to-day life.

Cognitive Rehabilitation Therapy (CRT) follows a step-by-step process, tailored specifically to each client’s unique needs and goals. The primary steps in the process typically include:

1. Evaluation: The first step of CRT involves a thorough evaluation of the client’s cognitive abilities and deficits. This assessment may include formal neuropsychological testing, medical evaluations, and interviews with the client and their family.

2. Goal setting: Once the evaluation is complete, therapy goals are identified in collaboration with the client and their family, and the wider MDT, if there is one. These goals are often functional in nature, relating to activities of daily living that have been impacted by the cognitive impairment.

3. Therapy: The therapy phase involves targeted activities and

exercises designed to improve cognitive functions. This can involve retraining intact cognitive skills, teaching compensatory strategies for impaired abilities, and cognitive exercises to challenge and strengthen cognitive abilities. We focus on the key cognitive domains, often commencing with attentional processes.

4. Re-evaluation and adjustment: Progress towards therapy goals is regularly monitored, and the rehabilitation plan is adjusted as necessary based on the client’s progress and evolving needs.

5. Transition and maintenance: As the client meets their therapy goals, they may transition from intensive therapy to maintenance therapy, with a focus on continuing to use and reinforce learned strategies and skills in their daily life.

The intervention incorporates four core strategies, forming an integrated approach to rehabilitate individuals with cognitive impairments.

1. Education: This approach enlightens clients and their families about the nature and effects of cognitive impairments. It involves learning about the brain, understanding how the injury has affected cognitive functioning, and what to expect throughout the rehabilitation process. I create

bespoke education packages for each client, utilising medical reports and family feedback. Education is ongoing around specific areas of cognition, with fatigue management playing a large role.

2. Functional training: This focuses on specific skills that a person needs in their daily life. It is highly personalised and can include skills such as managing finances, cooking, or using public transportation to more complex processes related to vocational goals.

3. Process training: This strategy aims to improve the cognitive processes underlying these daily life skills. Exercises might be undertaken to enhance memory, attention, perception or problem-solving skills, with the aim of improving overall cognitive functionality. These are informed by initial assessments and other neuropsychological assessments that have been undertaken.

4. Strategy training: This teaching method involves implementing compensatory strategies to help clients manage their cognitive difficulties. For instance, techniques for memory enhancement—such as the use of reminders— might be taught, or organisation strategies might be shared to help manage time more effectively. The list is often endless and the strategy toolbox

Launch of FND Service to redefine traditional pathway

A new approach to diagnosing and treating Functional Neurological Disorder (FND), and related conditions such as somatic symptom disorder and chronic pain, is set to transform patient care and outcomes, with a pioneering partnership leading the charge to redefine traditional pathways.

Proclaim Care have collaborated with Brain & Mind to devise a new approach to, and a specialist rehabilitation pathway for, FND, with extensive clinical expertise and experience of supporting people with the condition combining to create the Functional Neurological Disorder Service (FND Service).

The service is set to revolutionise FND treatment and support from the earliest opportunity, replacing the traditional Immediate Needs Assessment with a joint diagnostic and rehabilitation assessment from Proclaim Care and Brain & Mind’s expert teams, with reports completed within 42 days. A fixed fee service is offered for the initial review and assessment.

The FND Service - for patients aged 16 and over - has been created in response to the growing need for new approaches to supporting people with the condition, with the condition becoming more widely acknowledged

and understood, but NHS resources are becoming increasingly pressured in response to the demand and referrals often being made to the incorrect service.

Evidence suggests that with timely, effective treatment, two thirds of people with FND and related complex neuropsychiatric conditions will make significant improvement - but NHS waiting lists are currently around 12 months for the initial specialist assessment, with a similar waiting time expected again before specialist treatment can be accessed.

Clients of the service - which has been created in consultation with insurers, claimant and defendant solicitors - benefit from the significant clinical expertise of case manager Flora McMullon, who also has 25 years’ experience of neurological nursing, consultant neuropsychiatrist Dr Michael Dilley and consultant neurologist Professor Mark Edwards, founders of Brain & Mind.

As an established name in case management and rehabilitation management, Proclaim Care has supported clients with FND for many years, and its belief that something needed to change in this area was echoed by Brain & Mind - a unique service which brings together neurology, neuropsychiatry and specialist neurological and psychological therapies into holistic, client-focused care.

“It’s one of our passions to really drive forward the way in which we deliver case management services, and through this partnership with Brain & Mind we can really change the way in which we’re working across the industry,” says Neil Irwin, commercial director of Proclaim Group.

“The pathway we have created is a new and different way to achieve better outcomes for our clients. Case management hasn’t changed in a long time, and we are always trying to find ways to do things differently and to improve the industry through education - and we believe, working with Brain & Mind, this is going to be a really important addition for people with FND.”

The challenges in provision and recognition

While FND is not a new condition, the profile it now has is more of a

Revolutionising stroke recovery: Vim Health robotic-assisted therapies

According to the National Library of Medicine, Stroke is one of the leading causes of long-term disability today. Stroke, characterised by the sudden interruption of blood flow to the brain, can have profound and often life-altering effects on individuals. Stroke survivors often face challenges in regaining their motor skills and independence. However, the landscape of stroke rehabilitation has been transformed by integrating robotics into treatment plans. In this article, Vim Health looks at how technology is helping stroke survivors as they embark on their journey towards recovery.

At the core of robotic-assisted therapy lies neuroplasticity, the brain's

remarkable ability to rewire itself in response to injury or learning. Stroke can damage neural pathways, leading to impaired motor functions. However, consistent, and targeted therapy stimulates the brain to forge new connections, allowing patients to regain lost skills. Rehab technology capitalises on this principle by

providing intensive, repetitive, and precise movements essential for enhancing neuroplasticity.

No two stroke survivors are alike, and their rehabilitation needs can vary widely. This is where innovative technology truly shines. For example, Gait training devices, such as the Lyra from THERAtrainer and the LiteGait,

can be tailored to an individual's needs, adjusting factors such as range of motion, resistance, and intensity. This personalised approach ensures that every individual receives the therapy that will be most effective for their unique circumstances, enhancing the chances of a successful recovery. Traditional rehabilitation often faces challenges in providing the required intensity and consistency of therapy due to time, resources, and human endurance limitations. However, the treatment offered at Vim Health differs. With the use of robotics, Vim Health are able to give highly repetitive and consistent movements, which are crucial for retraining the brain. The ability to engage in a higher number of repetitions within a single session accelerates progress and improves motor skills, leading to faster recovery.

Rehabilitation is a journey that requires dedication and persistence. Equipment such as the Balo from THERAtrainer and the Tyrostation from Tyromotion incorporate real-time feedback mechanisms that guide patients through correct movement patterns. This instant feedback helps individuals adjust, improving their technique and overall progress. Furthermore, the interactive and engaging devices at Vim Health boost patient motivation, make rehabilitation sessions more enjoyable, and increase compliance with therapy plans.

Integrating sensors and data collection capabilities in robotic-assisted therapy empowers therapists with valuable insights. Objective measurements of patients' range of motion, strength, and coordination allow evidence-based decisionmaking. Therapists can monitor progress and make necessary adjustments to treatment plans, ensuring patients are continually challenged appropriately.

Rehabilitation professionals play a pivotal role in guiding stroke survivors through their recovery. However, traditional manual therapy can be physically demanding for therapists, potentially limiting the quality and duration of sessions.

Allowing therapists to focus on guiding patients' progress - traditional hands-on therapy and robotics work in synergy to maximise impact in therapy sessions.

Early mobilisation prevents complications such as muscle atrophy, joint contractures, and pressure sores in stroke survivors. Rehab robotics enables early engagement in therapy, enhancing the likelihood of a full recovery. As patients regain mobility sooner, they have a greater chance of regaining their independence and overall quality of life.

Robotic-assisted therapy is redefining the landscape of stroke recovery, offering a promising path toward regaining abilities. The personalised treatment, intensity, real-time feedback, and objective measurement provided by these devices contribute to more efficient and effective rehabilitation. While traditional therapies remain invaluable, integrating robotics creates a comprehensive approach that harnesses the power of technology to unlock the potential of the human brain's remarkable adaptability. Vim Health is a neurorehabilitation centre offering roboticassisted therapy, including the latest innovative technology.

For more informatin, visit www.vimhealth.co.uk.

Harnessing success: one person’s inspiring para carriage driving journey

This is a story about Naomi Sutton and her journey into Para Carriage Driving. The story begins in October 2019, and has been driven by Naomi’s passion for equestrian sports. Her path has not been without obstacles. Naomi had been diagnosed with Hypermobility Spectrum Disorder from a young age, and later developed Functional Neurological Disorder (FND). Her FND was diagnosed in April 2019, and it prevented her from continuing to participate in horse riding. Undeterred by these challenges, Naomi sought ways to enhance her performance and support her physical needs in the sport she had grown to love. Determined to pursue her passion for equestrian sport, Naomi transitioned into Para Driving. Functional neurologic disorder (FND), also known as conversion disorder and functional neurologic symptom

disorder, refers to a group of common neurological movement disorders caused by an abnormality in how the brain functions. FND is not caused by another disorder and there is no significant structural damage in the brain.

The most common symptoms include motor dysfunction: Functional limb weakness/paralysis; Functional movement disorders including tremor, spasms (dystonia), jerky movements (myoclonus), and problems walking (gait disorder); Functional speech symptoms including whispering speech (dysphonia), slurred or stuttering speech.

It is estimated that between 50,000 and 100,000 adults and up to 20,000 children under the age of 16 live with FND in the UK. In addition, there are an estimated 10,000 new cases per year.

Naomi working out with her Bodypoint Stayflex support set-up The Stayflex is a chest harness which Bodypoint designed with both support and safety in mind. Though looking a bit like a butterfly harness, it has added materials that allow dynamic movement across the shoulders, and along the lower fastening straps, but not in the central padding, thereby avoiding the problems often arising from elasticated butterfly harnesses which often ride up the body giving risk of strangulation.

Carriage Driving is a sport that received a lot of publicity as being one of the late Duke of Edinburgh’s favourites.

Carriage Driving is a friendly and inclusive sport where there are many opportunities to become involved. There are many different types of Carriage Driving available, whether it's simply for pleasure or for competitions (which are known as horse driving trials). Drivers control a carriage that's hitched to one, two (positioned in tandem or as a pair), or four, horses or ponies.

Para Driving consists of drivers sitting on a vehicle drawn by a single horse or pony while facing three trials –dressage, marathon, and obstacle driving. Since 2006 Para Driving has fully joined the ranks of the other 7 FEI (International Federation for Equestrian Sports) disciplines with national and international competitions in Driving for individuals with a disability. A Para Driver is classified into one of two grades according to his or her functional ability, to ensure a level playing field.

In Para Driving there is an attendant ('groom') who stands behind the driver and can give support and verbal direction to the driver. Steps on the carriage behind the driver are called the backstep and the grooms are also called ‘backsteppers’. Grooms are required for safety reasons because the driver must stay on the carriage at all times, holding the reins, and controlling the horses. They have an important role to fulfil ensuring the safe release of the driver should the carriage overturn.

Naomi did not explore any supportive aids since she did not anticipate competing at a high sporting level. However, she soon excelled in Para Driving, and began searching for solutions to accommodate her conditions and provide improved stability. Initially Naomi tried using a lap belt, which is a standard accessory, and which she placed around her chest. Although of some help, this did not provide the necessary support, and the backstepper had to hold the strap in place manually. To ensure adherence to the regulations of the sport (which prohibit fixing any equipment without a quick-release system for safety reasons), Naomi continued to seek a more suitable option.

Naomi's journey took a significant positive turn when she met her mentor Julie, the Chef d'équipe for Para Driving, and Pandora's Diplomat, Julie’s pony. Recognising the need for a more effective support system, they connected with BES Healthcare. Virginia Saavedra, one of BES Healthcare’s Assistive Technology Specialists (ATS), visited the yard to assess the situation and collaborate on finding a FEI legal, safe, and functional solution.

The team worked together to incorporate rings into the mounting system, providing the necessary support for a Bodypoint Stayflex harness. Naomi became the first person to be set up this way, and the results were remarkable!

Armed with her improved set-up, Naomi took on the competition arena, showcasing her new-found confidence and physical ability. Her exceptional performance led her to become the reserve champion in her class, marking a significant achievement in her carriage driving journey. Word quickly spread, and other athletes expressed their interest in adopting the same set-up for themselves, recognising its potential to enhance their performance.

Reflecting on her experience, Naomi said: “In the second phase of the competition – the cones – I got the best score out of all of the competitors, including the able-bodied entrants, and I wouldn’t have been able to do this without my Bodypoint Stayflex set-up.” Naomi's testimonial stands as a testament to the power of determination and the impact that proper postural support can have on an athlete's performance. Through the collaboration between BES Healthcare, her coach Robert, Julie, and Pandora's Diplomat, alongside the implementation of the Bodypoint Stayflex set-up, Naomi overcame significant physical challenges and continues to excel in the world of Para Driving. Her story serves as an inspiration to others facing similar hurdles, offering hope, and a reminder that, with the right tools and support, anyone has a chance to achieve their dreams.

To find out more, visit beshealthcare.net.

Naomi Sutton with BES Healthcare’s ATS Virginia Saavedra, and camera-shy dog! Naomi Sutton with her Bodypoint Stayflex set-up on the field

"I wouldn’t have been able to do this without my Bodypoint Stayflex set-up"

20 years of PhysioFunction

The 27th of August 2023 marked an enormous milestone for PhysioFunction, our 20th birthday! From humble beginnings, offering a domiciliary service to clients in Northamptonshire and the surrounding area, emphasising hands-on therapy (Bobath, N.E.T.) and exercise to continue with rehabilitation after NHS discharge, PhysioFunction has grown into a leader in neurological rehabilitation provision with our flagship clinic based in Spratton housing a vast array of world leading rehabilitation technology and our expert team.

Throughout PhysioFunction’s evolution, clinical provision has remained at the forefront of our service and in 2006 our Clinical Director, Jon Graham coined the term – Rehabilitation Triad - to describe the combination of handson therapy, technology and exercise. The key to physical rehabilitation is refining the prescription and delivery of these components at various phases during recovery. To support this PhysioFunction began expanding its services to incorporate technologies, beginning with the Saeboflex and Odstock Footdrop FES,

and expanding to incorporate a wide range of rehabilitation and functional technologies to support both physical recovery and day to day function. Over the years PhysioFunction has also expanded its geographical coverage beyond the bounds of the Midlands to Bedford, Oxford and London through an associate network and to Sheffield, Harrogate and York with a franchise network, before refinement and focus of the service around a commitment to exoskeleton technology, beginning with the REX and ReWalk in 2016 and being enhanced by the addition

Supporting parents of children with complex care needs

For parents of children with disabilities and complex care needs, life can be extremely challenging. Here, Michelle Marshall, case manager at ILS Case Management, discusses options around care and support, including home care and hospice respite

Deciding to have respite care for a complex need’s child is a decision not often taken easily by parents. I have met many families who have put off having respite care for many years for a variety of reasons they may feeling that they are failing in their parental role and feel that they should be the person that their child relies on, they may not trust others to look after their child or be concerned that their child will not know the care givers. So, what can help parents to make this tricky decision? Sometimes it can be hearing about the experience of other parents whose children have complex care needs and have care in place already. Speaking to someone who is going through the process and can tell a parent how they find it, can be extremely powerful and influential. Fast forward through those years without respite to the time when they begin having respite and parents will often reflect and think ‘why didn’t we do this earlier?’.

of the package and the care being delivered to her son, the mother was struggling. Having carers in her own home for long period of time meant that she was finding it difficult to relax and distance herself from her son and the carers. In addition, her son’s bedroom was small meaning that a lot of the care was being delivered in the main family living area. She felt she could not relax on her own home and was continuously making sure that the house was always tidy. She found that she was always doing things such as getting meals and medicines ready, even though she was not asked to by the carers or obliged too. These factors meant that she could not switch off and was not benefitting from the service. This home care package was reviewed and amended to provide a mixture of community care and care away from the home which met this family’s needs.

In a previous role, I worked for over ten years at my local children’s hospice as a children’s palliative care nurse. A large proportion of my work was organising, delivering, and managing the short break care which happened either at the hospice or in the community depending on the family and their preference.

Respite for parents whose children have complex care needs can mean many different things. For some it allows parents to go back to work, and others use the time to complete household chores, catch up on sleep or spend time with their other kids doing activities that they would not normally be able to do as a whole family.

Having the flexibility and choice of where to have the respite is usually the next big decision to be made by the family. All families have diverse needs, preferences and circumstances which will influence their decision and sometimes the reality of that decision can be quite different compared to initial thoughts, once the care is in place.

I’ll use an example of a family I have previously worked with. The mother was due to have a care package introduced at home to enable her to have a break from her caring role and she was excited about this starting. A few months after the care package started, we discussed how this was going, and although there were no problems or concerns with the running

Community care does suit many families. One family I have worked with decided that they wanted home care based on a number of reasons. The first and main one being the reduction in risk of their son picking up an infection. Secondly for convenience, his morning routine of medicines, feeds and physiotherapy would have meant it would have been a rush to get everything done and travel to the hospice. Add to this the very time-consuming activities of packing clothes, medicines, and equipment for their child to access respite outside the family home, especially for short respite, having someone come to the home was more practical for them and less time consuming.

Travel distance that some families is also a factor to consider, a long journey to pick up and drop off can significantly

How I got my cockiness back

After being left with a serious brain injury in a car collision in 2019, Lawrence - then a member of the SAS Reserves - has made huge strides in rebuilding his life. Here, he shares his story of recovery and how his ability to communicate has been transformational in rediscovering the confidence and cockiness which are so important to his life as a ‘normal’ 23-year-old

As a 21-year-old man achieving his life’s ambition of joining the Armed Forces - winning a place in the prestigious SAS Reserves and progressing through his training -

Lawrence had much to look forward to in his future.

But in a devastating car crash in October 2019, he sustained a brain injury and catalogue of serious physical injuries.

His life as he knew it was over, and despite a good physical recovery, Lawrence became insular, with the struggle to participate in conversations or determine his friends’ sarcasm making him withdraw from society. His confidence all but disappeared. However, through the power of therapy - and particularly speech and language therapy and its project based online communication groups - Lawrence has

achieved his ambition of being able to rediscover a social life.

He is able to confidently participate in the conversations he would once shy away from, he has a girlfriend - something he feared may never happen in the earlier stages of his recovery, when he could only see an isolated life ahead - and is set to begin a plumbing diploma.

“There have been a lot of bad times, but I’m now in a good place. I’m happy,” Lawrence tells NR Times.

“I used to want to be on my own, but not anymore. Through the groups, I have got my confidence back. They have probably been the most important part of my rehab and I wouldn’t be able to do anything like I’m doing today without them.”

Surviving and regaining independence

After being left fighting for life after the car accident in 2019, Lawrence was faced initially with a battle for survival, followed by a long road to physical recovery and ongoing implications of his brain injury.

Having been taken to the RVI Major Trauma Centre in Newcastle, Lawrence spent three-and-a-half weeks in a coma in intensive care.

“I don’t remember the crash at all. I just remember waking up in hospital and wondering why I was there. I was in intensive care for weeks and I have no memory at all of that time,” he recalls.

“I would talk to my brothers when they came to visit but they said I was saying stupid stuff, really random things that just didn’t make sense. I remember just lying in bed, looking out of the window.

“There were times that I didn’t even know who any of my family were when they came to visit me, and I wasn’t even sure who I was. I was introducing myself as being someone completely different.”

After Lawrence thankfully won his battle for survival and began his recovery, he was transferred from the RVI to a hospital nearer his Northumberland home.

“I saw more of my friends, and also I now had the chance to leave the hospital, people could come in and push me around in a wheelchair,” he says.

“But while I had a bit more freedom, being in hospital with such short visiting times felt like I was in prison.

“I was lying in bed all day and I wasn’t having any of the therapy I went on to get, like speech and language therapy or occupational therapy, and had just a bit of physio.”

After a private rehab package was secured, Lawrence was able to go home - and with support of a law firm and his case manager at A Chance for Life, he was able to really step up his recovery.

“It was so much better to be back home. At first, I couldn’t do much, but my mam and dad would push me in the wheelchair while they walked the dogs, or I’d push myself,” he says. “Once I got a case manager and a rehab team, things did start to improve massively. I made big progress with my physio, I did struggle with the pain when I was walking and had to keep going back to the wheelchair, but I could walk for a bit and then stop.

“I built up what I could do and I felt

like I was making progress, just the fact I could see some progress made me feel better.”

Continuing to advance thanks to his therapy, Lawrence also spent three months in specialist rehabilitation centre STEPS in Sheffield, equipping him to live independently.

By unfortunate coincidence, Lawrence’s parents had sold the family home to downsize to a smaller property - with Lawrence and his two older brothers living their own lives, and another brother still living at home, his parents had moved into a two-bedroom house - meaning his quest for independence was even more important to him.

“My mam and dad used to sleep in the living room at first so I could have my own room. But I wanted my own space and I wanted to live independently,” he says.

“I was really happy with how things went at STEPS. I had my own apartment for the last five weeks to get me used to living on my own. It was really good for me, I enjoyed my time there and made some good friends too.

“When I left STEPS, I had a trial of living independently and it went well. I can cook for myself and live on my own. I live fully independently, but my mam and dad are close by, which is nice.”

The life-changing impact of brain injury

While Lawrence achieved his ambition of regaining his independence, he began to realise the extent to which brain injury had affected his life, particularly through his social interaction.

From enjoying an active social life with a strong group of friends before the

life-changing crash, Lawrence now felt excluded and unable to participate. Fatigue was also an ongoing issue. “When I was in a group, I couldn’t keep up with the conversation,” recalls Lawrence.

“I didn’t know who was saying what and I wasn’t taking it all in. If someone was talking to me, I might not hear it all because of the noise of other people speaking, so I might say something completely wrong.

“I felt better if I didn’t join in. I wouldn’t talk at all if there was more than one person in the group.”

Sarcasm was also something Lawrence really struggled with.

“My brothers can be quite jokey, but I thought they were being serious. They’d say something and then say ‘We’re being sarcastic, Lawrence,’ but to me it didn’t seem like they were joking,” he says.

“I would tell them I didn’t understand but they would still do it. I guess they found it hard to change the way they had always communicated with me. “But I did get frustrated at times when I was talking to my brothers because I couldn’t tell when they were joking with me and when they were being serious.”

Lawrence’s fear of becoming involved in conversations meant he became withdrawn.

“I got to the point where going out would only make things worse for me emotionally. It made me so much less confident. If I was at home by myself, then I had no reason to talk and no need to interact with anyone,” he says.

For what was once a young man with a budding elite military career, Lawrence’s life felt like it had changed “beyond anything I had imagined”and his confidence hit rock bottom. The cockiness enjoyed by Lawrence, and by so many other young people in the prime of their lives, had gone.

“I was never the most cocky person, but I do think it’s a good thing to have to some extent. It’s part of your confidence and helps with your ability to deal with things,” says Lawrence.

“But then I didn’t have it anymore. I struggled to read emotions and struggled to find the things to say and I couldn’t handle situations.

“I needed to get some of that

Becoming an effective communicator and rediscovering the cockiness

The loss of the confidence to speak in conversations, even with family and friends, affected Lawrence significantly.

“I just wanted to be normal but I knew I wasn’t anymore. I didn’t know what to do at this point, to be honest,” recalls Lawrence.

Lawrence identified his goal of wanting to regain some of his cockiness to his speech and language therapist, Matthew Nakonesky of Speech Therapy North East.

Group therapy was identified as a course of action for Lawrence - and

one which would turn out to be transformative.

Lawrence took part in a number of online communication groups, where he was joined on video calls by a number of other people who also lived with brain injury, and had similar stories of struggling to communicate.

“I didn’t know anyone in the groups at first, but we were all the same. We all struggled, but we all helped each other to get better,” he recalls.

“Everyone was the same, we all had suffered a brain injury and we were trying to rebuild our lives, so I felt less pressure speaking in front of them because they understood.”

Within a short space of time, Lawrence began taking a lead role in the

sessions, his confidence returning in abundance with the progress he was making.

“Because you can speak and have a conversation in this situation, it helps your confidence in going out there and doing it. You know you can do it, so then you can go out into the street and into the world and do it,” says Lawrence.

“It was such a massive boost to my confidence and it has helped me deal with the pressure I felt. If I hadn’t have been part of the groups, there is no way I would be like I am today.”

Happily, Lawrence is also pleased with the level of cockiness he has regained, rating it at around 6/10, which he believes is enough.

“I think I have the right level of cockiness,” he smiles.

“I am happy. I wake up happy. I know I have the confidence to deal with what lies ahead.

“But I know that if I didn’t have my speech and language therapy, I might be physically fit, but I wouldn’t be able to sit here and have a conversation. I can do that now, and that has changed my life.”

Matthew, who has specialised in speech and language therapy for almost 24 years, says: “It has been fantastic to see the progress Lawrence has made, and to know that the communication groups have been such a central part of this.”

“The whole reason we have the groups is for people to build their skills and boost their confidence in a safe environment, which they can then take into the real world outside.”

“When we first met, Lawrence really lacked confidence and would say very little in meetings, if anything at all.

Now, he takes a leading role. I’m so proud of the progress he has made and continues to make in his life.

A bright future

From the devastation of what happened in 2019, Lawrence is now in a positive place and is looking ahead with optimism.

He is in a happy relationship and has just returned from his second holiday with his girlfriend, and has big plans for the future.

“When I was little, I had two dreams - either to be in the Army or be filthy rich. I can’t be in the Army anymore, so it’ll have to be filthy rich,” he smiles.

Having volunteered at a rock climbing centre, something which has become a passion for him and has been crucial in regaining physical fitness, he is now volunteering with a plumbing business to gain the vital skills for his future career.

He will embark on his Level 2 plumbing diploma in September.

“I still have a lot of problems with fatigue, so I can’t just go and get a job, but I want to work and do some graft,” he says.

“I’ll be going to college two nights a week from September, and then I’ll be working one day, which I am confident I will be able to manage. I want to do it.

“I think eventually I’d love to set up my own property development company, so I’m learning some of the skills I’ll need to do that. I hope that will make a great career path for me.”

While Lawrence can now look ahead with confidence, and continues to access speech and language therapy intermittently when he feels he needs it, he is keen to support others who may be in his position with reassurance.

“I feel like a normal person again, but it has taken a lot of work,” he says.

“You can’t flick a switch, it’s hard, really hard sometimes. But don’t quit. Don’t give up.”

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Neuro Rehab Times issue 29

NR TIMES

Celebrating 20 Years of Sleep Unlimited

Editor's note

Celebrating achievement

Collaborative content

Here, we unveil the shortlists of the inaugural NR Times Awards.

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20 years of PhysioFunction

Supporting parents of children with complex care needs

How I got my cockiness back

Surviving and regaining independence

The life-changing impact of brain injury

Becoming an effective communicator and rediscovering the cockiness

A bright future

JOIN OUR EXPANDING TEAM OF EXPERT WITNESSES