Neuro Rehab Times issue 26

DEFYING ALL EXPECTATIONS

IN PROVING MEDICS WRONG

Don't tell me what's poss ible

THE GROWTH OF SPEECH AND LANGUAGE THERAPY

RCSLT chief executive Kamini Gadhok and her commitment to change

LEVELLING UP MENTAL HEALTH CARE

The physical and psychological needs of SCI survivors

ACCESSIBLE GYMS

TV personality

Sophie Morgan discusses

For our interactive digital edition visit nrtimes.co.uk

Editor's note

Every day I do this job, I am thoroughly inspired.

Inspired by the survivors who continue to rebuild their lives, often after unimaginable trauma; by the professionals who work so hard to deliver the most selfless and best possible care; and by the academics and innovators who are working to change the future.

Every day, and in preparing every edition of NR Times, I come across more stories which leave me ‘wowed’ and in awe of what can be possible.

This issue is of course no different, and our cover story is a super example of that. It was a true pleasure to speak with Tom Green, a former Army PTI who was left paralysed after being hit by a truck while out on a charity bike ride.

Send your stories and opinions to Deborah Johnson, Editor deborah@aspectpublishing.co.uk

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Also on the NR Times team: Andrew Mernin, Founder / MD andrew@aspectpublishing.co.uk

Chloe Hayward, Sales

Sophie Dinsdale, Design

Sorina Mihaila, Contributor

Andrew Nealen, Contributor

Upon being told the utterly devastating news that he would never walk again, Tom replied ‘Watch me’. And since that time, barely two years ago, Tom has defied the expectations of medics and his rehab team by dedicating himself completely to his one goal - to walk again.

Late last year, typical of his determination to show what’s possible, Tom became one of the world’s best adaptive athletes, and will not stop until he becomes the best.

My chat with Tom, humble about his colossal achievements but laser-focused on his end goal, is something that will stick in my mind for a long time, and certainly will leave me questioning whether the ‘impossible’ truly is that if you have the right mindset and support around you.

It was also a privilege to meet with Kamini Gadhok, a speech and language therapist for 40 years and chief executive of the RCSLT since 2000, who has done so much to lead the development of the profession and to make positive change into the lives of patients.

A true champion of equality, Kamini has led nationally-significant projects in widening access for non-English speaking communities and children in particular, and more recently took a leading role in representing allied health professionals during the COVID-19 pandemic.

As Kamini gets set to retire, we reflect on her four decades within the profession and how she has supported speech and language therapists everywhere with some of the biggest issues facing them and their clients.

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)

In addition to everything in this issue, our website is updated several times each day with new content, which we hope you find relevant and useful to your work and professional or personal interests. Please visit us at www.nrtimes.co.uk

And also, please do get in touch with any feedback or story ideas. We are always delighted to hear from you and very much welcome new ideas, so please do drop us a line.

Deborah Johnson deborah@aspectpublishing.co.uk

how Heel and Toe is increasing provision for children

54 OT AND THE MDT how a focus on rehab takes a leading role

56 MAXIMISING POTENTIAL

Hunters Moor continues to expand neuro-rehab

58 NEXT STOP, INDEPENDENCE how Isabel is rebuilding her life

60 RECOVERY FROM CATATONIA role of physio in the MDT in achieving this

64 REFLECTIONS ON 40 YEARS IN SLT

Kamini Gadhok looks back at her career

70 CYCLING AND BRAIN INJURY is the sport treating it seriously enough?

74 SETTING GOALS

helping clients to achieve their ambitions

76 NEUROPLASTICITY

harnessing its power in neuro-rehab

CONTENTS

78 UNLOCKING POTENTIAL the positive role in therapy in life-changing outcomes

80 ONGOING GROWTH

Komplex Care continues to develop

81 HUNTINGTON’S CARERS given hope through new study

82 ENDORSING QUALITY care home secures accreditation

52 SOPHIE MORGAN discusses accessible gyms

50 LIFE-CHANGING THERAPY

DEFYING ALL EXPECTATIONS

IN PROVING MEDICS WRONG

Don't tell me what's possible

Here, NR Times learns more about the fearless former Army PTI, his progress to date and how he is inspiring fellow spinal cord injury survivors around the world

When Tom Green sustained a serious spinal cord injury when he was hit by a truck while cycling, he was given the devastating news that he would not be able to walk again. Having been a physical training instructor (PTI) in the Royal Regiment of Fusiliers for the previous nine years, Tom led a particularly active lifestyle, and had become a father for the first time just 2 years earlier.

So, the news of his paralysis was a particularly devastating blow - although not one that Tom accepted would ruin his life.

“I still remember it so clearly. The doctor came in and said ‘Mr Green, I have some bad news. You have a severed spinal cord. You’ll never walk again,” recalls Tom.

“I thanked him for his honesty but said ‘Watch me’. And since then, I’ve been trying to prove him wrong.”

And from that point in summer 2020, Tom

has left medics and rehab professionals alike stunned at his progress, which has been described as an “almost miracle” recovery. Defying odds at every stage in what is possible, Tom invests hours and hours each day in his rehabilitation, as he bids to achieve his goal of being able to walk again.

“There are no other serious goals than that. Walking is the primary goal,” says Tom, from Salisbury.

“I’m an all or nothing person, and I’m giving this my all, and my son has only increased my determination. If I don’t give it everything, what example am I setting him? That when life gets hard you give up? That’s not an option.” Such has been the progress of his rehab that Tom has recently become one of the best adaptive athletes in the world after taking part in the WheelWod Games, in which Tom competed in a category which wason paper - well beyond his physical ability. But typical of his determination to push himself, Tom finished fourth among the field of global competitors, with ambitions to finish even higher in future.

After being told he was paralysed after a cycling collision, Tom Green refused to accept that as his future - and is now defying all expectations in proving medics wrong

Annabelle Lofthouse, director and co-founder of Breakthrough Case Management, is Tom’s case manager, and admits continuing to be astonished by Tom’s progress.

“While he is bound by the limitations of his injury, his mindset is coming at it from a totally different place. It has been amazing to see Tom’s journey. I don’t want to use the word miracle, but there are times we have stood back and watched and have thought that is almost miraculous,” she says.

“People who have worked in rehab for years shake their heads in disbelief, because some of the things Tom can do don’t really make a lot of sense. We know the extent of his injury, but then he just goes and defies everything we thought possible in front of our eyes.

“Tom is truly an inspiration, to his son and to so many others. And by refusing to accept what others think impossible, Tom is showing the power of rehabilitation and the power of the possible.”

The expectationdefying rehab

From being an Army PTI at the peak of physical fitness, with a strong focus on mental resilience, Tom’s life was changed in an instant when he decided to take part in a charity cycle ride to raise money for Combat Stress. Around 40 miles into the 100-mile route, he was hit from behind by an articulated truck.

“I remember being in the hospital after being told I wouldn’t walk, thinking about what my life would look like. I remember checking myself, checking my legs, and thinking I am going to walk again,” recalls Tom.

“But that’s not to say there weren’t moments where it all seemed bleak - but I told myself if I keep on going down this line of thought, it’s going to be twice as hard to drag myself back. So, I knew if I looked for the positives, the silver linings (my son), I’d have the best chance to get to where I want to be.”

Initially, Tom did find himself having to draw on his mental strength, when the journey ahead looked especially long. Confessing to finding his hospital rehabilitation “passive”, Tom was desperate to be challenged more. It was at this point he met case manager Annabelle, of Breakthrough Case Management - a company which is never afraid to push boundaries itself, Tom was instantly assured by Annabelle’s straight talking nature and willingness to listen to his goals.

“I’d never dealt with case management before so I didn’t really know what to expect, but from speaking to Annabelle, she talked me through the process and did put my mind at rest that I would hopefully be making some progress from here,” says Tom.

Recognising Tom was “not starting from what might be deemed more usual functional ability than the average person at the start of rehab”, Annabelle identified Tom’s general and higher level priorities to begin with, before appointing a specialist team and devising a particularly challenging regime of rehabilitation.

“From the first moment I met Tom, two things were very clear to me. One was that I was going to be dealing with somebody that is incredibly determined, with his military background and hugely disciplined mindset,” she says.

“The second point being his son, who is absolutely the most important thing in his life. Tom’s personality drives him forward, but his son is at the centre of everything he does both as a role model and as a father. This is a very strong combination of factors which are firmly at the root of his determination.”

Tom’s specialist rehab team are supported by his rehab assistant Tom from Breakthrough, who the team refer to as ‘T2’ and who has been hailed as being “cut from the same cloth” as the former PTI due to their shared passion for fitness and achieving ambitions. T2 is with Tom every weekday and is said to be hugely significant in supporting his recovery.

With an immensely challenging regime in place, over the months, Tom has built up the physical and functional capability to regain the ability to take steps independently using the support of parallel bars. He also walks regularly using his Indego exoskeleton and operates at elite athlete level through his daily relentless strength training.

“Because of his PTI background, it was really important for him that we as a company tried to create an environment where physical functional rehabilitation can happen every day. We always work to our clients’ strengths and goals, and it was clear that because of Tom’s unique goals, he was really going to benefit from a very different kind of regime,” says Annabelle. “I recall watching Tom with his neuro physio and he lay on a plinth raising his legs. I have never seen a spinal cord injury client with his level of injury do that,” says Annabelle.

“The focus is on retraining Tom’s muscles to use every little bit possible, which can explain some of the gains, but Tom is defying every single expectation. His attitude, focus and determination are such that if there is a piece of equipment which is going to help in his rehab, Tom will do what’s required and then some more to really maximise things.

“The work he is doing with T2 is fantastic and the relationship they have is a real recipe for success. While his injury is very severe and there’s no getting away from that, the way he is pushing the boundaries is truly incredible.”

While huge gains have been made in only two years, Tom remains determined to continue with his advanced level of rehab, as he continues to aspire towards being able to walk again.

“It’s probably important to say that while I maybe a bit more driven and motivated than your average individual, you can’t understate the importance of the support I’ve got around me in doing that,” says Tom.

“I’ve got my partner Fran who is amazing, my rehab team, T2, Annabelle, and especially my family and friends, and having that structure in place is so important. Not everyone is fortunate enough to have this around them.”

Annabelle adds: “No rehabilitation pathway is the same, every single person is different. While equipment might be the same, someone’s ability to use it will vary. It might not work for them, and when you’re looking to buy very expensive pieces of equipment, insurers rightly want and need to see the justification for that as there is the possibility that devices may just be gathering dust.

“But with a client like Tom, he will give anything a go, and nine times out of ten whatever piece of equipment we try will work because he will make it work. The determination we have seen from Tom has been on another level and we look forward to seeing where our programme takes him.”

Pushing boundaries for survivors everywhere

While used to inspiring others through his role as a PTI, Tom is now having that impact on both a small and larger scale. Having recently competed in the international WheelWod Games - finishing fourth in a category which should have been well beyond his physical means - Tom is looking to combine his professional and personal experience together to offer personal training to spinal cord injury survivors, adaptive athletes and also able-bodied individuals. His first client, who he is supporting free of charge, is a young man injured in a mountain biking accident, leaving him paralysed below the waist.

“This young lad sadly had a no-fault accident, so he is in a completely different position to me. But I can still understand what he’s going through, both physically and mentally,” says Tom.

“One of the nurses at the hospital I was in after my injury reached out to me and told me about his situation, she said she thought he’d benefit from having a chat with me. Since then, we have got to know each other and completed a training session together.

“I looked straight at him after our session, and he was smiling. His girlfriend said she hadn’t seen him smile like that in over a year. For me, that is invaluable.”

And while giving hope to individuals and supporting their physical and psychological recovery, Tom is helping to inspire people around the world as to what may be possible despite life-changing injury or physical impairment through his participation in the WheelWod Games.

Held in December last year in North Carolina, in the United States, Tom - accompanied

by T2 - competed against seasoned disabled athletes in a category for those who have hip function – even though Tom’s is minimal. He finished fourth and is already planning a return next year.

On the Games, Tom said: “What an experience, it was a pleasure to share the dance floor with so many adaptive athletes, so many people that simply have not quit.

“It was a great challenge, and more importantly I have highlighted some weaknesses to work on for next year.

You either win or you learn!

“It was great to meet so many athletes who all have a backstory but refuse to let external factors decide their fate. When the odds are stacked against these individuals, they smile and say, ‘Let’s dance’.”

Now looking ahead to the WheelWod Games 2023, Tom is also eyeing participation in CrossFit challenges, as he continues to show what is possible through dedication, hard work and belief.

“It’s a real testament to Tom that he is not only focused on his own rehabilitation, but he’s also helping people directly and indirectly too. What an inspiration he is to everyone, but particularly people living with lifechanging injury,” says Annabelle.

“It’s an enormous privilege to be working with Tom and it gives the whole team great pride to see how far he has come.”

Tom adds: “Nobody expected me to be where I am now. But I'm not where I want to be.

“However, nobody thought I could be doing what I’m doing, so who knows where I’ll be in another year, two years, or four years?

“I’m at the point now where I can look back on my progress and see I’ve come a long way but looking forward there is only one goal - to walk - and I’m not going to stop until I get there.”

‘Almost all’ cases of CTE linked to repetitive head impact

Almost all cases of chronic traumatic encephalopathy (CTE) analysed through research are linked to exposure to repetitive head impact, primarily as a result of contact and collision sports, a groundbreaking new study has discovered.

Over 600 cases of CTE have been published in literature from multiple international research groups – and 97 per cent of those have confirmed exposure to repetitive head impact (RHI).

And of the 14 of the 17 purported CTE cases that occurred in the absence of RHI, where up-to-date criteria were used, the study authors found that families were never asked what sports the individual played. The review of research – led by Dr Ann McKee, director of the BU CTE Center and world-leading authority on CTE – confirms that, despite global efforts to find CTE in the absence of contact sport participation or RHI exposure, it appears to be extremely rare – if it exists at all.

“In studies of community brain banks, CTE has been seen in zero to three per cent of cases, and where the information is available, positive cases were exposed to brain injuries or RHI,” says Dr McKee.

“In contrast, CTE is the most common neurodegenerative disease diagnosis in contact and collision sport athletes in brain banks around the world. A strong dose response relationship is perhaps the strongest evidence that RHI is causing CTE in athletes.” CTE has been subject to a significant increase in scientific research over the past 17 years, primarily led by researchers at the BU CTE Center, but despite mounting evidence of the link between RHI and neurodegenerative disease, criticism has been made of sports bodies for not taking action to protect players quickly enough.

CTE became national news in the United States in 2007, but it was not until 2016 that the National Institute of Neurological Disorders and Stroke/National Institute of Biomedical Imaging and Bioengineering (NINDS-NIBIB) criteria for the neuropathological diagnosis of CTE were

published, and they were refined in 2021. CTE has been diagnosed in amateur and professional athletes, including those who took part in football, rugby union, rugby league, American football, ice hockey, bull-riding, wrestling, mixed-martial arts, and boxing. The research continues to make advances in knowledge around CTE. While it cannot yet be diagnosed during life, evidence is showing that MRI may show the disease in the living.

It is hoped the new review of research to date will help to increase the prevalence of CTE in looking at the impact of RHI, particularly in sport, and to encourage governing bodies to take action, with aims being set out to find a cure for CTE by 2040.

“The review presents the timeline for the development of neuropathological criteria for the diagnosis of CTE which was begun nearly 100 years ago by pathologist Harrison Martland who introduced the term ‘punchdrunk’ to describe a neurological condition in prizefighters,” explained Dr McKee.

“The review chronologically describes the multiple studies conducted by independent, international groups investigating different populations that found CTE pathology in individuals with a history of RHI from various sources.”

From over 600 cases of CTE, 97 per cent of those have confirmed exposure to repetitive head impact

The role of the Lyra in neuro-rehab

THERA-Trainers are used in neurorehabilitation clinics right around the world and are a leading brand due to their continued innovation and the availability of complete training systems for gait improvement, in addition to therapeutic cycling and balance solutions.

In this VIM Healthcare spotlight article, we are going to focus on the Lyra, a fantastic gait trainer that we have now had the opportunity to continually use with clients at our centre

GERMAN INNOVATION

Being based in Germany may automatically give medica Medizintechnik GmbH, the owner of the THERA-Trainer range a competitive edge – Germany is automatically associated with technology and innovation in many people’s minds! These assumptions about the equipment available from THERA Trainer are backed up by published research and evidence. Founded by Peter Kopf over 30 years ago, the company have produced market-leading robotic therapy devices and software for people undertaking neurological recovery journeys. Before we even opened the doors at VIM Healthcare, we knew that equipment from THERA-Trainer would be a crucial part of our rehabilitation technology lineup, as our founder, Tom, had a particular interest in robotics.

We see Kamara and Mikey meet with his MP Saqib Bhatti in the documentary, to ask if he can bring the issue of apraxia and dyspraxia into Parliament, which Bhatti agrees to and has subsequently duly raised the issue in the House of Commons.

LYRA BENEFITS

The concept behind the Lyra is quite simple – it enables the user to get up out of their wheelchair and replicate a normal gait pattern whilst supporting body weight, in minutes.

The user wears a comfortable harness that gently lifts them into an upright position – the feet are then secured onto two footplates. The footplates then move so that the user is assisted in walking. It’s safe to use, and effective and the patients we have had use it so far at the clinic love the confidence they feel whilst using Lyra.

Lyra can be used in a few different ways

and for people that have different conditions, but an effective application is in post-stroke clients, particularly those that are reliant on a wheelchair. One of the key aims of equipment like Lyra is to bring independence to those that are either unable to walk after a stroke or are having difficulties with gait. Lyra can help people regain the ability to walk, improve their speed and persistence, and also their gait pattern. Post-stroke, or a neurological injury, walking is the common number one goal for many people – the ability to stand and walk unaided is a key indicator of independence levels for most people. With this independence comes confidence and freedom.

Studies done by THERA-Trainer indicate, as does other scientific research, that people participating in robotic gait training, combined with physiotherapy after a stroke are more likely to regain the ability to walk independently than people that don’t use this type of technology. The THERA-Trainer study shows this to be particularly true for people that receive this type of therapy within three months of having a stroke.

THERA-TRAINER LYRA AT VIM HEALTHCARE

We have all sorts of people using Lyra at VIM but it’s become particularly useful in our intensive rehabilitation programmes. Our intensive programmes aim to get clients training at a higher intensity, more frequently. It’s the repetition of movement that is crucial during these programmes to encourage positive neuroplasticity in clients, helping them reach their therapy goals.

One of the best ways for people to practice walking and rebuild those neural connections is by walking. That’s why the natural gait Lyra helps clients replicate is essential – users can walk for much longer using Lyra and build up those important repetitions.

You can see in the short video below how we use Lyra in the clinic – the equipment is demonstrated by Piers Henderson, a client who is participating in a post-stroke intensive rehabilitation programme with us. You can read more about Piers’s journey here.

It’s beneficial how quickly the Lyra can be adapted to suit each user – we can adapt stride length and the handrail height quite quickly. Transferring from a seated position to Lyra is also easy as the base opens to accept a wheelchair, secure the harness on the person using it, lift them and then remove the chair. This is convenient and safe for both users, and our therapists.

Of course, our clients don’t only use the Lyra, successful rehabilitation takes a host of equipment and we’ve found the THERA-Trainer – Tigo complements Lyra. Whilst the Lyra is focused on gait patterns, Tigo is great for strengthening and conditioning muscles. Our clients and therapists have both been impressed with Lyra and we’re looking forward to helping more people gain independence using this important piece of kit.

If you are interested in any of the equipment available at VIM Healthcare or are ready for an initial assessment, please get in touch to book an appointment.

Reconnections continues to expand with new appointment

Groundbreaking neuro-rehabilitation centre Reconnections has continued its expansion by appointing Kelly Hodgson as client car and business development consultant.

Kelly has worked in health and social care for over 20 years, holding client care and business development roles with a number of market leaders including Carewatch, The Priory Group and Exemplar Health Care. She has also worked for niche companies including Team Brain Injury and NRC Medical Experts, a specialist expert witness chambers of neuro-rehabilitation specialists co-founded by Professor Mike Barnes.

In her new role at Reconnections, Kelly will further develop relationships for the centre with case managers, solicitors and commissioners.

“I’ve never seen a service like Reconnections –it is truly ground-breaking,” said Kelly. “Now entering its third year, Reconnections is delivering outstanding clinical outcomes by combining high quality, interdisciplinary neurological care and support with outdoor activities. It’s such an exciting time to join the team.

“I feel really passionate about reaching ABI survivors, through engaging and working in partnership with case managers, solicitors and commissioners in health and social care.

“I am particularly looking forward to introducing our highly skilled and specialist multi-disciplinary team which includes neuro occupational therapists, neuro physiotherapists, neuro speech and language therapists, neuro psychologists, positive behaviour practitioners and rehabilitation coaches.”

2022 was a breakthrough year for Reconnections with the service releasing its first evidence-based outcomes review.

Analysis of participants’ outcomes indicated:

100 per cent improved their ability to carry out everyday activities

100 per cent needed less support when they were discharged and 60 per cent have progressed onto independent living

100 per cent reported an improved hope for the future and an improved sense of purpose and direction in their life

90 per cent achieved their goals

80 per cent felt more empowered through

greater participation and control over decisions that affect their lives.

Head of service at Reconnections, Claire Appleton said: “We are thrilled to be working with Kelly as we build ever closer relationships with solicitors, case managers and commissioners.

“2023 is a massive year for Reconnections. “People with ABI can sometimes find the set procedures of neuro-rehabilitation too clinical, inflexible and impersonal. “At Reconnections, we believe in doing things differently. At our unique neurorehabilitation centre, we bring together the beauty and benefits of the great outdoors with the very best in personcentred care – delivered in an enjoyable, homely environment that inspires and supports people to become the best they can be.

“ABI is life-changing. It can leave people feeling lost, apprehensive and reliant on others. At Reconnections, we help people face and embrace their new normal empowering them to push perceived limitations and become more independent.”

Chroma set for growth in 10th anniversary year

(CATs) through collaborative working as part of a multi-disciplinary team.

Daniel Thomas, managing director at Chroma, said: “This year looks set to be another amazing one and we could not be more thrilled, especially as we approach our 10-year anniversary this October! I’m always amazed at how Chroma has grown over the last ten years from my kitchen table to what we are today.

“From our continued partnerships with some of the very best rehabilitation specialists in the UK; specialist schools and medico-legal partnerships, our ongoing CPD sessions, and the implementation of innovative software – Goal Manager to enhance rehab goal setting, 2023 is set to be a good one.”

‘Pay it forward’ therapy initiative launched

A charity has launched paid-for therapy sessions to enable it to widen its reach of free interventions for those who need it.

The Brain Charity has devised a ‘pay it forward’ initiative in its specialist neuro psychotherapy service, which involves the delivery of paid-for sessions for the first time to individuals across the UK.

Chroma is looking to build on the success of 2022 as the UK’s leading arts therapies provider as it approaches its tenth anniversary in October.

Established in 2013, Chroma now employs over 100 therapists, and that number looks set to grow as demand for arts therapy services increases, with a series of contract extensions and new deals set to be agreed. Chroma collaborates within sectorleading partnerships including with STEPS Rehabilitation, Sue Ryder, Hobbs Neurological Rehabilitation and Voyage Care. Additionally, they’re entering the eighth year of supporting HCA Healthcare UK, a leading healthcare provider in the UK, working at the Wellington and Portland Hospitals on a full-time basis.

Chroma has also seen a 100 per cent increase in medico-legal work in the past 12 months, handling over 700 cases with many of the UK’s leading case managers, deputies, insurers, and injury lawyers including Stewarts, Bush & Co, Stokes, Jaqueline Webb, Irwin Mitchell, Slater & Gordon, AXA, Aviva, and Allianz.

Chroma’s successful business approach was recognised last year when it won the Supporting the Industry Award at the prestigious Personal Injuries Awards 2022; an acknowledgement of their success in professionalising the Creative Arts Therapies

Building upon the success of its CPD sessions, Chroma is looking to widen its CPD training programme of specific theory and techniques, to better prepare educators, lawyers and case managers to support clients with trauma or attachment difficulties.

Sessions range from understanding how questions around gender and identity can affect adolescents, with practical advice on how to help, to using arts therapy and wellbeing techniques in the classroom.

“We consider ourselves a socially aware organisation and aim to continually educate ourselves which is why we have taken steps to become more diverse –as a workforce and in the delivery of our sessions – and inclusive by introducing the ReciteMe tool to the website. With each year we aim to be better, and thankfully, we are on target to achieve that,” said Daniel.

“For us, the key to growth is providing added value services to our partners as well as spending more time with clients and less time on admin work. We’re also excited to be introducing more technology and Goal Manager, a new clinical tool that improves the quality of rehab goal setting and streamlines the goal setting process which sets a new gold-standard practice around this aspect of arts therapy work.

“As we approach our tenth year in the industry, I’m very optimistic about the future for Chroma and the arts therapy sector.”

Through the introduction of a charge for those who want to access therapy without having to wait, it is supporting other people who would not be able to afford to pay for specialist counselling to access the service for free.

The Brain Charity has a team of licensed therapists who are specialists in neurological conditions and the mental health challenges that are often associated with them.

Sessions are available in-person at its base in Liverpool, or via video or telephone call to anywhere in the country. ectly through improved wellbeing of nurse leaders,” added Bunn.

The Brain Charity said it decided to launch a paid-for therapy service in response to increasing numbers of clients nationally who were accessing the free service asked if they could make a contribution for their sessions to support the charity’s work.

Sharon Berry, counselling coordinator at The Brain Charity, said: “When you purchase specialist neuro psychotherapy through The Brain Charity, you are not only accessing high quality professional therapy – you are also funding one of our clients to receive this for free.”

The Brain Charity’s therapists offer a range of psychotherapy types, including CBT, personcentred and integrated.

Its interventions can support many of the mental health concerns associated with brain injury or neurological conditions, including anxiety, depression, PTSD, bereavement and grief, anger management, relationship problems and communication barriers.

Prices for a single therapy session start at £65 per hour, with block bookings available for individuals, or for businesses wanting to find new ways to support their workforce.

Brain health risk

Experiencing three or more concussions is linked with worsened brain function in later life, new research has revealed.

The study – the largest of its kind – also found having just one moderate-to-severe concussion, or traumatic brain injury (TBI), can have a long-term impact on brain function, including memory.

Led by teams at the University of Oxford and the University of Exeter, the research included data from more than 15,000 participants of the online PROTECT study, who were aged between 50 and 90 and based in the UK. They reported the severity and frequency of concussions they had experienced throughout their lives, and completed annual, computerised tests for brain function.

The study found that people who reported three or more concussions had significantly worse cognitive function, which got successively worse with each subsequent concussion after that. Attention and completion of complex tasks were particularly affected.

The research adds further to evidence of the links between head impacts and long-term neurological consequences, and researchers say people who have had concussions should be warned of the dangers of continuing highrisk sport or work.

Lead investigator Dr Vanessa Raymont, from the University of Oxford, said: “We know that head injuries are a major risk factor for dementia, and this large-scale study gives the greatest detail to date on a stark finding – the more times you injure your brain in life, the worse your brain function could be as you age. “Our research indicates that people who have experienced three or more even mild episodes of concussion should be counselled on whether to continue high-risk activities. We should also encourage organisations operating in areas where head impact is more likely to consider how they can protect their athletes or employees.”

The team found that participants who reported three episodes of even mild concussion throughout their lives had significantly worse attention and ability to complete complex tasks.

Those who had four or more mild concussion episodes also showed worsened processing speed and working memory. Each additional reported concussion was linked to progressively worse cognitive function.

Furthermore, the researchers found that reporting even one moderate-to-severe concussion was associated with worsened attention, completion of complex tasks and processing speed capacity.

In the online PROTECT study, participants share detailed lifestyle information, and complete a suite of cognitive tests every year, for up to 25 years. This data helps researchers understand how the brain ages, and the factors involved in maintaining a healthier brain in later life.

Dr Helen Brooker, a study co-author from the University of Exeter, said: “As our population

ages, we urgently need new ways to empower people to live healthier lives in later life.

“This paper highlights the importance of detailed long-term studies like PROTECT in better understating head injuries and the impact to long term cognitive function, particularly as concussion has also been linked to dementia.

“We’re learning that life events that might seem insignificant, like experiencing a mild concussion, can have an impact on the brain. “Our findings indicate that cognitive rehabilitation should focus on key functions such as attention and completion of complex tasks, which we found to be susceptible to longterm damage.”

Dr Susan Kohlhaas, director of research at Alzheimer’s Research UK, said:“Studies like this are so important in unravelling the longterm risks of traumatic brain injury, including their effect on dementia risk.

“These findings should send a clear message to policy makers and sporting bodies, who need to put robust guidelines in place that reduce risk of head injury as much as possible.”

The PROTECT study is conducted entirely online, and is open to new participants aged 40 and over.

To find out more, visit: https://www.protectstudy.org.uk

‘raised with each concussion’

We’re learning that life events that might seem insignificant, like experiencing a mild concussion, can have an impact on the brain

Bringing new levels of client support to case management

In looking for new ways to assist a client, Circle Case Management’s Nicola Weller devised a bespoke and innovative way of supporting him to achieve his goals – with her work now helping to change the lives of other clients.

NR Times speaks to the award-winning marketing and events manager

From the desire to use all available expertise to help a client with a brain injury to achieve his goal of setting up his own business, has come a new and innovative model in delivering ‘outside the box’ support.

In assisting a case manager colleague at Circle Case Management, the company’s marketing and events manager Nicola Weller has delivered an accessible and truly life-changing way of empowering a client through the creation of bespoke video content.

Through bitesize tutorials covering all aspects of establishing his business – covering topics such as what is marketing, what is PR, setting up a Facebook account and how to sell on social media – Nicola has now created around 40 videos, all supporting the client to achieve his goal.

Now, several months later, the client is running a thriving Facebook-based business which is generating profit and has fast-growing numbers of followers – but crucially has given him back his independence, confidence and self-esteem. And in recognition of her efforts in this case, Nicola was awarded the case management (internal) supporter of the year at the CMSUK Awards 2022 – following case manager Maria Morris, who received an accolade from VRA for the same pioneering initiative.

“The main goal of rehabilitation is helping somebody back either to how they were pre-injury, or to give them enough tools and confidence to be able to re-engage in independent life. Our client has absolutely smashed his goals in this case, and our very bespoke support has enabled him to do that,” says Nicola.

“He’s fully motivated and is really happy, because now he has a reason to get up on Monday mornings. He has a structure, he has a routine back and he feels like he has a role in society again. It has been life-changing for him.

“He wanted to set up his own business and we gave him the tools to do it – and by us empowering him to do it, that has been so much more impactful than if we just did it for him.

“There isn’t enough business support for disabled people, and I think that if us as professionals can help in any way, then we are well placed to do that. We understand our clients, we know their back story, and we have the skills to help propel them further toward their goals.”

The innovative approach is demonstrative of the new strategy Nicola – whose background spans communications, marketing, sales and business development – has introduced into Circle, with digital and video content playing a key part of its forward-thinking approach.

“I was working with our rehabilitation case manager Maria and discussing this particular case, and I realised from what she was telling me about this client that I had skills and expertise that could help,” says Nicola.

“We are very keen to push boundaries and make positive change at Circle, and while me becoming involved in this way might not have been a traditional thing to do, I have always enjoyed thinking outside of the box and I knew I could make an impact.

“From speaking to the client, I could see how badly his executive function had been affected through his brain injury, so I realised we could make something bespoke for him which would enable him to understand – we could use video, with big text, with sounds, addressing issues in small chunks.

“We trialled the approach and it was really well received by the client, but also by his support network, who were able to take part in supporting him if needed and in understanding what he was doing and trying to achieve.”

And from the involvement of Nicola in the client’s rehabilitation and the sharing of her expertise – a substantial part of which she did on a voluntary basis, in her own time – he was able to achieve one of his biggest goals.

For Nicola, this is indicative of how effective the skills of the wider workforce or network in

a case management company can be.

“I really hope the success of this project is a reminder that in case management, you’ve got a team of professionals who sit in your head office, and they could be really valuable to your clients,” she says.

“Whether you’re a secretary or work in HR, you have skills that could help a client get one step closer to their goal. I would love other case management companies to look at what we’ve done and see if this approach could help any of their clients.

“When I tell people about what we’ve done, they often remark that it’s quite a simple idea and why didn’t they think of it – but I think sometimes, it’s not until you have a specific problem and hit that wall in solving it that you find the solution.

“In this case, I’m so pleased that I could help and I’m so pleased my award has helped to draw attention to it. If one thing could come out of me winning this, it would be for others to consider doing something similar, because I’ve seen for myself how important it has been.

“Being involved in a client’s case in this way was something new, but the feeling of job satisfaction and knowing I’d made a difference to someone’s life was very special.”

Nicola is now implementing this approach with other clients, including one client with a brain injury who is now becoming a public speaker to share his experiences.

“This client is from a business background, so I didn’t need to tell him how to market – but public speaking and essentially building your own brand is something totally different,” she says.

“I’m really enjoying doing this kind of work with this client and others. I have seen how valuable my insight and input can be, so to use it in other situations is fantastic and a genuine privilege. It also shows just how we work at Circle – we are always looking at how we can do things different and better, to do the absolute best we can for our clients.

“Case management is changing and we are really pleased to be seen as one of the names in helping to drive it forward – and I’d absolutely love to see others follow our lead in this instance, and using the expertise they have in-house for the good of the clients.

“Clients are the priority for absolutely everyone at Circle, and we’ll do anything and everything we can to make a difference to their lives and rehabilitation.”

* For support or guidance in creating content of this kind and offering additional ways of supporting clients, contact Nicola via circlecasemanagement.com or by calling 01297 24145

The international nongovernmental organisation PINK Concussions will host top brain injury experts in a groundbreaking event in Dublin to debate the need for a femalespecific concussion management protocol for women athletes.

The 12th PINK Concussions Summit, taking place on March 30 in Dublin, aims to bring together international medical experts to debate changes needed to level the playing field for female athletes, from rules changes to a new concussion protocol.

The event, moderated by founder and executive director of PINK Concussions, Katherine Snedaker, will focus on the need for a femalespecific concussion management protocol in sports, equal access to medical care on the pitch for women’s sports teams and whether women’s sports teams should consider modifications in “rule-specific engagement” based on current concussion research.

Snedaker says: “For over a decade, PINK Concussions has been advocating for recognition of sex differences in brain injury mechanisms, symptoms, and recovery trajectories to support practitioners in delivering individualised medical care.

“We believe a debate on a female-focused concussion protocol in sport will highlight the updated medical training needed on sex differences in brain injury.

“This is essential as brain injury is not identical in women and men.”

Back in 2012, the American Medical Society for Sports Medicine issued a position statement stating that “in sports with similar rules female athletes sustain more concussions than their male counterparts”. In addition, they highlighted that female athletes experience or report a higher number and severity of symptoms as well as a longer duration of recovery than male athletes in several studies.

Research over the last decade has continued to support these findings yet there

has been no change in the protocol and care for female athletes.

“Worldwide research into female concussion continues to support and strengthen the view that females suffer an increased incidence of concussion compared to males in contact sport,” explains Dr Marshall Garrett from the University of Glasgow School of Medicine. “Their symptoms also appear to be more persistent and cognitive deficits more pronounced than males.

“World sporting bodies need to acknowledge this difference and make provision for female specific assessment and recovery protocols.” While the event focuses on female athletes, PINK Concussions hopes the impact will be broad, reaching girls in youth sports and women with non-sport brain injuries.

The summit will be held during the IBIA 14th World Congress on Brain Injury, in partnership with Acquired Brain Injury Ireland, at the Convention Centre Dublin from 4-5:30 PM GMT.

Speakers participating in the debate include: Willie Stewart, Queen Elizabeth University Hospital, Dr Marshall Garrett, University of Glasgow School of Medicine, Katherine Snedaker, LCSW PINK Concussions, Abigail C. Bretzin, University of Michigan, Christopher C. Giza, Mattel Children’s Hospital, UCLA, Christina L. Master, University of Pennsylvania and Dr Inga Katharina Koerte, Ludwig-Maximilians-Universität.

For more info, visit pinkconcussions.us or email katherine@PINKconcussions.org.

Top brain injury experts to debate the need for “female-specific concussion protocol” for women athletes

Worldwide research into female concussion continues to support and strengthen the view that females suffer an increased incidence of concussion compared to males in contact sport

Richardson Care Continues to Impress in Family Surveys

The results of the survey completed at the end of 2022 show that:

> 100% of respondents were happy with the care provided

> 100% felt that their relative was treated with dignity and respect

> 100% felt that staff were friendly and approachable

> 89% said that their loved one’s quality of life had improved since admission to the service

> 94% would recommend Richardson Care, if appropriate.

In addition, one respondent, who’s son has an acquired brain injury summarised her thoughts as:

“I agree 110% that his quality of life has improved since he arrived at Richardson Care. [They provide]:

Professional care - kindness with knowledge applied

Happy faces - staff and, more importantly, residents

Clinical knowledge - access to expert advice, attention to detail of personal care plans.”

Laura Richardson-Cheater, Director at Richardson Care comments: “We are delighted with the survey results again this year but we’re never complacent. We welcome all feedback and are always looking at ways to provide better outcomes. Our service users have complex needs and we are entrusted with their care. We take that responsibility very seriously.”

The Northampton-based care provider has six residential care homes and a long proven track record of delivering successful outcomes for service users. It provides a flexible care pathway, which allows individuals to progress within a stable home environment.

THE SERVICES ARE:

1. ABI assessment & complex diagnosis unit, The Coach House

2. ABI rehabilitation & transitional service, The Richardson Mews

3. Long-term community neuro-rehabilitation service for men, 144 Boughton Green Road

4. Transitional & long-term LD & complex needs service, 23 Duston Road

5. Long-term community LD & complex needs service, 2 & 8 Kingsthorpe Grove

GRAPH KEY

Families were asked if they strongly agreed, agreed, didn’t know or disagreed with the following statements:

Q1. I am happy with the care provided for my relative

Q2. The home has a warm, non-institutionalised feeling

Q3. The home provides an inclusive or ‘family’ environment

Q4. The staff are friendly and approachable

Q5. I am regularly updated with information

Q6. I feel that my relative is treated with dignity and respect

Q7. I feel that their quality of life has improved since they arrived at Richardson Care

Q8. I feel that my relative takes part in meaningful and/or enjoyable activities

Q9. Would you recommend our service to others? Yes/No

Richardson Care is a specialist provider of rehabilitation and residential care for adults with acquired brain injury, or learning disabilities, and complex needs. Each year it conducts a survey of the family members of its service users about the quality of care that it delivers.

I’m so much more than what happened to me "

‘Only if you tell me about the worst day of your life first?!’

Here, Sophie shares some insights with her trademark searing honesty, as well as her hopes for greater awareness around disability and to remove the taboos around being in a wheelchair

Five years ago, I had a spinal cord stroke. It’s a very rare form of stroke where a blood clot essentially passes through your spine, and has left me paralysed and in a wheelchair. This is my reality and this is my life. Without doubt, it is the most traumatic thing to happen to me - but I won’t let it define me. I am me, the Sophie I have always been, but now I use a wheelchair.

In adapting to my new life, I have found that paralysis is not something we as a society are used to talking about. Being around people in a wheelchair is unfamiliar for so many people, and they just aren’t quite sure how to approach you. I’ve had to adapt to a lot of change in the last 5 years and learning how to navigate the world in a wheelchair has been challenging.

I don’t think I realised how frequently I’d be asked clumsily about what happened to me. In a black cab, the cabbie will say ‘Do you mind me asking, love, what happened to you?’ and I find myself repeating my story, opening up the scar and reliving the horror over again. It’s tempting to say

So now, I’ll often tell new people as soon as I meet them, then we’ve got it out of the way and we can get on with the conversation and they can hopefully start to see me and not my wheelchair. It’s my way of feeling a bit more in control of the situation. Then question isn’t lingering and they aren’t wondering what happened and if it’s ok to can ask me or not. It’s been a huge learning curve from the moment I became paralysed. You think you know about disability but you have no real understanding until it happened to you or someone you love. You have to learn a whole new vocabulary, how to advocate for yourself and how to ask for help. Often people think they’re helping by pushing your wheelchair. I’ll ask someone if they can open the door for me, and I’ll look around and they’re suddenly pushing me through it. I’ll put my hand on theirs and say ‘Thank you so much, but I push my own chair’. It’s so personal to touch someone’s wheelchair, it’s a part of you. But you can’t expect someone who’s never experienced being in a wheelchair to know that. Those interactions can feel so awkward and difficult to navigate. On one hand you’re asking for help and on the other there’s the boundary where I can do it myself. There’s so many grey areas that my friends and family know the rule, I’ll ask for help if I need it, it’s so important for me to still be as independent as possible.

I’ve definitely had to become much more patient and remember my sense of humour. When I was on holiday about a year after my stroke, the lady on the next sun lounger realised I was paralysed and said ‘I’m a spiritual healer, please can I pray over you’. Twenty minutes later, she was still silently touching my legs, and I’m thinking ‘Please God, listen to her prayers so I can get out of here!’. I quickly learn how to create boundaries and how to politely say no.

I’ve learnt to be very organised and to plan ahead. So if I’m going to a restaurant, or a building I’ve never been to before, I’ll email ahead to let them

know that I’m in a wheelchair and we can work out any access arrangements in advance or ask them to remove a chair from the table to make way for my wheelchair. I find by letting them know before hand allows them to be more prepared, I find things always run a lot smoother and it makes me feel a lot less anxious too. You have to find your way of advocating for yourself, to be confident and not self conscious. Last year I got some crocheted wheels covers for my chair. I’d seen lots of girls with them on instagram, there’s this incredible woman in the Netherlands who knits them all herself. They instantly become a great ice-breaker and talking point, it was such a positive way for people to engage with me and so refreshing to chat with strangers about something other than my disability.

I try to encourage people to ask questions, disability is an unknown for so many people. When you have a spinal cord injury you don’t wake up the next day with all the correct language, I’m still learning as I go. I try to remember that most people are coming from a good place and want to do the right thing. I hope by sharing my experience as openly and honestly as I can, I can help others like me, but also show how to relate to disabled people. Attitudes towards disability are slowly changing and it gives me hope for the future. As society becomes more exposed to people living with disabilities, and people become more open about what it’s like, seeing someone going about their daily life in a wheelchair will become less of a novelty.

Of course it’s frustrating when you don’t feel ‘seen’ if someone won’t speak directly to you. Even the word ‘disability’ is so dismissive, when I’ve overcome so much, and still feel so able. All I hope is for some kindness and empathy while I navigate this world that’s not yet fully adapted for me.

My life changed forever on that day five years ago. This is now my new life, and I’m living it.

After a rare spinal cord stroke which left her paralysed, Sophie Shane now relies on a wheelchair to retain her fiercely-guarded independence. But in a society which still has much to do to be disability friendly, Sophie continues to experience many challenges along the way.

‘Help us raise £100,000 for life-changing SCI research’

Stoke Mandeville Spinal Research has committed almost £1million over the past decade to support four key priority areas –assistive technology for upper limb function; neuropathic pain; pressure ulcers and urinary tract infection.

And now, to support it to support even more life-changing research going forward, it is aiming to raise £100,000 during this year to support people living with SCI, of which there are currently 50,000 survivors in the UK. Every four hours, someone sustains a spinal cord injury.

“It’s now 10 years since we pledged to put quality of life at the centre of our research efforts for people with spinal cord injury,” explained Derek Cutler, research manager at Stoke Mandeville Spinal Research.

“Since then, we have committed close to £1million to finding treatments and practical solutions to the major complications of spinal cord injury, including pressure ulcers, pain, urinary tract infections and upper limb function. “This year, and with the help of supporters, businesses, schools, and the local community, we’re aiming to raise an additional £100,000 to kickstart the next decade of research, so we can help to fund even more breakthroughs in the prevention and treatment of secondary complications to improve quality of life for people living with spinal cord injury.”

The charity was born from the work of consultants at the world-famous National Spinal Injury Centre at Stoke Mandeville, and since 2019 has given annual grants to research projects to support best practice in SCI research.

In 2013, it launched the SCI Priority Setting Partnership, which brought together people with SCI and those who care for them, to discuss what research would be most beneficial to their lives. The priorities identified have shaped the future of the charity and continue to do so, and in making positive change to the lives of survivors, are also helping to support the NHS through tackling some of the causes of secondary SCI concerns.

Statistics show that treatment for pressure ulcers costs the NHS around £3.8million each day, and a further £1million per day to treat urinary tract infection.

To learn more about how to get involved in the anniversary fundraising campaign as an individual, team or business, visit https://www.lifeafterparalysis.com.

A charity dedicated to funding the research to improve the quality of life and wellbeing of people with spinal cord injury is marking its tenth anniversary with a bid to raise £100,000 by the end of 2023.

Part-time workers’ holiday entitlementkeeping up with changes

As a result of this judgment, they are now entitled to a larger holiday entitlement than part-time workers who work the same total number of hours across the year.

Employers are urged to take part in the Government consultation, ahead of a probable overhaul of their part-time worker holiday policy - but here, we look at the current situation and how to ensure you are compliant in meeting your obligations

Current entitlement

Here, Cecily Lalloo, managing director of care and case management specialist HR provider, Embrace HR, details the current situation and how employers should review their current policies and procedures ahead of any further changes

Part-time workers are set to see changes in their holiday entitlement, which employers must ensure they are aware of to stay on top of their legal obligations.

Following a recent judgement from the Supreme Court, a consultation over holiday entitlement for part-year and irregular hours workers is being launched.

The Harpur Trust v Brazel case concerned the calculation of holiday pay and entitlement of a permanent part-year worker on a zerohours contract. The judgment held that the correct interpretation of the Working Time Regulations 1998 is that holiday entitlement for part-year workers should not be pro-rated so that it is proportionate to the amount of work that they actually perform each year.

Part-year workers are entitled to 5.6 weeks of statutory annual leave, calculated using a holiday entitlement reference period to determine their average weekly pay, ignoring any weeks in which they did not work.

Under the Working Time Regulations 1998 (WTR), all workers (this includes employees) are entitled to 5.6 weeks’ annual leave. For someone who works five days a week, this is 28 days. 28 days is the maximum statutory annual leave that must be given. Complications have arisen over the years in calculating this for those who work for less than five days a week, or less than 52 weeks in a year. For part-time workers, working 52 weeks a year but less than five days, the solution is simple: their weekly days or hours worked are multiplied by 5.6 to get their yearly entitlement. For those who are not required to work for 52 weeks in the year, but are permanently employed (i.e., not on a fixed term contract), things are less clear. In the Harpur Trust v Brazel judgment, the Supreme Court ruled that part-year workers must be given 5.6 weeks annual leave, but this cannot be prorated in accordance with the number of weeks they work in a year - consultation is now underway by the Department of Business, Energy and Industrial Strategy (BEIS).

Pro-rated holidays

A part-year worker is anyone who doesn’t work every week of the year, such as someone on a term-time only contract. A part-time worker is anyone who works every week of the year but on fewer days or hours than a full-time colleague. A part-time pattern might mean they work three days per week instead of five, or 4 hours per day instead of 8, but they work 52 weeks per year.

With a significant Supreme Court judgement set to reform how part time workers’ holidays are calculated - and a Government consultation on this currently underwayemployers must ensure they are on top of this fast-changing situation

It is important to understand the difference between a part-year worker and a part time worker as the holiday calculation is different for each. Annual leave can be pro-rated for a part-time worker. This is anyone who works 52 weeks per year but on less days/hours than a full-time colleague. For example, someone who works three days per week instead of five. This person would be entitled to 16.8 days’ annual leave instead of 28 days (5.6 x 3 = 16.8 days). Annual leave can also be pro-rated for fixed-term contracts, where there is a clearly agreed date for when the employment will end. For example, if an employee is contracted to work for three months only to cover a busy period (e.g., summer holidays), their holiday entitlement will be 1.4 weeks. This is worked out by dividing 5.6 by 12 months then multiplying by three months (5.6/12 x 3 = 1.4wks). Finally, annual leave can be pro-rated for new starters and for leavers (e.g., someone who starts and/or leaves during an annual leave year), so that the entitlement is only based on full months worked under the contract. However, the Supreme Court judgement was clear that the amount of leave for part-year workers under a permanent contract must not be pro-rated to be proportional to that of a full-time worker. Therefore, zero-hours, variable hours, casual, agency and term-time staff should all get 5.6 weeks’ leave per year. What will the current Government consultation reveal?

Calculating leave entitlement and holiday pay

All employees are entitled to 5.6 weeks paid annual leave. As such, there should be no need to do any further calculations to work out accrual or entitlement (unless for part-time or fixed-term staff).

The percentage method (where 12.07 per cent of the hours worked / pay received is used to determine holiday entitlement and pay) should not be used for any holiday calculations. You must have measures in place to keep track of what entitlement has been used so far in the holiday year (in the same way you might do for full-year staff) and ensure everyone takes their full 5.6 weeks’ leave. Holiday pay should be paid at the normal rate of pay. Where weekly pay varies (for example, for workers on a zero-hours contract), you should calculate holiday pay based on an employee’s average weekly earnings over the previous 52 paid weeks. The reference period must only be weeks for which the worker was actually paid. It must not include weeks where they were not paid as they did not work. It should also not include any weeks where “normal” pay was not received, for example, because they

were on sick leave and they received sick pay. You can go back for a maximum of two years (104 weeks) to obtain the relevant 52 weeks’ pay data. In the event that the employer does not have 52 weeks data from the previous 104 weeks, then the reference period becomes the number of weeks’ worth of data available.

Example calculation - Average weekly pay

Add earnings from previous 52 working weeks / 52 = average weekly pay

Pay for holiday period = average weekly pay x no. weeks’ holiday

For example, if an employee’s average weekly pay is £100 and they want to take 2 weeks’ holiday: £100 x 2 = £200 holiday pay. This calculation should be re-done at the beginning of every holiday period.

Rolled up holiday pay

Government guidance states that holiday pay should be given at the time when annual leave is taken and that an employer cannot include an amount for holiday pay in the hourly rate. It also states that if a current contract still includes rolled-up pay, it has to be re-negotiated. In the past, employers could try to use rolled up holiday pay by being transparent with employees and ensuring they are given time off. But, employees could still raise a claim if they think they had been prevented from taking their annual leave.

However, since rolled up holiday pay typically uses the 12.07 per cent method to calculate accrual, the Supreme Court’s judgment that this should not be used adds extra risk. As such, it is best to reach alternative agreements with affected staff and ensure they are given 5.6 weeks’ annual leave with the pay for this leave given at the time the holiday is taken.

Holiday calculationsresolving errors and new approaches

Paying in lieu

Paying in lieu of statutory minimum entitlement (5.6 weeks) is not allowed unless employment is terminated. You must let employees take the full 5.6 weeks leave within the current holiday year and pay for leave at the time it is taken.

Backpay for previous years

If you have been calculating pay incorrectly (e.g., by using the 12.07 per cent method rather than taking a 52-week average), it is possible that you may owe employees compensation for underpayment of holiday pay. You can proactively take steps to provide the employee

with backpay. Some employers may try to take the “wait and see approach” and let employees raise this, but this might not be possible for unionised environments since the union will likely be in contact to campaign on behalf of the employees they represent to get backdated pay. It is important to remember that not taking action could significantly increase the risk of unlawful deduction from wages claims being raised by employees. When calculating what backpay is due, you will need to assess what was paid using the 12.07 per cent method and what should have been paid by taking a 52-week average; the compensation for underpayment of holiday pay will be the difference between these two figures. Where an employee or union request that backpay is given for previously underpaid holiday, it is likely you will have to do so, otherwise you are at significant risk of receiving an unlawful deduction from wages claim. Usually, an unlawful deductions claim must be paid within three months of the last deduction, or in this case, within three months of the last holiday pay payment. But, given the scope of the situation, tribunals might allow employees to bring a claim within three months of the end of the holiday year in which holiday pay was calculated incorrectly. The tribunals claims backlog is significant at present. Additionally, there are the risks of disrupting employee relations, thus reducing productivity, engagement and satisfaction, as well as action from trade unions.

Consequences of failing to give sufficient holiday

Not providing the full 5.6 weeks entitlement will be in breach of the law and is not recommended. In this situation, there is a significant risk of tribunal claims, industrial action, employee grievances and resignations. There could also be wider implications for the organisation’s reputation with the general public.

Alternatives to part-year contracts

Term-time, variable-hours and zero-hours contracts, like any other type of contract, have their pros and cons. . It is useful to consider why you are introducing a part-year contract in the first place. Is it because you only need someone to cover busy periods, like summer or Christmas, or term time? If so, a fixed-term contract or annualised contract may be a more effective alternative. If you want to continue having staff available year-round, and only call on them as and when needed, zero-hours and variable-hours agreements may be beneficial but consider all the terms involved. As such, it is worth understanding each of the different types of contracts and considering which is most appropriate for your workers.

The PWA case conceptualisation model

Having seen differing perspectives at play and finding it harder to coordinate a package of care, PsychWorks Associates has devised a model to help achieve an interdisciplinary way of working which keeps the client at the heart at all times and that maximises rehabilitation outcomes.

Following the publication of the model last month, Dr Shabnam Berry-Khan, clinical psychologist, Advanced BABICM case manager and founding director of PWA, tells NR Times more

In rehabilitation, we talk about client-centric approaches, client-focused service – and while that’s always the intention, it can sometimes be difficult to achieve, particularly when several different agencies are involved.

We’ll have the legal requirements, the client’s needs, the family perspectives, the carers as the ever-presents on the ground, therapy and other medical input too, with the case manager trying to piece it all together.

There isn’t always a mechanism to share the knowledge and fully coordinate an approach where everyone is collaborating. Often, it can feel like there are a series of different camps around the case manager, with the case manager at the centre as the keeper and holder of all the knowledge that has been collated. That is a lot of pressure for the case manager, to go between all of these different camps to piece together, coordinate and review everything within the package.

Given the many dynamics at play, and the logistics of coordinating this, it becomes easy to see how a client can become lost in the process, which is absolutely not what any of the

parties involved in their rehabilitation wants. As a case manager with psychological training to inform my clinical stance, I found it easier to think about my clients when I borrowed from my psychology toolkit. In particular, my case conceptualisation skills – or formulation to those with psychological background – seemed so appropriate and helpful for assessment, planning, interventions and reviewing the packages of care and therapy.

Formulation – or case conceptualisation – is described as a story or narrative that is pulled together collaboratively between client/ family and professionals. In this way, client life experience and intuitions about their life are put together with the clinical skills and observations brought by the team for a ‘best guess for now’ shared understanding of the client and their needs. Formulations are revisited throughout the input and it becomes a process by which distress, needs and successes can be made sense of for those with a role to improve outcomes.

There isn’t a known model to help us think and process a case managed personal injury client’s needs with the wider family and teams involved and so I began to develop one, which we hope will underpin a shared rehabilitation process to keep the client at the centre, and to crucially promote the value of interdisciplinary working in securing the best possible outcome. It originated from working with ethnic minority

clients and wanting to make clear the challenges that are experienced and soon developed into a model that could fit any client in a case management context.

The client – the central component

The Personal Injury Formulation and Intervention Model (PIFIM) I devised is just at its preliminary stages, but it’s so far been quite effective in the case management and treating psychology work we are doing.

The model places the client at the heart of everything the team does, guiding the care and therapy towards personally held life goals and aims. Family can often be involved in this goalsetting experience especially when the client is a child, has a significant brain injury and/or lacks capacity. Eliciting client goals as part of the Immediate Needs Assessment or prior to a first care or therapy meeting is key.

The model recommends learning about the client, their life, their story, their personality, their sleep, their cognitive impairments and fatigue levels, to gain the understanding that is needed to work with them therapeutically. This exercise gives us an idea about how our client or their family were like premorbidly and upon which we can gain huge insights about the initial parameters our client and their family bring to the rehabilitation table.

From there, we can widen out to look at factors

With several different professionals routinely involved in rehabilitation, challenges can emerge in shared goals and understandings which keep the client at the centre of the process.

like the client’s environment, their accommodation, the importance of fit of carers and therapists to the client and family. Carer and therapist retention in particular is improved if you have already come to know the client and family perspectives. Once we have a basic sketch of our client’s overarching goals, their background story as they see it, their challenges that need to be considered, the kind of likely best fit personality the team around them need to exhibit and their surroundings, we can develop some accurate care plans and risk assessments.

Also key to understanding how our clients might think and feel are linked to socio-cultural factors that have shaped and continue to shape their experiences in life – what I sometimes call ‘hidden factors’ – such as trauma, attachment style, culture, feeling like they belong, all of which affect the language we use, the boundaries we keep and how attuned we can be to our clients. Maintaining engagement and a supportive therapeutic alliance is dependent on understanding these key factors. The model goes on to use signs of distress in client and/or setting to determine how well we are meeting their needs. If distress is identified, the model proposes a cycle to further assess, treat and measure the distress to review interventions, until distress is minimised.

To learn more about how PsychWorks Associates are using the PIFIM model with some of our cases, visit here.

The value of interdisciplinary working

Where multiple professionals are involved in any situation, attention to the system is vital to support relationships and manage dynamics to promote engagement and joint working. In the case of a client’s rehabilitation, which is typically pitched as a whole person approach, it can be very damaging, and can create a gap in understanding if the differing parts of the package are not communicating and the work is not collaborative with the client, family or colleagues.

Without the overarching, guiding goals from the client/family, there is a risk of each professional group working in a silo pattern, where goals are independent of one another, uncoordinated and potentially confusing for the client/family. After all, it’s much harder to understand the greater purpose of the hard work they are undertaking when the goals are potentially unrelated. It can also be much harder for a case manager to determine the value and progress of the package as a whole.

To be efficient in our working and to allow for a more shared perspective, we need to see more interdisciplinary working. More collaboration, more sharing, more joint work, more co-created programmes and a shared underpinning or formulation to frame the work the whole team is

doing while holding the client at the centre. There is then an opportunity for the team and the work to become bigger than the sum of its parts, which is vital in achieving the best outcomes for our client.

To enable this to happen, and for everyone to feel heard and involved in the process, it is important to have a mechanism in place to help recognise this, which is where formulation works very well. PIFIM is one of the first formulation models available to case managers working in personal injury that considers the client’s needs at the core of the decisionmaking, which then emanates out to the wider professional teams, pulling them together using the power of co-created, evolving narratives. And this formulation is something that should be revisited and re-evaluated until we are confident that we are meeting the client’s needs, and that there is minimised distress. We can share the knowledge we have individually and piece it together in a jigsaw

that we are all working to complete. By working in this way, we would hope that, in theory, this would lead to less distress for the client. By working in an interdisciplinary way, with consideration given to client need, group dynamics, team formation, we can all work more effectively together for the good of our client, to ensure we are delivering on our commitment to act in their best interests and support their rehabilitation in every way we can. At PsychWorks Associates, we are trialling the model and we look forward to sharing more updates in due course.

In the meantime, if you would like to read more about the model, please see Chapter 7 in Boayke and Mwale’s book on systemic approach to brain injury published in December 2022. If you feel you clients could benefit from a streamlined, coordinated care and therapy package, we would be happy to see how we might be able to support your client and their family.

The importance of RehabWeek

Zen Koh, General Chair for RehabWeek 2023, Co-Founder and Global CEO of Fourier Intelligence

Here, NR Times speaks with Zen Koh, general chair of RehabWeek 2023, about its importance in further developing the sector and why this year is so significant for Asia

What role does RehabWeek play in the development of neurorehab globally?

RehabWeek is an interdisciplinary event that brings together researchers, clinicians, and industry professionals from different fields to foster innovation and advance the development of neuro-rehabilitation globally. The conference provides a unique platform for knowledge-sharing, interdisciplinary collaboration, and the translation of research findings into clinical practice. Through educational sessions, workshops, and keynote speakers, attendees can learn about the latest research findings and best practices in the field of neuro-rehabilitation. In addition, RehabWeek offers an exhibition hall where companies and organisations can showcase their latest products and technologies, providing attendees with the opportunity to learn about and interact with the latest advancements in the field. Ultimately, RehabWeek aims to enable healthcare professionals to provide the best possible care to patients with neurological conditions by facilitating the translation of research findings into clinical practice.

How quickly is this sector advancing, and how important is this for patients?

The field of neuro-rehabilitation is advancing rapidly, with new technologies and therapies being developed constantly. The use of AI, virtual reality, robotics, and other technologies in neurorehabilitation has increased significantly in recent years, leading to more effective treatments and improved patient outcomes.

Such advancements are essential to improve patient’s quality of life with neurological conditions, such as stroke, traumatic brain

injury, or spinal cord injury, often face significant challenges in their daily lives. Neuro-rehabilitation helps these patients to regain lost functions, increase independence, and improve their overall well-being. The use of innovative technologies in neuro-rehabilitation has the potential to revolutionise the way these patients are treated, providing more personalised and effective care. Therefore, the field of neurorehabilitation must continue to advance with ongoing research and development of new technologies and therapies. The collaboration between researchers, clinicians, and industry professionals through events such as RehabWeek is crucial in driving these advancements and ensuring that patients receive the best possible care.

How important is it for Singapore - and Asia - that RehabWeek is to be held there for 2023?

RehabWeek is being held in Singapore in 2023 for the first time, which is significant for Singapore and Asia. Singapore is a hub for healthcare, innovation, and research in the region, and hosting an event of this calibre will showcase the country's strengths in these areas. It will also highlight the importance that Singapore places on advancing the field of neuro-rehabilitation and promoting collaboration and knowledge-sharing among experts in the region.

Moreover, Asia has a rapidly growing and ageing population, and the number of individuals suffering from neurological conditions such as stroke, traumatic brain injury, or spinal cord injury is increasing. Therefore, the need for effective neurorehabilitation is becoming more crucial than ever. The fact that RehabWeek is being held in Singapore provides an opportunity for experts from across the region to come together to share knowledge, discuss new developments, and work collaboratively to advance the field of neurorehabilitation.

Overall, hosting RehabWeek in Singapore is a positive development for both Singapore and Asia. It provides an opportunity to showcase Singapore's strengths in healthcare, innovation, and research while facilitating collaboration and advancing the field of neuro-rehabilitation in the region.

Why should professionals working in this field attend?

Professionals working in the field of neurorehabilitation should attend RehabWeek for several reasons.

Firstly, RehabWeek provides an opportunity to learn about the latest research findings and best practices in the field. The event features educational sessions, workshops, keynote speakers, and poster sessions, providing attendees with a wealth of information and knowledge. This information can help professionals to stay up to date with the latest developments in the field and apply this knowledge in their clinical practice. Secondly, RehabWeek provides a unique platform for interdisciplinary collaboration and networking. Researchers, clinicians, and industry professionals from different fields come together to share knowledge, discuss new developments, and work collaboratively to advance the field of neuro-rehabilitation. This collaboration can lead to new ideas, approaches, and innovations that can improve patient care and outcomes.

Thirdly, RehabWeek allows professionals to interact with companies and organisations, developing new neuro-rehabilitation technologies and treatments. The event's exhibition hall features a range of exhibits, allowing attendees to learn about the latest advancements in the field and interact with the companies and organisations driving the industry. This interaction can help professionals understand how new technologies and treatments can be applied in their clinical practice, ultimately leading to improved patient care.

In summary, neuro-rehabilitation professionals should attend RehabWeek to learn about the latest research findings and best practices, engage in interdisciplinary collaboration and networking, and interact with companies and organisations driving the industry. Ultimately, attending RehabWeek can lead to improved care and outcomes for patients.

Learn more and sign up for RehabWeek 2023 at rehabweek.org

RehabWeek has built a reputation as being one of the must-attend dates in the calendar for professionals working in neuro-rehab, providing a forum for the global community to unite.

Amputee Rehab

Case management for limb loss requires specialist expertise and significant relevant clinical experience. Breakthrough Case Management asked Rebecca Clemence, their Amputee Clinical Lead to discuss and consider what rehabilitation may be necessary following a lower limb amputation. Rebecca has 20 years’ experience in amputee case management and shares her insights within this in-depth reflection, Rebecca also includes valuable feedback from industry peers to widen the discussion.

For rehab to go well the client needs a bespoke team of people who fully understand the needs of a new amputee, considering the full picture and not overlooking any needs. The case manager needs to guide the transition to life beyond limb loss. An accessible, proactive, and responsive case manager is pivotal in moving the individual goals of an amputee forward along with the recommendations of the team, whilst simultaneously addressing the complications that can crop up along the way. The client’s domestic environment and personal situation needs to be fully appreciated to transfer the recommendations of the clinical team into day to day life and to ensure rehab is realistic and with purpose. Exhausting every avenue in relation to NHS and statutory provision requires a set of skills in itself but is part of a case manager’s role.

It is important to understand the demographic of the amputees we support as case managers – most of whom are of working age with the amputation occurring as a result of trauma or following a period of limb salvage attempts. Their limb loss tends not to be as a consequence of long-term disease management and co-morbidities in the same way the NHS demographic is. Therefore, the level of unexpected trauma, that is like a tidal wave through somebody’s life and family, must be understood.

Considering loss of a lower limb, the case manager aims to move the status of an amputee from long term wheelchair user to active prosthetics user and guide them towards living life to the most functioning and independent level possible whilst navigating the litigation process. There can be many barriers along the way and it takes a robust case manager to stand up and be counted on the client’s behalf. What aids this process, is when instructing parties work with the same rehab goals and accept the reality of rehab provision.

An amputee’s mobility status will be heavily influenced by the quality of rehabilitation on offer and the quality of prescribed prosthetics. However, it is important to highlight that even in the event of successful prosthetic rehabilitation,

there will always be times of the year when a lower limb amputee will be a wheelchair user (ill health, fatigue, sore skin, ill-fitting socket, maintenance, repairs to prosthesis).

A new amputee is faced with gaping holes in many areas of life and by way of an overview (not an exhaustive list), the aspects of rehabilitation that may need to be considered include:

> Multidisciplinary amputee rehabilitation team (consultant in rehabilitation medicine, physiotherapy, occupational therapy, prosthetist, counsellor, rehab assistant)

> Care needs: eligibility for funded care should be assessed and timeframes considered for periods of domiciliary rehabilitation. Support may be available via the continuing care rules, via local authority social services and may be augmented with a privately appointed longer-term agency care package

> Psychological/peer support

> Family support

> Cognition

> Fatigue and sleep

> Care of the residual limb

> Care and protection of the upper limbs

> Compression garments (Juzo)

> Management of phantom pain and sensations

> Prosthetic rehabilitation and access to a limb centre

> Wheelchair/seating

> Home environment/home safety/ accommodation/domesticity

> Household maintenance/gardening

> Integrating with community

> Food and nutrition

> Moving and handling training for family

> Relationships

> Pet welfare

> Transport

> Falls prevention

> Finances

> Employment

> Travel and leisure

> Co-morbidities

At this stage it is important to be realistic about what can be provided by the NHS and statutory services and this realism impacts timescales and outcomes for rehab.

The NICE guidelines 2022 specific to rehabilitation following traumatic injury assist in benchmarking of provision:

> Reducing delays leads to better coordination of care and rehabilitation outcomes

> Goal setting should be introduced as early as possible

> Specific to amputee rehabilitation, the rehabilitation should not be delayed by waiting for prosthetics to be fitted because the maintenance and improvement of range of movement will help prevent complications and optimise functional outcomes

> The importance of MDT involvement at all stages of complex traumatic injury rehabilitation is stressed

> Rehabilitation programmes should include physical, cognitive, psychological therapies and treatments as well as injury specific therapies and treatment

> In the post-acute period, an intensive inpatient or outpatient rehabilitation programme for people with complex injuries and rehab needs should be considered if this is likely to have an impact on change in function e.g., living independently

> Outcomes that matter the most have been researched to be overall quality of life, how acceptable the patient finds the rehab intervention, changes in mood, return to education or work and pain

There can be many barriers along the way and it takes a robust case manager to stand up and be counted on the client’s behalf.

Reflecting on my most recent amputee clients, the reality presented itself very early on with no offer of an NHS rehabilitation bed (bilateral lower limb amputee) and an extremely sparse discharge plan. There was no option of care or community rehab provision. This left the client and their family fearful and isolated, and any dispute of the discharge plan cannot always be addressed in time for discharge. This was closely followed by the delay in NHS rehab getting underway and the reality is the first time a client sees a physiotherapist is often when they first visit an NHS limb centre. Whilst waiting for this appointment they can reach a poor level of physical condition. There can also be delays in accessing equipment, accessing consultant led reviews and accessing all aspects of rehab. It cannot be underestimated how much the waiting game impacts psychological well-being.

The NHS team does their very best to support the client, create a team around the client, and get rehab appointments started but they do this knowing that there is a likelihood that the patient will at some stage go to the private sector – be that pre or post settlement.

Looking at it from the point of view of the NHS, it would be interesting to have data on how many NHS appointments are used until the amputee is transferred to the private sector. Where the litigation process allows, a speedier funding agreement between instructing parties would mean many of the NHS appointments could be allocated to other service users. The NHS, when aware of a patient in litigation can be equally as frustrated at the time it can take for funding to be agreed. Geography issues aside, are we simply using the NHS for the very early stages of amputee rehab when there is litigation involved?

During this time there is so much that can be done to improve conditioning which will optimise outcomes when prosthetic rehab gets underway. Introducing a local private physio/rehab assistant/gym who is willing to work under the guidance of an amputee specialist physio in the longer term, is beneficial. In the absence of community OT provision or where statutory services incur a lengthy delay, a private OT can address immediate issues within the home environment and ensure the client can access the community and their rehab appointments. Ongoing OT input will focus on restoring independence via equipment and adaptations and restoring roles within a family. The family may need additional support to resume a

functioning routine such as domestic and gardening assistance or a period of care. Anything to reduce the overwhelm and fear that can take some time to clear. In the longer term the OT will explore the viability of continuing to live in their current home, social outlets, driving, vocational rehab and domestic skill base.

Where funds allow, a case manager can build the right team around the client at an early stage. Collectively the team will set goals that will shape the future. The client feels that life is moving forward, and motivation moves with that.

There is the option of a period of residential rehab with achievements that exceed the outcomes of the most capable of local, private clinicians. My clients arrive as one person and leave as another!

accessible taxis are an acceptable temporary measure but the independence that driving brings also offers a chance to reinstate the role of an active parent or the ability to socialise or go to work. It is at this stage that clients often feel in control of their day.

Pain management can be one of the most challenging parts of the rehab process with intrusive phantom limb pain and sensations impacting the flow of rehab and psychological well-being. When I think back to my MSc 14 years ago as I travelled the UK interviewing amputees about their personal experience of PLP management, I question what has really improved. Of course, there are advancements in management e.g., technology, virtual and augmented reality, psychotherapy techniques, surgical techniques such as TMR but the mainstay from an NHS point of view still seems to be a pharmacological approach which is not always automatically revisited after discharge from hospital. There is expertise within the NHS but accessing a pain service with any regularity and with the relevant expertise is challenging. The private sector offers the expertise, but the availability can be geographically limited.

Clients are not always ready for robust psychological support at this stage. They are distracted by trying to establish a routine and managing daily tasks. They can also be very busy with rehab appointments. Psychological support can take many forms and clients often feedback the value that peer support and acceptance add at an early stage. Support via charities such as the Amputation Foundation and The Limbless Association add a lot of value. They have support staff and volunteers across the UK some of whom are amputees. There is nothing quite like the support of a fellow amputee. There is the opportunity to socialise, share experiences and where rehab funds are limited, charities can be very helpful in helping to access vital pieces of equipment and support. This could be the first time a client starts to see what life as an amputee really looks like.

Clients are often desperate to drive again irrespective of whether they are walking again. Hospital transport can really restrict life and consume hours of the day. Wheelchair

NHS prosthetic provision is a topic of significant discussion in the litigation process. However well-meaning, determined, and passionate the NHS limb centres are there are restrictions. Of course, there are some NHS limb centres that have supported clients to a very high standard and the client has remained with the NHS, particularly where the centre is geared up to supporting military personnel and is equipped for that purpose, benefiting all service users.

There is the National Framework to consider, operational in 2021 and due for review in March 2023. The reality currently remains that there is no strong framework in operation. Despite the concept of improved access and choice (prosthetics), the choice is controlled by what is available through the NHS with the misconception that options are now vast. This is not wholly accurate, and constrictions remain, with the recent additional funding the framework alludes to going to advanced hands and upper limbs. Budgets are regional and so service users are not getting the same input U.K. wide. It is important to highlight the demographic of NHS limb centre service users. A high proportion have not suffered limb loss because of an accident. Their co-morbidities and clinical need will be different and will have an impact on “typical” NHS provision.

NHS prosthetic provision is a topic of significant discussion in the litigation process.

Some of the issues my clients have faced when supported by the NHS include:

> Manufacturing off site which can lead to wait times of several weeks between a cast and a fitting

> Time between appointments means a client is working with an ill-fitting socket for a long time which limits the tolerance time and mobility outcomes

> Limited ability to respond to residual limb volume changes in the moment with accumulative delays for the rest of the team

> Remaining on a basic limb for a protracted length of time before a higher functioning prosthesis is considered (if at all)

> No sports prostheses for over 18s

> No microprocessor or advanced ankles

> Very rarely is there a second activity (water) limb

> No second/back up limb

> Availability of all MDT members at each appointment

> Limited amount of physio available via the limb centre (4 weeks for a current client) before being referred out to a local physio department. This impacts the MDT approach as the new treating physio cannot call in other members of the team to discuss issues in the moment. The client must then be referred back to the limb centre which incurs accumulative delays

Of course, it is unreasonable to expect the NHS could or should compete with the private sector who can exceed what the NHS has delivered and at speed (in the absence of complications). However, the private sector is also important in opening doors to social and sporting connections. It is equally important to fully appreciate the lifestyle goals of the amputee, balancing expensive technology with what the amputee actually wants or can cope with. There are now surgical advancements such as osteointegration which is something the majority of amputees will have talked about or researched. Whilst the surgical expertise is available within the UK it is still limited and therefore the availability of local post operative support is a significant consideration. There are times when setbacks occur; wound issues, neuromas, intrusive pain, the need for remedial surgery to the residual limb and issues (knees/hips) you discover once mobile. The case manager needs to respond accordingly which involves navigating the growing issue with NHS delays, leaning towards the private sector to access the expertise needed.

Whilst writing this piece, a question was put to my clinical colleagues to gauge opinion on what they rate as the most important aspects of amputee rehab. Their responses include:

> Early intervention with full specialist MDT –addressing physical, emotional, psychological, environmental, and socio-economic factors

> Pain management and education

> Close physio collaboration with prosthetist in prosthetic set up and alignment – same room

> Understanding a prosthesis is an aid/device, not a replacement limb – setting this expectation is vital to supporting patient acceptance

> The fit and comfort of a prosthetic system that is aesthetically satisfactory to the user

> Timely therapy at different stages of rehab –intermittent and varied intensity over at least 12 months (rehab dosing)

> Finding a long-term exercise that they enjoy and can participate in

> Rehab that is applied to everyday life and goals in the short, medium, and long term

> Offsite rehab, not just in clinic rooms

> Appropriate alternative mobility aids when not wearing a prosthesis

When discussing what we get wrong, there was an overriding concern that the litigation process can sometimes interfere with a patients recovery:

> it takes too long

> it often discourages people from returning to work

> there can be encouragement to use inappropriate prostheses and unrealistic expectations around prosthetics and rehab

> intermittent and withheld funding has a devasting impact on psychological well being

In summary, successful amputee rehab requires an experienced and responsive team around the client with access to the highest levels of expertise who collectively fully understand the needs of a person who has sustained an amputation as a result of trauma. Goals are interlinked and the lack of funds in one area of rehab limits the ability to provide holistic support and can adversely impact overall progress.

Home care plan for the 5 stages of Parkinson’s Disease

However, there are many treatments available, from medications to a variety of therapies.

Parkinson’s disease is a progressive neurological condition. It causes problems in the brain that gets worse, specifically affecting the levels of dopamine.

Supporting someone with Parkinson's disease can be challenging. Cavendish Homecare is an organisation that can help support clients living with Parkinson's disease and their families. Mairead Liston, Founder and Nursing Manager of Cavendish Homecare, says, "We have extensive experience in nursing and caring for clients with Parkinson's disease. Our care focuses on the client, and we ensure a bespoke home care service that allows them to remain at home and maintain the best quality of life."

Although this guide seeks to address the physical effects of the disease, it’s important to remember that Parkinson’s symptoms are not limited to only physical or motor symptoms.

There are other factors to consider including:

> Impaired sense of smell

> Sleep disorders

> Cognitive symptoms (memory loss)

> Constipation

> Bladder issues

> Sweating

> Sexual dysfunction

> Fatigue

> Pain

> Tingling

> Anxiety

> Depression

145,000 individuals in the UK have been diagnosed with Parkinson's disease, and as of now, there is no known cure for the condition.

Stage one of Parkinson’s

According to The Parkinson’s Foundation: “During this initial stage, the person has mild symptoms that generally do not interfere with daily activities. Tremor and other movement symptoms occur on one side of the body only. Changes in posture, walking and facial expressions occur.”

Symptoms of Parkinson’s may not be that noticeable at this stage, but prescribed medications can work effectively to minimise and reduce them if they are more pronounced. A doctor will be able to assess and prescribe any treatments that can start to counteract the symptoms, even if they are not currently interfering too much with everyday life.

Home care plan for stage one

At this early stage of the disease, the best thing to do is get as much information as possible. Speak to loved ones about organising potential care, or, if you are helping a loved one to come to terms with the diagnosis and early symptoms, seek advice. You may also want to begin thinking about the later stages by planning for mobility aids or home care.

Stage two of Parkinson’s

In this stage, symptoms may be more noticeable. Tremors may start to appear and changes in facial expressions. Muscle stiffness might begin or get worse if it’s already being experienced. This could make walking a little more difficult and change posture.

Speech difficulties can start to arise too and some everyday tasks such as getting dressed or shopping may become a little tricky to navigate without help.

Home care plan for stage two

The majority of people with stage two Parkinson’s can still live alone, as the progression from stage one to stage two can take months or even years. The experience will be unique to each person. However, if some tasks are becoming more difficult, home care options are available. Some options to consider:

Occupational therapy

An occupational therapist can provide help with ways to perform a task that has become more difficult (like eating) in a different way. They may also talk about using strategies, techniques and gadgets where you need them.

Practical changes, such as rearranging furniture at home to make it easier to move around are also something they can help with. Occupational therapists work with you and your loved ones to develop strategies to cope with tasks that may become a problem in the future.

Dietary aids

There is no recommended diet for Parkinson’s sufferers, but if you are taking medications or experiencing particular symptoms you might need to stop eating certain foods or alter your diet slightly. A dietician can help you to work out what you can and can’t eat.

Stage three of Parkinson’s

As well as previous symptoms perhaps worsening, you may also experience loss of balance and mobility. As movements become slower, there is an increased risk of falls. Dressing and eating, in particular, will be more difficult. Memory impairments must also be considered, especially if numerous drugs or treatments repeat each day.

Home care plan for stage three

Further home care options that might help someone with stage-three Parkinson’s manage are:

Speech and language therapy

Communicating can be difficult for people with Parkinson’s. A speech and language therapist will develop exercises to help with volume and clarity of speech, but they can also assist with other problems like swallowing and eating and drinking. They will have a wide knowledge of tools or gadgets that can help.

Physiotherapy

This therapy can help people with Parkinson’s to manage everyday activities that involve sitting, walking, standing and getting in and out of the bath, a chair, bed, etc. As well as useful stretches and exercises, physiotherapy can help to strengthen muscles and help people with more severe mobility issues to manage falls and gain confidence.

Stage four of Parkinson’s

At this stage, mobility is likely to be a much greater concern. It can even be dangerous for some people to be left alone as the likelihood of a fall or confusion is higher. Movement may require a walker or other type of assistive device as limbs become painful or stiff. If a tremor is one of the symptoms being experienced, it may now be quite pronounced.

Home care plan for stage four

Many people are unable to live alone at this stage of Parkinson’s because of significant decreases in movement and reaction times. Assistance will likely be required for daily tasks such as eating and washing. It may be time to consider long-term home nursing, in which case you are going to have questions. Read our guide questions to ask when looking for home nursing.

Stage five of Parkinson’s

This is the most advanced and debilitating s tage of Parkinson’s disease. For many, they may now be confined to bed or require a wheelchair as they can no longer walk. Because Parkinson’s is a neurological disease, and due to some of the side effects of drug treatment, people may also experience hallucinations and delusions. This can be difficult to manage for a carer. If you are looking after someone with Parkinson’s, be sure to seek support. Parkinson’s UK has an entire section on its site that can help those caring for someone with Parkinson’s.

Home care plan for stage five

Round-the-clock care is likely to be required at stage five. Most tasks will require some form of assistance.

Why choose Cavendish Homecare

At Cavendish Homecare, we are experts in providing home care for anyone who wishes to remain in their own homes while they receive treatment, recover from surgery, or manage medications. We work to support the patient and their family with private care to reduce pain, improve comfort and quality of life. Supporting a loved one that is going through Parkinson’s can be emotionally stressful and physically demanding.

As Mairead Liston, our Registered Nurse Manager and Founder, explains, "Cavendish Homecare's Parkinson's care allows you to reduce that pressure and take on the care where required."

Get in touch today.

"We work to support the patient and their family with private care to reduce pain, improve comfort and quality of life."

The clinical usefulness of data analysis

Cathy Warne, clinical support case manager at StanleySmith Case Management, details the importance of data collection and effective analysis in rehabilitation

Whereas in the early years of case management decisions were based on intuition and judgement calls, or time-consuming analysis from paper records, now we are very much a

profession embracing the power of digital. We have systems that enable quick and easyto-complete electronic forms, which can be updated and shared with key people instantly. Rather than wading through the traditional paper-based records, this is immediate, with notifications you can act on as soon as they arrive.

And with this instant digital information comes

hugely valuable data. The quantifiable information that allows you to see what works and what doesn’t; how a client responds to rehabilitation; the progress they’re making; the performance of teams and what more they need. All supported by statistics, which are at our fingertips whenever we need them. But are we making best use of this data? While we all know it is there, are we analysing it regularly and thoroughly, to be able to make judgement calls based on factual evidence, and give the best possible rehabilitation potential to our clients?

At StanleySmith Case Management, we are keen adopters of data analysis. While I would not call myself a data analyst, nevertheless this scrutiny of clinical information is a key part of my role as a clinical support case manager and something we see regularly –among both clients and our team – exactly how worthwhile it is to assess the data for the good of everyone involved.

Through the capture and analysis of data, clients and teams can be supported in ways that are often hugely difficult without the collection of such information.

Supporting clients

Clients’ daily support records, incident reports and some therapy session records are, for many case managers, now routinely received digitally and shared instantly among those who need to see them. So, we really do have the data at our fingertips.

I probably first became aware of the value of data collection about ten years ago, in capturing evidence to support a young man in his ambition to live independently. While this was not entrenched in routine practice at that time, the value of this – and its impact on informing the care experts and in turn supporting his litigation settlement – was hugely important to his whole family. There are have been many other cases over the years where the analysis of relevant data has proved really valuable to rehabilitation. As one example, I worked with a teenage girl who lived with behavioural difficulties and a mild learning disability as a result of brain injury. We saw the problems she experienced with sleep and the impact this had on her family, so devised a bespoke form capturing episodes of waking between the client first going to bed each night and rising for each day, which her mum completed daily over the course of a month, so we could gain the evidence to support our knowledge around the problem. The records kept by her mum – which we created primarily in a tick-box format, to make it as quick and easy to complete as possible – helped us to evidence what she had exhaustedly tried to communicate to the therapy and legal teams. As well as supporting more tailored care and recommendations, it also informed statutory service assessments, and may yet help with a continuing healthcare funding application.

There is also the example of a young man, who we saw from support work notes had been experiencing some bowel-related issues after consuming certain food and drink, which then contributed to behavioural challenges. You can only ask the ‘right question’ to be able to pull out the right information through being aware of the challenge, so by this link being made known, we could then collect the data to support that, creating colourful and engaging charts to discuss with this man’s family and support team, so that changes could be reasoned, understood and followed through. By having this evidence in place, the impact can truly be life-changing for clients and families, who may have been battling particular issues for some time.

Support for the treating team

For clinical professionals, in supporting our clients to the absolute best of our abilities, we benefit greatly from having the opportunity to reflect and offload with colleagues. By taking the time to do this, we can support each other in being able to best support our clients.

At StanleySmith, the wellbeing of our team is paramount, and we are committed to their welfare and protecting them from burnout. As well as holding psychologist-led mentoring for case managers, we often provide psychologistled reflection and development sessions for teams supporting clients, which gives the opportunity to share experiences and offload in a supported environment. We have seen the value this brings to us as individuals and as a team in being able to be at our very best in doing our jobs.

And data also has a place in this process. As well as discussion, the collection of evidence and statistics to support change is also very important, in matters ranging from staff development and progress, through to CQCinforming information. But it can also be applied in more ways.

As an example, a clinical psychologist and case manager sought evidence around the psychology input for a man whose brain injury resulted in behavioural difficulties that led to him being well known to police. Through creating a survey/questionnaire for team members, they were able to clarify that the team did find the psychology input very helpful and supportive – giving reassurance for the professionals involved that the strategy being taken was effective.

Additionally, data gathering is effective in gauging happiness and wellbeing of team

members more generally, and that is a very important process to undertake. We have recently sent out questionnaires to our support workers, and their views are crucial in us being able to gather and assess the data to see what is working and what we could do better.

Effective analysis

While it may be seen as more of an admin role than something for a case manager, there is great importance for a clinical focus in shaping the questions that are asked on the forms and analysing this kind of information. In my role, I personally look at data in the context of my role and with my clinical background. My years of experience of working in this field mean I understand the clinical and claims process, and how they work together for the good of the client, and data should be captured and assessed in support of that. With deep knowledge and experience, you can shape the questions and format accordingly, to ensure the information you gather is entirely relevant to the client or/and the wider team and their best interests. By understanding the clinical implications, you can anticipate that and contribute meaningful suggestions and solutions.

I am very pleased to see data now becoming more widely adopted in case management, and I would encourage those who do not use it – or don’t use it to best effect – to look at how they can do so.

The addition of evidence-based statistics into the rehabilitation process can be invaluable, as I have seen now for over a decade, and can support clients, families, teams and individual team members to feel heard and for change to be made in ways which previously may not have been possible.

Why should you stand regularly following a spinal cord injury?

People who cannot walk or stand unaided due to a spinal cord injury often must sit for more than 8 hours a day, and as a result are at risk of secondary complications including the development of pressure ulcers, limb contractures, compromised circulation, and aggravated bowel and bladder function. In addition, an improved sense of well-being and improved quality of life are associated with standing.

For this reason, passive standing is encouraged by clinicians as soon as rehabilitation starts with the aid of a product or structure that can typically stabilise at least the hips, knees and ankles. Commonly used methods include so called standing frames, standing wheelchairs and orthoses. The ease with which these can be used varies with the nature of the injury.

SUGGESTED DOSAGE

Evidence-based guidelines defining how long or how often adults with spinal cord injury need to stand to have been published (MASCIP, 2013) Paleg and Livingstone (2015) reviewed the literature and noted that stronger evidence underpins the impact of regular standing programs on range of motion and activity for both stroke and spinal cord injury populations with some mixed evidence supporting impact on bone mineral density. Dosage data suggests that the use of a standing device should occur for thirty minutes, five times a week for positive impact on most

outcomes such as self-care and standing balance, joint ranges of motion, spasticity, pain, skin and bladder and bowel function. Sixty minutes for 4-6 times a week may be required for positive impact on bone mineral density and mental function.

PRODUCT CHOICES

The most commonly seen product in the UK is perhaps the standing frame which comes in various guises such as the wooden 'Oswestry' frame or the more modern 'EasyStand' designs. These achieve the basic objectives of allowing a person with lower limb paralysis to stand and may also allow other passive activities to take place at the same time. They need to be set up for the stature of the individual and steps taken to make it as easy and safe as possible to transfer on and off. The biggest objection we hear is that they can take up too much space in modern houses and are a bit 'boring' to use. The problem with being boring is that this is not exactly an incentive for regular use!

Less well known is the unique, Tek RMD from Matia Mobility. It is neither a standing wheelchair nor a passive standing device but a unique product that can allow users with a spinal cord injury or other neurological injury to readily stand and move in an indoor or outdoor environment. The user of the Tek RMD can now largely have hands free to engage with their environment. Unlike the typical standing wheelchair, the user is not tilted back when standing upright so that

for most users a perfect therapeutic posture can be achieved and held for longer periods. Thick pads are positioned just below the knee and at the chest and a seat cushion spans the hip area so that the user is safely held whether fully upright, seated or at any point in between. This balanced posture allows much easier interaction with the environment. Many users find that they can at last use a standard kitchen layout and they can at will move from picking something from a high shelf or a low cupboard.

Each Tek RMD is setup to suit the stature of the individual user; some people need more trunk support initially and the product can be reconfigured as the user's requirements change over time. What surprises many users is that the product is both narrower and shorter than their typical wheelchair so it is very easy to manoeuvre. Using the control panel the user may sit or stand at will, and use the joystick to steer around their environment.

Domestic users should find that they can achieve a good balance between social and therapeutic benefits by using the Tek RMD.

It is always a good idea for people in the market for these products to understand that each device will have different strengths and weaknesses and no product can be perfect for everyone. There are good clinical reasons to make standing part of life and weigh up the most suitable way of achieving this in each individual case.

You may not think of ‘just standing’ as a form of exercise but it is both an effective and practical method for most people following a spinal cord injury.

in the kitchen.* Causing a stir

Introducing the Tek RMD – the pioneering new mobility technology from Anatomical Concepts.

Using the lightest touch, the Tek RMDs fully electric, motorised system safely provides upright support and comfort. Freeing up your hands to get the job done.

So, from food prep to plating up, the Tek RMD empowers you to navigate life your way.

[*With no guarantees you’ll be a better cook.]

Discover a life elevated anatomicalconcepts.com/life-elevated

Bringing the C word to the forefront

Let’s Talk about Cannabis!

A title that gets us straight to the point of why we are bringing together leading professionals in community brain injury rehabilitation, to inform and educate those in the field about the tricky topic of recreational cannabis use.

BIS Services work with a diverse range of clients, all of whom are recovering from an acquired brain injury; some clients have just returned home from acute settings, others are 10 year plus in their recovery. No matter the timeline, the influence of post and preinjury usage and addiction of cannabis use is extensive. Yes, there is the Good, the Bad and the Ugly, and all too often the issue is anticipated to bring two of the three, with very few clinicians looking at the Good. Before we get carried away, we are not here to recommend or advise the use of recreational cannabis in neuro rehabilitation, but we do need to tackle the topic head on, and look at the drivers for the usage, and to be frank, consider that there may potentially be some benefits.

There has certainly, in our experience, been an increased prevalence in recreational usage within our clients. Our male clients aged 16-30 make up the bulk but then we have our females, our more mature clients, and then of course some younger who tick the prescription box, not for brain injury, but other comorbidities. 2022 alone saw a three fold increase in referral for private prescription for replacement of recreational cannabis in our current client group.

Is it the case that prevalence or usage is increasing? Or is it that we are just seeing a random sample that just so happen to have high usage? What we can certainly attest to is that it has a considerable impact in both medico-legal spaces, goal setting and attainment and engagement in rehabilitation. Clinician and therapy perspectives can be in direct contrast to the client or patient, with considerable chasms between them, impacting rapport and therapeutic alliances. There is a middle ground to be had, and it is important that we discuss that for many of the individuals that we work with, the benefits that they perceive far outweigh the negatives presented to them .

The team at ABI Solutions were more than open to the conference when I approached them about the topic last year, with their exceptional conference production skills and their willingness and drive to bring important but potentially controversial topics to the centre of professional development in the neuro rehabilitation field, we have produced a balanced program of topics and debate. Our sponsors Irwin Mitchell, also leaders in their field have supported the program and bring their own medico-legal challenges to the program.

The conference will explore the history of cannaboids and current prescription uses in the UK will be highlighted, by Professor Mikes Barnes. Client perspectives on the disparity between their views and the MDT will be highlighted by the team at BIS Services and some very brave clients. This will provide clear insight into the personal motivations of these case studies alongside reflections of impact on rehabilitation planning.

The conference will also explore aspects from psychological perspectives. The application of therapy and psychological approaches such as Compassion Focused Therapy will be discussed by BIS’s clinical supervisor Dr Fiona Ashworth, furthermore Dr Penny Trayner, Paediatric Clinical Neuropsychologist discusses Impact of cannabis on neuropsychological functioning, mood and psychosocial function in adolescents.

To provide an early life perspective of cannabidiol usage in managing epilepsy, Dr Shanika Samarasekera, Neurologist will provide insights into the efficacy of use in this population.

Financial and litigation impacts will be covered from a Personal Injury and CoP team perspective from Irwin Mitchell, providing insights into the medico-legal challenges that these behaviours impact. An MDT approach and required adjustments from a clinical lead perspective, presented by Dr Tomas Campell and Erika Turner will complement the content, providing suggestions for adjustments and accommodations to consider in rehabilitation planning.

We will also be hosting drinks afterwards, with some guest DJs to encourage further networking and discussion, at what is sure to be a day of conversation and collaboration. For further information to book visit https://www.abisolutions.org.uk/website/ pdfs/Lets_Talk_About_Cannabis.pdf

By Natalie Mackenzie, Director BIS Services.

It has a considerable impact in both medicolegal spaces, goal setting and attainment and engagement in rehabilitation

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Isaac's Project

France + Associates are a multi-award winning Chartered Architectural Practice, that specialises in designing accessible homes for individuals living with life changing injuries.

In this case study, France + Associates share Isaac’s project, which is one of many excellent project examples completed over the years by F+A, of how a fully accessible home can maximise a person’s quality of life, support their independence and enable continuing therapy, whilst avoiding ‘clinical finishes’. France + Associates are of the belief that a home can be both practical, accessible but maintain the home comforts we all enjoy. This recently completed, fully accessible family home in Yorkshire has been designed and built for Isaac, his parents and siblings.

ISAAC

Isaac is 11 years old, he was born full term, but very underweight and suffered a brain injury at birth in July 2011. As a result, he lives with cerebral palsy, cognitive impairment and has a diagnosis of autism.

He requires ongoing support and therapeutic intervention, such as physiotherapy, occupational therapy and speech and language therapy to support his health and welfare as well as promoting his learning, development and independence. Isaac also lives with impaired mobility, which means he finds stairs difficult, and in time, may require a wheelchair.

ACCESSIBLE HOME

His family were previously living in a terraced house, which they had undertaken minor adaptations to, but required a bigger, fully accessible home for Isaac to grow up in. With a big supportive network of family and friends living nearby, the family were keen to stay in the local area and began the search for a suitable home. After searching for some time, they identified a suitable dormer bungalow in late 2018.

France + Associates were first appointed to visit the property and appraise whether the property could be suitably adapted to suit Isaac requirements as well as his family’s.

The suitability report identified areas of the building that would need to be addressed to ensure the property would assist and improve Isaac’s day-to-day living.

Extensive surveys of the property were undertaken to allow France + Associates to better understand the building and potential issues that would need to be resolved as part of the building process, as well as produce a design scheme highlighting the most effective way, from a building viability, cost and of course suitability perspective to meet Isaac’s needs.

The family were delighted with France + Associates proposal, which addressed level access issues, included new single storey extensions to the side and rear of the property to provide enough space to include a ground floor bedroom and specialist bathroom for Isaac along with his own therapy room. Extensive external work was also proposed to allow Isaac to play safely with his siblings and friends.

A key aspect of the design was to ensure the home would be viable for both Isaac’s present

needs and those he may have in the future. Use of rooms, the building’s layout and potential future alternative uses were carefully considered to ensure the home would suit Isaac’s needs long term. Planning consent was applied for and achieved in December 2019. Each stage in the process including the tender process was explained clearly to the family, to better understand their role and what was to be involved, along with expected timescales. This allowed Isaac and his family to make informed, timely decisions.

France + Associates produced the appropriate documentation to be formally issued to primed building contractors to obtain competitive building costs.

Following receipt of quotations, F+A undertook the detailed cost analysis process, providing recommendations of the most viable route forward.

At the same time, statutory consent was sought from various authorities to ensure the works could safely commence onsite.

Construction commenced in January 2021, with France + Associates appointed as Contract Administrators, liaising with both the family, the contractor and other stakeholders.

The construction process would include extensions to the home, internal adaptations to suit access needs, along with renovation of the dwelling to create a completed build in harmony with the design that was deemed suitable for Isaac and his family’s needs.

Key accessibility features

FUTURE PROOFED

This home has been designed and built to accommodate Isaac’s present needs as well as being future proofed to accommodate those that he may have as an adult. When Isaac is old enough, he will have the choice to live independently in his home, so a major consideration has been to include live-in carers accommodation, including a small kitchenette area for care staff. Future consideration around mobility was carefully thought of, such as the ceiling infrastructure, to ensure a hoist system could be installed in specific areas if ever required for Isaac.

ACCESSIBLE GARDEN

As well as adaptations inside the home, Isaac and his family were also looking forward to having a secure property to provide a safe, accessible garden. With access to the garden directly from his own bedroom, Isaac can now play safely and independently.

ACCESSIBLE KITCHEN

As the ‘heart of the home’, it was important to design a kitchen that could be enjoyed by the whole family.

The large kitchen / living area at Isaac’s home is designed and orientated to be part of Isaac’s life, learning vital life skills and cooking for himself.

Isaac’s kitchen is open plan with ample space for a wheelchair to navigate should it be required in the future.

There is open access between the dining area, living space and kitchen, which also includes a height adjustable worktop. Key food

preparation areas looks out through the large expansive doors and windows into the garden, to form a relationship with the outside space.

THERAPY ROOM

Isaac requires regular physiotherapy, occupational therapy and speech and language therapy sessions to help him maintain mobility and allow him to develop.

In order for this to be conducted at home, Isaac now has a dedicated therapy room, which is positioned in a more private area of the home, with a separate entrance for the coming and going of various visiting therapists.

SMART TECHNOLOGY

Rain sensor skylights that automatically close when they sense moisture have been installed, along with smart technology to enable Isaac to control the lighting and temperature in the home. Thought has been given with regards to the electrical infrastructure to more easily install automated internal doors, if required in the future.

If you would like to know more about our work, please contact us.

T: 01484 960560

E: admin@franceandassociates.co.uk

W: www.franceandassociates.co.uk

the building’s layout and potential future alternative uses were carefully considered to ensure the home would suit Isaac’s needs long term

Centrobed: Smart tech for a restful sleep

The short answer is ‘Yes you can.’ And, you probably should.

With this in mind, we created our bespoke range of beds.

Our aim for our customers is to improve posture by allowing the individual to move all parts of their body independently. This gives them the ability to move into the most comfortable position for a restful night's sleep.

Our turning beds are suited to clients who suffer from a variety of conditions. These vary from strokes, DMD to MS and Motor Neurone Disease, specifically the Arctic.

The Arctic is a unique product that has been specifically designed to enable individual leg movements to complement the turning functions.

This means means you could have your right knee elevated and turn towards your lefthand side, alternating pressure for ultimate comfort while asleep.

The Arctic comes with all the standard features expected such as profiling, Hi/Lo, and compatibility for environmental control.

Our aim for our customers is to improve posture by allowing the individual to move all parts of their body independently

Clients also enjoy the benefits of independent leg movements and the ability to programme and automatically turn through the day and night.

The Arctic was designed for comfort and to accommodate the most complex of needs. This product helps clients to reposition themselves without the need for assistance of care givers, empowering independence by a simple push of a button.

ABOUT MND

Motor Neurone disease (MND) is a rare condition that affects approximately 2 in 100,000 people in the UK.

Over time, this life-limiting disease irreparably damages parts of the nervous system, leading to increased muscle weakness and a reduction in mass and mobility.

In addition to other symptoms such as cramps and twitches, weight loss and difficulty in controlling emotions.

Motor neurone brain cells are responsible for muscle control throughout the body, impacting walking, speaking, swallowing and breathing. As the condition progresses, these actions become increasingly more difficult people for people with MND.

Over time, these individuals become increasingly reliant on family or caregivers as well as assistive technology to help perform these functions.

Over the years, technology has evolved, empowering people with MND and other conditions to live more independently and have more full lives.

The Arctic, along with our other bespoke turning beds, is designed to assist and relieve clients with limited mobility.

Many stroke survivors suffer from a significant loss in movement, typically in one side of the body, similarly to MND.

STROKE

Our aim is to provide these individuals with postural support, rather than having to rely on caregivers.

The recovery time from a stroke can range from a few weeks to years, and having the correct assistive technology can help aid the recovery time.

The lesser movement ability that someone has, the higher risk they are for pressure care issues caused by immobility.

This can exacerbate everyday issues like the common cold or a chest infection which can in some cases lead to further complications. To combat this, caregivers are required to regimentally move patients to redistribute pressure throughout the day and night.

In December 2019, former rugby player Rob Burrow was diagnosed with MND, changing not only his life but also the lives of his family.

Since October 2020, Rob has been using our Arctic turning bed to help ease the strain that his condition has put onto both him and his family.

In the intervening years, Rob has found that he is able to sleep easier, helping to reduce the struggle for his loving wife Lindsey, too.

ROB TOLD US:

“The Arctic bed has been my saving grace. "The bed does everything I need for a good night's sleep, legs raised so I don't slip down the bed, the head raised up to my comfort and the turn of the bed enabling me to turn in automatically.

"The bed is comfortable, and it has helped me out massively since I got it.”

Since the launch of the Arctic, we have been able to provide countless families and caregivers some relief by adding an automatic turning function that can be programmed for use during the day or night. This reduces the risk of injury for caregivers through manual handling and reduces the cost, in some cases eliminating the cost for carers at night altogether.

OUR STORY

Centrobed first started by promoting independence with products such as our Nile leg lifter and pillow lifters for clients who were struggling to either get into bed or manoeuvre while in bed.

A few years on, we found that there were so many different communities that could benefit from these products but were also in need of more!

Because of these communities, our products quickly evolved over time onto our bespoke range of beds.

Not only with turning for complex needs such as MND, but also for a variety of other different scenarios.

The business was created in 1982 and has been passed down through the generations, bringing along our core beliefs and values, a legacy that puts people first and improves quality of life and independence for disabled people of all ages and disabilities.

To this day, Centrobed remains within the family who created it. Our products and the way we have developed them over time have been and will always be patient-led.

As a company, we look forward to serving our community and celebrating many more birthdays with many more generations to come, adapting to the changes in health and implementing new products to assist with a peaceful night's sleep.

Find out more about Centrobed at centrobed.com

The Arctic bed has been my saving grace

Stiltz Homelifts: Assistive tech that’s on the up

Stiltz Homelifts manufacture truly unique domestic lifts enabling homeowners to live independently for longer.

The spacious and comfortable lifts offer an aesthetically-pleasing alternative to the stairlift and come with additional practical benefits.

Stiltz Homelifts CEO and Chairman, Mike Lord has many years’ experience working within the mobility and accessibility sector, both in the UK and internationally.

We got in touch with Mike to find out more about the technology and what we can expect from Stiltz in 2023.

WHAT BENEFITS DOES A STILTZ HOMELIFT OFFER OVER A STAIRLIFT?

There are aesthetic, practical and safety benefits.

People associate stairlifts with disability and ageing. Nobody ever wanted a stairlift, they just need one!

A homelift – especially our clear-sided Plus range – is an attractive product in its own right.

It can be an interesting talking point. However, it can also be installed discretely out of sight or even be installed into a cupboard or a shaft, making it completely hidden, unlike a stairlift which is clearly visible.

From a safety perspective, consider how a less-mobile person such as a wheelchair user might transfer onto and off, a stairlift. The risks associated with moving from chair to stairlift seat, especially at the top of the stairs, are obvious for all to see.

Practically, our lift doesn’t just move people, it moves stuff too – vacuums, washing baskets, suitcases… all the things that get harder for our customers as they get that bit older. This gives true independence.

WHAT MAKES STILTZ DIFFERENT TO OTHER HOME LIFTS?

You just need to look at our lift to see how different it is.

In fact, it’s so different that we would argue that it’s actually the only true-blood homelift on the market.

Unique slim rails, one on each side of the lift across the centre line, mean we can fit it anywhere in the home. Literally.

We don’t need a wall. We could even fit a lift in the middle of the room if that’s what the customer wants.

This gives users maximum flexibility of positioning options in their home.

The rails also provide two completely unique features in homelifts; a void installation, and a ThruCar option.

Because the lift is freestanding, it can install into the empty space in the turn of stairs or straight up to a galleried landing without the need to cut a ceiling aperture.

The ThruCar really enhances this feature as it provides a door at each side of the lift, increasing options for our customers. Additionally, we have the drive system fully enclosed in the lift, not separate like a traditional elevator and no need for a remotely located pump like an hydraulic lift. Finally, it just looks fantastic compared to the rest.

WHAT DESIGN CONSIDERATIONS DID YOU LOOK AT WHEN DEVELOPING THE HOMELIFT?

Safety is of course a primary consideration for a domestic lift product.

It’s a comparatively large, electro-mechanical unit designed to be installed in the domestic environment, so naturally we must make sure the safety features are extensive. Our product has sensors top and bottom as well as the usual fall-arrest, balance, and weight-limit monitoring.

Where our product is unique is its safety light curtain. If this beam across the inside of the door is breached by a limb or even by clothing, the lift will stop.

Most other lifts rely on the edge of the lift coming up against an obstruction, resulting in compression entrapment before they stop. Aesthetics have always been a very significant design consideration.

Stiltz Homelifts entered the marketplace with the intention to disrupt the accessible-living industry, an industry not known for its focus on attractive design.

We have always believed products which assist people to live safely and independently in their own home should have just as strong a focus on attractive design as on functionality and safety.

WHAT DO CUSTOMERS LIKE ABOUT STILTZ?

Stiltz customers are a very particular about the products they select for their home. Whether they’re purchasing privately or have secured funding via a Disabled Facilities

Grant, they are keen to continue to enjoy their home as a home, and not an extension of a medical facility.

As potentially vulnerable users, they expect exceptional levels of service when interacting with Stiltz staff, and a product that delivers on its promises.

Our customer service is second to none which includes our same day fix aftersales service. 24/7, 365 days a year.

Our customers depend on their Stiltz Lifts so we make sure that they can always get to bed no matter what time of day or night a problem occurs.

As a business, Stiltz is on a continuous learning curve, and the overarching mission is to ‘Make it Easy’ for our customers.

That’s not just making it easy for customers to interact with Stiltz teams, but also ensuring the product user interface, installation process and handover is as straightforward as it can be.

HOW HAS THE RANGE GROWN AND THE TECHNOLOGY EVOLVED OVER THE YEARS?

Our products now look radically different to the early days of Stiltz Lifts.

We have introduced new styling, clear lift car bodies, new colourways, and a more intuitive and attractive interface.

The essential technology has remained the same though; a car suspended on steel cables, a cable drum, two rails to the sides of the lift car to channel the cables, and some clever electronics to make the whole thing run.

We continue to invest in new product development, and we will keep well ahead of the competition for years to come with new products and services already well through the design stage.

WHAT WERE YOUR HIGHLIGHTS OF 2022?

2022 was a year of consolidation. We focused on growing our export business, putting in place lead generation programmes and staffing up to support our key markets of Spain and Italy. We also worked with mobility dealers in the UK to strengthen our trade support network. In the background, significant advances in product development took place. New technology will soon be introduced into completely new products which will create a seismic shift in our lifts specifically and will really be a gamechanger for the whole homelift industry generally. Moreover, this will firmly cement our position as market leader.

We are approaching 400 employees and we grew sales by 20 per cent as a result of all these efforts.

We also implemented a new five-year strategy with a target to triple sales driven by new product and innovative distribution strategies.

WHAT DO YOU HAVE COMING UP THIS YEAR?

More growth, more people, more investment and more product. Pretty much business as usual for Stiltz.

If I say any more about planned product launches though our Product Management team would be most put out!

Watch this space…

Find out more about Stiltz Homelifts at stiltz.co.uk

Aquasure UK Limited: The hydrotherapy pool experts

Aquasure UK Limited was formed with an in-depth personal knowledge based on first-hand experience.

After a spinal injury over 20 years ago, Martin Brook required hydrotherapy. Martin searched the market and could not find a suitable off the shelf home hydrotherapy pool to meet his needs.

At this point, Martin consulted with Andrew Flynn MISPE, a swimming pool engineer. Together they designed a pool which was specific to Martin's needs.

During this process Martin and Andrew noticed the lack of knowledge and advice available for people requiring hydrotherapy at home for their bespoke needs.

Together, Martin and Andrew set up Aquasure to specialise in Hydrotherapy and help clients access pools that are specific to their needs. Aquasure works closely with physiotherapists, occupations therapists, architects and their clients to provide bespoke hydrotherapy pools tailored to the client.

Aquasure designs and builds both domestic and commercial hydrotherapy pools.

A commercial hydrotherapy pool may be required to operate for over 12 hours per day. The filtration and water treatment systems are designed according to PWTAG recommendations, ensuring a safe environment for bathers and staff.

Water treatment systems such as Ultraviolet light disinfection allow for chlorine levels lower than drinking water.

The ultraviolet light disinfection removes chlorine biproducts which can be an irritant for bathers. This is especially useful when the pool is being used by clients with skin allergies. The ultraviolet systems also irradicate all bacteria, ensuring bathers who are susceptible to infections can use the pool with a low risk. The air heating ventilation and dehumidification systems are designed by Aquasure to provide the correct humidity and air temperatures. If the pool hall is to hot and humid the environment may be dangerous to bathers and staff.

Equally, if the pool hall is too cold, many clients may not be able to use the pool due to the sudden change in temperatures when exiting the warm hydrotherapy pool.

In recent years, Aquasure has developed a home wellness range including accessible steam rooms and saunas.

Many clients simply cannot use the commercial wellness facilities due to lack of accessible saunas and steam rooms.

Talking to our clients, we have realised how

important it is to ensure previous wellness pastimes can be enjoyed at home with family and friends.

Designing a truly bespoke hydrotherapy pool means our clients have total control over the look and functionality of their pool. Aquasure UK offers a vast range of optional extras to choose from, including underwater speakers, therapy LED lighting, underwater treadmill, an array of different pool covers, resistance swimjets and massage seating areas.

Massage seating areas are again designed bespoke, considering each clients measurements and how they wish to use the seating area to design something which suits their individual needs.

In addition to the option extras, Aquasure UK offers all available options when choosing pool finishes.

Ensuring each pool is designed and finished to our clients' individual tastes, fitting with their home.

A hydrotherapy pool can vary in size from 5m x 3m x1.2m to 10m x 5m x1.3m.

The hydrotherapy pool can be partially above the ground, fully in ground with the water below the below surround or deck level where the water is level with the surround.

Aquasure construct all options for hydrotherapy pools and advise on the most cost-effective method to provide the hydrotherapy pool clients require.

A hydrotherapy pool requires various design features to ensure the hydrotherapy pool and hydrotherapy pool building are eligible for VAT exemption.

All Aquasure domestic hydrotherapy pools designed for for a disabled individual and installed by Aquasure are eligible for VAT exemption.

A major part of the Aquasure design method is to ensure the pool the pool relates the smallest carbon footprint possible.

Aquasure installs all the latest energy efficiency equipment to reduce running costs for years to come. Aquasure is also instructed to reduce the running costs of existing pools.

Aquasure operates a nationwide maintenance service.

The maintenance of your pool is necessary to provide a safe environment for bathers and employees alike.

Aquasure provides planned nationwide hydrotherapy pool maintenance contracts. Including 365 days a year helpline. The maintenance service is also available for a pool which has not been constructed by Aquasure.

Our team of nationwide engineers provide a reactive and planned maintenance service ensuring your pool always remains in safe working order.

Aquasure provides free of charge quotes and designs and advice prior to your project being tendered or designs finalised.

Working closely with the client architects, designers, physiotherapist, and occupational therapists prior to the project getting to site minimising delays helps with planning and allows for correct cost budgeting.

Find out more about Aquasure at aquasureuk.com

Tracey regains her independence in the kitchen with Ropox

Tracey Doolan from Cardiff is enjoying a newfound independence at home following the installation of a new kitchen which features four cabinets which are fitted with the Diagonal Lift System from Ropox - one of the leading manufacturers of accessible kitchen and bathroom solutions.

Tracey has Rheumatoid Arthritis and as it progressed, she was finding it increasingly difficult to do anything in the kitchen and was relying on her husband Lyndon more and more.

“It had got to the stage where I was unable to get anything in or out of the cupboards, so we decided that a modified kitchen was the best solution” explained Tracey. The couple looked at various options to help make the kitchen more accessible and decided the Diagonal Lift System was the best solution as it meant the cupboards would automatically come right down to the work surface at the press of a switch as opposed to other systems where you have to pull the basket down manually.

Tracey has been using her new kitchen for just over a year now and loves the new found independence it has given her.

“Now I can make a drink or prepare food on my own instead of having to keep asking Lyndon for his help and as the cupboards come right down to the work surface, I can even reach the back of the cupboards with ease.

"I also love how easy they are to operate, and the auto sensor means if there are any obstructions on the work top the cupboards stop lowering until the item has been moved.

"I would not hesitate in recommending the Ropox Diagonal Lift System to anyone who wants to regain their independence in the kitchen as it makes the cupboards so accessible” concluded Tracey.

“It is fantastic to hear how Tracey and her husband are benefitting from their new Diagonal Lift Systems.

"Our aim is to help every client live as independently as possible and we feel we have certainly achieved this for Tracey and Lyndon” commented Suki Ram, Area Sales Manager, Ropox.

The Diagonal Lift System turns a standard kitchen cupboard into a height adjustable cupboard and can be fitted to new kitchens or retrofitted to an existing kitchen, and not only does it lower the cabinet, but it can also move the cabinet forward and closer to the user. This means that someone like Tracey with limited movement can access the contents of the cupboard as can users that are unable to stand from their wheelchair.

The height adjustment range of the system is 43cm in height and 18cm horizontally while the diagonal movement of the system means that as it is lowering (up to 43cm) it is also moving closer to the user by 18cm.

For more information on the full range of Ropox equipment or to book an assessment, contact:

Mark Sadler on 07444 577609 email ms@ropox.com

Suki Ram on 07704 102393

email: sra@ropox.com

or visit www.ropox.co.uk

Changing children’s lives through therapy

Meeting the need

Back in 2008, amidst a lack of provision in the North East for children with Cerebral Palsy and other disabilities - and significant waiting lists for parents to secure diagnoses and access to NHS therapy - a group of families took the initiative to do something themselves, or else face a potentially lengthy wait for the support their children badly needed.

NR Times learns more about the therapies delivered by the charity, how it is helping to meet urgent need in its native North East, and why fundraising is all-important to its future sustainability

Fifteen years ago, a group of parents got together to create desperately-needed provision for their children, following the closure of a local service in the North East which supported young people with Cerebral Palsy and other complex disabilities. And from their desire to make change for their own children, a charity was born which is now changing the lives of young people across the country.

Heel and Toe works with hundreds of children every year, supporting them with a range of therapies and access to specialist facilities, as well as being by the sides of families as they work in close collaboration to achieve outcomes well beyond expectations.

With two sites in County Durham - a main therapy centre in Pelton and a dedicated hydrotherapy site in nearby Perkinsville, opened in 2018 and currently being extended furtherit delivers weekly sessions to local families, as well as intensive blocks during school holidays. The charity also delivers school outreach projects and online support for parents, supplementing the life-changing work of its centres further.

“We had one boy who came to us at about seven months old, we weren’t sure he would ever be able to walk,” says Jane Long, business development executive at Heel and Toe, who supported the creation of the charity and has been there ever since.

“But he took his first steps with us in our centre, and then moved on to using the treadmill, and has gone on to thrive. His dream was to play football - and he now plays for his local team.

“That has been absolutely fantastic to be part of, I can’t tell you the joy it gives us as a team to see things like that happen.

“Over the years, there have been so many stories like that, of children who come to us and our amazing therapists genuinely help to change their lives. It’s a privilege to be part of.”

“My friend has a child with Cerebral Palsy, but the place they were accessing Conductive Education therapy was closed down because there was no funding. So my friend and other parents got together and decided they wanted to provide a service to do the same thing,” recalls Jane.

“It all started in response to a service that was being pulled away, and they sought help from people from different backgrounds to help make a success of it. My background is in business development, so I came in to support with the development of Heel and Toe as a charity, and it has grown so much from there.”

And from the very earliest days, the need for this new service quickly became apparent, with huge demand from families.

“When we started, it was really difficult for parents to get a formal diagnosis for their child, they were essentially working with their clinical teams to try and establish the milestones their children were supposed to be hitting at certain times, and realising from there that their development might be quite delayed in certain areas,” says Jane.

“They were absolutely desperate for access to therapy that would help their child, but waiting lists were absolutely exhausted and when they did get access to therapy, the staffing situation was a massive problem as well. There just wasn’t the quality or quantity of therapy they badly needed.

“So when we opened a centre where families could come and access a range of therapies, the demand was huge.

Through the work of Heel and Toe, young people living with Cerebral Palsy and other complex needs are being supported to make life-changing progress and achieve milestones their parents never thought possible.

We expanded our services based on what was needed - from Conductive Education to physiotherapy to occupational therapy and so on, we now have a whole range of support that has grown as the demand increased.” And with NHS waiting lists continuing to grow, and the huge additional pressure put on the healthcare system during and in the aftermath of the COVID-19 pandemic, demand for Heel and Toe’s services has never been greater.

“While access to therapies is wider than when we first started, because demand is so high, capacity is a problem for many services. We just keep growing in response to that,” says Jane.

“Yes, the demand is absolutely massive, but we've got an incredible team of therapists and fundraisers, and we all work to maximum capacity. We just want to see children thrive and be able to develop in a way that's going to make things accessible in life that they didn't think was going to be possible.

“We always try and provide as much as we can. We have had families come to us from miles away. If we can support them, we will. And if we find any other centres or charities that have facilities and availability, we can forward on that information to our parents. We want to do the very best we can for every child.”

Through the work of the Heel and Toe team, children are enabled to exceed expectations, having fun while taking part in life-changing therapy.

“Many children who come to us have never taken any steps so their core stability is quite weak, the muscle tone is quite weak,” says Jane.

“But after three or four weeks of sessions with us, the difference is massive. They realise they really enjoy their therapy, so want to do as much as they can.

“We’re always getting calls through to the fundraising office saying ‘You have to come and see this’. We share the joy as a whole team in seeing children progress like there areand that’s what it’s all about.”

‘Fundraising is our lifeline’

While Heel and Toe deliver a wide range of therapies and support, everything is funded by grants, fundraising initiatives and donationsthere are no guaranteed sources of income to finance its work.

“We are the only charity in the North East to provide the amount of services we do without any funding, and we are only too aware of the need for us to continue to deliver and grow our services,” says Jane.

“The COVID pandemic, and now the cost of living crisis, is making this a very difficult and slow process, as the main part of our income is through donations from public and businesses and through fundraising events.

“And the reality is that if we don’t have the funding, we’re not going to be able to provide the services. We’re all really motivated by the need to stop this from happening as we have families who need us so much.”

Fundraising has been key to the growth of Heel and Toe, with every bit of its work and equipment funded by donations. Its ongoing expansion of the Perkinsville centre will see the creation of new treatment rooms, which will need to be filled with equipment, and is a current focus of fundraising.

Among its many successes over the years has been its two-year Footprints Appeal for the creation of its hydrotherapy centre generating the £280,000 needed to bring a vital resource to the area.

More recently, its support of children and families remotely with online therapy sessions during the COVID-19 pandemic was funded through grants, and has been hailed as a “lifeline” for many parents amidst the extended ‘stay at home’ guidance to protect their vulnerable children.

“Every single service we provide needs to be funded, if we want to do something, we have to go and raise the money to do that,” says Jane. “If there is something specific we want to offer, such as the hydrotherapy pool or the online therapy, then we’ll put out a capital appeal, but we need to fundraise just to keep our centres open and our therapies running.

“For example, we raised the money to create the hydrotherapy pool, which was fantastic, but then you have to pay for its upkeep, the electricity, the maintenance. The fundraiser was for the actual building, but then you need to find the funding to maintain it. Nothing is certain, but we keep going.

“With our expansion we are creating more therapy rooms, and the equipment and sensory toys are very expensive, so that’s something else we are currently looking to fund.

“We do get some great support from the children’s families, and that spills out into

their community and the parents’ workplaces, and all of the little things that individual families or workplaces might do really add up and it has a huge holistic effect on the whole charity.

“We have some great relationships with some local businesses, but I’d love to work more closely with more of them. We are centrally located in the North East, while also supporting children from outside of the region, and because we are reliant on fundraising, their support means so much to us.”

Heel and Toe has a number of fundraising events planned in the coming months, including the return of its hugely popular All Ability Bike Ride, sponsored by Slater and Gordon Group. For more information on how to support its events, visit www.heelandtoe.org.uk/events

For information on corporate sponsorship opportunities for the charity or any of its events, contact Caroline Nevin on 0191 3868606 or email: caroline@heelandtoe.org.uk

Ben Gent, principal lawyer at Slater and Gordon:

The work done by Heel and Toe and their determination to succeed against the odds, and without statutory funding, is nothing short of astonishing. We admire the charity’s achievements, share their values, and are delighted to commit to supporting them.

This year, Slater and Gordon will again be sponsoring the charity’s All Ability Bike Ride, Lake District 5 Peaks, Great North Run and their annual Gala Ball. All of these events are inspiring and enjoyable in equal measure, and necessary to raise the funds needed to continue their amazing services.

Slater and Gordon has a long history of supporting children, and families of children, with Cerebral Palsy and other physical and neurological disabilities. We’re dedicated to ensuring those who Heel and Toe support received the legal support they need, whether that is trying to find answers about medical care, offering help with benefits or working towards securing compensation.

We hope our continued support for this outstanding charity will help them to reach even more children and families.

Sophie Morgan On Accessible Gyms

Sophie Morgan has become a familiar face on television screens in recent years and is one of the first female tv presenters with a physical disability. Appearing on Loose Women and her new show: Living Wild, How to Change your Life, Sophie has also forged a career as a writer and producer.

Q&A with Sophie Morgan

WHAT DO YOU TYPICALLY DO TO LOOK AFTER YOUR HEALTH?

I find having a routine is tricky for my overall lifestyle, but I do try to focus on having a balanced diet and fit in exercise where I can. Having a long-term disability means my health can and does change, so looking after my body is a priority.

IS EXERCISE AN IMPORTANT PART OF YOUR ROUTINE?

It is but my job takes me on the road a lot so fitting in time for a workout can be a struggle! I try to do some cardio work every week and use my weights daily; I have my own weights that I carry with me wherever I go, which I find really helpful for maintaining exercise whilst I’m on the road. Having a disability does make exercise more difficult so having the right guidance, access to equipment and spaces is essential.

WHAT IS ACCESSIBILITY LIKE IN GYMS?

Pretty bad! I think some gyms need to get the basics right first, wheelchair access should be the norm, but it isn’t in many places. Often gyms don’t have the right equipment, or staff to handle people living with a disability. Then when spaces are more accessible they tend to be really sterile and clinical. This is what sets VIM Health and their accessible gym, apart from the rest.

CAN YOU TELL US A BIT MORE ABOUT WHAT MAKES VIM HEALTH SO SPECIAL? HOW WAS YOUR RECENT VISIT?

Incredible. Being able to visit a gym that was completely geared towards people with disabilities is brilliant, I would love to see gyms of this standard in more places around the country. The gym is run by physiotherapists, has equipment that works for everyone and is designed so beautifully. It’s such a game changer for me, and it’s why I keep going back. They have a monthly gym membership, which allows members to come as frequently as they like. They also have a great booking system which prevents the space from getting

overcrowded and ensures that a physio can be on hand for those who need it. The space really is one of a kind, the pictures don’t do it justice, you have to see it and feel it for yourself.

ARE THERE ANY PIECES OF EQUIPMENT YOU ENJOYED USING?

Yes! The SkiErg is my favourite for cardio! I’ve used one before and think it’s amazing. Pairing it with the REX for a personal training session is great. The REX is an exoskeleton that allows me to be upright and weight bearing, which is great for increasing circulation and strengthening bones. I also use their app which has my own tailored exercise plan. This is a great way for me to keep on top of what I am doing. It allows them to monitor and change my plan remotely which is

super helpful as I am on the road so much. I have to mention the Lyra machine that they have at VIM! It’s a robotic gait trainer which allows you to replicate walking whilst your body weight is supported by a harness. That was cool and not something you will find in any other gym!

HOW CAN OTHER GYMS BE MORE INCLUSIVE?

I think perhaps the environment and culture can have a big impact on how inclusive a gym feels. Many people feel nervous going to a gym for the first time, so an overall atmosphere of inclusivity really helps. That’s something VIM have got right with their gym – as well as having great access, accessible equipment, and trained staff, the environment just feels inclusive and welcoming.

VIM Gym

VIM Gym is a new type of accessible and inclusive gym featuring specialist equipment and healthcare professionals on hand to support gym goers. Situated in Mid Sussex, VIM is open to anybody looking for a different type of gym experience, at standard gym membership prices. VIM Health is also just downstairs and offers a wide range of therapy services supported by a combination of robotic technology you can’t find anywhere else in the UK.

In her spare time, Sophie enjoys riding around on her adapted motorbike, and keeping healthy is a large part of her lifestyle. We caught up with Sophie to talk about how she keeps fit, gym accessibility and a newly opened accessible gym she regularly attends.

Empowerment through therapy - Specialist Rehab OT and the MDT

Here, NR Times discovers the importance of specialist rehabilitation occupational therapy (SROT) and its role in leading a multidisciplinary team (MDT)

For Jada, a 14-year-old girl whose dream was to move into higher education to study music, those ambitions looked to be potentially shattered when she sustained a brain injury. As she battled to recover, her school grades deteriorated significantly, and her vast potential was put at risk. With a school struggling to get to grips with Jada’s new challenges, and complex family dynamics, the future which had seemed so bright was overshadowed by the impact of brain injury.

“The main challenge was around executive dysfunction; difficulties with initiating and completing tasks, maintaining attention and switching between activities, and regulating her emotions; all of which led to low selfesteem and her withdrawal from her friendship groups and support networks. She was a musical prodigy, and after her brain injury she could still play, but her other subjects in school began to suffer,” says Penny Wosahlo, managing director of Think Therapy 1st (TT1st). “Her grades dipped, her relationships with other people were breaking down, she was very frustrated and couldn’t work out how to handle those emotions, which is so common in young people with traumatic brain injury. But because she appeared to be OK, the school were not able to give her the support she needed initially.”

Having been appointed jointly by her solicitor and the insurer, TT1st introduced its unique approach to rehabilitation into Jada’s lifewith truly transformational impact.

Through its focus on specialist rehabilitation

occupational therapy (SROT) and devising a range of functional activities for Jada, which would engage her in practical tasks while enabling her to rebuild her life, TT1st proved vital in its role in assembling and leading the multi-disciplinary team (MDT).

“We introduced functional cognitive rehab in our sessions, and she had sessions with a neuropsychologist to help regulate her emotions and address other aspects of her executive dysfunction. We worked with the school to introduce an Education Support Plan. She needed some help with her vision, so we brought in a neuro optometrist. We made

“Her occupational therapist Fiona accompanied Jada out Geocaching. Geocaching proved really important as part of her cognitive rehab, thinking and following clues, and there were also some vision aspects to it through reading maps.”

And through TT1st’s approach, despite the outlook looking particularly challenging for Jada, she was able to gain a place at a prestigious higher education institute to study music - a golden moment for everyone involved, the pinnacle of what she was working so hard towards, and it was achieved.

Jada spoke of how “I feel like I’m able to make my own decisions now and my life is going great… I feel more able to know when I need help, and also more importantly, I know what to do when I need help and don’t just bury my head in the sand”.

recommendations and sought agreement from the referrers and got all of those things in place,” says Penny.

“Our approach is that every single thing we do is about rehab, nothing is wasted. We recommended the insurer give us a budget for us to support her with rebuilding independence, which might seem quite an odd thing to ask, but because we were looking at her being able to go into higher education, independence and money management were really important.

“It was so lovely to be involved in this, it really did change everything for her. It’s heartening to see where she is now, off living her life and being able to cope with the day-to-day challenges her brain injury presents which she was not able to at one point,” says Penny. With its unique take on OT, and results-driven outcomes measured against goal achievement, TT1st facilitates strong outcomes for clients throughout the country.

Taking last year as an example, of the clients who completed their therapy with TT1stmore than 20 in number - only two needed ongoing support; one of whom already had a longstanding case manager in place at the point of referral.

And its results, combined with the SROT approach which can positively support every aspect of a client’s life, mean TT1st regularly undertake leading and coordinating the MDT. “For most people, they hope to return to how

Through a focus on functional rehabilitation, Think Therapy 1st are supporting clients to regain the maximum levels of independence possible after serious or life-changing injury, equipping them with the skills and tools they need to move on with their lives.

By heading up the MDT we coordinate services, ensure goals are aligned and ensure the different specialities are working cohesively to optimise outcomes and recovery

their life looked before their injury, or as close as they can get to that. Ideally, that’s what we want to help them get back to through restorative rehab, so we will assess every aspect of their life now and look at what the issues are,” says Penny.

“Our SROT approach delivers some lifechanging results, but we can’t support a person alone. Evidence and best practice indicate that the best recovery will involve an MDT, with the client at the centre of that.

“The MDT will be based entirely on the bespoke needs of the client; no two clients are ever the same. We work across brain injury, amputations, orthopaedic trauma and often times with psychological trauma. We work with both children and adults, and everyone needs a different construction of an MDT to reflect their needs.

“We assess the person functionally, and look at the impact their injury has had on each bit of their life. We do that in their own environments - be that their home, their workplace, their school, wherever is crucial to them being able to live their life - and look at the activities they used to do, in addition to the day-to-day reality of living their life. They may want to go to the gym, they may want to go nightclubbing, they may have hobbies they want to return to.

“Whatever it is they want to do, we’re breaking everything down into component pieces and looking at who we will need in the MDT to help them achieve that. We bring that together and help to cultivate that.”

True to TT1st’s approach of empowering people to regain independence and being able to complete activities on their own - Penny says they will never do anything for a client they can do themselves, preferring to encourage them to be self-sufficient and confident rather than do

something for them - this is also reflected in the MDT they build.

“Clients are in a position at first where their lives have been turned upside down, so of course they will need a huge amount of support. But as their situation changes, the role of the MDT and the people working within it changes, and we need to reflect that,” says Penny.

“At the nucleus of the MDT is the client, that is constant, everything will always revolve around them. Because of the work we do and our role in the team, we will be in the inner circle, often alongside the person who will have a close link with their claimant solicitor. We consider ourselves a joint coordinator of a client’s rehab, working in full conjunction with them. We’re teaching them and working side by side in doing that.

“But others in the MDT will move around in terms of the position they occupy. Because it’s multi-agency and multi-disciplinary, we have to respond to what is needed. We all overlap to some extent in the role we play. For example, at first after their injury, their orthopaedic surgeon may be in the inner circle, but their role will lessen as time goes on. Physio input may vary throughout, so they may be in the inner circle sometimes, but then their involvement may reduce, and they move to the extended team.

“By heading up the MDT we coordinate services, ensure goals are aligned and ensure the different specialities are working cohesively to optimise outcomes and recovery.

“We naturally use our OT skills to therapeutically plan and coordinate input from other teams and specialities by introducing treatment and interventions at the most appropriate stages of the client’s recovery and holding regular All Party/ Way Forward meetings at frequencies tailored to the clients’ needs.

“We include the client in every step to develop their self-efficacy, streamline their progress and ultimately optimise their achievements with the client becoming the expert in their own recovery, with the ultimate aim of learning valuable transferable life skills along the way.

“We need to respond to the needs of the client so they are best served, and as a progressive business focused entirely on maximising the outcome and independence for the injured person, that is our priority.

“We all need to be focused on the same goals and delivering those for the client. It may seem strange to include the insurer or defendant solicitor in the extended team but in joint instructions they will agree funding for rehab and services and so it makes

sense to include them in that extended capacity.

“We always have a plan in place, and do update reports every month, which the client also contributes to. We have space where we input feedback from each provider, so we can review how things are going, we'll be able to track progress, looking at the goals and whether they being achieved or not.

“Practically, with everyone working so symbiotically together, every month we are seeing progress - and if we’re not, we’ll ask the client, look at the feedback and review the outcome measures to understand why and make the necessary changes to benefit the client.” In line with its commitment to working side by side with a client, TT1st - a growing national provider - appoints OTs based locally to the client.

“In our own work, and in leading that of the MDT, it is important to have people working in the area and with knowledge of the structures in place,” says Penny.

“Each area will have its own pathways, which can be very frustrating, but local knowledge can help to negotiate this and often find new support structures. If we don’t know someone in this particular area, it won’t take us long to build those relationships. We’re a national service and very well connected, so we will always be able to find the professional or service the person needs.

“And by using therapists who are local to the community the client lives in, that can be important to their rehabilitation. Humans who are very isolated do not flourish. We are not remote, we do everything face to face as much as possible, we get to know the client and there are no barriers there.

“That’s the level of service and client focus we are committed to delivering - and that’s why what we do works.”

Hunters Moor maximising potential through neuro-rehab

taking patients out of frontline care and into a specialist neuro-rehab environment.

“The patients are the cornerstone of Hunters Moor and we are all dedicated to providing them with the best possible levels of care,” said Dr Waheed.

NR Times learns more about the centre, its service expansion, and ongoing investment and development work to ensure its team can deliver the best possible care to patients

A long-established neuro-rehabilitation service is broadening its specialism even further through the addition of dedicated spinal cord injury and tracheostomy care.

Hunters Moor has a strong reputation for its support of people with brain injury and neurological conditions, with intensive neurorehab programmes devised by the in-house multidisciplinary team helping to deliver outcomes for patients well beyond expectations.

And now, as the Level 2 neuro-rehab centre in Birmingham - owned by Active Care Group - continues to invest in its facilities and staff to ensure it offers the best possible service to clients, it is delivering the required training to enable it to provide support to patients with SCI and with tracheostomy needs.

Since the appointment of Dr Khuram Waheed last year, an in-house specialist doctor with a background in rehabilitation medicine, Hunters Moor has seen strong progress, with new levels of development and support available to staff and a host of new procedures around best practice introduced.

Statistics show that, in the past year, the work of the centre and its team has helped to reduce hospital admissions by 76 per cent.

And with the demand-led addition of dedicated SCI and tracheostomy services - and beds currently available to accommodate these patients - Hunters Moor is also looking at the potential to use existing unoccupied space as a care setting, further supporting the NHS in

“Since I have come here, we have made many changes to help make that the best it can be, our staff are more able to communicate and work together and there is a very good set up for our patients. We want to make Hunters Moor the best it can be and we are all working to achieve that.”

Growing levels of specialist neuro-rehab support

Hunters Moor has built a reputation over many years as a key site in delivering neurorehab, with patients from a wide geographical radius across the midlands and surrounding areas - moving to the 42-bed centre for its specialist support.

With a specialism in brain injury work, Hunters Moor’s MDT also cover the full spectrum of neurological conditions and illnesses, achieving often life-changing outcomes for patients during their time at the centre, which is usually for a minimum of 12 weeks.

Now, with the addition of dedicated SCI and tracheostomy care, it can support even more people.

“We are known for our work in acquired brain injury and traumatic brain injuries,

Having delivered life-changing outcomes to patients for years, Hunters Moor is now expanding its scope even further with the addition of specialist spinal cord injury and tracheostomy care.

as well as progressive neurological conditions. But through the extensive training we have undertaken to broaden our offering, we are now advancing into spinal and tracheostomy patients,” said Dr Waheed.

“Our nursing teams have undergone extensive training and we are now ready to accept new patients who need our specialist care.”

Lisa Mullineux, business development manager at Active Care Group, said: “Our development of the spinal and tracheostomy care pathways at Hunters Moor are as a direct result of referral demand.

“We are pleased to have been able to harness the expertise we have within our wider group, and well-established care in the home division, to support all of our staff in specialist training for spinal and tracheostomy care to enable us to offer our services to these patient groups.

“It’s a really exciting time for us at Hunters Moor, our hope is this offering will allow for more local people to remain as close to home as possible having their specialist care needs met in an expert therapeutic environment .

“We are working with our commissioning partners to explore opportunities to develop additional residential step down provision for those patients who have ongoing needs requiring skilled clinical oversight and transitional living settings before they can safely be supported in the community.

“Such an approach will enable cost savings to the public purse, progressive pathways and partnership working, which we are looking forward to exploring further.”

The developments at Hunters Moor come after years of successfully supporting patients to achieve and surpass their outcome expectations.

“Each of the patients we are privileged to work with at Hunters Moor is individual and their rehab journey is their own for some, their needs will be met within three weeks, for others that may take 12 weeks, and for others that road will be longer. This is an intense period of neuro-rehabilitation, and as we work towards discharge, it is the responsibility of us all to ensure this is safe,” said Dr Waheed.

“The two things we focus on from the outset are maximising quality of life and reducing the care burden, while promoting independence as much as possible.

“We work very closely with everyone involved in discharge planning and what that is going to look like, to ensure our support goes right up until the point of discharge. We are absolutely committed to doing the best at every point whilst our patients are with us, we are proud to have assisted our patients to have

achieved some really, really good outcomes.”

One recent example is from a man who arrived with a hypoxic brain injury after an insulin overdose. He arrived in a prolonged disorder of consciousness (PDoc) with minimal expectations for his progress.

“This gentleman was with us for several months and we were seeing glimmers of change in his presentation. We worked with his responsible commissioner to extend his stay as we were seeing the progress and wanted to maximise his opportunity for that,” recalls Dr Waheed. “He arrived here with a need for one-to-one care 24 hours a day, to being discharged to a nursing home with a reduced care burden and no longer needing one-to-one support.

“You can imagine the cost saving to the NHS when funding a placement for a patient in a nursing home with the needs this gentleman arrived with, compared with when he left us. “Aside from the financial benefit and most importantly the positive impact this has on the patient is enormous We were all very pleased with the outcome for him, and the progress he made during his time at Hunters Moor.”

‘We want to be the best we can be’ Keen to continue to build and develop the reputation it has for the quality of its neurorehab, Hunters Moor is always looking for opportunities to improve its ways of operating to maximise the care it can deliver to patients. In the past year in particular, since the arrival of Dr Waheed, a raft of major changes have been made in the centre, supporting its staff with new processes and training to enable them to deliver the highest standards of care.

The closer working between the therapy teams and nursing teams, with Dr Waheed at the centre of the link, has given rise to a number of other measures.

“We have weekly electronic ward rounds, each plan for patients is updated for our nursing and therapy staff to follow. We have a new admissions policy, which can be done electronically too, so everything can be found digitally,” says Dr Waheed.

“I am in charge of heading up the MDT meetings, and we also have new levels of medicines management training and emergency drills. We’ve had specific training in a range of areas and I give educational lectures on staff training as well. Maintaining patient safety is the absolute priority.”

Dr Waheed provides a consistent point of contact and support, working with colleagues around the clock to deliver the best possible service to clients.

“Because we know our patients so well, we can identify issues and intervene at the earliest opportunities. If I or one of my clinical colleagues are contacted at any time of night or day, as well as providing reassurance to the team, our patients and family members, this can very often avoid long delays in sourcing external support, whether that be through NHS 111 or a GP service,” he says.

“Because we have very complex patients with brain injury or progressive neurological conditions, any change in them can have a massive change on their outcome. Unless we pick up the signs early, it could potentially have lifethreatening complications.

“There is that security for our staff of knowing they will always be speaking to someone who knows the patients and their specific circumstances and needs. That reassurance can make them feel more confident in their roles, and that is a theme which has run throughout our regular staff and also our agency nurses.

“There was one gentleman who had a cranioplasty and came to us from hospital after having that done. Within two days he developed a swelling and if no-one was there to recognise it, he could even have died. But within two hours, our staff had recognised the problem, spoken to me, and organised a transfer to hospital under his neurosurgeon, who I spoke to on the phone, and the patient was stated on antibiotics.

“That probably did save his life, and that is why I and the team invest the time we do in getting to know our patients, their conditions, their history and their needs.”

Next stop, independence

A 57-year-old former bus driver and mother of three who experienced a life-changing bleed on the brain in July 2022 is now approaching her final destination of regaining independence thanks to a specialist rehabilitation team.

Through a combination of regular physiotherapy, occupational therapy and wellness sessions, Askham Rehab, which forms part of Askham Village Community near Doddington, has been working closely with Isabel to restore her motor functionality and improve her mental wellbeing following what she describes as “one of the most challenging times of my life”.

Isabel, who was very active before her stroke, was referred to Askham Rehab for an initial eight weeks and since discharge, now attends its outpatient service to fulfil her ongoing rehab goals.

Since joining the progressive and personable community, she has come on leaps and bounds — overcoming the challenges of being restricted to full use in just one arm and leg.

Upon arrival, she required assistance to sit, stand and maintain balance due to a rightsided weakness, which was more pronounced in her upper limb. The priority was to centre her treatment around active movement, focussing on things like wrist flexion — using state-ofthe-art robotic equipment, such as the Pablo system — an interactive therapy device. The mental hardship of this restricted movement was one of the most challenging components of Isabel’s rehabilitation and occasionally left her feeling unmotivated and daunted by the process.

Despite this, the consistent ‘can do’ attitude of her specialist care team, coupled with her continued resilience, has amounted to significant progress and positive steps towards independence.

Commenting on her rehabilitation journey, Isabel said: “When you have a stroke, it can be a very consuming time of your life and without the guidance and continued support of a community like Askham, I’m not sure how I would have got through it.

“I am fortunate to have three amazing children and a loving husband of 39 years, who have supported and motivated me throughout this whole process. I think I owed it to them and to myself to give this everything I've got, even on the days when it feels like an impossible task.

“Noticing progress in your rehabilitation journey is difficult as you are experiencing it every single day. However, my friends, family and care team are constantly reminding me how far I’ve come and when I think about my situation now compared with when I first had the stroke, it’s truly amazing.

“When I first came to Askham, I couldn’t do half the things I can do now — and I can’t put into words how grateful I am for their support. Being from Turves in Cambridgeshire, I was so lucky to have such an amazing care community right on my doorstep and I couldn’t recommend them more to anyone unfortunate enough to find themselves in my position.”

Askham Village is a family-run community with

a rehabilitation service that has transformed the lives of many individuals, and its remote setting and person-centred approach is the perfect place to address any personal challenge — big or small. With the latest robotic equipment and state-of-the-art gym and hydrotherapy facilities, it is leading the way in the local area for rehabilitation services.

Sara Neaves, Clinical Lead and Outpatients Service Manager at Askham Rehab, said:

“When we first met Isabel, aside from her terrific sense of humour and caring personality, there was a strong sense of determination to face her situation head on — and throw herself into the rehabilitation programme. It's a real privilege to see how far she has come, and to see her engaging in activities she loved to do prior to her injury is just amazing. A key part of Askham’s ethos is empowerment and Isabel's journey really encaptivated this.”

For more information on Askham Rehab, please visit https://askhamrehab.com/

Askham is always welcoming new residents and staff into its growing community. For further information, please contact 01354 740269

A key part of Askham’s ethos is empowerment and Isabel's journey really encaptivated this

How physiotherapy in ABI Multi-Disciplinary Team enabled Rose's recovery from catatonia

so that other physiotherapy teams and psychiatrists can think ‘Oh, I have this patient, is there any reference to a similar case that can help us to define a clinical approach?’”

By using a multi-disciplinary approach, led by the physiotherapy team, Rose was supported in her recovery in a case so unique that the specialist physiotherapist, Jyothi Kraleti, involved in her care has now written a paper as a reference point for other clinical teams. NR Times learns more

Having arrived at St Andrew’s Healthcare with schizoaffective catatonia - which resulted in an inability to use her arms or legs, or to speak - Rose left the hospital having regained the ability to walk and communicate after intensive therapy from the multi-disciplinary team. While schizoaffective catatonia is very rare, each manifestation is different - meaning Rose’s case was unique and unlike anything the St Andrew’s multi-disciplinary team had seen before.

Physiotherapy proved particularly important in Rose’s rehabilitation, with a bespoke regime to initially free her from her catatonic stupor, gaining in momentum as she regained her ability to move.

Working alongside psychologists and supported by a combination of medication and treatment - which was continually adjusted until it could best support Rose’s recovery - the physiotherapy team were able to lead Rose’s rehabilitation during her time with St Andrew’s. Having secured such a successful outcome for Rose and her family during the five-month programme, specialist physiotherapist Jyothi

Kraleti has produced a case study paper to help guide and inform other therapeutic teams about the unique circumstances of this patient, the interventions and engagement from the St Andrew’s team and lessons learned along the way. While the majority of previous studies have primarily used drug therapy, this case involved a multidisciplinary approach, with physiotherapy playing a key role in Rose’s recovery.

“Rose’s diagnosis was very complex, and in these cases each particular patient comes with a different presentation. We referred to Journals but the approaches identified were deemed unsuitable for our patient, even though it was the same diagnosis,” says Jyothi.

“However, drawing the skills from across our specialist multi-disciplinary team meant that we were able to help Rose secure a very positive outcome. Her family were incredibly happy. I think the combination of the right interventions with the right frequency was very important here, and without our MDT working, I’m not sure we’d have got that. “This is a very unique situation and that is why we wanted to produce a paper.

“I wanted to shine some light on this case

Supporting Rose in her recovery

Rose had a long history of schizoaffective disorders, with her first mental health problems presenting when she was 16.

In 1994, she experienced her first psychotic episode. Over the years, she had some catatonic episodes, but its manifestation in late 2017 was profound.

When she was admitted to the specialist unit at St Andrew’s in Northampton, she was bed-bound, mute, immobile and unable to feed. Assessment using the Barthel Index scale scored zero, indicating minimal functional capacity.

With a longstanding history of schizoaffective disorders, Rose arrived at St Andrew’s Healthcare with catatonia, which resulted in profound physical effects.

Jyothi Kraleti is a Specialist Physiotherapist working across St Andrew’s Brain Injury Unit. To find out more about Jyothi and what she loves about her job, watch her video here

“There was no movement and no response from her. She couldn’t talk to us and was only able to make the same expression for everything, which was very difficult to understandthere would be the same expression for fear, for pain and for anything positive. It was very difficult to reassure her and provide the right care,” recalls Jyothi.

Whilst in her previous catatonic episodes she had displayed what her family described as ‘manic-like behaviour’, there were no physical symptoms - which this time were the dominant feature of her presentation.

However, following the intervention of the St Andrew’s specialist team, a short time later she regained her ability to speak.

The fact that Rose was mute when she came to us and then after a short period of clinical intervention she was able to speak again was very interesting. It felt like something you’d see in a movie, but gave us confidence that the prognosis was good.”

The role of physiotherapy

Beginning with three sessions a week, Rose’s physical rehabilitation got underway very shortly into her stay with St Andrew’s.

“Initially the patient had no movement, so we were facilitating movements for her. She was presenting with a lot of rigidity, but over time you could see the rigidity loosening and see the muscles working in both the agonist and antagonist groups,” says Jyothi.

“We were using proprioceptive neuromuscular facilitation (PNF), where we are basically training the body functions to correlate with the brain. Through verbally counting and explaining the movements, and the use of mirror therapy for the patient to see and recognise the movements, we were able to make good progress.

“Initially Rose was laying flat on the bed restricting the range of movement we could perform with her, but through employing PNF techniques with a particular rhythm and frequency to get it working, we began to see positive movement.”

With Rose being brought out of her catatonic state, Jyothi and her team were then able to focus on the next phase of her physical recovery, including sitting, balance, upper limb PNF and mobility.

“We incorporated more sensory-related techniques, like Tai Chi and ball activities. Initially we would throw a ball across a room to another patient, and she would sit and watch. As she progressed, we would throw the ball to her, but she would not catch it at first. Eventually, she would start kicking it,” says Jyothi.

“The sensory integration techniques we incorporated alongside the physiotherapy were very important, and we know she enjoyed the Tai Chi movement with its calming music.

That was a great addition to the physiotherapy and she would make active attempts to move her limbs.”

Over the course of several months, Rose regained the ability to walk, and went home with just a walking frame to support her.

“It was so nice to see her walking, and she actually improved to a stage where she didn’t always need the walker, but we had to come up with a plan which could support her movement for the long term, and again that was a team approach.”

Drawing the skills from across our specialist MDT meant we were able to help Rose secure a very positive outcome

Elgar ward in Kemsley is our female brain injury ward for women who have an acquired/traumatic brain injury requiring specialist programmes of care that enhance recovery and community reintegration. To find out more visit: stah.org/Elgar

The day room on Elgar

The importance of the MDT approach

While physiotherapy played a key role in ensuring Rose could regain her physical independence, the role of psychologists as part of the MDT, as well as the introduction of medication and treatment, was key to the outcome.

“It’s very much a team approach. So if you look at me doing my movements, and facilitating this regularly, that would not have had as much value without a much wider team approach,” says Jyothi.

“Without the input from the doctors I would not have the insight I needed to adapt my approach to Rose’s physiotherapy. Or if myself and my team are doing movements and report she is very stiff today, then the doctors can see that this medication maybe didn’t suit her so well.

“I think without these lines of communication in place, we would have struggled a lot more.” After Rose regained mobility and made strong progress in her recovery, the team decided to slowly reduce the intensity and frequency of her physiotherapy sessions following five months of intensive rehabilitation, reducing the medical interventions.

However, Rose experienced a relapse in both physical and psychological terms, meaning the team needed to scale up their support again. Again led by the physiotherapy team, the increased frequency and intensity of the sessions thankfully yielded positive results within a week.

“When she had a dip, we persistently provided physio input, because the team recognised that this was needed and thankfully the intervention was able to turn things around,” says Jyothi.

“We reintroduced the intensive physiotherapy and deployed the whole team to restart the treatment approach with full force like we did before. Rose’s recovery was quite quick and she was able to continue progressing.”

St Andrew’s commitment to on-site, full time multi-disciplinary teams was crucial in achieving a positive outcome for Rose.

“I think that without the interventions that were used and put into place, she would probably still be here at St Andrew’s, she may well still be bed bound,” says Jyothi.

“We firmly believe that if we are persistent in the input of our interventions, then even patients with long term conditions can see some improvement and can get better.”

Rose received her treatment on one of St Andrew’s specialist brain injury wards because although her presentation was catatonic she required the same neuro rehabilitation techniques to regain movement and function as those people who are admitted with an acquired or a traumatic brain injury.

As a Specialist Physiotherapist Jyothi Kraleti has had extensive experience of working with patients with complex neuro and neuro muscular conditions.

If you are interested in finding out more about Jyothi’s research case study and the approaches she used you can contact her directly on jvkraleti@stah.org

To find out more about Brain Injury care at St Andrew’s download a brochure here or visit the brain injury area of the website.

Kemsley, situated in St Andrew’s Northampton site has led the delivery of person-centred care for over 40 years for people with a range of complex cognitive, physical and psychological needs following a brain injury.

We firmly believe that if we are persistent in the input of our interventions, then even patients with long term conditions can see some improvement and can get better

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Making impact in speech and language therapy

After a career spanning 40 years and over two decades as chief executive of the Royal College of Speech and Language Therapists, Kamini Gadhok MBE is retiring.

Kamini Gadhok’s reason for going into speech and language therapy was simple, and remains the motivation even today - “I wanted to help people who are vulnerable and do what I could to improve their lives”.

And the career choice she made aged 16 has seen Kamini pursue a stellar career in speech and language therapy, a field which has changed so much in the 40 years since she qualified in 1983 and which she has done so much to improve, for professionals and patients alike.

of Health to set up its Race Equality Unit. She has also become known as an advocate for the prioritisation of children’s speech and language therapy services by the Government, having been part of the advisory group for the ten-year impact assessment of the Bercow Report.

Here, NR Times speaks to her about work she has done to help inspire and lead change over the past four decades

Graduating from Manchester University, Kamini found herself rising to prominence through her work with Nottingham Community Health NHS Trust, particularly in terms of her commitment to bilingualism through establishing the Asian bilingual co-worker service, the first of its kind in the country. Her commitment to equality also saw her become ethnic health projects coordinator for the NHS and appointed by the Department

Having become chief executive of the Royal College of Speech and Language Therapy (RCSLT) in 2000, Kamini has become known for her commitment to reducing health inequalities, widening provision and also for her leadership during the COVID-19 pandemic, where she played a leading role in a coalition of 18 professional bodies to help ensure members and their patients were supported during the unprecedented time.

Here, Kamini addresses some of the major challenges for the profession going forward, and reflects on 40 years of great achievement in her profession, which also saw her awarded an MBE in 2009.

CHALLENGES IN PROVISION AND URGENT NEED FOR CHANGE

When Kamini qualified in 1983, speech and language therapy was a growing phenomenon, a developing service which was being adopted in increasing numbers of specialist fields. While she recalls the scope of the work was narrower in the 1980s, that has developed over time as the prominence of the profession has developed.

But while it has developed in profile and reputation, sadly that has not been reflected in access.

Even in the early days of Kamini’s career, she saw the vast variation there could be in regional and local provision.

“In my first job, if you had a stroke, there was just no service. I remember feeling quite shocked at that, because I'd qualified at Manchester University, and Manchester has some some of the bigger hospitals where a lot of these services had been developed,” she recalls.

“I’d gone to a much smaller place where I think I was the second full-time speech and language therapist - and it was a shock.

“Even at that time, I felt that some of the ways of working were out of date from what I been trained to do . That was when I saw, even as a newly-qualified therapist, how different provision could be.”

But shockingly, 40 years on from that initial experience, the local disparity - or ‘postcode

lottery’ as it is often referred to - remains a massive challenge for speech and language therapy.

“I guess back then was a bit like what's happening now, access to provision in some areas seems to have got worse. That is dreadful to say,” she says.

“We very much need to reduce this variation, particularly in the community. There is plenty of focus on acute care, which is not wrong. Prevention and early intervention are so important, but how are we supporting good community care for adults and linking that with social care? And similarly for children?

“We know this is so critical but these are all big policy discussions and debates the

Government has to take really seriously and actually do something about - we need to be empowering and enabling regional and local decision makers to think about the populations they are serving and the best way of meeting the needs with the resources they have.

“There are opportunities here. We’ve had many meetings with regional leaders about how they can work more strategically with their partners and get the right people around the table.

“With adults, which will see the workforce cut across health and social care, with children it will cut across health and education. We know resource differs and there is a lot of pressure, but we need to maximise what each area can do with the workforce they have available.”

The well-documented pressure on NHS resources is often cited as a reason for the

lack of provision - which statistics have shown has been amplified massively by the pandemic - but Kamini points to reduction in provision being a much more longstanding issue.

“The impact of austerity has been very significant. I know it has been said that the NHS wasn’t touched in 2010 (with the beginning of austerity measures) but that’s not the case, we lost a lot of leadership at that time. I think we’re still seeing the impact of that loss of leaders,” says Kamini.

“While it’s one thing getting rid of expensive people, that does not take account of the fact that these are practitioners at the top of their game helping to support the next generation. They’re a key part of the system that develops the next generation of experts. We continue to feel the impact of that.

“But we need to maximise what we have now, and a key part of that lies in properly supporting the workforce.”

Kamini and the RCSLT have been vocal in the need to better support therapists, both within speech and language therapy as well as the wider transdisciplinary team.

“We want to look at how allied health professionals can work together and with others to reduce pressure on the system. There is a huge shortage in the workforce, but we are working together where we can,” says Kamini.

“I am really concerned at the current situation. We know, for example, speech and language therapists are already working in A&E to assess adults who have swallowing problems. This is still considered as innovative practice, and there are certainly pockets of innovation happening, but how do we help this to spread? How can we work differently?

“This is a huge challenge, and something we (RCSLT) have been meeting with NHS England to discuss.

“Towards the end of 2020, I met with policy leads in NHS England to look at how we were going to support the workforce, they were depleted, they were demoralised, they were exhausted. I don’t know whether they assumed the pandemic would disappear, but there wasn’t any planning in the system to think this through.

“As a priority, we need more appropriate workforce planning and to make sure services are funded for the workforce to be able to deliver them. If a service isn’t funded, it won’t be delivered, even if we do have the workforce.”

We need to be empowering and enabling regional and local decision makers to think about the populations they are serving and the best way of meeting the needs with the resources they have

PROVISION FOR CHILDREN

The 2008 Bercow Report helped to lay bare the problems faced by children and families who are affected by speech, language and communication needs, looking at how such issues at an early age could lead to often profound later life consequences. As well as limited education opportunities, speech and language issues were found to be at the root of anti-social behaviour, criminality and disengagement with society.

A great area of interest for Kamini, she was involved in the ten-year review of this milestone report and has advocated that greater emphasis be put on such vital early-life interventions. Since that review, the impact of the COVID-19 pandemic has significantly amplified the scale of the situation.

Yet while the need has been articulated in both 2008 and 2018 - and on an ongoing basis by RCSLT and others - the ongoing debate over funding continues.

“The challenge that has always faced children’s speech and language therapy services and access to them are arguments over who should fund it. Is it a health need? Is it an educational need? It is very distressing to see children’s needs being almost boxed into different containers like this, particularly when they are denied access because of it,” says Kamini. “This is a person, a human being.

Communication is a basic human right. It is a door to our culture, our communities, our friends and family, it enables us to access the education that is fundamental to our future. If you can’t communicate, your ability to learn is affected.

“But the fact that health and education have these arguments is not acceptable. Does it matter who funds it? Isn’t it more important that, as health practitioners, we support and enable children’s communication so they can access all of these things?

“With the impact of the pandemic - we would never normally see the numbers of preschoolers being referred that we are currently - we have to make change and we can’t just see the same themes continuing.

“Children are the next generation, and we need to work together to find solutions. I know we are always looking for money and the impact of a lack of resource, but that doesn’t really work for children. It’s a long term investment.”

MAKING A DIFFERENCE

During her 23 years with RCSLT, much has changed in the profession of speech and language therapy, much of which has been due to the work of Kamini and the organisation. Early into her time with RCSLT, she was able to address the disparity in support for children and young people in Northern Ireland through inspiring the creation of a strategy, and also played a key role in the review of the Bercow Report in 2018 - at the heart of both were Kamini’s commitment to seeing the situation on the ground, travelling extensively around the UK to find what mattered most to members and patients alike.

“We have to be mindful of the populations we serve and how we can really make a difference,” says Kamini.

“We work in prisons, in the justice sector, with people with mental capacity issues, with children on the edge of care, with people from all cultures, we have provided a lot of evidence around the impact of domestic abuse on children - the areas in which we touch people’s lives are very significant and varied.”

It is for this reason that Kamini is committed to promoting the importance of protecting the workforce, with their role in society more generally now more widely recognised than ever before.

“We have had significant growth in the number of universities providing courses for speech and language therapy training, and while like with every profession in the NHS at the moment, the big concern is around morale and retention, that has to be a priority going forward,” she says.

“This is a key thing for NHS leaders to address - how do they create a positive environment

to empower their teams, like my managers empowered me when I first started in Nottingham?

“Leadership that exists in all of us. I will say to our members that everybody's a leader, you don't have to have the title of manager, I was just an ordinary speech and language therapist but wanted to make change. We're all leaders, we all can speak up and do something positive.”

The focus on data and evidence is something RCSLT is also leading on, becoming the first membership body to create a tool, which is free to members, to collect real-world data.

“We are collecting information for our members to record about the population they service. We want people who fund the services to ask for outcomes data, because that’s the hook here,” says Kamini. “If we're saying there is a poor service, or what's making that service poor, we need to know why. Where is the evidence to support that?

By measuring the outcomes of care, people will hopefully start asking the right questions, looking at why things aren’t working and what needs to change. At the moment, the system places too much focus on waiting lists, waiting times and inputs.

“We need to reduce the variation across the country and create better services we need to influence the decision makers and can only do that effectively with proper evidence.”

In addition to widening access of speech and language therapy through addressing language and culture barriers, RCSLT has also been instrumental in the creation of other means, including the award-winning Communication Access UK initiative, which supports businesses to deliver inclusive communication. The steering group is chaired by Kamini and includes other partners including the Stroke Association and MNDA

“It’s a privilege to work with other stakeholders on this, and we’re really hoping to get as many businesses on board with it, it’s a brilliant initiative,” says Kamini.

We have to be mindful of the populations we serve and how we can really make a difference

CHAMPIONING EQUALITY

In the early stages of her career in Nottingham, Kamini realised the need for greater emphasis on non-English speech and language interventions.

Having established the first-of-its-kind bilingual co-worker service, having secured the funding to do so, Kamini won an award from Nottingham City Council for her commitment to race and community relations - something she still regards as “quite a thing” three decades later. And it was through working in multicultural areas, with clients who did not speak English as a first language, which made her realise the need for change.

“When I moved to working in an inner city clinic, I thought it was a bit strange that the majority of the population were from a particular region of Pakistan - but if you looked at the caseload we had, there were hardly any children from that community,” Kamini recalls.

“It made me realise that if people didn’t refer, there was a problem in picking those children

up if they had a need, and making them aware that a service was available to them. I didn’t speak the dialect, so became very aware I needed do something to address this issue.” But while Kamini implemented that service over 30 years ago, for some areas, this remains something that is only being looked at now.

“At the moment, I think some some areas are trialling this as a model, where there is a majority community where you can make a business case to say rather than working with interpreters, and training interpreters, we need somebody who's more highly trained and skilled that's from the community and can speak the language,” says Kamini. “We know we have a long way to go. We’re still quite shocked that a lot of schools and NHS services do not employ interpreters as part of the system. I have raised this with NHS England because it doesn’t align with what our expectations should be, particularly in this day and age.”

For Kamini, the need to ensure this equality has been prevalent throughout her career. In 1997, Kamini became ethnic health projects coordinator for the NHS and was seconded to the Department of Health to set up the Race Equality Unit, continuing her commitment after joining the RCSLT by establishing a bilingual e-learning platform.

“As a society, we need to be looking at the needs of the population and making sure resourcing is appropriate and meeting needs,” says Kamini.

“It’s not just about language, it’s also about culture and religion. How can we make sure we are supporting personalised care? For speech and language therapy it’s an absolute must, because how can you make a diagnosis of communication difficulties if you can’t assess them in their home language?

“Being able to communicate in their language of choice is critical, because language is a door to your culture. We need to think about this, and we need to do better.”

IMPACT OF THE PANDEMIC

Even before the COVID-19 pandemic, speech and language therapy - like most other branches of therapy - faced significant pressure on resources. But through lockdown, and access to therapy being restricted, the needs of many people have increased significantly. Statistics have shown that over half of those living with neurological conditions who could not access speech and language therapy during COVID-19 lockdown have seen their mental health, social and home lives worsen as a result.

“For many people, we know it has had a significant impact,” says Kamini.

“We know of people who have conditions they were not able to be diagnosed with during the pandemic, or were not able to access early therapy, so have now got more significant difficulties than they perhaps otherwise would have.

“Our members are reporting their distress when they are seeing patients who are coming in with more significant needs th because their needs were not being met during the pandemic. We have excellent members and they are deeply affected by this.

“We are seeing how it is starting to pan out in terms of accessibility, and we have seen how big the waiting lists now are. All of our members

are reporting an increase in waiting times for care. The system is so depleted and we are very aware of the issues. It’s something we are all worried about, and we’re committed to doing what we can to bring down the challenges that exist with hospital pressure.”

As well as the concerns around provision, RCSLT had huge concerns for its membership during the pandemic and the lack of access to PPE, given the levels of interaction it has with patients. This inspired Kamini’s work within the COVID-19 coalition.

“We realised very early that there was a problem. Our members were contacting us because they were doing dysphagia assessments and when you assess someone’s swallow, you generate a cough, and they’re doing that with clients several times every day,” says Kamini.

“At that time, nobody knew if someone was COVID positive or not, so there was great anxiety about viral load and having exposure to a virus we knew could kill you. This was literally a life and death matter for our members.

“I wanted them to be protected from this as far as possible, so we joined forces with over 18 professional bodies and experts to work together to make our concerns heard.

“Healthcare workers were dying, and we had to consider whether these lives could have been

saved, what were we being exposed to. That’s something that we were jointly very, very concerned about.

“That was a very challenging time, but absolutely vital we protected our members, particularly until we had the access to PPE, which was a challenge in itself.”

While many therapists, in the absence of being able to see patients face to face, did turn to remote communication during the pandemic, while Kamini sees it does have some role, for speech and language therapy it will never be a substitute for in-person therapy, she says.

“We did use Telehealth and push out guidance to our members on Telehealth, but we’re very aware that there are people with communication needs who just cannot access Telehealth because of their needs. For them, it is just not appropriate,” says Kamini. “We also have people who live in digital poverty, or may not be digitally literate. We have to think about the health inequalities that exist in society to think about how these things will work practically.

“While yes it is an innovation, and has been used successfully in some cases, we need to think about who we are working with, what is the best approach for them. That isn’t necessarily the case for everyone.”

Levelling up mental health care for those with spinal cord injury

As we commit to coming together to talk, listen and change the lives of those with mental health conditions, we need to hear about those who are not receiving the mental health support they should receive.

One such group is those with spinal cord injuries (SCI) who have been saddled with onesided care, with the Spinal Injuries Association saying: “The psychological damage caused by a spinal cord injury is, at best, considered as an afterthought, and at worst, completely ignored by the medical profession.”

Levelling-up between the physical needs of a spinal cord patient and their mental health issues is first going to need an accurate picture of what the need is in this area. The current statistics of one in four patients experiencing psychological problems is thought to be an under-estimate and is due to the dominant method of referring patients by the lead clinician to the Liaison Psychiatry services. Although referring does get some patients the mental health care they need, there tends to be a biased view in who needs that care, with only the most complex cases thought to need psychological support but those with incomplete injuries, thought to be in the least need. There is no research that backs up the assumption and this has led to the lopsided, patchy provision of mental health services for this group.

What’s now proposed is to add the screening and monitoring of patients. Screening means both a standardised and therefore fairer approach to identify individual needs. It also will help in terms of recognising how prevalent psychological and mental health conditions are following a spinal cord injury. As screening can be done by all members of the multidisciplinary team, hopefully more people can be identified without adding to the workload of Liaison Psychiatry.

So how would these proposals work?

Dr Jane Duff, Consultant Clinical Psychologist and National Spinal Injuries Centre (NSIC) Head of Clinical Psychology at Stoke Mandeville Hospital, said: “For those patients with preexisting mental health difficulties, the treating team in the major trauma centre (MTC) or district general hospital (DGH) will need to understand their ongoing mental health and associated treatment needs, with additional pre-admission planning prior to specialist SCI rehabilitation, as outlined in the Psychological and Mental Health Standards.

“For all patients it is recommended that a brief screen for symptoms of anxiety and depression

and suicidality be completed within four weeks of injury.

“For patients being transferred to specialist SCI rehabilitation, further screening and formal assessment/treatment and screening prior to discharge to identify community needs is recommended, as outlined in the SCISTFINAL-2022.pdf (mascip.co.uk).”

This would’ve helped Andrea from Wilshire, who said: “I really wish a proper psychological evaluation could have been done in hospital to help not only identify what issues I might have, such as PTSD from the accident that can get triggered by everyday situations, but also recommend possible solutions.

A new screening method to ‘catch’ patients with emerging and existing mental health problems is proposed, but will the resources and treatment on offer result in the change that is so desperately needed for people living with spinal cord injury?

Ruth F Hunt discusses the matter

“As it is, it took a riding instructor to talk about her own experience with Eye Movement Desensitisation and Reprocessing (EMDR) therapy for me to even hear of it and realize that sounded like it could be very helpful.”

Andrea also felt that the nursing staff were of little help during her rehabilitation: “There was a huge gap missing in the rehabilitation stage of recovery talking about the link between your physical and mental needs. I remember thinking there was little empathy from a lot of the nurses who, for them, were there to do a job, but for us, having things done to our bodies, or to ourselves, it was all new and horrible and honestly traumatising.” This knowledge gap and a lack of confidence in assessing and addressing the psychological needs of patients is something Duff and her colleagues have identified as key.

NHS England transformation have supported a time limited psychology education project, which has been oversubscribed, as part of the NSIC Clinical Education Transformation Team. But the funding for this project ends in March 2023.

A bid to make this provision substantive has been submitted to NHS England, but funding has yet to be allocated. What it would provide is a training curriculum for all staff working with people with spinal cord injuries. To also support education and training, the Spinal Injuries Association have secured funding from the NHS for a Mental Health Support and Education Pilot Project for the Southeast, the project will supply training and support to healthcare professionals in the area to build greater understanding, awareness and skills amongst district general hospitals, major trauma units and SCI Centres. Often patients can’t disclose how they are feeling on-cue in a ward-round or outpatients meeting. Instead, it’s far more likely they will identify a nurse or other support staff member who they trust to speak to, which could be in the middle of the night or as they are being helped with a task. Such staff members, as Andrea said, need to be able to respond in an empathetic manner.

The problems are not just limited to staffing but also the current treatment on offer to those with psychological/mental health needs who following their discharge are usually referred to their local services. The route is often through NHS England » Adult Improving Access to Psychological Therapies programme.

This is a stepped care, protocol, and time limited approach. Psychoeducation in cognitive behavioural strategies is the first step, with individual therapy from a psychological wellbeing practitioner at level 2 and individual therapy with a clinical psychologist at level 3. The protocol nature of the intervention means that it often fails to adequately meet the concerns following spinal cord injury, with the drivers of someone’s mental health difficulties being their adjustment and transition into the community, identity, confidence, and sense of purpose.

Duff said: “If these are not adequately addressed, they can lead to depression or anxiety and/or a worsening of mood problems and reduced quality of life. There is also a significant potential for self-neglect after SCI because of mood difficulties with issues like pressure ulcers and rehospitalisation.

“There is a wealth of research evidence showing that psychological adjustment continues for some years after discharge from inpatient rehabilitation and the time limited and protocol approach of Improving Access to Psychological therapies (IAPT) is not flexible enough to respond to this need.

“All patients admitted and discharged from the NSIC between 2017-2018 were interviewed and 40% of these said they would have needed, and did not receive, psychological support after discharge.

“This estimate does not include people with complex mental health needs. International research has also found that about 10 per cent of patients who did not experience depression and anxiety during their initial rehabilitation developed depression and anxiety later. Almost all SCICs are unable, due to resourcing, to provide outpatient psychological treatment after discharge.”

This gap in provision has left people floundering. Trying to access the right mental health support in the community can be difficult enough with the demand high but add on to that a real lack of services for SCI and mental health. It’s no wonder people are left wondering where they can go to get help. This is where the Spinal Injuries Association have recognised the lack of suitable provision and have worked hard to plug this gap with their advocacy and new counselling and wellbeing service. Tina from Southwest England said she had been searching for the right mental health care that considered her SCI: “I tried everything suggested by Google and that included private therapy, but nothing seemed to work.

“It wasn’t until I was put in touch with Stephen from the Spinal injuries Association that there was a breakthrough. “Stephen came up with a simple plan, making small changes and addressing different aspects of my life after each session.”

This had such an impact on Tina that even when she needed an operation, she still managed to achieve her daily exercise plan along with journaling, creative writing, and meditation.

The recommendations now are to screen for mood, substance use and pain during outpatient reviews, referring patients on for treatment if that is required. The aim of this is to catch those who have ongoing mental health problems, patients who should be seen by local services or identify those whose needs have changed over time. Also, if patients are admitted to SCIC for secondary care related to their SCI, screening for mood and substance use would be completed on admission. Picking up more people with existing or emerging mental health needs is only possible if there are the resources to do the screening, and for those then referred for treatment, viable options available for them. This is crucial because currently mental health provision for those with SCI is dire as outlined here.

Organisations such as The Spinal Injuries Association and Back-Up continue to have a very important role, supporting people with spinal cord injury from the start of their journey, and then throughout their life.

There was a huge gap missing in the rehabilitation stage of recovery talking about the link between your physical and mental needs

Cycling and brain injury

Are we taking brain injury in cycling seriously enough? Heather Batey, managing director and founder of brain injury rehabilitation specialist

travelling in excess of 20mph as he started to lean into the corner and his tyres lost traction with the road.

Marcellusi continued to the conclusion of the tour without further incident and I’m sure he was fine, he was handed a replacement bike and sent on his way to finish the stage only 41 seconds behind the leader. But one is given to wonder how thorough any assessment could be that would allow a rider to re-join the race without incurring sufficient time penalty to render any challenge for the general classification (GC) ill-fated? And for any readers unfamiliar with the world of professional cycling, the GC is top prize in any cycling tour and is won by the rider with the quickest aggregated time of all stages of the tour.

Are we taking brain injury in cycling seriously enough? Heather Batey, managing director and founder of brain injury rehabilitation specialist Reach, looks at attitudes, the role of cycling helmets, and the need for greater awareness of ‘invisible injury’

The cogs just keep on turning

As Gonzalo Serano took to the podium as the de facto winner at the end of stage five of last

year’s Tour of Britain after its early termination in respect of the passing of Queen Elizabeth II, I recalled an incident at the start of the tour when one of the Bardiani CSF Faizanè riders, Marcellusi I think, had his bike disappear from underneath him in rather wet conditions as he came into a corner at speed. The position of the camera and the quality of the footage made it difficult to see in any detail, but it looked like his helmet impacted the tarmac with what must have been some force… he must have been

Unlike field sports, where the referee can stop play, add-on injury time, and the team managers have the option to supply substitute players to limit the effects of injury on competitive outcomes, the peloton rarely stops. All directors of sport (DS) and team riders know that every second counts in a grand tour of cycling, or any road race for that matter. When you combine this with the competitive drive, endurance and indomitable attitude of sporting cyclists, it presents some serious obstructions. And anyone thinking that this an issue limited to those with the Y chromosome would be mistaken, as women at various levels of cycling are equally prone to dismissing serious injury to continue a race, it is an issue that transcends the sexes.

Reach, looks at attitudes, the role of cycling helmets, and the need for greater awareness of ‘invisible injury’

Fighting attitudes and conditioning

Cycling is a sport that conditions participants to push themselves beyond the normal limits of endurance, to ignore the pain from screaming lungs and leg muscles, and its athletes are not psychologically conditioned to abandon a race. There are countless examples of professional cyclists treating serious injury in the same way as Monty Python’s Black Knight treats a missing limb “Tis but a scratch!”, when these are injuries that would see the likes of us lesser mortals screaming in pain for medical assistance. For instance, take a look at the injuries that Lauren Dolan crossed the finish line with in the 2017 UCI Road World Championships!

More pertinent to the crux of this article is the crash involving Romain Bardet in stage thirteen of the 2020 Tour de France, when Bardet brushed himself off, and then got back on his bike to complete the remaining 90km of the race in the mountain passes of the Massif Central. Despite admitting to feeling a little groggy, Bardet pushed himself to finish the stage in 27th place, no doubt fuelled by his desire to limit his time losses in his contention for the GC title, where he was then sat in fourth place. According to statements released by his team, he was found to have been concussed in the crash and subsequent neuroimaging revealed that he had in fact sustained a “small haemorrhage” as a result of his impact. They went on to say that he would “rest for an indefinite period”, ending his tour. The incident with Bardet is far from an isolated one, with similar scenarios played out throughout the history of competitive cycling. The previous incident that comes to mind involved Toms Skujins, who came a cropper

at speed, his front wheel slipping out from beneath him as he entered a turn on one of the descents in Stage 2 of the 2017 Tour of California. After sharing clear signs of vestibular issues with the viewers and spectators at the roadside, he was helped onto his bike by one of the neutral support outriders. He was eventually pulled from the race by his team and hospitalised with a broken collarbone and concussion. It’s a little disappointing that one of the support mechanics, who are often the first on the scene of an incident, aren’t a little better trained to spot some of the more obvious signs of concussion… like disorientation and poor balance!

Given that the idolatry of sporting heroes is not a phenomenon that has escaped cycling, it is not difficult to imagine that this spirit of indomitability has pervaded the amateur cycling scene and that a dismissive attitude towards injury is often seen at club level. Keen amateurs compete in local level races at significant speeds and with limited access to medical support, especially with good knowledge of concussive injuries, so it is important to promote awareness at all levels of the sport to increase the opportunity for the identification and early management of head trauma. Recent years have seen progress at the professional level and a number of sports have made significant improvements to their safeguarding procedures in relation to concussion and traumatic brain injury, the RFU’s Head Injury Assessment protocol a fine example. Awareness of the potential long-term consequences of undiagnosed head trauma is growing within sporting communities, but it is important that we continue to encourage the adoption of best practices, even when they may conflict with aims of competitive sport.

The obligatory discussion about helmets

Given the old idiom that prevention is better than cure, no article about brain injury and cycling would be complete without a discussion about helmets, which remains a hotly debated and very contentious issue in some circles, though I suspect that this is not one of them. Whilst the UCI (the international body for cycling) made the wearing of helmets compulsory almost twenty years ago and affiliated national bodies followed suit, the use of cycling helmets is still optional for noncompetitive, everyday cycling activities. There are robust arguments on both sides of the mandatory helmet debate, but like smoking, the focus should really be about educating people to make the right choices, especially amongst younger riders who may have image concerns that need to be overcome. However, there is a problem, in that the messaging is very mixed even within the broader medical community, which makes education a divisive issue in some circles. The majority of medics that see the consequences of head injury acquired while cycling would regard the use of a helmet as a no-brainer. On the other hand, some public health professionals believe that the statistics do not merit a legislative approach to mandate their use in law. They say that protection is only afforded in minimal circumstances and that an enforcement approach will dissuade a significant number of potential cyclists from ever adopting the activity. Then we have cycling personalities implying that helmets would not be as necessary with better traffic legislation and street design to improve cyclist safety, which may well be true to some extent, but helmet use should really be encouraged and such messages are bit of a distraction. The Press are just as divided, with The Grauniad reporting studies suggesting that helmets may not improve safety, as drivers and riders take more risks when the rider is wearing a helmet and that this compromises safety and that people should not have “to dress for urban warfare”. The previous year, the very same publication reported a study that helmets reduce risk of serious injury by almost 70 per cent, so their readership is left to form their own opinions based on these conflicting reports.

One of the issues here is that the lobby against the mandatory helmet use for cyclists has the unintended consequence of creating negative sentiment surrounding helmet use.

Many lobbyists are not specifically anti-helmet and may even wear one for the majority of the time that they ride, but to counter the lobby for a mandate, they have to find evidence that says that helmet use is not sufficiently effective to make it a legal requirement. The rise of the e-bike has seen an increase in both the older generation and novice cyclists hitting the road, which is great, but if they have had their world view informed by some flake arguing that helmets aren’t that effective, then you have a number of ingredients in a recipe for disaster. Sprinkle with a momentary loss of control and an ice-cold kerb stone and we have everything needed for a cone.

A more recent study, Evaluating the impact of cycle helmet use on severe traumatic brain injury and death in a national cohort of over 11000 pedal cyclists: a retrospective study from the NHS England Trauma Audit and Research Network dataset (Dodds N, Johnson R, Walton B, et al, 2019), should strengthen the argument in support of helmet use, as it finds a significant post-accident increase in crude 30 day mortality rates (almost four per cent) in unhelmeted riders, whilst those wearing helmets saw huge reductions (almost 30 per cent) in severe traumatic brain injuries (sTBI) and ICU admission rates (almost 10 per cent). And if retrospective cohort studies fail to impress the bare headed cyclist, maybe the potential for financial injury will offer a more convincing argument. Whilst judgements are complex, there have been a number of cases through the British law courts that have successfully argued that the failure on the part of the cyclist to wear a helmet amounted to contributory negligence, and that injuries sustained would have been less severe if a helmet had been worn. Such judgements have had a significant impact on the final settlement of these cases. Holiday insurance is a variation on this theme, as cycling holidays are ever more popular it is worth mention that many insurers will invalidate a claim if it is found that an injured cyclist was not wearing a helmet.

The need for rehabilitation

With early intervention being one of the most important factors in a good recovery, we are always enthusiastic to see improved protocols and procedures that can enable this. However, with milder head trauma there is often no visit to A&E, resulting in the absence of proper medical evaluation. This absence of a medical diagnosis means that it is only

the symptoms that can be addressed, but as we know that intervention goes hand in glove with assessment, the opportunity for the best outcome is afforded to those who seek triage early on, ideally at the point of injury. High velocity impacts, such as those that befall cyclists, will often result in cerebral contusions from the impact of the brain against the skull, the common side effect of sudden deceleration. The potential for these types of injury is quite high in these scenarios, irrespective of the choice to wear a helmet. The longer-term effects of a mild head trauma can be ongoing cognitive and executive issues, for which the early identification (such as via triage assessment) and treatment offers the best possible outcome.

Reach have identified this as an area where there is a paucity of services to treat those in need and have developed Headlight to afford those with the benefit of funding access to a high-quality head trauma triage service. Through Headlight, we are able to identify the need for intervention and supply individually tailored therapies, while signposting to other specialties to ensure holistic treatment. Because the mechanism for reporting is not standard, there remains a high risk that those with concussive injuries will slip through the gaps. However, in instances where there is a case manager involved, we would be confident that the need for identification and treatment would be picked up and referred appropriately.

The case of the invisible injury

As we know, some of the injuries that may be sustained falling from a bicycle can be pretty… well, not pretty at all. If the fall was a direct result of an impact with a motor vehicle, or dare I say, an HGV, then the results can be horrendous and will often involve significant forces. A patient with pelvic injuries and a normal GCS will not meet inclusion criteria for a neuro-assessment and, once they have been treated for their injuries, they often fall onto the desk of a case manager with a referral for physio following pelvic injury sustained in an RTC.

Case management is a sometimes-tricky task requiring years of experience, and whilst case managers will usually pick up on clinical issues that may not have been disclosed on a referral form, or discovered in an INA, sometimes the nature of the injury being treated will mask subtle neurological symptoms sufficiently to

allow them to be overlooked. This is not a common occurrence, but for cases where there are no case managers involved, it merits a quick review.

Look out for invisible injuries

Mild head trauma may not be picked up and it is important to look beyond the obvious injuries. It is something that we are all aware of, but it is useful to be reminded from time to time.

Mild symptoms are an early warning sign

It is important to follow-up on mild symptoms that may appear to be of no real concern.

The effects of mild head trauma can spiral over time and it is important to assess symptoms as early as possible, to limit their impact on the clients’ independence and wellbeing.

Always be on the look-out for the red flags

Despite the injury being treated, if there were impact forces involved in the accident then there is the potential for head trauma. These will be obvious to most clinicians, but it is important to keep them in mind when treating someone with an orthopaedic injury sustained in an impact.

> Reduced tolerance, or increased irritability.

> Difficulty maintaining emotional control.

> Lethargy, or excessive fatigue.

> Mild altered cognition, such as reduced attention and memory.

Refer to appropriate services for the best outcomes

Early intervention is the gold standard for positive outcomes. Refer as early as possible to an appropriate neuro-rehabilitation provider if you have identified any of the red flags for mild head trauma.

The increasing recognition of the long-term impact of mild head trauma has resulted in the inception of Headlight, which is the head trauma triage service created by Reach to provide case managers, insurance claims handlers and solicitors an early intervention pathway to address the effects of mild head traumas.

Reach provide specialist, tailored neuro-rehabilitation programmes to clients with acquired brain injury as a result of trauma, and to those with functional disorders requiring neuro-OT intervention. To make a referral to our service, click here or call a member of our team on 01423 326000.

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Setting goals - and making them happen

As a Case Manager, goal setting underpins everything we do and guides our client’s rehabilitation.

In this article we consider how goal setting might be different for our Case Managed clients who have sustained life changing injuries.

Using an example from one of our clients, Mandy (pseudonym), we break down the steps required in order to achieve what to some might seem an easy or everyday task. In this instance one of Mandy’s long-term goals was:

To meet my friend at the seaside to have a Mr Whippy 99 ice cream for my birthday in August

Mandy (19) was in a serious road traffic collision when aged 17 whilst travelling in a friend's car. Mandy sustained a mild Acquired brain injury (ABI) which has left her with executive functioning difficulties, including reduced short-term memory and word finding difficulties.

She also sustained lower limb crush injuries and is now dependent on a wheelchair for mobility.

Mandy has elevated levels of anxiety which increase significantly when travelling in a vehicle.

For Mandy to achieve her long-term goal, several short-term goals were identified. Each short-term goal required co-ordination by the Case manager with a number of delegated actions.

The Case Manager instructed several professionals: Occupational Therapist (OT), Physiotherapist, Speech and Language Therapist (SLT) and Psychologist to provide focussed rehabilitation. The Case Manager held multi-disciplinary team meetings (MDT) at regular intervals to co-ordinate Mandy’s rehabilitation and ensure that she the team was working towards her long-term goals.

With the start of the new year, many of you will have reflected on the past year and be setting your intentions for the year ahead.

The Case Manager, with input from Mandy, also recruited a support worker/enabler who had the relevant skills, experience, and personality to motivate and support Mandy to achieve her goals.

Mandy’s short-term goals were:

1. To identify a suitable location with access, parking, and ice cream outlet by March 2022.

Action required:

> Support from the Enabler for Mandy to research possible destinations

> The Enabler to visit potential locations to complete a risk assessment

> Review of disabled toilet facilities based on Mandy’s known needs

2. To be able to travel from home to the beach by June 2022.

Actions required:

> An assessment for a wheelchair accessible vehicle

> An enabler who can drive and support Mandy with the outing.

> Psychological input to manage anxiety and develop coping strategies for travelling in a vehicle.

> Physiotherapy to work on ability to sit to stand and get in and out of vehicle.

> A manual handling assessment and training for the support worker.

3. To be able mobilise in her wheelchair 200metres along the promenade to the ice cream kiosk by June 2022.

Actions required:

> Apply for a Blue Badge in order to park within 200m of the kiosk.

> To arrange a wheelchair assessment and provision

> Training from OT to develop wheelchair skills and safety

> Physiotherapy to develop sufficient upper body strength to be able to self-propel.

> Support from the enabler to carry out regular physiotherapy exercises

> A graded approach to increase the distance Mandy is able to self-propel.

4. To be able to purchase the ice cream independently by July 2022.

Actions required:

> Speech therapy to develop Mandy’s expression and understanding. Specific intervention to acquire relevant vocabulary and increase Mandy’s confidence in social situations.

> Role play within SLT sessions the social and monetary interaction required.

5. To choose the best day to succeed during August 2022.

Actions required:

> Enabler (with support from Psychology) to monitor fatigue and anxiety to understand which part of the week and day Mandy is functioning at her best.

> Check the weather to ensure there are no strong winds and extreme temperatures.

Although it required six months of careful planning with input from a large MDT, Mandy successfully achieved her goal. By using person centred goals, we were able to make Mandy’s rehabilitation meaningful and maintain her engagement and motivation in the process. Ultimately, the skills acquired in achieving this goal will be transferable across Mandy’s day to day life.

So, the next time you are at the beach

For Mandy to achieve her longterm goal, several short-term goals were identified

Harnessing the power of neuroplasticity to optimise rehabilitation

Therapists are always seeking new and practical ways to translate research into practice. As one of the key concepts underpinning neurorehabilitation is neuroplasticity, specialists are particularly interested in applying the evidence base behind this to optimise treatment outcomes for patients.

In this article, GripAble senior occupational therapist and neurorehabilitation specialist, Lauren Edwards, describes the ten principles of neuroplasticity, and how GripAble provides a platform to harness its power to optimise rehab and support better treatment outcomes.

Neurons that fire together, wire together

Plasticity describes the adaptability of an organism to change according to the demands of the environment.

Neuroplasticity specifically describes the adaptive capacity of the central nervous system to adapt and change, enhancing existing neural connections and forming new neural connections. Following a stroke or brain injury the brain becomes primed for learning. Neuroplastic

potential is greatest in the peri infarct areas and contralateral motor system of the brain. Neurorehabilitation can benefit a person at any stage of their recovery; however, it must be prioritised in these early stages to fully capitalise on neuroplastic potential. The brain responds to environmental input and neural networks can be laid down and strengthened during this period. Indeed, we know that the more a neural network is used, the stronger it becomes and the more resilient it is to deterioration.

Ten principles of neuroplasticity

The evidence base underpinning neuroplasticity is vast, and it’s important to understand and consider the various factors influencing and impacting the brain’s potential for change.

1. Use it or lose it – neural circuits which are not actively used will deteriorate, and increase the risk of learned non-use, which occurs when parts of the body are not used, and the brain ‘forgets’ how to use the affected hand or limb

2. Use it to improve it – we know that repetition of movement is required to induce long lasting neuroplastic change

3. Time since injury – research shows there is a time sensitive window of great opportunity for neuroplasticity in the subacute phase. Changes can also be seen years after injury, as neuroplastic potential remains, but at a lower capacity

4. Age of person – it is thought that neuroplastic potential declines with age, and neural changes may be slower and less profound the older the patient is

5. Transference – as motor practice can improve performance in multiple functional domains, the effects of neuroplasticity can spill over into other areas of the brain.

6. Interference – neuroplasticity is not always positive. The brain is shaped by the environment a person lives in, and we must consider the impact of stress, use of orthotics, and other daily activities the person is carrying out

7. Repetitions – a significant and positive relationship exists between dose and response, meaning the more repetitions of a movement, the more neuroplastic changes will be laid down and strengthened. Moreover, the dose and duration of activities also play a role, with the best results delivered when therapy is given at a high intensity over a short period of time

8. Intensity – it is important to get the intensity of the activity ‘just right’ and gradually increase it through ‘growing’ the challenge, combining increased coordination, sensory input, and strength to create a demand for better performance and achieve systematic progression

9. Specificity – making exercises taskorientated helps to ensure they are relevant, interesting, challenging, and goal directed for the patient

10. Salience – having the ability to gain and maintain a patient’s attention, motivate them by initiating and generating repetitions, and induce a sense of ‘flow’ are also key variable factors influencing neuroplasticity

The capability of the brain to grow and change can be truly life changing, so it is crucial that patients can access tools and techniques that harness the power of neuroplasticity.

Neurotechnology offers applications and devices which can drive neuroplasticity and enhance function. Combining elements of gamification using sensor-based devices encourage a significant number of movement repetitions through fun and engaging games.

GripAble: supporting neuroplasticity

GripAble is a two-in-one assessment and training device with a neurorehabilitation specific design, to help people with impaired upper limb movement. Used by neurological, paediatric, and musculoskeletal therapists in both therapy and community settings, the handheld device connects to an app on a tablet and tracks four key hand movements –grip and release, wrist extension and flexion, radial and ulnar deviation, and pronation and supination, together with repetitions, and minutes of training.

The device is highly sensitive and can be used by most patients, even those with limited grip or movement. Easy to set up, GripAble can be calibrated and personalised to each user’s ability, with real-time feedback to help build motivation and engagement.

GripAble supports neuroplasticity by requiring recorded repetitions, with the level of challenge increasing over an extended period, and can be used early on in the rehab process within the time sensitive window. Portable and easy to use in a variety of settings, patients can play up to 12 interactive games, with multi-player options encouraging social connection, competition, and engagement. Underpinned by the fundamental principles of neuroplasticity, GripAble is an evidencebased innovation that is both fun and engaging, making it the ideal addition to every therapist’s toolbox.

Contact the GripAble team to see if GripAble could help you support better treatment outcomes for your patients.

www.gripable.co

Supporting therapists to maximise people’s potential

Keen to maximise the rehab potential of every service user they support, routinely investing months in supporting them to make the smallest of gains, they believed he could achieve more than being confined to his bed for the rest of his life.

“We were told there were too many barriers for him to improve and that he couldn’t progress physically because of the impact of his mental health. He hadn’t left his bed for a very long time,” says Helen Wilson, senior physiotherapist and therapy lead at Tyne Grange.

neurodegenerative disease and complex mental illness.

But through the bespoke approach of the team, achieving the full potential of each and every one of the 22 service users at Tyne Grange is the priority - often enabling them to live a life far beyond what they and their families may have imagined possible.

“Everything we do is person-centred, so we will ask the service user and their family right at the outset where they want to be, what are their goals,” says Helen.

By being able to invest the time to build relationships with service users, tailoring rehab to achieve their goals and supporting them every step of the way, therapists are enabling them to achieve outcomes well beyond expectations.

Here, we learn more about how the team at Tyne Grange complex care service in Newcastle are delivering person-centred therapy sessions, while continuing to learn and develop in their own careers.

When a man living with schizophrenia and Parkinson’s Disease arrived at Tyne Grange care home, who had successfully managed his conditions for several years but had been badly affected by a more recent change in circumstances, he came with a suggestion that there was no further rehabilitation potential. Having been in hospital, and then a specialist neuro-rehab unit, for well over a year, the man had become bed bound and was expected by medical teams in his previous environments to remain that way.

But for the therapy team at Tyne Grange, a specialist Exemplar Health Care home in Newcastle upon Tyne, that was not a view they shared and resolved to see what was possible.

“At first, we spent time talking and performing only basic bed exercises, to try and get his confidence back that he could do more. It took time, but eventually he trusted me enough to try sitting on the edge of the bed. We built it up little by little, and then fast forward nine months, and he’s now walking up and down the corridor using only a frame.

“To go from a place of exceptionally low mood with limited hope, to supporting him to the stage he is at now, is just absolutely brilliant for us as therapists.

“It’s the best part of the job and what we do it for - to be able to invest the time in developing relationships like we have with this service user, and to see him go on to achieve goals like this, that others thought weren’t possible, is everything we could want from our roles.”

Identifying and maximising potential

Through supporting service users to rediscover the levels of ability and independence many feared may have been lost forever, the therapists at Tyne Grange - typical of the approach taken throughout the Exemplar Health Care portfolioare able to really maximise their skills and push the boundaries of supposed limitations. The specialist care home is home to people across the spectrum of neurodisabilities, from brain and spinal cord injury through to

“Every single person has a different goal here. It could be something very physio specific, like ‘I want to be able to get from my bed to my chair without support’. Or it could be that they want to engage more in the community, to go to church, to be able to go out for a coffee, to be able to prepare their own food or do their own shopping. It could even be something like the prevention of secondary problems, where we will find ways to reduce things like skin breakdown, chest infections and recurring illnesses through education, better positioning and postural support.

“We will break these up into smaller goals, and then we spent time considering how we can work together to achieve them. We’ll get the family involved, plan out what it might look like for them. The most important thing for us is that the service user takes ownership of their rehab and what they want the outcomes to be.” And what their ambitions may be - and how that is achieved - is entirely dependent on the individual.

“For our service user who was said to have no further rehab potential and is now walking along corridors and standing independently, that has been absolutely life-changing for him. What might take many people a few days to achieve has taken him six to nine months, but the focus from us was on him achieving his ambitions,” says Helen.

While many therapists working in healthcare are under significant and growing pressure, and cannot spend the time with clients they wish, for those working in Exemplar Health Care’s multi-disciplinary teams, the situation is thankfully different.

“We will do absolutely everything we can to help them get there. We have one service user who has had a stroke, and the goal for her was to improve her communication, as sadly she has lost the ability to communicate verbally,” says Helen.

“She began her rehab journey in a minimally conscious state, but she can now communicate with gestures, so we’ve been working on dexterity of hand movements so she can tell us what she wants by gestures. Then we work with the staff to train them in what the gestures mean, what she is referring to, and we have opened up a new channel by which she can tell us what she wants and wants to say. This has given her a level of independence that she wouldn’t otherwise have had.” But what is constant with every service user is the Tyne Grange team’s commitment to doing everything they can to support them in achieving their goals - even when others may not see the potential. In this environment, the ability to integrate our rehabilitation through the culture of the home is the key to our success. “We’re always looking at how we can make improvements for our service users, how we can empower them to live better lives, in whatever way shape or form. Our whole team will persevere and persevere until we absolutely know we’ve done all we can,” says Helen. “Finding those little wins, so there are things that absolutely everyone can achieve, is really important to all of us - and really brilliant we can spend the time in supporting our service users to do this day in and day out, providing consistent and continuous therapy alongside their day-to-day care.”

Relationships at the heart of rehab

For all therapists, the ambition is to support people in every way possible, investing the time and building the relationship to enable them to unlock their full rehabilitation potential. However, the challenges in the healthcare sector currently are well-documented, and being able to work in the way that therapists trained to do - and badly want to do - is not always possible, particularly in under-pressure NHS environments.

For Helen, she is grateful that she and the multidisciplinary team have the “unique” opportunity to enjoy a very different situation, which she believes is absolutely fundamental to the outcomes Tyne Grange regularly achieve for service users.

“You can support people in every aspect of their rehabilitation – physical, emotional, social and mental - and for a physio, you don’t have the

luxury to do that in many other settings,” she says.

“If you’re in a hospital setting, for example, you will likely see people for a very small portion of their life, or maybe for 20 minutes at a time, or appointments a couple of weeks apart. But in what we do, you’ll see them day in day out, for the duration of their time here, which is brilliant because you get to know them, and they and their family get to know you.

“By getting to know people, you can put plans together based on what you know about them, their personalities, their preferences, their wishes, their capabilities and their potential, and then work on them together.

“Sometimes it can take a long time for them to achieve what they want, but it’s fantastic to be able to build the trust and develop the relationship that can really support them in doing that. Just the process of working towards something that they’ve been involved in decision is motivating enough in itself to engage consistently.

“The beauty of it is that we can try things, change things, and consistently adapt to the changes in conditions and presentation. We can make things more intensive or less intensive, and increase or decrease other therapies or activities around that to meet a service user’s needs.”

As a physiotherapist, Helen is also able to tailor her activities according to people’s needs, and invest the time in delivering that.

“My role is quite diverse in terms of the physio work, working across such a wide range of conditions, and being there all the time to see the progress our service users are making” says Helen.

“I can be doing anything from postural support or positioning through to functional rehabilitation. We do a lot of strength and conditioning, functional practice of activities of daily living, and supporting balance and coordination for those who have conditions like Parkinson’s or Huntington’s. We have service users who are physically independent and want

to keep fit, so we do exercise sessions to help with maintaining their fitness.

“Just one day could cover almost the full spectrum of physiotherapy intervention, and it’s great to be able to have the chance to do such a range of work.”

Opportunities to develop

To ensure staff are best placed to support service users, while also maximising their own abilities, Exemplar Health Care is keen to offer training and development opportunities to its team - both the clinical team and health care assistants.

“I think there is a really good energy here with people always wanting to learn more, always learning new things and new ways to engage with our service users,” says Helen, who helps to oversee training.

“We promote understanding the conditions, because neuro can be very complex. Suddenly people will change their presentation, they might struggle with their walking where they haven’t before, they might struggle to swallow where they haven’t before.

“I think that’s the benefit of the MDT we have here, that we can support each other in our roles and invest the time we need to solve any challenges.”

Exemplar Health Care is also keen to involve and develop its health care assistants, as the ones who spend the most time with each of the service users.

“A lot of our health care assistants haven’t worked in neuro before, and perhaps don’t have the confidence with positioning when working with someone with a neurological condition, so we do a lot of moving and handling training and education about conditions,” says Helen.

“There is a lot of shadowing work with the therapy staff, and sometimes with the nurses in terms of handling and learning about conditions. I regularly have health care assistants shadowing my therapy sessions.

“I think by doing this, health care assistants can see what a service user is able to achieve - and for me, we might have two sessions a week with someone, when the health care assistants are going to be there the rest of the time, so it makes sense to involve them in the rehab sessions. They can see what people are capable of and the progress they are making, in ways they perhaps otherwise wouldn’t so they can support them to build on these skills outside of structured therapy sessions.

“It’s all about learning and development, which is brilliant. When we have staff who are showing an interest in upskilling, we’ll do shadowing, training, and support them how we can to achieve their ambitions.”

In 2023 we are splitting the company into regions, The North and The South of England. Furthermore, supporting clients with nurse-led care, with the business enabling clients with even the most complex health conditions to thrive within their own homes. As part of our expansion, in January we recruited two highly experienced regional directors; Esther and Erin (see image) to support Komplex Care continue its upward trajectory in the care sector.

Arron Zaib (Managing Director) commented: “We would not be able to expand without the incredible care and support staff we have, working with a dedicated and highly skilled team has given Komplex Care the confidence to expand our footprint across the country”. The team delivers a range of specialist complex care to both adults and children across the country, with the aim of supporting individuals to lead full and dignified lives, with each client having their own operations manager and registered nurse in their preferred place of care.

Its commitment to quality and drive to continually improve services resulted in achieving a ‘Good’ CQC rating within its first two years of operating. This affirmed that Komplex Care’s processes and services are in line with its ethos of delivering high quality care.

Komplex Care have grown dramatically within the past 2 years, they run an effective service based business that has grown upon the success within the clients and service users they support, Komplex Care are very open about their decision to not have a dedicated sales team within their business, Arron Zaib (Managing Director) commented: “Komplex Care have been lucky enough to grow our business based upon the service we deliver, we want our clients and service users to know we are not just saying to everyone what we can do but we are actually proving it within the fantastic success we have had with our service, its clients that have given Komplex Care the opportunities to grow based upon the provision they provide”

The training we provide is tailored specifically for the client’s needs and includes one to one training sessions and competency sign offs in the field from the clinical team. We provide specialised training in complex care as well as clinical training in the hospital to home environment.

This is a necessity to ensure all staff are constantly at the forefront of best and safe practise following CQC guidelines and legislation.

The dual training includes safe practise of Manual Handling for neurological clients ensuring bespoke risk assessments are carried out for training to be tailored to the client’s needs. All staff are deemed competent by a qualified nurse after assessing both theory and practical aspects. Some Neurological conditions we provide care for include but are not limited to Acquired Brain Injury, Multiple Sclerosis, Multiple Dystrophy and Locked-In Syndrome.

Komplex Care a specialist provider of high acuity care, with the ability to support clients throughout the UK.

Formed in 2019, Komplex Care has continued to grow year on year, allowing continued addition to its services along with the creation of employment UK wide.

Hope for caregivers of loved ones living with Huntington’s Disease

An innovative PhD research study to determine if music therapy (MT) can help caregivers of Huntington’s Disease is underway in collaboration with Chroma – the UKs leading arts therapies provider, the Cambridge Institute for Music Therapy Research (CIMTR) at Anglia Ruskin University (ARU) and the Independent Neurorehabilitation Providers Alliance (INPA).

To date, most research surrounding Huntington’s and music therapy has focused on the effects upon those living with the disease and not on the family caregivers themselves. This first of its kind study could help support the wellbeing of caregivers of those living with Huntington’s.

Psychology forms the foundation of music therapy and aims to support a person’s mental wellbeing. Releasing neurochemicals dopamine, endorphins and oxytocin, music therapy helps to improve mental state and this improvement can help enhance a person’s outlook on life and support positivity. This study anticipates music therapy sessions will provide a therapeutic space in which to process feelings related to caregiving and build resilience for the challenges they face in their day-to-day life.

Caregivers of Huntington’s face challenges that differ from any other condition or disease. Domaradzki (2015) noted some of the challenges – one of these, most poignantly being social ignorance.

Caregivers taking their loved ones outside often face incidences of judgement from people who could view their family member as drunk; the chorea or dystonia symptoms of the disease can cause staring and inappropriate comments.

Dr Jonathan Pool, senior music therapist at Chroma, senior research fellow at the Cambridge Institute for Music Therapy Research and Research Chair at INPA commented, “If we are able to address the needs of those who provide care for their loved ones, they’re better able to provide the level of care their loved one needs.

“From other studies, we know that mental health, mood and quality of life can be affected for people who provide care for family members, so if we can find a way to look after the health of the person caring, they’ll be better able to provide the care that’s needed.”

Primarily, the study will start with an in-depth literature review, which will provide essential information and will be followed by focus

group discussions with caregivers as well as help co-design the music therapy treatment model. Following that, a music therapy intervention will be created and delivered to determine if music therapy can help address the needs of caregivers.

Evelyn Mason, senior music therapist at Chroma is a vice chancellor’s PhD scholar who has been awarded a scholarship to carry out this 3-year PhD.

Evelyn commented, “Huntington’s Disease is often overlooked and unfortunately, not all of society is aware of the challenges these caregivers face. Not only is there an ignorance surrounding the disease but also a difficulty in the hereditary nature of the disease. “This study will serve as an ‘awareness raising’ tool. And through this study, it is my hope that caregivers feel heard, supported and have access to a therapy which could help them cope with everyday life. This study could offer hope to other caregivers and provide up-to-date research that is essential to develop future studies.”

Huntington’s family caregivers are invited to participate in this study by contacting Evelyn Mason at em300@pgr.aru.ac.uk.

Stanley House Celebrates HDA Quality Assured Accreditation

Stanley House Care Home, part of Elysium Healthcare Neurological, is celebrating after receiving their Huntington Disease Association (HDA) Quality Assured accreditation.

The accreditation is a quality assurance programme that identifies the behaviours, cultures and specialist services required for a care home to meet the needs of caring for people affected by Huntington’s disease. Stanley House is now one of only five care homes in the country who have achieved the HDA Quality Assured status. The specialist care home in Herefordshire has now been added to the HDA’s directory of accredited care homes, which provides more guidance for people with Huntington's disease and their families in finding care homes. During the comprehensive accreditation process which involved the whole team, the HDA said that Stanley House’s ‘support for the individual and positive risk-taking was of particular note’.

Positive risk-taking is a vital component of specialised Huntington’s care because it enables individuals to make their own decisions and exercise choice. Although it may seem counter-intuitive, empowering individuals to take small risks or participate in activities that are not typically regarded as positive for health, such as drinking alcohol or not having to shower 7 days a week, can produce a positive outcome rather than negative. Of course, the negative consequences of risk must be assessed and managed appropriately, and a person’s capacity to make decisions revisited and documented as their condition fluctuates but as part of a person-centred approach to care, within a specialist setting, positive risk-taking can be very beneficial for people with Huntington’s. Often leading to a decrease in agitation or frustration and associated behaviours. Care Centre Director, Heidi McCarthy, said that positive risk-taking had been part of the person-centred approach at Stanley House for many years.

Heidi said: “It’s something that we do quite naturally. We always say, who is it a problem for? If it’s not a problem for the individual we are supporting, it shouldn’t be a problem for us. And I think that's a really good saying. So, if somebody's got 50 cups of squash in front of them and they’re happy, why am I going to remove them if it’s not causing a problem?

“It’s all about trying to give every resident the best life that we can: by understanding their needs, wants, likes and dislikes. This is their home for life and our aim is to build a

secure and happy environment that reflects individuality – and sometimes that involves risk taking.”

One of the primary goals of HDA Quality Assured is to improve the experience of choosing a care home for families of loved ones affected by Huntington's disease. A high proportion of families report having a negative experience and so the scheme aims to reassure families that core standards are in place and their loved one will receive quality specialist care.

Changing care homes or experiencing placement breakdowns is very unsettling for individuals and distressing for the family members that are supporting them. Common reasons for placement breakdowns are restrictive practices enforced by the care home, i.e. not letting individuals take positive risks, which contribute to challenging behaviours, and lack of training and understanding of the specific needs of individuals living with Huntington’s.

For Heidi and the team at Stanley House, communicating with the resident and educating their family about what to expect is a key part of the settling in process, and ensuring a positive experience of care.

Heidi said: “I think it’s about giving them the knowledge. Families want to feel settled and want to know that their loved ones are being cared for. So if they've got a worry or a concern they can come and see us, they can ask what they want to ask. What we want to show or explain to both our residents and their families is that there can be a good care setting, and that there can be a life living in care with Huntington’s.

“Each resident here has different needs and I explain how we accommodate those, we work around individual needs rather than enforcing set routines. For example, a lot of placement

breakdowns result from an enforcement of personal care. A resident might not want to shower or wash and forcing them to do so will create agitation and behaviours.

“We focus on building a relationship with our residents first and starting very slowly. We will always ensure appropriate hygiene levels, but in a modified way that is acceptable to the resident. We have to be flexible in our approach but that’s all part of person-centred care, it starts with the individual and not with us.

“Person centred care is at the heart of everything we do here at Stanley House. We can’t offer positive risk-taking without it all focusing on the individual and their needs rather than a set way of doing things. People with Huntington’s are all so different. They all have the same condition which has traits along the way, but they’re all individual.

Because the team at Stanley House have a wealth of experience and knowledge, this feeds into the specialist staff training to support new learners in delivering this type of care to those with HD. All staff learn to support people with HD and their families to face the challenges, often with feelings of fear, self-doubt and loss and how this can affect both physical and mental wellbeing and evolving relationships.

“We’re thrilled to achieve the accreditation status which recognises our continued hard work and commitment to our residents and their families.”

Helen Santini, Team Leader, Huntington's Disease Association said:

"The Huntington's Disease Association congratulates Stanley House on achieving accreditation and of particular note was their support for the individual and positive risk-taking. Achieving accreditation is a long and time-consuming process, which involves the whole team.

“However, this is particularly true for providing a good quality of care for people with Huntington's disease which needs to be demonstrated throughout the process.

“It is great to see more care homes added to our directory of accredited care homes to provide more guidance for people with Huntington's disease and their families in finding care homes. We look forward to working closely with Stanley House over the next two years and further ahead."

www.elysiumhealthcare.co.uk/location/ stanley-house