NR Times issue 18 by aspectpublishing

ISSUE 18 QUARTERLY

INTERVIEW S A M EYO U - A VO I C E FOR B R A I N I N J U R Y S U R VIVOR S Game of Thrones actor Emilia Clarke and mum Jenny lead the campaign for change

I N S P I R I N G N EU R O RE H AB O N A G LO B A L SCAL E How Craig Hospital is leading the way with its pioneering treatment and stellar outcomes ADVERTISEMENT

Fourier Intelligence reveals further global expansion plans after securing Saudi Aramco as major investor

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The future of rehab robotics NRT-2021

S E E N R T I M E S . C O . U K F O R T H E V E R Y L AT E S T N E U R O - R E H A B N E W S A N D O P I N I O N

INTERVIEW

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EDITOR'S NOTE

“There’s a better way to do it - find it” I’m not a huge fan of inspirational quotes, but this statement from Thomas Edison is something I do consider every day. How can I do things differently? How can I effect positive change? Change, as they say, brings opportunity, and hopefully in turn the discovery of a ‘better way’ to do things. And change, inspired by those committed to achieving and delivering that, is a theme that runs throughout this issue. The quest to make a difference to the lives of people who need it most, the determination to redefine the recovery prospects of those living with brain and other life-changing injury. Too often, we hear from brain injury survivors they feel alone, unrepresented, like their voice is not heard. SameYou is committed to changing that, and is already making waves around the world. “We want to make as loud a noise as possible to represent the voices of brain injury and stroke survivors and their carers,” says CEO Jenny Clarke, who alongside her daughter Emilia, founder of the charity, is already making change happen. The advances being made in technology are also critical in bringing about change.

The global expansion of Fourier Intelligence means even more people worldwide will benefit from their cutting-edge rehabilitation robotics. BrainQ’s potential to rehabilitate stroke survivors beyond any previous expectations is set to become a commercial reality within the coming years. Cognetivity’s ability to diagnose pre-dementia symptoms earlier than ever before, so treatment can be enabled. The innovation from Nourish Care in using digitalisation to enable providers to deliver better person-centred care. Craig Hospital too, and its proud history of delivering stellar outcomes for brain and spinal cord injury patients since 1956, continues to be a global leader in neurorehabilitation, making positive change to patients’ lives, and empowering them to achieve their goals. “I love it when I hear patients say ‘I do what I used to do, but now I do it differently’,” says Dr Jandel Allen-Davis, CEO of the pioneering hospital. Positive change is happening - and we look forward to continuing to chart the progress of these amazing individuals, teams and organisations who are driving this forward. D E B O RA H JO HN S O N

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CONTENTS

34 C HANG ING T HE RE A L ITY FO R S TRO K E S URVIVO RS How an AI-led invention is set to revolutionise recovery potential

0 6 C OVER STORY T H E F U TU RE OF R OBOTI CS

38 E M POWE RM E NT, NOT RE S C UE Help For Heroes discusses how it supports veterans to rebuild their lives post-serious injury

Fourier Intelligence targets further global expansion following Saudi Aramco investment

46 S A M E YO U A CATA LY S T FO R C HA NG E How Emilia and Jenny Clarke are enabling brain injury survivors to have a voice

1 2 N E WS The latest from the world of neuro-rehab.

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CONTENTS

72 L EADING T HE WAY G LOBAL LY IN NE URO RE HAB How Craig Hospital is delivering life-changing outcomes for its patients from around the world

6 0 D EF YING THE ODDS How Rolf Zartner went from almost dying after four strokes to running a half marathon within a year

80 FUTURE PRO O FING A BUSI NE SS How the MBO of a case management company was devised and executed

76 RE DE FINING DE M E NTIA DE TE CT IO N How AI is playing its role in detecting pre-dementia symptoms more quickly and cost-efficiently than ever before

84 RE DE FINING CA RE DE L IVE RY T HRO UG H DIG ITA L IS ATIO N

6 4 LET’S TALK A B OUT SEX How one care provider is leading the way in taking the stigma out of discussions about sex and intimacy

How Nourish is empowering care teams to deliver person-centred care by turning to technology

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COVER STORY

Rehabilitation robotics unicorn Fourier Intelligence is set to take its ongoing global expansion to the next level after securing funding from Saudi Aramco, becoming the first rehab tech company in the world to gain financial backing from a major player in the international investment market.

Investing in the future of rehab robotics NRTIMES

COVER STORY

Fourier

is now targeting global market expansion with the United States and EU being key targets for the near future - ongoing development of its world-leading technology, and adding further to its international team through the C+ financing round, which the company’s co-founder Zen Koh described as being of “humongous” significance. A pioneer in the global rehab tech market, the business is already on an unrelenting path of growth, expanding into 54 countries to date from its native Singapore, including the UK, with more than 1,000 uses of its technology in 30 of them. The adoption rate is increasing “exponentially”, says Zen, with more than 10 million usage hours for its portfolio of over 20 AI-powered rehabilitation robots so far. And as well as its work in enabling access to rehab through the popularisation of its technology, Fourier which has grown hugely during its six years in business - is committed to leading, supporting and participating in international scientific research in rehab robotics to enable the delivery of technology-led solutions to solve specific clinical constraints. So far, it has established ten subsidiaries and joint research laboratories in international destinations, including Singapore, Chicago - in the world-leading Shirley Ryan AbilityLab - China, Malaysia, Melbourne, Zurich and Spain. Now, to add to its stellar progress, Fourier’s securing of backing from Saudi Aramco - the world’s most profitable company and biggest oil producer - indicates both the potential of the rehab robotics market and Fourier’s huge presence within it.

OUR GOAL IS TO EMPOWER CLINICIANS AND SERVE PATIENTS IN THE GLOBAL MARKET AND THAT HAS NEVER CHANGED. WE WANT PATIENTS TO GET BACK AS NORMAL A LIFE AS POSSIBLE, AND WE WANT OUR TECHNOLOGY TO MAKE THAT HAPPEN. 07

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COVER STORY

“For the past three decades or so, since we started introducing technologies and robotics into clinical rehab settings, no global players have been willing to enter the field,” says Zen, deputy group CEO of Fourier Intelligence Group. “We have witnessed many promising companies, startups and technologies retreating or moving on. But this funding round from such a major investor indicates that the rehab technology industry is now getting the long-overdue attention and support needed to make a positive difference in patients’ lives.” One initial move in the advancement of Fourier’s work enabled by the investment is the upcoming collaboration with Johns Hopkins Aramco Healthcare (JHAH) to create an advanced rehabilitation robotic service. This round of financing will further accelerate our growth and allow us to invest more into our core technology development, talent acquisition and global market expansion,” says Zen, who has worked in the advancement of rehab robotics for over 20 years. “The two main targets for our expansion are the United States and the European Union. We do have some presence in the EU but not yet on a large scale. Initially, when you develop products, you focus on places close to you before launching globally, but the time has now come for more aggressive expansion and a more extensive installation base. “The United States is very exciting, it is one of the largest markets in the world. We are entering into a joint venture and are willing to invest in factories and in talent acquisition.

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“Being based in Singapore, we are sandwiched between East and West, but while there are differences in those markets, we do not see the politics - we only see that patients need our technology. Our goal is to empower clinicians and serve patients in the global market and that has never changed. We want patients to get back as normal a life as possible, and we want our technology to make that happen.” In becoming the first ‘major player’ to give its financial backing to a rehab tech company, Prosperity7 Ventures says it has identified the potential of this as a largely untapped industry with huge growth potential, and is supporting Fourier with its network and resources in addition to the funding, with a focus on partnerships. To date, Fourier - which has been infusing creativity into exoskeleton and rehabilitation robotics development since 2015 - has launched over 20 self-developed products globally, all geared towards the purpose of improving patients’ lives through better quality and access to tech and robotic-led rehabilitation.

COVER STORY

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It also aims to grow its global team, which currently has around 400 people, and will be concentrating its efforts on creating new teams in Australia, the United States and Europe. “We are focusing a lot on research and want to add the right talent to the team. We will start in Australia first as that is closest to us, but we don’t see geography as a challenge in preparing teams, working remotely is now something we are all used to,” says Zen. In 2020, Fourier developed and launched its pioneering intelligent robotic solution, RehabHub, which is widely used in neurorehabilitation, elderly care, and community-based rehabilitation settings. The comprehensive rehabilitation solution is equipped with highly efficient, interconnected, and cost-effective robots that deliver functional training, assist clinicians in providing treatments, and enable effective and consistent rehab to patients. RehabHub is an area in which Fourier is set to see significant further growth, with Zen highlighting the potential for collaboration, supported by ongoing investment in all areas of its technology - from its pioneering hardware, software and AI through to the telerehab system used in support of its implementation. “We aim to build a world-leading collaborative rehabilitation ecological system, through our RehabHub concept, and to consolidate ’ ’Fourier’s global leading position further to create greater value for our customers,” says Zen, who is an ambassador for IISART. “We think we are well-positioned to collaborate with some of the leading players in the field through our RehabHub concept. Through collaboration and working together positively, we can move this industry forward - but by competing in a negative way, that will

FOURIER WAS FOUNDED AS WE HAD SEEN THE CHALLENGES THAT EXIST AND WANTED TO SEE HOW WE COULD MAKE IT BETTER, HOW COULD WE PROMOTE THIS INDUSTRY BETTER. WE SEEM TO BE DOING THE RIGHT THINGS, AND OUR STRATEGY HAS BEEN PUT TOGETHER FROM 20 YEARS IN THE ‘SCHOOL OF HARD KNOCKS’- WE HAVE LEARNED THE HARD WAY THROUGH THE EXPERIENCE. NRTIMES

COVER STORY

set us all back. We want to work together for the benefit of this industry, so it is responsible and sustainable. “Fourier was founded as we had seen the challenges that exist and wanted to see how we could make it better, how could we promote this industry better. We seem to be doing the right things, and our strategy has been put together from 20 years in the ‘School of Hard Knocks’- we have learned the hard way through the experience. “We wanted to change mindsets - 20 years ago, you’d never have imagined using a mobile phone app to get a taxi, but Uber has totally changed the mindset. Technology supports the convenience of this and now makes it indispensable. We have the same principle in empowering clinicians to make a difference to patients’ lives. “We see collaboration as being something really promising for the future. We have already successfully licensed technologies from universities, completed technology transfer and productisation, and collaborate with more than 30 strategic alliance partners under the RehabHub concept. By working together, we will make things happen.” While the COVID-19 pandemic has been a challenging period for the business, it is now poised for further growth, underpinned by how widely technology has been embraced in healthcare globally, marking a huge departure from its previous approach. ”Underpinning the successful financing is our impressive

growth numbers in recent years and increased global adoptions, despite the challenging COVID-19 pandemic,” says Zen. “This has been a challenging period for us, as it has been for a lot of companies, but the pandemic has fuelled the need to reduce reliance on manual clinical interventions, vindicating our advocation of technology integration in rehabilitation. “Rapid iterations and the ability to deliver high performance, low cost, and efficient technological solutions are key to successful clinical adoptions. “Fourier is well-positioned to capture the opportunity enabled by advanced rehabilitation robotics. We’re pleased to be part of this exciting global shift towards technology-focused healthcare solutions and believe. Fourier’s domain-specific expertise will lead and fuel innovative solutions for the healthcare challenges we see today.” Looking forward, and with significant global plans already in place, Fourier is now set for the next phase of its growth, supported by the backing of Saudi Aramco. “Our partnerships with Prosperity7 Ventures and Aramco Ventures inspire and strengthen our resolve in delivering innovative healthcare solutions. Fourier will continue to invest in our core technologies to stay ahead of the competition,” adds Zen. “We look forward to the next stage of our journey, together with our strategic partners.”

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NRNEWS

A groundbreaking neurorehabilitation centre has opened its doors, bringing a new dimension to brain injury rehabilitation in the UK.

Calvert Reconnections, the UK’s first intensive acquired brain injury (ABI) rehabilitation centre which offers a unique approach to rehab for its residents, is now open after having to previously delay plans due to the COVID-19 pandemic. The centre, on the outskirts of Keswick in the Lake District, offers the first residential programme of its kind, combining traditional clinical therapies with physical activity in the outdoors. “The opening of our new centre is the culmination of years of meticulous planning by the Lake District Calvert Trust. It is a landmark moment for the ABI rehab market and for us,” said Giles Mounsey-Heysham, chairman of the Lake District Calvert Trust (LDCT) trustees. “Working with leading clinicians and academics, our new rehabilitation centre will provide a groundbreaking, world-class rehabilitation programme tailored to support individuals in their recovery.” Calvert Reconnections will actively seek to incorporate a wide range of outdoor activities into each participant’s rehabilitation programme, depending on their unique needs and interests. This may range from reflective activities such as fishing, bird watching or a nature walk, to higher adventure activities such as horse riding, canoeing, rock-climbing and abseiling – all closely assessed and graded to a person’s interests and functional abilities.

Natural daylight could be a “highly effective” treatment in supporting recovery from Long COVID, having shown benefit in people living with other debilitating conditions. With cases of the post-COVID syndrome rising continually, uncertainty persists around the best way to treat and support people with the condition due to the developing knowledge and lack of data on the topic. But sunlight could play a significant role in supporting people in their recovery, says psychologist and sleep specialist Dr David Lee. “One of the core symptoms of Long COVID is fatigue, and natural daylight could be a potential intervention,” says Dr Lee, clinical director of Sleep Unlimited, who has been teaching, researching and disseminating findings from his own research into sleep and the psychobehavioural treatment of insomnia for over 15 years. “Through getting outdoors there is a kind of triple whammy effect of exposure to natural daylight: increasing Vitamin D and promoting the production of melatonin which helps with sleep initiation and maintenance,

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while also promoting serotonin production which makes you feel happier and collectively gives a boost to the immune response. “As a potential treatment, getting outdoors could be a highly effective intervention. This is my hypothesis, there’s no data yet as it’s too soon, but we do see a general benefit to people’s sleep with exposure to natural daylight.” The lack of exposure to natural daylight for many people during the lockdowns has potentially amplified the effects of Long COVID, as well as impacting negatively on the mental health of countless others, says Dr Lee. 12

NRNEWS “Our lives have mainly been the same – the difference is to other people’s lives.” As pioneering research continues into experiences of loneliness during the pandemic for brain injury survivors, some of the preliminary findings are stark. The resilience of survivors – many of whom face loneliness every day even outside of the pandemic – in dealing with the isolation many others were experiencing for the first time, is one of the themes to already come to the fore. Dr Stephen Dunne, from the University of Sunderland, who is leading the research project – which is being carried out in conjunction with Headway – says a more ‘level playing field’ appears to have been created in the understanding and experience of loneliness. “Loneliness is a common experience after a brain injury, but from the data we have gathered so far, the social restrictions placed by the pandemic have not changed

life too significantly for those living with a brain injury,” he says. “This may be explained by the adaptation that comes with sustaining a brain injury. Friends and family drifting away, changes to the way people socialise and adapting to a new normal are commonplace after brain injury. “Instead, the pandemic has created a ‘level playing field’, where those without a brain injury have a snapshot of what life post-brain injury is like.” While research is still ongoing, with participants still being sought, Dr Dunne says initial findings are helping to show the reality of the situation survivors face, particularly now restrictions start to lift. “Preliminary conversations have been enlightening, with participants highlighting a number of key themes, largely around lockdown providing a greater awareness of what living with a brain injury is like,” he says. “However, this increased awareness has been short-lived at times. When restrictions have been eased, one survivor told of their frustrations with how quickly friends forgot about their issues.

Rebuilding lives and

“The neuro rehabilitation package that QEF delivers is so comprehensive and holistic, and in my view a real leader in this speciality.”

creating futures Expert neuro rehabilitation and nursing care in a modern, spacious centre

NHS neuro rehab placement manager

Find out more: Tel: 01372 84 11 11 Email: neurorehab@qef.org.uk Web: www.qef.org.uk/CRC_professionals

Registered Charity No 251051

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NRNEWS UKABIF Launch ‘Acquired Brain Injury and Neurorehabilitation in Wales: Time for Change’ UKABIF have today launched a report which sets recommendations to improve services and support for people with Acquired Brain Injury in Wales. ‘Amser am newid’ covers five key areas including health and social care, education, criminal justice, sport, and welfare and will be circulated within the Senedd after the summer recess. Amser am newid builds on the success of the AllParty Parliamentary Group for Acquired Brain Injury’s report on Acquired Brain Injury and Neurorehabilitation which was published in 2018. The report outlined the state of affairs and gave recommendations for policy changes in health and social care; education; criminal justice; sport and welfare. The APPG has worked alongside UKABIF and its special interest groups to take these recommendations forward and has seen particular success in education, criminal justice and sport. Though the 2018 report focused on England and Wales, the unique socio-cultural landscape of Wales warranted a specific focus, which has led to production of this new report. In addition to the publication of the report a petition asking for appropriate provision of services and support for people with Acquired Brain Injury in Wales has been set up. You can visit the link below or scan the QR Code to complete your details and support the recommendations made in Amser Am Newid/Time for Change Wales. Please note you do not need to be Welsh or live in Wales to complete the petition.

Chloe Hayward, Executive Director of UKABIF, says: “We hope that this piece of work is as pivotal as the 2018 report and look forward to working with the Senedd and Welsh government alongside clinical, academic and voluntary sector colleagues, and those with lived experience of brain injury, to improve access to care and support for the people of Wales.” UKABIF would like to thank Katherine Simmonds and the charity Kyle’s Goal. Dr Leanne Rowlands who researched and drafted the report, UKABIF’s regional groups covering Wales and the South Wales Acquired Brain Injury Forum who supported UKABIF in completing and launching the document. And to all our colleagues who provided information and advice. Please see www.ukabif.org.uk/TFCWales for a full copy of the report and further information about the work being carried out in Wales. The Welsh translation of the report is underway and will be available soon.

https://petitions.senedd.wales/petitions/244879

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#AmserAmNewid #TFCWales and #TimeForChange

NRNEWS A new chair has been appointed by the British Association of Brain Injury and Complex Case Management (BABICM). Vicki Gilman has taken over at the helm of BABICM, which is the representative body for continued professional advancement of case management and promotes best practice in supporting people with brain injury and complex conditions. She takes over from Angela Kerr, who steps down after five years in the role at the helm, in what is BABICM’s 25th anniversary year. “I’m delighted to be BABICM’s new chair in our 25th anniversary year. The organisation has a wellestablished, powerful and influential voice and we will continue to ensure that the needs of people with brain injury and complex medical conditions are recognised and met,” says Vicki. An experienced case manager, health entrepreneur and clinical specialist neurophysiotherapist, Vicki is currently managing director of Social Return Case Management, a

Therapy centre pioneers Long COVID rehabilitation study A community gym is playing a crucial role in supporting patients with Long COVID through a pioneering study into how power-assisted exercise can help in their rehabilitation. West Berkshire Therapy Centre is set to support 100 people living with the post-COVID syndrome through a 20-session programme, with its evaluation of their outcomes set to be some of the first research into rehabilitation for the debilitating condition. The centre has raised over £19,000 to fund the study, titled ‘The role of power-assisted exercise in the rehabilitation of Long COVID’, with a further £10,000 grant secured by Dr Deepak Ravindran, who runs Berkshire Long COVID Integrated Service, which will enable the study to be bigger than initially planned. Dr Ravindran, a pain consultant at the Royal Berkshire Hospital, has referred patients to the physio-led West Berkshire Therapy Centre since its creation in 2014, and its ability to deliver both physical and psychological benefits to its clients has led to it now supporting the rehabilitation of people with Long COVID. “For several years we have worked with clients with 15

company she established over six years ago. She qualified in physiotherapy at King’s College, London and completed a Master of Science degree in neurorehabilitation at Brunel University. For several years, Vicki worked in a specialised military neurorehabilitation unit, treating adults with brain injury, spinal cord injury, and other complex conditions. Vicki coordinated and worked clinically in NHS and independent sector multidisciplinary community teams treating people with neurological conditions, and she was an expert witness in brain and spinal cord injury for over 20 years. Her work in a multidisciplinary team steered her into case management, and for six years Vicki was on the BABICM Council and chaired its training events group, returning last year to BABICM Council for a preparatory year before stepping into the role as chair.

fibromyalgia and we have the equipment here which can support them, so we wanted to use our experience and equipment to offer some help,” says John Holt, trustee at the centre who was instrumental in its creation. “If you go back to March 2020, myself and the team were stuck at home feeling useless, but now all of a sudden, we have this opportunity to help clients living with this new condition. “People tell us it helps them and that’s all we need to know, but now through our evaluation, we hope this could mean something to researchers. We’re completely geared up for it, our staff are all on a high. “We will be referred 100 Long COVID clients with a variety of complexities, they may have mental effects or heart impairment or reduced mobility, some will have mild disability and for others that will be more significant. We will look at all of that and then do our assessments to see what is safe. “We will be guided by the clients - we know a bit, Dr Ravindran knows a lot, but they know most about this condition. We may discover our service makes no difference to Long COVID - we’re not trying to set out to show what a brilliant service we offer, we want to continue to make a difference to people’s lives through finding out what can work.”

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Through the AI-led analysis of a single drop of blood, it is possible to detect brain cancer. Having been verified through two groundbreaking clinical studies, the Dxcover Brain Cancer liquid biopsy, the first of its kind in the world, is now set to go into pivotal trials with a view to commercialisation in 2024 - paving the way to save lives and improve quality of life globally through the earlier diagnosis of cancer. With the creation of the Dxcover Platform - which combines novel hardware with artificial intelligence algorithms to analyse a patient's blood - and its patented Drop Dry Detect method of detecting cancer, a process which currently may take eight weeks or more to fully diagnose can be fast-tracked into a matter of minutes. At a time when COVID-19 has increased waiting times for cancer diagnosis and treatment dramatically, the creation of a technology which simplifies and quickens the process of diagnosis is being widely supported, with £5.1m raised to date to progress its work. And its application is also set to be extended into other forms of cancer, with the Scottish startup currently developing liquid biopsies for individual cancers through its Dxcover Cancer project, as well as a multi-cancer test which could detect many forms of the disease. The business, which began life as a research project at the University of Strathclyde and spun out in 2019, plans to launch its first life-saving technology initially in the United States pending the success of the pivotal trial and regulatory approval process. Dxcover - which recently rebranded from ClinSpec Diagnostics, and now also has the tagline The Future of Cancer Diagnostics - has also expanded into laboratory and office space in Glasgow three times the size of its former base, to help facilitate its ongoing growth and further development of its pioneering work. “We work on the basis that every day counts - for patients who need a diagnosis and treatment, for doctors looking for better diagnostic methods, for healthcare service providers who want to do things more efficiently,” says Dr Mark Hegarty, CEO of Dxcover. “But the day we will be able to say this company is successful is the day we can say we have saved a life.” The company’s journey towards its lifesaving aims began in 2012, when Dr Matthew J Baker began his first experiments to establish whether a biopsy could be analysed by AI to distinguish between cancer and noncancer diagnoses.

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Once the potential of his work was realised, Dr Baker an inventor with over 18 years’ experience in the field of clinical spectroscopy - patented his spectroscopic liquid biopsy technology and was introduced to Dr Hegarty by the University, who were keen to bring in the expertise to support the development of such game-changing research into a viable business which could apply its technology around the world. Dr Hegarty, with over 20 years of experience in supporting startups and healthcare products into international successes, immediately recognised the potential of what Dr Baker had created - and the two men also realised they could work together effectively - “We both like fast response times and are not afraid of hard work,” says Dr Hegarty. And from there, Dxcover has progressed into a venture with the clear potential to transform cancer diagnosis as we know it, leading the way in the marketplace with its innovation. “Liquid biopsy is a hot topic, it’s a cutting-edge technique which holds great promise,” says Dr Baker, chief technology officer of the business. “Most research focuses on genomic data, the big US companies are focusing on the genetic information from the tumour - but ours is different and looks at the entire signal from the serum. We don’t just look at tumour markers, we look at the human response. That is then teased apart by machine learning. “There isn’t really another company out there with our approach, and we hold the patents for the diagnosis of all cancers, so no-one can do exactly what we do. Our platform methodology can handle any serum sample, it’s exactly the same analysis, so there’s great potential.” 16

THERAPY

Music Enrichment Delivers Rehab Benefits Music Enrichment is part of the holistic approach to brain injury rehabilitation offered by Richardson Care in Northampton. “Music has an immense power to affect emotion and its benefits are well-known in rehabilitation,” says Greg Richardson-Cheater, Director. “It can help to rebuild neural pathways and trigger memories, but most importantly, it can bring joy and a sense of yourself. “The ethos at Richardson Care is to provide an inclusive home environment with a feeling of community and respect. By focussing on well-being, and enabling service users to feel comfortable in their own skin, we have found that other benefits will follow. For instance, greater confidence and self-esteem leads to increased

motivation to engage in different therapies. “So, instead of taking a traditional ‘music therapy’ approach, our focus is on enriching the lives of our service users. Martin Reeves, Music Enrichment Leader, plays guitar and sings with (or to) service users in weekly sessions. They have the choice on how they interact – anything from singing and dancing, to the type of banter that you’d have at a gig in a pub. The music takes the service users out of themselves and gives them a sense of normality. They can relax and have fun.” Music Enrichment activity at Richardson Care is provided by professional musicians who have a passion for music and its transformative effect. By bringing compassion and warmth to their roles, they enrich the lives of adults with brain injury supporting their rehabilitation. For more information call 01604 791266 or go to www.richardsoncares.co.uk

Respect & Restore Specialist residential care and rehabilitation for adults with acquired brain injuries. • Portfolio of services to meet a variety of needs • Innovative person-centred care • Unique ‘family’ environment • Focus on social integration • 30-year proven track record Proud to be an independent family business.

Call us on 01604 791071 to find out more or email admissions@richardsoncares.co.uk

www.richardsoncares.co.uk The Richardson Mews, Kingsland Gardens, Northampton NN2 7PW

NRNEWS

The first digital health intervention for families affected by ABI has been launched, with a view to national roll-out in the coming months. CBIT In Hand has been created to provide immediate, tailored information via a mobile device to families of children and young people who have been affected by concussion, and or acquired brain injury. After three years of planning by the Child Brain Injury Trust, the app is now live and is being trialed in Alder Hey and Birmingham Children’s Hospital for the next three months. CBIT in Hand will then be rolled out to 19 hospitals nationally, with more continuing to come on board. CBIT in Hand, which can be accessed by QR code or downloaded from App stores, is being targeted at A&E departments and major trauma units, to ensure families can find the digital information ,resources and support they need instantly during the most difficult early stages of their loved one’s injury. Statistics show that each year, 500,000 children and young people attend A&E each year with a head injury, for whom the CBIT in Hand app could prove invaluable to give the information they need. And for the families of the 40,000 children each year who sustain ABI, the app enables them to access information or refer themselves to CBIT for support a process which previously was usually done via third party referral - and ensures they receive an immediate response from the charity’s team. CBIT in Hand marks a significant investment for CBIT, with £130,000 already committed - supported by the National Lottery Community Fund and law firm Leigh Day - but a further £400,000 being sought to enable it to continue to scale and support more families nationally. “Each year, our team supports 1,400 families, which is great, but clearly our resources need to reach further. That was one of the main reasons in creating this app - to reach more families who need us, without diluting the service we provide,” says Lisa Turan, chief executive of the Child Brain Injury Trust. “By creating CBIT in Hand, we can ensure access is given

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to personalised resources that are needed without having to wait, and if a family needs to be referred to us, then that process is now much easier and instant. Rather than face the ‘fear factor’ felt by many of having to phone organisations, they can now get in touch with us with a tap of their mobile. “While there is information out there for families of children with brain injuries, it can be inconsistent. Through creating this instant digital access, we’re taking away some of the burden on the NHS to pass on this information. So if they need advice about aspects of brain injury, on benefits, school support, local services, or how to connect with other families, that can all be accessed via CBIT in Hand.” Now in pilot, CBIT in Hand has been a huge undertaking for the CBIT team, who have worked closely with families and medical partners along the way. “We’ve put our heart and soul into creating this, it’s been three years in the planning and we’ve worked alongside Alder Hey and Birmingham Children’s Hospital for over a year to get it right. We’ve done extensive remote testing across the UK with parents of children with ABI, so we are looking forward to rolling it out further after the pilot,” says Lisa. “The clinicians we’ve worked with have been so helpful, they all carry their phones so will show families our QR code so they can access our resources straight away. There will also be posters up for families to scan the QR code. “We think this app will be so valuable for many families - for those needing a lighter touch, they may find everything they need there, but for those who need more, they can refer and access our specialist team. We’re so pleased this has been possible - in time, we’d like to build it out further but will need investment to do that. But for now, we’re really looking forward to national roll-out and to extending our support more than ever before.”

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An app which uses AI to enable stroke survivors to rebuild their speech and language capability at home has bee launched, inspired by the personal experience of its creator. SpeechFirst supports survivors to build on their speech and language therapy provision through using AI to detect incorrect facial movements and pronunciation and provide real-time tips and recommendations to enable them to make progress. The app is the first British built creation to make use of AI in speech and language therapy, and with its launch is set to increase the rehab potential of thousands of survivors nationally. Its home-based approach enabling people to continue their rehabilitation remotely, while supervised by their therapist who can access the person’s SpeechFirst dashboard. Its creator, Holly Brown, was inspired to develop SpeechFirst by the experiences of her father, who had a stroke aged only 43 which left him with serious communication difficulties. “He was in a rehab centre for a little while and had the standard six-week therapy from the NHS, but then was left to his own devices. It’s a postcode lottery depending on where a person lives and what is available, and private speech therapy can be quite expensive,” says Holly. “We were well aware of the resource restraints so we looked for whatever was available. There were a few apps out there but they were quite expensive, but for people like my dad they were badly needed.” Holly, a consultant at digital leader Capgemini, developed the idea for SpeechFirst and pitched it to her employer as part of its Tech4Positive Futures campaign, which sought ideas to help address society’s biggest issues through technology-led solutions. SpeechFirst was named as one of three global winners and was given the funding and resources by Capgemini to bring the project to fruition during an intensive ten-week programme, with support from UCL and the guidance of Professor Rosemary Varley. A further round of funding will bring an additional six weeks of development. “We initially chose to specialise in articulation of

consonants, consonant pairs and sounds, words and phrases, but the next round of funding will enable us to personalise those words and phrases,” says Holly. “We want to enable people to do things like being able to say their wife’s name or their children’s names again, and through using the app and getting the feedback, they can work towards that.” The app, which was conceptualised before the pandemic, has taken on increased relevance and importance since lockdown came and therapy has often been postponed or cancelled during the past year, with the impact on resources continuing to be felt. “The final round of pitching was in June last year, and at that time we were aware of many people not even getting six week of speech and language therapy, they were maybe getting two at a push, so we hope this will help,” says Holly. “This is designed to be done alongside their speech and language therapy, the therapist has access to the back end dashboard, so even if that allows them to stagger sessions more, knowing the person can progress between them, that will help. “Longer term, we would like to look at it being a standalone app, perhaps something a carer or family member could have access to, and it would also be great to see if this could go beyond stroke and benefit people with Parkinson’s, other neurological conditions, even autistic children who could use it in schools.” And for app’s inspiration, Holly’s father, SpeechFirst has thankfully passed the test. “He feels like a bit of a superstar,” laughs Holly. “He’s been testing it out for us and has been involved in everything, from the illustrations testing through to the marketing materials. “Even now, he’s still so motivated to keep progressing, he uses a lot of paper-based books, dictionaries, and he’s willing to try anything new. We hope SpeechFirst will benefit people like my dad, but so many others too.”

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Building confidence and learning new skills how vocational work supports rehab “Being at Workbridge gives the person a sense of purpose. It provides them with an aim to achieve. They can stand back and be proud of what they’ve done.” Tom, Service User accessing Workbridge at St Andrew’s

For Tom, who has attended this pioneering vocational centre for over 10 years, the impact on his life and countless others is significant. Based within the St Andrew’s Northampton hospital site, and integrating public facing retail offerings, Workbridge provides a vocational pathway for people living with brain

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injuries, mental illness, learning disabilities or autism. The centre operates to provide training and social opportunities for people living in the community and within the inpatient setting of St Andrew’s and here people can learn new skills through the array of activities on offer, supported by vocational skills instructors. Departments ranging from ceramics to woodwork, horticulture to catering, allow service users to learn both life and work skills, building confidence and social capability in the process. The products made in the department sessions are sold in the public-facing garden centre, charity and coffee shop where service users can also work, meeting the public and learning retail skills. Workbridge has helped hundreds of people to gain or regain skills and build their confidence and independence over the 41 years since it was established. Tom, who accesses the centre as a community based service user is a regular and an enthusiastic advocate of the service. “I’m sure everyone benefits from being here, but that’s quite subjective and down to the individual, but for me the consistency it gives me has been really important,” he says. Having sustained two brain injuries - the first in 2001 as the result of an assault and another in 2008 while

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cycling - Tom is now rebuilding his life with the support of Workbridge, where he attends textiles sessions and volunteers in the charity shop. “I know I need structure as a result of my head injury and Workbridge gives that. It is an incredible community and there is a real family vibe. It has also helped with my patience... I’ve developed more patience over the years. This is a non-intrusive environment but friendly and that has helped.” For Neelam too - a young mother who needs ongoing care and who is currently a patient in St Andrew’s Brain Injury services after a tumour on her pituitary gland left her with a range of needs - her participation in ceramics sessions at Workbridge are an important aspect of her recovery. “In ceramics, at first they had a jar already made and to start with I just had to clean and tidy it up. But slowly they gave me more jobs and responsibilities because I was capable,” she says.

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Neelam

“Now, I feel I am confident in meeting new people. I am working and have an important job to do and I feel more responsible; because what I am making is going to be sold to the public I have to be really careful. I try to give 100 per cent with any painting or modelling, I go there and I always try my best.” For both Tom and Neelam, their positive experiences at Workbridge mean they now hope that one day they can find paid employment. “Before my brain surgery, I was working in a multi-national company as a quality assurance officer. However, after my surgery, I was literally doing nothing and was just in hospital,” says Neelam. “Now I feel my life has totally changed. I have hope that I can work again.” Tom continues: “I need an employer with good understanding of head injury and my strengths and weaknesses. I think Workbridge would be an incredible employer for that and I could be a pathway example for other service users. “I am quite engaged and sociable so would love to be a service users’ representative and a voice for other people.” For the multi-disciplinary team that support patients on St Andrew’s brain injury wards and the vocational skills instructors based at Workbridge who work with service users from the community and hospital patients, they see first-hand the significant benefits that vocational opportunities bring. “Everyone has different levels and abilities and things they are able to progress towards, but Workbridge offers opportunities for everyone. It’s an amazing example of

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what our service can provide,” says Gemma Thornton, an occupational therapist in the St Andrew’s Brain Injury service who works closely in supporting Neelam. “With Neelam, she is a very creative person, and I know she puts a great deal of effort into making something which will go on sale, in her mind it has to be perfect. “She has made some great progress with her skills and confidence through ceramics, in addition to the excellent progress we’ve made with her moods and frustration in our wider therapy work." Louise, a senior vocational skills instructor who works closely with Tom, adds: “Tom really enjoys the structure of attending Workbridge as he feels it gives him a purpose for the day. He’s given most things a try from upcycling, making bags for the mors bag project - morsbags.com to sanding and painting. All of these projects help with fine motor skills and Tom is certainly an asset within the department.” Incorporating work back into their lives following their brain injury has certainly been an important part of Tom and Neelam's recovery. As Tom says: “Vocational activities provide an individual with more meaning in their life, that distract from more troubling elements they may be living with, and they will also provide transferable skills which people can deploy in other areas of their life.”

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A new programme has been launched to help education professionals gain a better understanding of how an acquired brain injury (ABI) can affect young people. The initiative, from The Children’s Trust, will be used to show teachers and carers the daily challenges each child with ABI faces. Every professional in the education sector can access the programme, which features a number of 30 minute online interactive sessions delivered from a teacher’s point of view. Users are guided through a school environment and shown some of the hidden effects of brain injury, including fatigue, memory issues and difficulty forming friendships. The programme also shows the best practice teachers can take when it comes to offering guidance and support to these children. Katy James, head of community services transformation at The Children’s Trust, says: “It’s a programme that we’re launching initially for all primary schools. It’s about working on the basis that we need to raise awareness amongst school staff at a general level about brain injury. “The programme is giving an introductory level of information to school staff, so that they can have an understanding about how an ABI can have an impact on a child’s ability to access their education. “It’s very much about equipping school staff, empowering them and giving them the confidence to be able to recognise when a child might be having difficulties, and a bit of an idea about what they can do to help that child within the classroom.” Statistics from the charity show that one child in every class will be affected by brain injury at some point in their education. For many this can lead to a long rehabilitation process – and returning to mainstream education is one of the biggest parts of this recovery.

Schools provide a form of ‘natural rehab’ for children, allowing them to experience a setting which other forms of rehab cannot offer, meaning it is crucial for teachers to have an understanding of brain injury, enabling them to provide specialist support to those who need it. “We use the term ‘hidden disability’ all the time,” Katy says. “Those cognitive difficulties, the impact on a child’s confidence or their communication is what you might not be able to see. “Their sense of self as well, who they are as a person, all of those sorts of things can be really impacted by the brain injury. “That can have a real knock on effect on their ability to take part in everyday activities and take part of their normal life, such as engaging their friendships and also engaging in the classroom. “There is a real need to be able to support people to understand and recognise those hidden disabilities, so that children can then get the right support they need. “If you’ve got a workforce that is knowledgeable and who can recognise when a child is struggling, then they’re going to be able to really put things in place to help that child and allow them to reach their full potential.” This new guidance follows an All-Party Parliamentary Group (APPG) report published in 2018 which highlighted the need for a better understanding of ABI in the education sector. The ‘Time to Change’ guidance showed teachers often have difficulties identifying the effects of a brain injury and that there is an overall lack of awareness of the condition. Because of this The Children’s Trust has also launched a further part of the guidance which allows schools to expand their knowledge in this area. Katy says: “The programme also then has a second layer, which is around schools who want to take their learning a bit further. “They can really start thinking about how they can tailor their school environment and tailor what they’re doing, in terms of teaching, to cater for children with brain injury. “So we’re taking their knowledge base to the next step and to the next level. “There’s lots of other organisations out there and we recognise that this isn’t something that we should or can do alone, collaboration and partnerships are really vital for this work.

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Turning to nature for rehabilitation Dr Anita Rose, director of clinical development at Renovo Care, discusses how nature can support physical and psychological wellbeing for adults with acquired brain injury (ABI) or long-term neurological conditions (LTNC) We can all find ourselves in stressful situations during our lifetime. In fact, the whole of humankind has faced challenges and adversity during the recent pandemic. When we are facing crises it is natural to look for refuge, a safe environment, a place of healing. In the narratives of history, we are shown the natural environments of gardens, pastoral landscapes, mountains, meadows and lakes as places of refuge and shelter. These are places we can hide from the distress we may be facing, places to find physical and mental restoration. Two years ago, I was diagnosed with cancer at the same time as my eldest daughter. As you can imagine this was a very stressful and fearful time. A time of asking “who am I?”, “is there hope?”.

IT TOOK CANCER TO BRING THE IMPORTANCE OF CONNECTION AND IMPACT OF NATURE INTO MY THINKING

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It was during this period I was able to access Nature Based Therapy via a local charity set up to help people living with cancer and life limiting conditions using complementary therapies. I recognised through this therapy that being out in nature helped keep me grounded and supported my psychological and physical wellbeing in a way that other medically based therapies didn’t. This experience led me on a journey to explore how we could utilise the natural rhythms and seasons of nature in supporting the healing journey of those with ABI and LTNC. At the beginning of my journey, and being a Neuropsychologist, I did what all psychologists do, went to the research databases. My thought being there must be something there that that will help me understand the connection between nature and wellbeing, something that would explain my experience that I could then use to help my patients. In the 19th Century the Naturalist Henry David Thoreau commented that Humans need “the tonic of wilderness” and John Muir, an activist and conservationist, “Everybody needs beauty as well as bread, places to play in and pray in, where nature may heal and give strength to body and soul” yet there was nothing more of note until the mid-1990s when suddenly there was an explosion of studies. These studies came from many different fields of research

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Being in nature is not only inspiring, it also has medical and psychotherapeutic potential. By experiencing nature, we place our body in the original functional circle made of humans and the environment from which we emerged. We put two matching puzzle pieces together – us and nature into one whole. Clemens G. Arvay (Healing code of nature)

from landscaping and urban planning to environmental psychology all highlighting the effect nature can have on physical and emotional wellbeing. Yet it took cancer to bring the importance of connection and impact of nature into my thinking and I found myself asking why this was. I then took time to reflect on my clinical practice, and as I did I realised that instinctively I had used nature in my work of rehabilitation of people who had suffered an acquired brain injury for many years. Among some of the things I was regularly doing included, working with those who struggled to engage sitting face to face in an office in a talking therapy session suggesting we went out into the hospital gardens. In doing this I would find they were more expressive of their struggles around self-identity following their brain injury and were also more receptive of interventions. I was conducting mindfulness sessions in the hospital grounds as this appeared to support both patients and staff in engaging with self-care. If a patient was very distressed, I would recommend sitting outside and using mindful breathing exercises or just talking them for a walk. We created nature tables in the hospital to show the changes in the seasons, the rhythms of the natural world such as the Solstices in order to orientate patients to the time of year and their

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THERE IS SOMETHING INFINITELY HEALING IN THE REPEATED REFRAINS OF NATURE – THE ASSURANCE THAT DAWN COMES AFTER NIGHT, AND SPRING AFTER WINTER.

surroundings. I used planting herbs in pots to enable patients in low awareness states to experience sensory touch and smells. I instigated and supported gardening clubs within the places I worked. I had even built grass boxes (turf laid into thin wooden boxes and allowed to grow) so that patients in wheelchairs could experience the feeling of grass under their bare feet. Following this reflection, I also found myself asking why it took my cancer diagnosis to bring to mind what I already instinctively knew, the importance of connection and impact of nature on physical and psychological wellbeing of my patients. So back to the question I originally posed, can nature support physical and psychological wellbeing in those with ABI or long-term neurological conditions? Well in my research exploration were very few studies looking at the impact of nature in these populations and what there were all concluded the same thing “it is possible nature can impact but more research is needed”. Looking more generically at research using naturebased interventions the consensus is that using natural environments can promote positive changes in physical and psychological wellbeing. Considering my reflections

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of my personal experience and the anecdotal evidence of my clinical practice, all be it I was not consciously setting out to use nature based interventions, I believe the evidence suggests nature based interventions have the capacity to benefit those with an ABI or LTNC, regardless of severity. So, the journey has started and what are the next steps? Well research will always be an important part of understanding, planning and executing interventions, gaining funds and encouraging others to participate. So, at Renovo Care where I currently work, we are planning a series of small studies to explore what in our natural surrounding we can use to benefit our patients. But more importantly I want to encourage others to recognise our connection to the natural world, to think outside the box (our buildings) and explore the environment around us. How can we bring the sense of hope that the natural world gives us and bring this to our patients (as well as to ourselves) to aid the feeling of a personal sense of hope for the future, whatever that may look like. Afterall, “There is something infinitely healing in the repeated refrains of nature – the assurance that dawn comes after night, and spring after winter.” Racheal Carson

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VR gives new possibilities to brain injury survivors A new VR platform for brain injury rehabilitation has been created by a team of medical professionals, whose commitment to the use of technology in rehab is helping to advance thinking in the area nationally. Brain Recovery Zone provides the resources for brain injury survivors to support their own recovery from an early stage, and increase their capability to manage fatigue, improve speech and mood and stabilise their emotions from their own home. The platform offers a safe virtual space for people to practice the habits that aid recovery in an immersive environment, of which there are 11 to choose from, ranging from the Northern Lights to the Hundred Acre Wood of Winnie the Pooh fame. Mindfulness and meditation experiences are also offered. And alongside the relaxation opportunity, Brain Recovery Zone also provides education through animation, taking survivors on journeys through the brain to explain brain injury and stroke so they can better understand what has happened to them. Brain Recovery Zone has been developed by Dr Abeyomi Salawu, a rehabilitation medicine consultant, and consultant clinical neuropsychologist Dr Katherine Dawson, with support from colleagues in speech and language therapy, occupational therapy and clinical psychology. Dr Salawu and Dr Dawson are both dedicated to the use of technology-led rehabilitation, having seen significant benefits during its use with clients, and believe Brain Recovery Zone has the potential to become the leading platform in brain injury rehabilitation. “Brain Recovery Zone has been created to help give motivation for the practise and habit-building that is so crucial to recovery and our ultimate aim is to keep people engaged and practicing their rehab,” says Dr Dawson. “Virtual Reality can be of real benefit to neurorehabilitation with its immersive and engaging environment that mitigates some of the difficulties experienced during recovery. We are really excited about this avenue of treatment and look forward to seeing its potential to impact more people. “Whilst I think we can all feel a bit invaded by technology at times, there are great benefits in terms of its ability to help us track and monitor our behaviour. Technology

can also provide an element of gamification which can help with achieving small goals, which is often then linked to a feeling of success. “What we see in rehab is if people try things and succeed, they’re more motivated to try them again and this can often lead to an increase in confidence and a growth in someone’s comfort zone – all crucial when adjusting to a new way of life.” The creation of Brain Recovery Zone stemmed from a conversation in the summer of 2019 between Dr Dawson and Dr Salawu about at-home rehab, when they realised the power VR could have in enabling better engagement. “Over the years, I have developed a specific interest in how to support individuals and their families with managing emotional and behavioural changes following injury. I had seen that changes in thinking, and the ability to keep a lid on emotions and behaviour, whilst hidden, can have a major impact on all sorts of areas of someone’s life,” says Dr Dawson. “One day, Yomi and I were sat together in his office talking about how to manage some of the challenges of supporting individuals with brain injury at home. I had just started some research in the NHS into telerehabilitation and ABI, and we were discussing the great potential in linking technology and rehab. Yomi is a great believer in the power of VR in rehab and has been for a long time. “We were talking about a particular client, and I remember saying to Yomi: ‘I wish there was a way I could put a bubble around him so that he can properly switch off to the outside world and actually get some rest. “Yomi replied: ’Well, what about using virtual reality to create that bubble?’. He then introduced me to the VR headset and I fell in love with the immersive impact. And from there came Brain Recovery Zone.” For more information, visit www.brainrecoveryzone.com

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Chase Park expands into dementia care A specialist neurological care provider which has supported people for over 25 years is moving into dementia care with the opening of a dedicated unit on its site.

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Chase Park Neuro Centre has opened The Villa, an 11-bed residential dementia care facility, as the latest phase of investment in its offering to people with neurological conditions from across the North of England. The Villa has been repurposed as a dedicated dementia unit, having previously been a nursing suite on the site in Whickham, near Newcastle, with the first admissions expected in July. Recruitment is ongoing for new dementia care and therapy staff to add to its 90-strong team, with the addition of Paul Smith as Chase Park operations director a particularly significant move in helping to shape its dementia provision. Paul has previously held leadership roles in dementia and mental health for a number of the UK’s main care providers, and also sits on the steering panel of the Royal College of Nursing’s older people’s forum.

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THE WHOLE PREMISE OF CHASE PARK IS THAT WE OFFER BESPOKE, HIGH-QUALITY, PATIENT CENTRED CARE Dr Niraj Brahmabhatt, owner and director of Chase Park, which has 60 neurorehab beds including its new dementia Villa, says the move into dedicated dementia care is the latest phase of progress for the site, with significant investment being made since his acquisition in 2016. “This is a big step for us and our dementia care will be based on the same high quality, bespoke approach we have adopted into our neurorehab. We have our rehabilitation and step-down care, which are very established, and excellent facilities on site, so this is the next phase of our development,” he says. “We decided to convert the bottom floor of an existing nursing suite, which now has 11 bedrooms which are suitable for dementia care. We have had a number of young dementia clients in our service previously, so we are building further on what we can offer in specialist care.

“It feels very homely, with large rooms with wet rooms. Some rooms are traditional and some are more modern. “We have the option of expanding into the upper floor, and may look at that for other categories of care, but for now we are concentrating on the initial 11 dementia beds.” The expansion into dementia care is underpinned by the creation of a specialist team, with Paul Smith’s expertise in the field helping Chase Park to build its reputation. “Paul is a specialist in nursing and dementia care, he has a lot of experience in developing specialist care services, so he has joined us at a very important time,” says Dr Brahmabhatt. “We can now offer young and older dementia care, and have got our management, therapy and care team largely in place. We’ve recruited a number of new staff with some more to come, so we have the facilities, experience and people to support this.” The opening of The Villa adds further to the increasing provision on Chase Park’s site, which enjoys a tranquil setting amidst expansive grounds and Feng Shui Japanese-style gardens. The site’s health club, complete with hydrotherapy pool and beauty and holistic therapies - which are also available to external people, helping to build Chase Park’s reputation at the heart of its community - has recently been supplemented further by the addition of an in-house hairdresser and barber. As well as such wellbeing benefits for its residents, Chase Park continues to add further to its technology provision, with limb-training assistance being introduced into its neurorehabilitation work. While the opening of The Villa could have happened several months ago, Dr Brahmabhatt, working closely with neuro centre manager Jane Webber, decided to

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concentrate fully on supporting their existing residents through the COVID-19 pandemic, rather than admitting new ones. Thanks to their stringent safety measures, introduced in early March 2020 and enforced ever since, Chase Park residents have remained entirely COVID free throughout. “We made a conscious decision to keep our new unit closed during the height of the COVID pandemic, although there was some pressure for us to open to make beds available. But we didn’t feel that was the right thing to do,” says Dr Brahmabhatt. “The whole premise of Chase Park is that we offer bespoke, high-quality, patient centred care, we’re different to other centres out there. There are a number of challenges around being so quality-led, from the pressures of the pandemic through to funding and the scramble for staff. This is where our management and leadership experience comes in, which is so important in helping us to maintain our ethos throughout. “That played a big part in us waiting as long as we have to open. We didn’t want to rush the opening and open all the beds in one go. We tailor our services to the needs of our patients and their families, and if that means doing it slowly and in a more considered way, then so be it. “None of our residents have contracted COVID, so that was the right decision. “All credit has to go to Jane and our team for that, both for their work in ensuring infection control and keeping everyone safe, as well as making sure our residents didn’t feel isolated in the absence of family visits. That was a big challenge and a difficult one to get right, but the whole team deserve a big pat on the back for achieving that.

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“But now, with the vaccination drive in full swing for both our residents and our staff, we thought this was an ideal time to open. “We are now in a position to take referrals and hope to make our first admissions during July. We’re aware there is likely to be a lot of demand and within months we could be full, so we’re concentrating on a ten to 20-mile radius.” With Chase Park now preparing to welcome new residents, the ongoing emergence from the COVID-19 pandemic and associated restrictions is giving a boost to everyone on site with the resumption of visits from families. “This has been important for our clients. We arrange visits mainly in our conservatory and health club, which is working really well, so they can have the time and space alone with their loved ones while being in a part of the building which is accessible without walking through other parts and coming into contact with others,” says Dr Brahmabhatt. “For families of potential dementia care clients, the summer will be a great time to come and see what we have to offer here. We have the Japanese gardens, the pond and our grounds, it doesn’t feel like a traditional nursing home. We will be in a position to welcome people into our gardens and look forward to sharing it with families. “Things are feeling good now, finally. We have the vaccine roll-out, the easing of lockdown, the summer, all coming together at the right time. We really want to continue this feel good factor after what has been a really tough year, and the opening of The Villa will play a big part in that.”

THE VILLA,CHASE PARK NEW exclusive residential villa, caring for individuals or couples living with dementia. At Chase Park, we put people at the heart of our community and strive to create a family unit. Located in an exclusive area of Whickham with a unique setting, we offer a tranquil and supported environment.

OPEN FOR ADMISSIONS www.chasepark.co.uk

0191 691 2568

info@chasepark.co.uk

Chase Park, 8 Millfield Road, Whickham, NE16 4QA

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Robotic pets bring a smile to dementia and Parkinson’s patients Pets have always brought a connection to their owners and one company is making sure elderly neuro patients in the UK don't miss out with their unique robots.

For dementia patients one of the last things to leave their mind is the instinct to look after and nurture something. This is why a lot of these people are seen to be using dolls while in care as the brain instantly recognises this is something that needs to be taken care of. Pets are often something which can satisfy this need, but it is often too much responsibility for those with a neurodegenerative condition. Although it is not a conventional solution, robotic animals are now helping satisfy this urge across the UK. A lot of this is down to Deborah Spratley, founder of Plymouth based company RoboPets who distribute these devices to care homes up and down the country. The soft and cuddly animals have shown their power to transform dementia and Parkinson’s patients quality of life, particularly for those in care. They are more than simply toys however, as they use robotic technology to respond to their carers actions as well as making life-like noises. It gives these patients not only a sense of responsibility but a feeling of empowerment, allowing them to forget about their conditions and feel in control of their lives. Deborah spoke a bit more about the impact RoboPets has had. “The pets completely change a person’s mood,” she said. “One of the last things that leaves a person with dementia is this feeling of nurturing but in theri day to day lives they can't do that, they are the ones being taken care of.

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“By introducing the pets, and some dementia patients will believe they are real, it empowers them as they think they are taking care of and loving something, where normally they are the vulnerable ones. “Even I sometimes forget they’re not real because they respond to you, so when you touch and stroke them it's quite wonderful.” “The response people have from them is great, they’re happy and smiling and some of them just come alive again. I’ve seen this for myself in my local hospital.

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This isn't the most conventional idea when it comes to dementia care and Deborah had to battle with this, spending a long time persuading some professionals of its benefits. She recalls one occasion when she was first stating the company about a trial visit to a local care home who were initially unconvinced of the idea. One resident who suffered from dementia and was often unresponsive was given one of the robotic cats which instantly changed her. She was happy and rejuvenated and made such a connection with the pet that Deborah didn’t have the heart to take it away from her. “In the beginning it was difficult,” Deborah said. “But because of the word of mouth people now know the huge benefits. “Loved ones who buy it for their mother or father in a care home can really show everyone the benefits and now I have people from the NHS buying them.” Now there are a number of care facilities and hospitals around the UK and Europe who have looked past this scepticism and are now using RoboPets to improve a patient's quality of life. The companionship is another big part of why pets are so important for their owners. This feeling of being able to understand and love something that isn't too complicated draws a lot of patients to them and was vitally important for a lot of 33

people who were isolated during the pandemic. For a lot of people it brought some enjoyment to their lives after they had been cut off from their loved ones. It is not only the elderly that RoboPets are helping too. There has been a growing demand to use them for children with special needs and mental health problems, offering a relaxing device that teaches responsibility. There is also a specific model for children called Purrble, which is a small fluffy creature designed to help ease anxiety and stress. It is a family run company, with Deborah’s daughter Kerrie helping with operations and her 88-year-old mother having her own robotic pet. Through its good work the organisation has attracted a lot of media attention, such as starring in a special feature on BBC News which skyrocketed sales. “They showed one of the care homes in Essex we supply,” Deborah said. “That was where it stemmed from and the demand was just phenomenal, every second people were ordering from us. “Prior to the pandemic I was going out to care homes and hospitals on a one-woman mission to promote them and doing exhibitions. “But for that publicity to be there is just tremendous and it's wonderful that more people are aware of RoboPets.” For more information call 07904146849 email deborah@robopets.co.uk www.robopets.co.uk

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‘We can change the reality for so many people’ Through the use of AI-powered technology, BrainQ is set to revolutionise the potential for stroke patients in their recovery from disability and lasting effects of their condition. Deborah Johnson speaks to co-founder and CEO Yotam Drechsler about the life-changing potential of its electromagnetic field therapy In just a few years from now, the potential for stroke patients to reduce and even reverse disabilities could be reality. Through the groundbreaking work of BrainQ, whose AI-powered electromagnetic field therapy is revolutionising traditional recovery prospects, the outcomes for people who have had a stroke could be unrecognisable against today’s reality. Results from its pilot trial are undeniably exciting - after receiving BrainQ therapy, 77 per cent of patients had either no symptoms or minor symptoms, with no significant disability, scoring one or even zero on the modified Rankin Scale (mRS), the gold standard for measuring global disability. Additionally, over 90 per cent of people improved by two or more mRS points through the use of BrainQ’s technology. Crucially, in addition to such impressive statistics on the reversal of disability, the window of opportunity for intervention post-stroke can be extended by BrainQ from hours into weeks. Having been awarded FDA Breakthrough Device status in the United States, a multi-centre pivotal study is now planned, ahead of FDA approval. Under current timescales, BrainQ is aiming to bring its technology to market within the next few years in the

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US, with roll-out across the world, including to the UK, planned for the coming years - and the potential to expand into tackling other neurological conditions also in the planning. While Israeli-based BrainQ is now one of the most eagerly-anticipated launches in neurorehab, its road to this point has been long. Inspired by co-founder and chief innovation officer Dr Yaron Segal’s son Lear, who lives with familial dysautonomia, the creation of BrainQ stems from his father’s determination to find a solution to tackle his condition at its core, not just treat his symptoms. “You need an extra reason to do something against all odds,” says CEO Yotam Drechsler, who co-founded BrainQ with Dr Segal. “Yaron was on a mission to care for his own son, and when you have such a mission, you cannot accept no for an answer. “He has been on an almost 20-year journey, but now we will be able to change the reality for so many people.” Working at the forefront of tech innovation globally, BrainQ’s therapy works by using a cloud-based platform to map brain network activity using machine learning algorithms to extract biological insights that translate into precision therapies.

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The therapies - pioneered by BrainQ’s team of experts in AI, data science, machine learning, neurology and neuroscience - are delivered through a non-invasive wearable medical device that creates a frequency-tuned, lowintensity electromagnetic field. Following the concept and development stage, its work elevated to the next level when BrainQ decided the time was right to take it into the human testing phase, which culminated in its pilot trial for ischemic stroke. “When we opened the envelope and we saw the results, we realised this was a big breakthrough. It was really astonishing, it wasn’t just the potential to expedite recovery, it was two times the effect of the normal course of recovery,” says Yotam. “We realise the potential of the stroke market right now. The vast majority of stroke care within preventative therapies is administered within the first few hours following a stroke. Only about five per cent of patients can receive this treatment, as there is a limited window of opportunity of six hours. “But if you think about it, to recover that damage you need to reverse it, so we set out to do that, as well as to increase the size of the window of opportunity. So instead of talking hours, we aim to make that into weeks. So for us, the six hours and five per cent is now two weeks and a potential of applicability of 40 per cent. “In terms of scale, this is a huge opportunity for people who have had a stroke and for us, and this is the main focus we plan to lead.” Determined to set itself apart from the many other entrants to the market, BrainQ has been eager to put its technology to the test and to independently verify its claims. “With a lot of technology, everything looks good in the first minute but does it really work? The standards are so high to get to the pre-clinical stage, and many will fail to address this,” says Yotam. “The technology may be very much attractive, but that’s not enough. Most technology therapies don’t test to the highest criteria. “BrainQ has got a safety profile, there are no related adverse effects. It is below the threshold for exposure, so the transition from pre-clinical to clinical stage is an easy one from the risk side.

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“It has been designed to the highest standards after so much study, we have worked with some of the very best doctors and drove ourselves hard.” Now, as the business works towards its goal of commercialisation in the US, its gaze is now looking to the future even beyond that, in changing the reality for patients living with other neurological conditions. “Can it be applied on a grander scale? The answer is yes,” says Yotam. “BrainQ believes the technology could be applied to more than stroke, and preliminary indications are that it could be effective in Alzheimer’s, Parkinson’s, MS, spinal cord injury, and TBI. “It gives very different and almost unlimited opportunities in neuro care and we do believe this could solve many of the problems facing these different patient populations, with the ability to do this increasing all the time through our technology.” But the next crucial milestone in the grand plan is the multi-centre trial in the US, which is set for the months ahead. “We are now looking forward to kicking off the study. The plan is to make it to the US market in the coming years, so the main focus right now is with the multi-centre study,” says Yotam.

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INTERVIEW

We don’t We want to want to support and rescue empower veterans them NRTIMES

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For years, Help for Heroes has played a central role in supporting injured service men and women rebuild their lives as they return to civilian society. NR Times speaks to its head of clinical services Carol Betteridge to find out more about its life-changing work When service men and women sustain injuries - whether physical or psychological - frequently a main supporter in their recovery is Help For Heroes. The charity has supported more than 25,000 people to date, including some of those who have sustained some of the most serious, complex and life-changing injuries imaginable in conflict. Currently, the charity is working with 21 of the most critically injured UK service personnel in supporting them to rebuild their lives as people with complex injuries in a civilian world. And enabling them to move on with their lives is what Help For Heroes is committed to achieving, enabling access to the bespoke support and rehabilitation they need to do that. “We work with veterans with injuries of all kinds, including the most serious neurological and complex injuries and amputations,” says Carol Betteridge, head of clinical services at Help For Heroes. “We try and help veterans get back to normality. It’s difficult when you leave service anyway, but with an injury as well, you can lose a lot of confidence and not want to socialise. We want their lives to be the best they can be, although it might not be the life they had planned. “We don’t want to rescue people - we want to enable and empower them, and that’s really important to us, that they are in charge of what happens to them and have the decisions over their goals. That in itself helps. “We’ve got veterans who were injured ten years ago and we’re still supporting them, so we regularly support people for the long term. We’re not here to replace statutory services, or the NHS or someone’s GP, but we can help liaise between them. “It’s a huge difference when coming out of the forces, when you have your housing, medical and dental care all in place - but then you leave and that ends too. “If someone has been very seriously injured, then the MoD might help with housing adaptations or in buying some

specialised equipment, but it’s an ongoing situation, and there may need to be further adaptations later on, or their needs may change - it’s about providing the right support at the right time, and that’s where we come in.” In addition to the complex life-changing physical injury support offered by Help For Heroes, psychological support for veterans is equally important. “Most members of the armed forces have a very robust ethos through their military training which helps them to get through the difficult times, but for some they need more extensive support,” says Carol. “Mental health has always been a very big concern for our veteran community. In some cases, they may have lost friends through the circumstances which caused their injury, and to see your friends lose their lives in circumstances of conflict far from home has a huge psychological impact. “The hidden wounds of our service men and women can be very deep, and we’re absolutely here to support them in dealing with those.” To enable Help4Heroes to support its veterans as best they can, they have established their own in-house case management service, with support from AJ Case Management.

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“We had a team of welfare key workers within Help For Heroes but we realised that veterans were sometimes being bounced around from place to place when seeking external support - so we decided to up-skill our existing welfare workers to work as case managers, so we can help our veterans directly to achieve the outcomes they want,” says Carol. “AJ Case Management were great in helping us to up-skill our team in this way, and we can now work as part of Multi Disciplinary Case Conferences to case manage our veterans’ situations. It was a very good piece of work and one that is making a big difference to us.” As with every charity, Help For Heroes has keenly felt the effects of the pandemic. Online sessions have become the go-to over the past year in place of traditional face to face meetings, and financial resources have been redirected to ensure its frontline support can continue for the veterans who need it. Its Recovery College courses - designed specifically for wounded veterans and families to help them identify their ambitions and gain the confidence, knowledge and understanding to achieve them - have also been taken online, enabling the empowerment they offer to participants to continue unaffected by the pandemic. “The past year has undeniably been difficult but we’ve maintained the support during the pandemic for our veterans who need us,” says Carol. “Every day, five members of the armed forces are medically discharged. Not all of them need our support, but it can be hard to transition into civilian life and if they need our support, we’ll be there. “We’ve mainly adjusted from face to face to virtual meetings, but if we’ve felt it’s needed and there has been consent, then we have done some face to face meetings with all of the necessary safety measures. “The use of virtual technology has helped us to reach the hardest to reach veterans, those who live in the Highlands and Islands and

other very remote places, but for all that technology has been good, it can be hard for people with brain injuries to understand why there can’t be face to face contact, but we’ve done all we can to keep in touch and reassure them. “The Recovery College has been really important during the pandemic and has helped many of our veterans with the self-help techniques around sleep, anxiety and breathing, and many have found it really helpful. If they do that but then need support, then we’d be there for a one-to-one session, but often that was the support they needed to take it forward themselves, now that they knew how to help themselves. “We’ve organised virtual get togethers with groups, so they can still have that social interaction, and they’ve really responded to each other. There’s been some great banter, and that is what has been missed.” As a result of the pandemic, but also to enable Help For Heroes to adopt a more locally-focused approach going forward, the charity is scaling back the use of its centres in favour of support within veterans’ own communities. “The cost of maintaining these centres is really high so we haven’t been using them, we’ve had to redirect our resources to ensure we continued to offer the frontline services which were so badly needed,” says Carol. “We’re doing a lot more home visits, it is important to visit our veterans in their home environment and community, and we’re developing our clinical team to be more community-based. They are both things we’re focusing on at present. “We will try to identify what’s available for them in their own surroundings, rather than getting them to come to centres which could be miles away, and find the local hubs which could provide the support for them. “We’re looking at a blended delivery of meetings and local support, which we hope will work well. The months ahead are being looked at carefully, but what is certain is that our support for those who need us won’t end. We’ll always be there for our veterans.”

INTERVIEW

Achieving outstanding neurorehabilitation outcomes despite the pandemic

When Hayley Trotman walked out of Askham Rehab into her husband’s arms, having been able to move only a couple of her fingers four months earlier after being struck by Guillem-Barre Syndrome (GBS), her recovery marked a huge achievement. NRTIMES

As well as the remarkable progress made by Hayley, who had exceeded all expectations for her progress in that timeframe, her journey also showed what can be possible with specialist rehabilitation, even during the COVID-19 pandemic and its stringent restrictions. While for many patients around the UK and indeed the world, their rehabilitation was paused or delayed, at Askham, if anything, the team’s work with their residents intensified, ensuring that even during some of the most challenging conditions healthcare has ever faced, their recovery was allowed to continue. “The satisfaction of seeing a young mother walking back to her family, after first joining us only being able to move a couple of fingers, was wonderful. I must admit there were tears,” says Sara Neaves, clinical lead and outpatients service manager at Askham. “It was such a struggle for her at first, she had such a severe case of GBS, but progressed so much quicker than any of us imagined. She had all of the disciplines of therapy, plus hydrotherapy and access to the robotics, and because there were no visitors, we had more time for rehab - and we made the very most of that. “To hear her say ‘Thank you’ as she walked into her husband’s arms was truly special. I was one of the first therapists she met at Askham and she asked me to walk her out as she left. That is why we do it, and why so many of our team made so many sacrifices during 42

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the past year - for moments like this, where our residents can go home, knowing we have helped to make that happen.” Hayley, who was with Askham from November 2020 until March this year, is one of many residents who secured hugely positive outcomes during the pandemic, supported by the Askham team. Such was their dedication to the cause that staff routinely went over and above what could be expected - there are stories of nurses sleeping in their office over Christmas, not seeing their own families to help protect the residents who are at the centre of the ‘Askham family’. “I think that speaks volumes about how we work. We are one big family and did everything we could to keep our residents safe while making sure their rehab continued. We have some really vulnerable people here, but we have a real family ethos at Askham and COVID highlighted how important it was for us to work as a community,” says Sara. “Once we decided to lock down in March, probably a week before the official lockdown came, we had to change the way we worked and adapt pretty instantly, so we grabbed it by the horns and just went with it. “Our residents needed us, there were still people having strokes, road traffic collisions, falling down the stairs and having spinal cord injuries - they needed us for rehab so we had to be there. In the absence of their family visiting, we took on those roles too. We have held their hands, wiped away their tears, laughed, chatted. “We have given the physical and emotional support as best we could amidst a huge amount of uncertainty, particularly at first - and while at first some of the changes were hard to get used to, some of them are now really effective and will continue.” While traditionally, residents from each of the units 43

would collectively use the facilities including the gym and hydrotherapy pool, overnight that came to a halt in March 2020 - and while rehab would continue, it would be in a different way. “We had to think outside of the box, so split the gym equipment between the units so each one had its own gym. We also divided the therapy team so they could still carry out their sessions - everyone continued to have access to full rehabilitation and all four disciplines of the therapies throughout the pandemic. There was no cut in provision whatsoever,” says Sara. “The goals and SMART goals they were set all continued. We have some beautiful grounds at Askham, you are surrounded by trees and can hear the wildlife, it is a fantastic setting for recovery, and we made the most of the outdoors how we could. We have installed some gazebos in which we hold some exercise groups, following the COVID rules around distancing, which has increased what we can do even further.” Technology has played a major role for Askham during the pandemic - from the creation of Askham’s dedicated robotics suite, through to the use of video calling, the positive impact has been realised in many aspects of the team’s working practices. “Investing in robotics has been fantastic and is already assisting our outcomes. There is so much research that shows in stroke rehabilitation, it’s all about repetition,

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and robotics delivers that every single time. With human interaction, I might be able to deliver 10 reps, maybe 12, but the robotics will do 300. The impact is amazing,” says Sara. “Technology has been used in so many forms. We invested in a lot of iPads and tablets at the beginning of lockdown, and while we’ve always done ad-hoc photos and videos, suddenly we were doing them all the time and capturing some amazing moments. “We had people taking their first steps post-recovery, saying their first words again, saying ‘I love you’ in a message to their family. It was quite heartbreaking at times, but it’s something we will continue to do even after the pandemic.” “My eyes have been really opened to the benefits of technology. I’ve always been very practical, I’m a bit of a technophobe and as a physio am used to being hands-on with rehab, not sat in front of a computer having meetings. “But suddenly, from doing handovers face to face as we’d always done, we were doing them online. We would have clinical reviews with funders on site, but suddenly they had to be virtual too. It was very strange to adjust to, but with some of the meetings with funders, or even with families, technology plays a big role. “We now have residents from as far afield as Liverpool and Stockport, so to have a virtual meeting can help avoid a seven-hour round trip. Again, that is something we will continue.” And its newly-discovered use of technology has enabled it to support families during the heartbreaking separation from their loved ones. “Visitors could come and go freely before the pandemic, there were no set visiting times, but all of that changed and of course families still wanted to know what was going on. We came up with some ideas for that to continue as best we could,” says Sara. “Usually, families would just stop us in the corridors for a

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chat, but now that was being done by email and phone calls. I recall making weekly update phone calls to families on evenings and weekends, as we’re mindful that they work and have commitments too, so we had to be flexible around that. “It was so important we kept in touch, not just to update them with feedback from the therapy team, but also to find out information about the person, what treatment they’re having, what the plan for discharge might look like. “We had a series of virtual Meet the Therapist sessions, where the same questions a family could ask in the corridor could be discussed, although in a more formal setting, but it was still very good for addressing their questions and having impromptu discussions.” Happily, the Askham Rehab community is now returning to many of the things it missed - the hydrotherapy pool has re-opened, visiting is now allowed again, although the cafe remains closed - with a few changes to be taken from the experiences of the past year. “The sessions in the gym in each unit work really well, so we will continue with those, and I think the experience of the pandemic has brought the nursing and therapy teams closer together. It has enabled us to identify ways of working better together, and we’ll continue to work this way,” says Sara. “There is also absolutely a place for technology, we’ve had to embrace it but now I have learned I can set up a Microsoft Teams meeting and it works! We have got past the ‘scary’ bit of using technology and seen the benefits in communicating with people over distance. “One thing I’m really looking forward to is the return of visiting on site. I like interaction and noise, and our cafe is a great little place, which is open to the public, and does the world’s best cakes. A group of four gentlemen came in regularly and we’d always say hello - I can’t wait to see regular faces come back. It’s the little things you realise you miss. “But while we have had to pause some things, our residents have continued to progress and our rehab has been just as it always has been, and if anything our capacity to deliver it increased. Seeing such great outcomes, like with Hayley and many others, has been probably the biggest silver lining to a really difficult time.” For more information, visit www.askhamrehab.com 44

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SameYou a catalyst for change Tackling the vital issues of the lack of neurorehabilitation provision and the ongoing stig-ma around brain injury, SameYou was founded by globally-famous actor Emilia Clarke to fight the corner and provide a voice for survivors who feel they are forgotten. Deborah Johnson, editor of NR Times, speaks with Emilia’s mum Jenny Clarke, CEO of SameYou, about the charity’s brave campaigning and funding of research which is making waves on a global scale As the CEO of a charity committed to making a difference to the lives of people living with brain injury, as well as being the mother of

a survivor, and a patient herself, Jenny Clarke truly understands the impact of acquired brain injury. In a twist of fate, like her daughter Emilia, Jenny also has two mirror aneurysms in her brain. While Emilia almost died twice, mercifully Jenny did not experience such traumatic illness - yet its impact it still life-changing. “It’s familial, apparently. It was a complete fluke that I found out, really,” says Jenny. “I went for an MRI scan, and they said, ‘You’re fine, but did you know you have two aneurysms?’ It was a shock.

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“So I do understand what it’s like to have that diagnosis, especially after what happened to Emilia.” Emilia’s story is, of course, now well documented. Globally-famous Emilia, best known as Daenerys Targaryen from Game of Thrones, had the first of two brain haemorrhages in 2011, just after she had finished filming season one of the iconic series. The Emmy-nominated actor and her family continue to be indebted to the National Hospital for Neurology and Neuroscience (NHNN) Queen Square in London, which they credit with saving Emilia’s life. Emilia has since become an ambassador for the Royal College of Nursing and Nursing Now, after the hugely positive impact of nursing care during her time in Queen Square; indeed, her relationship with her nurse at NHNN continues to this day. Her second haemorrhage, in a hospital in New York two years later, was caused when a preventative procedure failed. Six years later, in 2019, having been shocked at the lack of focus on brain injury and its seismic impact - and the stigma that continues to persist in speaking out, despite the fact one in three people sustain brain injury during their lives - Emilia took the brave decision to share her story for the first time, to help inspire others who sustain brain injury and are forced to live with its effects. “We realised we had to do something because she has

WE REALISED WE HAD TO DO SOMETHING BECAUSE EMILIA HAS A GLOBAL PLATFORM. IT TOOK A LONG TIME TO TELL HER STORY, IT IS VERY, VERY DIFFICULT TO TALK ABOUT. THERE IS STIGMA AND SHAME ATTACHED TO IT, PEOPLE DON’T KNOW WHAT TO SAY, THERE IS NO COMMON LANGUAGE NRTIMES

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a global platform. It took a long time to tell her story, it is very, very difficult to talk about. There is stigma and shame attached to it, people don’t know what to say, there is no common language,” says Jenny. “Shockingly, brain injury is the biggest problem in the neurological world, it’s bigger than dementia - but who is saying anything about it? “Emilia had no idea (anything was wrong) before her first aneurysm, we had no history of stroke in the family, there was no warning. She was going through this tremendous transition with Game of Thrones when she nearly lost her life. “Then two years later, she came even closer to losing her life when her preventative treatment for her aneurysm went wrong, which I think highlighted how fragile the brain is. But she was lucky, being young and very fit, she survived, and has learnt to manage her residual fatigue, but our family knows how hard it is to cope with the impact of a sudden brain injury. “This whole experience made us realise how very different things could have been.” Committed to changing the situation, Emilia established SameYou, a UK and USA registered charity which tackles the issue of the lack of neurorehabilitation and stressing the need for holistic and ongoing care and support once an ABI survivor leaves hospital. Building on Emilia’s profile and personal experience, alongside Jenny’s expertise in business, the charity is already making waves around the world. With a website - sameyou.org - bustling with signposting information through its UK Neuro Recovery Directory, advice from leading experts and inspirational video content, survivors can find a host of resources on a daily basis, while knowing SameYou is fighting hard on their behalf in the background to bring about change. SameYou is also collaborating with global partners to find and test new treatments, with a number of exciting projects already underway. “With brain injury, you’re the same person inside even if your brain doesn’t let you appear that way. But you’re the same you,” says Jenny. “We decided the biggest gap we could see was in rehabilitation, there is next to nothing. If you’re severely injured, or have a TBI or stroke, then you can get up to 12 weeks of rehabilitation in the UK it’s similar in the States, but resources are so scarce. “The accessibility of neurorehabilitation at the moment is completely inequitable. If you’re lucky enough to be

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referred to Queen Square, then lucky enough to get in, then you have access to this fantastic care - but when you have a brain injury, it does alter the way you live your life. Often, people have no hope and thousands of survivors tell us they feel abandoned. “We want to put all our energy into this to make sure people get access to the resources and support that will help them recover.” The scale of the task ahead is something Jenny and the SameYou team continue to be shocked by but determined to make a positive difference - “We are certainly punching above our weight as a small startup, but believe that partnerships to deliver change will make the most impact on survivors and their families,” says Jenny. “The only positive thing I can say about COVID is this new consciousness is that people are realising hat recovery care is essential. Everyone understands the need for research, and the fantastic advances in acute care, but recovery is not prioritised,” says Jenny. “Successive Governments around the world have ignored it, social services can’t provide it. We want to make as

THE ACCESSIBILITY OF NEUROREHABILITATION AT THE MOMENT IS COMPLETELY INEQUITABLE. WE WANT TO PUT ALL OUR ENERGY INTO THIS TO MAKE SURE PEOPLE GET ACCESS TO THE RESOURCES AND SUPPORT THAT WILL HELP THEM RECOVER.

INTERVIEW

loud a noise as possible to represent the voices of brain injury and stroke survivors and their carers. “When I was a child, my grandmother and aunt had cancer and that was almost shameful - but look at how we regard cancer now. It shows the great strides we have made in that area, and I see that we are at the start of making that change with brain injury. “I do feel that there are so many people who want to make a difference – and who are doing great work, but our impact is reduced without collaboration.” And through such collaboration, SameYou is already making its mark. One area it is particularly passionate about is nursing care and in partnership with the RCN Foundation and the University of Edinburgh has developed the landmark Advanced Practice Neurological Rehabilitation Education Programme, to enable better care for young people recovering from brain injury and stroke. “When the brilliant neurosurgeons have saved your life, you don’t get to see them often and the continuity of care is delivered by nurses. If you have a specialist nurse who combines her clinical experience with care and compassionate that makes all the difference,” says Jenny. “Nurses can give confidence, strength and reassurance. “We still keep in touch with Tina, Emilia’s nurse at Queen Square. If Emilia is in LA, she will phone with any questions she has and get those answers from Tina, which shows the level of bonding and trust. “Through our work, we want to help create holistic rehabilitation, which we describe as being for ‘brain, body and mind’. We aren’t ashamed about using non clinical language because that’s how survivors think about it. “Every person with brain injury wants to be treated as a whole person so motor, cognitive and emotional support is essential for the best possible recovery.” Another initiative is to support and popularise the use of telerehabilitation for brain injury, through its work with N-ROL. Having initially been piloted at UCL, N-ROL aims to reduce social isolation and improve self-efficacy for ongoing post-stroke recovery by providing high quality, group-based online neurorehabilitation to patients denied conventional therapy due to COVID-19. It is now being rolled out into East Lancashire Hospitals NHS Trust, working alongside the University of Central Lancashire. “Technology is so important, and telerehabilitation has to be an essential part of the recovery pathway,” says Jenny. SameYou is partnering with Visionable, a

pioneering healthcare techniology company who are using their advances to improve the stroke and brain injury pathways. “We believe strongly that telerehabilitation gives rehabilitation people would not get otherwise. Hospitals can only see a limited number of patients a year, outpatient rehab numbers are so limited, so we see the role telerehabilitation can play. “Like with UCL, East Lancashire are committed to neurorehabilitation. We funded a pilot there and are trying to find the money to broaden that to other Trusts in their area.” While the pandemic has delayed one of its most eagerly awaited initiatives, the three-year project with Spaulding Hospital in the United States - which explores the interplay between physical, mental and social challenges of brain injury survivors - happily it is now set to get underway. “We recruited the cohort and then COVID came, but the project is now starting,” says Jenny. “We are looking at young adults’ resilience after brain injury, it is biopsychosocial research. One of the lovely things is that a lot of the team are young investigators, brilliant and very qualified to understand the issues.” With great progress already being made for the startup charity, its mission to truly make brain injury more accepted, with more resource channeled into care provision, is one that will only grow. “We have a long way to go,” says Jenny. “With cancer for instance, you can ‘box’ it, whether it’s in the breast or the bowel for example, but when your brain is injured there is the sense that your brain has let all of you down. “When you have a head trauma, people often tell us they think it’s their fault, any sort of brain injury is shockingly sudden and totally unexpected so there is no time to prepare yourself. “With endovascular coiling, which is used to treat an aneurysm, it’s a procedure which I found out uses technology that started 20 years ago. Every minute we’re getting new upgrades and updates on your phone - why not here? “We are a catalyst for change and are convening the most innovative minds in neuroscience, technology and neurorehabilitation to collaborate and put survivors at the heart of change and make a positive change. “That’s what we want to do – play our part in making brain injury recovery better.”

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INSIGHT

WE WANT TO HELP CHANGE PEOPLE’S OUTLOOK ON LIFE. Jane Symonds’ summary of the work of Neurokinex, and its approach to redefining possibilities for people living with paralysis, is a powerful one.

For aside from the work the rehab provider does with patients physically, using techniques to stimulate the whole body rather than only the functional areas, the impact its neuroscience-inspired approach has mentally is possibly even greater. In enabling people who are paralysed to have hope that one day they may walk again or at least make significant gains in their mobility and independence – and being at the cutting edge of developments which could enable this – Neurokinex is inspiring patients from

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well beyond the geographical reach of its centres in Hemel Hempstead, Gatwick and Bristol. Founded in 2013 by Harvey Sihota, now chief executive of Spinal Research who himself lives with spinal cord injury, not-for-profit Neurokinex was born from his extensive research into best practice and latest innovation in spinal cord injury therapies from around the world, to give hope and renewed confidence to those living with paralysis.

INSIGHT

“I think the biggest thing is the difference in outlook,” says Jane, clinical lead physiotherapist at Neurokinex. “Most people who come to us have been injured relatively recently, although some people have lived with paralysis for quite a long time. Some are elderly and we also work with children but whatever their age, the realisation of what they can do and can achieve is huge. “We do have some tears when we see what can be possible, it’s very moving. To see people regaining their confidence during their time with us, so they want to go out again or feel they can return to work or get back to driving, is very special. We want people to live their lives to the full once again.” Progress, particularly in terms of their outlook and expectations, is something the Neurokinex team is committed to supporting people to achieve, says Jane. “The expectations are quite low among people when they first come to us, many of whom have just come out of hospital,” she says. “Hospitals are really cautious in their approach, and don’t want to give false hope, which is understandable – but hope is so important. “Several of our team are used to doing rehab with professional sports players. They take that expectation of what people can do with the right mindset, combine it with the power of encouragement that enables people to achieve, and applied it to what they do here. “I worked in a spinal unit for eight years and found it quite frustrating that when people left, they were considered rehabbed and done. But they weren’t as fit and strong as they could be, their function wasn’t as good as it could be and with the right support they could do so much more. “Often it can be the case that people leave their daily physio in hospital and then face anything up to an 18 week wait for their community provision to begin. “Without the right support, it’s easy for people to go backwards, to lose any progress they had made and put on weight, experience pressure sores, and a whole host of other consequences. It’s very hard to regain what is lost. “But with intervention, they can make great progress. Through working with our team, we can help make gains in their function, strength and endurance, which can have a hugely positive impact on people’s lives.” And as part of its commitment to delivering the very latest innovation to its clients, Neurokinex is part of trials of technology developed by ONWARD, expected

to commercialise as early as 2023, which is set to enable paralysed patients to regain movement. “We’re really hopeful this will make a difference and it is very interesting to be part of this study. We are always looking to what can be done to change the lives and outlooks of people living with paralysis,” says Jane. “Our approach is inspired by what Harvey created here. He constantly surprises us with what he achieves. He is so positive and to him nothing is impossible. That’s what we try to instil in the people we work with.” Whilst striving to offer cost-effective services, part of the not-for-profit enterprise’s work is funded by the Neurokinex Charitable Trust, with fundraising activities helping to sustain its work. One of its key initiatives in accessibility is the Step Up Scheme, which offers six free sessions following NHS referral. “Through the Step Up Scheme, we underwrite the costs of those six sessions as we don’t want anyone to be excluded through cost, and we appreciate it is very hard for those who have to self-fund,” says Jane. “Every year we are growing in numbers, which is fantastic, but we have to work harder to find ways to sustain that. “With COVID, we were very worried about losing the scheme, but we had a big fundraising appeal which lots of our clients got involved with, and that raised over £50,000 which meant we could continue. “Our paediatric area in Gatwick was also created through fundraising. It’s a lovely space which challenges kids while keeping them safe. That was a big project for us but one which is so well used and valued, and we’ll keep on developing what we can offer through generating the means to do that.”

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THERAPY

First-of-its-kind high-tech house empowers brain injury survivors to return home A unique house has been created for people with brain injuries, using the latest in technology innovation to support them in their return to living independently. The Link is a pioneering project designed to bridge the gap between acute medical settings and return home, or to allow for a period of independent living, which uses assistive, smart and strategy technology to enable residents to live autonomously thanks to the ‘hidden’ support within the building. The purpose-built house, in Snodland, Kent, is a unique innovation from BIS Services, which has been meticulously planned for over three years. It offers a solution to people who are set to move back into the community but want to live in somewhere that feels like home during their transition, rather than a multioccupancy unit, while not compromising on levels of support. But while they are able to live independently, they have the benefit of round-the-clock subtle monitoring, with observations of skill, patterns of behaviour, independent motivation and initiation, all of which can be graded and reduced where appropriate, allowing for maximum safety whilst increasing positive outcomes. The Link has also partnered with Cambridge Brain Sciences for frequent delivery of cognitive assessment which is an exciting development in terms of providing evidence of improved functional skills, as well as cognition. In addition to its range of holistic therapy services, including mindfulness therapy, hypnotherapy, art,

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music and horticultural activities, The Link has also established close links with the local Kent community, enabling opportunities for vocational placements and further education courses, to further assess skills and relevant goal setting. The Link builds on the commitment of BIS Services to raise standards in cognitive rehabilitation provision, with it delivering person-centred care to people living with ABI through brain injury, neurological injury and mental health issues throughout the country. Transitional services will be available upon discharge with BIS teams to ensure seamless support packages. “This has been a dream project to work on. It’s a one of a kind which has been in the planning for over three years,” says Eky Popat, operations director at BIS Services. “We’ve put a huge amount of effort into the design of the house, making sure it feels like a home, rather than a clinical environment. Every little corner has been thought of, and the appliances and products are all absolutely what is needed, no stone has been left unturned. “In addition to the design of the house, we carried out a huge amount of research into how we could assess the impact of things like cold calling, internet usage,

procedural learning, and how we can capture that data. That data supports whether a client can live independently, so our decisions are based on evidence and robust assessments. It can be so challenging to manage the unpredictable nature of independent living in other settings, so we have worked hard to factor in how clients learn to deal with real life situations and emergencies. “We want to empower clients so they feel at home here, while also preparing for living independently with the assurance for them and their families that support is there if they need it.” In addition to the acquisition and development of the property, the use of technology marks another significant investment in the creation of The Link. “Brain injury is often called a hidden disability, and the support here is also hidden, we are using the very latest in technology to support our clients in a very modern way,” says Natalie Mackenzie, director at BIS Services. “We have some fantastic appliances throughout the house, which can all be used easily by clients but aren’t so expensive they are completely inaccessible to clients once they return to their own homes - we have made sure they are all affordable innovations which could be used as part of their future needs.

WE WANT TO EMPOWER CLIENTS SO THEY FEEL AT HOME HERE, WHILE ALSO PREPARING FOR LIVING INDEPENDENTLY WITH THE ASSURANCE FOR THEM AND THEIR FAMILIES THAT SUPPORT IS THERE

“We have smart devices throughout the house, including a smart fridge, the contents of which can be viewed while a client is out shopping to see what they need, as well as aiding with expiration, shopping list creation and so on, and a personalised shower system for people with hyper sensitivity or lack of sensation, which has auto shut-off to help with time perception, as well as prompts “We have Alexa throughout the house too, which further helps with prompts and reminders and can then be transferred easily into their own homes once their placement with us comes to an end. It of course works in tandem with the skilled staff that are trained in identifying cognitive deficits and their impact on function. “It’s really cutting-edge and we’ve identified that it’s the little things that often matter the most, it’s a great opportunity for our clients. There is lots more in there as well, including a therapy room and other smart technology focusing on different cognitive domains. When coupled with our company specialism in cognitive rehabilitation, the clients really do have access to highly specialized features. “We’ve supported clients in living independently for over ten years and it’s always a sticking point to find a property that meets the needs of some. They want and need the independence, but don’t want to be in a brain injury unit, so it’s brilliant we have been able to create something like this. We provide independence from the outset, which in turn will increase positive outcomes for the clients long term” And with the successful creation of the first The Link comes plans for a second are underway, with aspirations for even further roll-out. “We’re so happy clients have the opportunity to be part of this, they deserve this opportunity to show their abilities to live independently. They can look back on this time here and be very proud of what they have done. We want to offer it even further through the opening of more houses, that is in the plan.” Further referral information can be found on the BIS Services website www.thebiss.co.uk

IF THEY NEED IT.

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Callum’s Story How live-in care helps Callum is no less an adrenaline junkie today than he was as a teenager. Unfortunately, at age 16, while having fun with friends, Callum fell 30 feet. He sustained injuries including trauma to his head, memory loss and an acquired spinal cord injury. Callum spent the next two years in hospital. Working on his rehabilitation, Callum moved wards. Despite making progress, he didn’t feel truly supported, and this took a toll on his mental health. With his mobility declining and behavior becoming challenging, Callum’s social worker decided to research live-in care. Hope was nearly lost when it became clear many companies weren’t able to support his needs. Thankfully, Callum found hope again.

Agincare were assessed to be the best suited to support Callum. With great care, we matched him with Pawel, his new live-in care worker, who immediately began tailored training and getting to know Callum. Soon, Callum was ready to move back home to begin a new chapter. The move was emotional. Callum sometimes has difficulties processing feelings, but Pawel was there for him; patient, flexible and understanding. We’re proud to say that with Pawel advocating for Callum, he’s gone from strength to strength. Callum now has triumphs under his belt including developing his speech, recovering memories and putting his pen to poetry and art again. His mental health has been improving, too. Callum now can socialise, connect

Contact Agincare now 0808 271 9860 agincare.com/younger-adults

“I have my life back to the best it can be, I can see my friends when I want and my family. I am so happy and want others in my position to have the same level of care I have, and most importantly... hope.” Callum

with his community, and have friends visit with pizza and a few beers – empowered knowing his care worker is always there for encouragement and support. Callum is able to see his young daughter often, and his mother, who wanted an active role in his support, now has exactly that. With live-in care the possibilities are endless. Before lockdown, Callum would attend live rock gigs and visit local pubs and clubs with his care worker; activities that he loved. In his words - “It makes me feel normal.”

Are you looking for support to live life your way? If injury or illness means living life your way isn’t easy, we can support you. IT’S CALLED LIVE-IN CARE It’s an affordable alternative to care homes or home care visits. Live-in care means you have around-the-clock support from the comfort of your home.

WHAT OUR CLIENTS HAVE TO SAY ABOUT OUR SERVICE

98%

I’m treated with politeness and respect –

A PERSONAL APPROACH TO ARRANGING LIVE-IN CARE. Having someone come to live in your home can be a big step, that’s why Agincare takes so much care when matching client and live-in care worker – a process carried out by people, not a computer.

95% 97%

The service has helped improve my quality of life –

97%

Overall I’m satisfied with the service from Agincare –

Data from 2020 Client Satisfaction Survey

I feel comfortable and safe with my care worker –

Agincare looks for hardworking people with a special blend of compassion, reliability and a great sense of humour. All the care workers are English-speaking and enhanced DBS (police) checked. SUPPORT TAILORED TO YOU It can be support with your housework, personal care, socialising, your job or university; your care worker is there to help you. Agincare is experienced in supporting people with acquired brain injuries, acquired spinal cord injuries and more neurological needs.

The person-first approach you see in Callum’s story means we work with you, your medical requirements, and your specific support needs, every step of the way. REGULATED & MANAGED CARE Agincare’s live-in care service is special because we fully manage it. Other live-in care services offer less protection and fewer guarantees for the same price. Agincare employs and pays the care workers, which means we have the duty of care. For example, if your care worker is ill, it’s our job to find someone to replace them. We are fully regulated by the Care Quality Commission, giving you a higher level of protection and peace of mind. In addition to this, we’re always at the end of a phone should you need support. HELPING YOU LIVE LIFE TO THE FULL Our care workers take the time to understand you as an individual. What matters to you matters to us, and our goal is to empower you to live as full, active, and independent a life as possible.

Contact Agincare now 0808 271 9860 agincare.com/younger-adults

THERAPY

Tracheostomy Care: Keeping on the Right Trach To deliver safe and effective tracheostomy care within a neuro rehab setting, discipline, vigilance and communication are all essential elements that must be respected.

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The complex nature of the input that patients with tracheostomies receive exemplifies the importance of planning, organisation and frequent monitoring. If this structure is adopted by the professionals managing these patients, concurrently with the relevant guidance being followed strictly across the whole team, then the risk of potentially fatal outcomes is significantly reduced (Eibling and Roberson, 2012). Getting the basics right can mean that patients have the best opportunities to enjoy a more positive quality of life and work towards their own specific rehab goals. However, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) in their 2014 report, On the Right Trach? A review of the care received by patients who underwent a tracheostomy, found that there were often shortcomings in tracheostomy care across the UK, and the care regularly failed to reach safe standards. A significant part of these failings was found to be due to a lack of training, with 28% of hospitals shown not to be providing sufficient training for staff to deal with blocked and/or displaced tracheostomy tubes (Everitt E 2016a). A common issue with tracheostomies is a build-up of secretions within the inner cannula, which can create sudden or gradual blockages. Blockages may then result in difficulties with breathing, while the continual buildup of secretions can also lead to infection. For reasons such as these, the integrity of the tube needs to be checked at regular intervals and maintained through the necessary interventions.

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Good tracheostomy care depends on monitoring the individual regularly, cleaning and/or replacing the tube as required and suctioning the secretions out. Without appropriate training, as well as regular refreshers and close supervision, staff who care for tracheostomy patients will not meet or retain the required level of competence in these areas. Consequently, this can lead to poor practice, either through a lack of confidence or complacency, resulting in unnecessary errors or complications for the patient.

The Trach at Adderley Green Care Centre Adderley Green Care Centre is a modern, purpose-built, specialist neuro-rehab centre which has been designed specifically to support the needs of individuals who have complex care and rehabilitation needs. The centre is comprised of two buildings, Moorcroft Manor and Gladstone House. Moorcroft Manor provides services for men and women with complex care and/or neurological rehabilitation needs. Peacock unit, within Moorcroft Manor, is the specialist tracheostomy unit. Renjith Eettickal Reghu (Raj), is Therapy Lead/Lead Physiotherapist, at Adderley Green. With more than 15 years’ experience as a qualified physiotherapist, Raj has spent much of his career supporting patients with neurological conditions. His expertise extends to providing respiratory management for those residents who present with complex respiratory conditions including those who require tracheostomies. From 2015, Raj has played a key role in the development and operation of Adderley Green’s first specialist tracheostomy care unit. In the beginning, he created a bespoke training programme for the multi-disciplinary team that works on the unit, so that everyone involved in patient care holds at least the minimum set of competencies to support people with a tracheostomy. A fundamental focus of the training is the importance of checklists and schedules. Raj emphasises the need for a disciplined, meticulous approach; completing the checklists and keeping to schedules is the difference between a well-cared for patient and a patient at risk. In practice, examples include routine examination of the inner cannula to ensure this is clear of secretions and checking the air pressures within the inflatable cuffs, where these are being utilised to reduce the amount of oral secretions entering the patients’ lungs. Beyond

that, routine interventions, in the form of nebulisers and suctioning, must also be carried out, again with the objective of managing the patients’ secretions and respiratory function. All of these components are explained, demonstrated and discussed as part of the training programme, while the skills themselves are assessed by Raj against a competency framework of his own design. Raj says: “Some people can initially react to tracheostomies with concern, tension or anxiety – which is understandable. We’re not used to seeing tubes in the throat area. Plus, there’s lots of equipment and accessories that go with them. It’s such a high-risk area and if you don’t have specific training in how to provide tracheostomy care then it can be a bit daunting. “But actually, once you have knowledge and experience of tracheostomy care then you become desensitised to it. You realise it is all a matter of organisation and discipline. If all elements of care and their checks are done on time and effectively, then you can take something that is quite complex and make it look easy. It takes a lot of training and planning to reduce risks and make a unit run smoothly, but it can be done.”

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THERAPY

In doing so, Raj affirms, both trust and confidence have been built amongst the staff on the unit. Whilst they form the backbone of the input provided on Peacock unit, routine checks and maintenance are not the only focus of Raj’s training. To develop a wider scope of practice within the nursing team, as well as the therapy team, the tracheostomy training also looks at weaning – the process whereby some patients progress towards having their tracheostomy removed. The majority of this work is carried out by the therapy team, through various trials and assessments. However, it remains important for the nursing team to have an understanding of where a patient is in the process, given the potential implications for their everyday care.

Communication in Tracheostomy Care Increased knowledge and experience of tracheostomy care not only improves the patient experience, but also has multiple benefits for colleagues at all levels. In particular, it contributes significantly towards prompting clear and efficient communication. To deliver effective care, team members must fully appreciate the need for detailed communication with each other and the requirement for collaborative working. Raj says: “We’ve seen a big improvement in how our teams communicate with each other. Everyone is aligned in their thinking, they know what needs to be done, how it needs to be done and most crucially, the benefit that this has for the patient. “Clear and effective communication in tracheostomy care is vital because it reduces risks as there is proper patient and tube management. It means all checks are completed on schedule and we run into far fewer difficulties because we are always anticipating and

CLEAR AND EFFECTIVE COMMUNICATION IN TRACHEOSTOMY CARE IS VITAL BECAUSE IT REDUCES RISKS AS THERE IS PROPER PATIENT AND TUBE MANAGEMENT NRTIMES

problem-solving together as a team.” As time has passed, Raj has completed annual audits to record the effectiveness of his training package and has also formulated a dedicated admissions process, which ensures that care planning is specific and patientcentred prior to their arrival. The team at Adderley works closely with their regional NHS commissioning teams and local acute hospital teams who, in turn, demonstrate their confidence in the service with the number of people placed for complex packages of care. Currently, Adderley Green enjoys a CQC rating of Outstanding for Responsive Care, and Good overall.

Patient-centred care Tracheostomies are typically inserted to manage at least one of two core issues; either the respiratory function of the patient is impaired, or they are unable to independently manage their own secretions. In some cases, both may apply following an acquired brain injury. Given the range of backgrounds and aetiologies within the ABI caseload, each person presents with their own uniqueness. As such, each one requires a personalised care plan so that their individual needs are supported in the best possible way, and so that the care team are working towards the most appropriate outcomes for each individual. The patient-centred approach to care can only be delivered by a team of experts working together. On Peacock unit at Adderley Green, Raj supervises a team of dedicated therapists and care staff who together run the unit, look after the patients, and liaise with the wider multidisciplinary team across a variety of external agencies. Raj believes that knowing the service is run with a multidisciplinary approach reassures the referral teams that they are placing patients within a competent organisation. He says: “When a patient joins us at Adderley Green and the referring team know that we specialise in tracheostomy care, it gives them confidence that we can meet the needs of the patient first and foremost. “Peacock itself is a relatively unique unit, given it is based in a community setting. We run our whole unit on the principle of preparation. We carry out our preadmission assessment and subsequently complete a report afterwards, so whenever somebody new joins us we’re immediately able to adjust and adapt to their requirements and ensure they can settle in with us quickly.

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WE TAILOR OUR APPROACH TO CARE TO EACH INDIVIDUAL, AND IT HELPS PROVIDE GOOD CONTINUITY OF CARE - WE ALWAYS HAVE THE EXPERT KNOWLEDGE AND SUPPORT AVAILABLE WHEN THE PATIENT NEEDS IT. “Our extensive internal team, as well as the wider team we maintain contact with, are able to ensure the patient does not encounter any problems if the tube remains in place for an extended period of time. Sometimes patients will require long-term enteral feeding, so we work with an external dietician for regular nutrition assessments and to make sure there are no concerns about dietary intake. “Our philosophy is that our team composition, who our patients see and work with, is flexible and must reflect the patient’s needs. This means that we tailor our approach to care to each individual that we support, and it helps provide good continuity of care - we always have the expert knowledge and support available when the patient needs it.”

Support for the family too As part of the holistic approach to care, the needs of the patients’ families must also be considered. Often, invasive surgical procedures are the result of a traumatic injury or a sudden incident. Consequently, families may not have had time to come to terms with the implications of a tracheostomy and what the long-term impact is for family life and/or relationships. Raj elaborates on how a holistic approach has helped families understand and process what has happened to their loved ones. He says: “Our approach really benefits the family too. Typically, their loved ones have been through a lot – a significant trauma or a long stay in hospital – and the tracheostomy can be new for them too. So the family can often have some anxiety or confusion from not really understanding why the tracheostomy is there and what it is doing.

“We’re able to explain everything to them in more detail and discuss different elements of tracheostomy care with them. Like why we need to do frequent checks and what the benefit is for their loved one. They really appreciate getting the chance to talk this through, and the good thing is that all of our team have received thorough training, at least at a basic level, so if the family have any questions then each staff member on the unit can either respond themselves or refer these questions to the relevant professions, if these are beyond their scope of practice.”

Psychological support and wellbeing Whilst residing at Adderley Green, patients are supported to engage in bespoke person-centred treatment plans and therapeutic intervention. For patients who have a tracheostomy in situ, this can often involve psychological support and intervention specifically focused around the placement of, and procedures related to, the tracheostomy. Plus the implications that this may have around their daily routine and social interactions. Patients are offered access to formal psychological input focused around their own specific concerns, which often involves exploration of low mood or anxiety, and considers concepts such as self-esteem and acceptance. Typically, psychological support sessions related to tracheostomy care will feature some level of psychoeducation, anxiety management, and support for the patient to develop a positive post-illness identity, alongside more formal psychotherapeutic approaches such as Cognitive Behavioural Therapy (CBT). Within the wider MDT, psychological wellbeing is supported continually via the interactions that staff have with the patient and their family. The team draws upon a holistic approach to meet the care needs of the patient, by understanding what is meaningful to them and adapting their approach appropriately. Staff remain vigilant to the needs of the patient and involve the patient and their family within decisions related to any change of care or therapy needs.

References: Eibling D, Roberson D (2012) Managing tracheotomy risk: time to look beyond hospital discharge. Laryngoscope; 122: 1, 23-24. Everitt E (2016a) Tracheostomy 1: caring for patients with a tracheostomy. Nursing Times; 112: 19, 16-20.

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INTERVIEW

When Rolf Zartner was given a slim chance of survival after four strokes, his determination not to be written off - coupled with his background in extreme fitness - saw him begin his punishing rehabilitation while still in his hospital bed. Here, Rolf shares his amazing story of survival, defying expectations and overcoming the biggest challenge of his life

Defying the odds When Rolf Zartner experienced three strokes in March last year, followed by a devastating fourth after lifesaving surgery, he was given - at best - a five per cent chance of survival. But Rolf, a managing director at Deutsche Bank in London and lover of extreme fitness challenges, would not be written off so easily. From the point of him waking from more than three weeks in a coma, he resolved this would not be the reality for him, and began to plan for a future as full as his life was until March 21, 2020. And on March 21 this year - a year to the day that stroke struck - he ran a half-marathon, having pursued a punishing neurorehabilitation and training regime which begun even while he was still in hospital. “I knew they expected me to die, so that made me become very, very determined. I got out of my hospital bed and began to walk around the aisles on the ward, and then over the days and weeks, I started to jog. “I saw the doctor who felt I may not recover. I got out of bed and walked over to him - ‘Don’t write me off, doctor’, I said to him. He was amazed.

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“And from when I got home, my training began again, gradually, but my determination since I woke from my coma has not decreased. “I know doctors say I’m a medical miracle, but for me, it was about setting targets and working towards them.” It was while training for an Iron Man extreme fitness challenge - only shortly after securing a promotion at work - that Rolf sustained the injury that would lead to his strokes. While completing his swimming training in Fuerteventura on March 7, unbeknown to him at that time, he sustained a double artery dissection in his neck. “I swam 4,000 metres and sprinted the last part when my neck made a weird twist,” recalls Rolf. “I was in quite a bit of pain afterwards, particularly in my jaw, but I didn’t pay too much attention to it. The pain became stronger in the two weeks afterwards, so I went to see my GP. “She didn’t recognise anything was seriously wrong, except a muscle spasm, and told me to take ibuprofen. But while I didn’t realise it, the clots had been building up, and that same night, 12 hours later, was when I had my strokes.”

INTERVIEW

Rolf’s wife was the first to know something was terribly wrong, after her husband woke during the night. “She asked what was wrong and I said something, but she asked me to repeat it. I was slurring my words and she couldn’t understand what I was saying,” he recalls. “I was in much more pain and then realised I didn’t have feeling in my left side. She called an ambulance.” Rushed to St George’s Hospital in London from their Twickenham home, it was established that Rolf had experienced three strokes as a result of the dissection two weeks earlier. Having underwent surgery which was to save his life, Rolf then had a further stroke which caused complications through lung and kidney infections, which meant his outlook looked bleak. More than three weeks in a coma and eight weeks in intensive care took its toll on Rolf, to the point where thinking about the future was his only salvation. “I had my surgery two days before the UK went into lockdown and after that time I couldn’t see anyone. I wasn’t able to see my wife and daughter. It was very boring, very difficult being in hospital, and many weeks passed by somehow,” he says. “I woke from my coma like a toddler. I couldn’t do basic things like brush my teeth, it was shocking, my life had been turned upside down. “I didn’t really know what to do, so began to think about getting back to running. I began jogging while still on the hospital ward, but a week after I got home, my training began again. “While I had problems with my left shoulder, arm and hand, and they continue even now, I never had paralysis in my legs - so although it probably looked a bit funny, my ability to run was never hindered by what had happened. “A lot of effort went into my training, it was very important to me that I could do this. I started with 400 metres, then went to one kilometre, then three kilometres, then five, ten and finally the half marathon.” But for Rolf, the accomplishment does not end there, and plans for the next stage of recovery are already in motion with him set to undergo stem cell therapy in Bratislava. “I was getting to the point where I thought ‘Should I stop here? Should I accept the recovery that I have made?’

But that’s not something I want to do,” he says. “From my body point of view, my hand hasn’t recovered although I have done well otherwise, but my brain is my concern. I have a job which needs a lot of brain input, and while I can live with how my hand is, I want to have the best possible chance of processing thoughts and facts. “I am very lucky that I am able financially to have stem cell therapy, so I thought why not? It’s a fact that 99 per cent of people who had an injury like I did are dead and because I survived, I want to do all I can. “I’m not allowed to swim anymore and can’t go to a higher altitude than 4,000m - which means no more mountain climbing, I have climbed Kilimanjaro before my strokes, but that can’t happen now - although that feels a small price to pay for the fact I am alive.” And while Rolf’s phenomenal determination has been key in getting him through the trauma of the past year, he credits the support of those around him as helping him to reach this point. “My wife has been amazing and I could not have got through this without her. She saw me in a coma when I was at the very bottom and has been there all the way,” says Rolf. “The bank have stood by me too, they have displayed role model behaviour. Of course you worry what will happen with your job, how can you afford a life in London if you no longer have that, but they supported me from the start, enabling me to do my job while also having time for therapy. “This past year has been very difficult, of course, but reminds me of how lucky I am in what I have and what I have overcome.” Rolf has been supported in his incredible recovery by the Neuro Rehab Practice, based in Teddington, with consultant neurophysiotherapist Richard Sealy overseeing his therapy sessions.

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CASE STUDY

Successful Launch of a Unique NeuroBall™ TeleRehab Program for Upper Limb Rehabilitation By Jon Graham BA Bsc MSc MCSP HCPC reg, Clinic Director, PhysioFunction, Northampton, UK

Background

The NeuroBall Home Program

The coronavirus pandemic severely impacted rehab therapy for countless clients and therapists worldwide. As was the case at many care delivery sites, PhysioFunction (a private outpatient rehab facility) experienced a significant impact to its business when it had to close during the first lockdown. As a result, clients were given no choice but to stay at home and perform exercises on their own with the remote support of the therapy team.

Neurofenix trained PhysioFunction staff on the NeuroBall and its suite of tablet-based activities and games, and also how to incorporate the device into their TeleRehab sessions. PhysioFunction then offered the new NeuroBall Home Program to their existing and any new clients with upper limb impairment. The NeuroBall device and tablet preloaded with proprietary software were then delivered directly to the client’s home. Neurofenix supported PhysioFunction on the first TeleRehab session using the device. PhysioFunction then arranged regular TeleRehab sessions with their clients where the therapist evaluated progress, provided advice and adapted the program to the client’s needs.

To compliment the remote support and allow their clients to continue having effective therapy at home, PhysioFunction expanded their offering of home use innovative rehabilitation technology devices, including implementing a TeleRehab program using Neurofenix’s NeuroBall™ for clients needing upper limb rehab.

Results Offering this innovative new teletherapy program has benefited both PhysioFunction and its clients: For PhysioFunction: The clinic is now able to offer an additional effective therapy program that can be accessed from the comfort of home. Clients pay for the NeuroBall Home Program, and appreciate its added value compared to phone calls alone, as it helps them develop movements they want to recover. PhysioFunction is able to offer this new program beyond its immediate local community, unlocking a new customer base. Furthermore, – Therapists are able to see more clients in a single day, as there is no need for extensive sanitation between clients; they can move easily from client to client using video-calls. – Therapists working from home can now deliver teletherapy sessions. The NeuroBall Home Program creates a new revenue source, and enables the clinic to differentiate itself from other rehab facilities that do not offer this unique service. The first month of launching the NeuroBall Home Program: – 6 clients subscribed and paid for the use of the NeuroBall at home. – Each client booked 1-2 teletherapy sessions per week, increasing PhysioFunction’s revenue. – New clients from outside the local area accessed remote therapy due to PhysioFunction’s promotional efforts using client testimonials over social media and via its website.

For Clients: PhysioFunction saw strong engagement with NeuroBall; clients enjoyed the activities and games and consistently and frequently performed the exercises independently at home, which helped them work towards their therapeutic goals. Using NeuroBall, clients: – Trained on their own between 2 and 6 days a week; – Trained between 18 to 45 minutes per day; – Engaged with their upper limb 1 to 4 hours more per week vs. simply performing exercises at home alone. Clients reported: – NeuroBall was lightweight, and easy to set up and use; – They enjoyed the wide variety of activities and games; – Using NeuroBall helped to reduce wrist stiffness and improved wrist movement. – NeuroBall helped to increase concentration and enabled more natural arm movements. These results demonstrated that the NeuroBall Home Program is an effective tool to grow clinic revenues, enhance client engagement and further therapeutic goals from the comfort and convenience of the client’s home.

What’s Next As pandemic lockdowns have eased and clients are able to come to the clinic for rehab, PhysioFunction has begun offering a “blended” approach. Clients are able to use NeuroBall in the clinic but can also participate in the NeuroBall Home Program to continue exercising at home. PhysioFunction has found this blended program to be an effective way to extend therapy beyond the clinic, motivate clients and achieve high dose, high repetition therapy.

For More Information on How NeuroBall Can Benefit Your Practice and Your Clients, Contact Us Today: +44 (0) 77 6037 2647 or uk@neurofenix.com

The NeuroBall Home Program was a huge benefit to the clinic and our therapists during this difficult time. Moreover, the NeuroBall program has been popular with clients. Even after restrictions are lifted, I know we will continue offering this program. Claire Everett BSc MCSP HCPC reg, Clinical Operations Manager and Senior Neurological Physiotherapist at PhysioFunction

INSIGHT

Taking the stigma out of talking about sex In a groundbreaking move for the care sector, Exemplar Health Care has designed training for its team around sexuality, intimacy and friendships in care homes. NR Times learns more about the industryleading initiative and the benefits it will deliver to residents

“We are all sexual beings – we all want to be loved and we all crave intimacy at times. And that shouldn’t be any different for people who live in care homes.” Such a powerful statement typifies Exemplar Health Care’s bold attitude to tackling head-on what has long been widely considered a ‘taboo’ subject. The issue of sex and sexuality in care homes is something that is rarely discussed, even within care home settings, but determined to make a difference to this and bring greater empowerment to their residents, Exemplar Health Care decided to lead the change. Now, after many months in the planning, Exemplar Health Care is rolling out its specially-created training programme across its 3,000-strong team and 34 care homes, devised in collaboration with disability charity Enhance the UK, to enable its staff to discuss such topics with residents with confidence, fully aware of what is safe and legal. “It isn’t just about sexual relationships, it’s also about platonic relationships,” continues Julie Booth, head of quality at Exemplar Health Care. “We all have friends and people that we like to be with and interact with, and we want to give the people who live with us the same opportunities. “At Exemplar Health Care, life is all about choice. We want to encourage and support people to feel comfortable and confident expressing their sexuality and sexual needs as they wish, and in seeking and exploring

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relationships of all kinds, in a way that promotes their choice and dignity, and ensures their safety.” The project traces its roots back to 2019, when Exemplar Health Care worked alongside Leeds University to research the topic. “We were looking overall at our service user’s needs, and realised we weren’t addressing some things as much as we should, and thought there may well be some unmet needs,” says Julie. “We mainly support young adults, and apart from the tick-box questions on the admission form, we found that we didn’t consistently ask them about some more personal aspects, such as sexuality, and how that might impact on their life. “We didn’t feel we could complete such impartial research, so asked the University to look at this for us.” The research study’s remit was to understand the extent to which people’s needs were being met around personal relationships, intimacy and sexual expression. The results suggested that many people who live in care homes thought that they weren’t allowed personal relationships, and how much people want a friend who was there through choice rather than because it was their job. The extent of low self-esteem as a result of disability was also laid bare, with one participant asking: ’Why would anyone want to be with me?’ “Some of the comments were really poignant and it was quite clear they felt they were missing out on some aspects of life,” says Julie. 64

INSIGHT

“We wanted to do something about this. For too long, these subjects haven’t been talked about, but if they are then people aren’t equipped to have these conversations so they can get shut down quite quickly. “We wanted to help give people the confidence to explore these topics and talk about their feelings and needs.” Working alongside Enhance the UK, the project was also a first for the charity, who had never before designed training for use in care homes. User-led Enhance the UK is committed to changing the way people view disability, and through its #UndressingDisability campaign, which aims to normalise sex and disability, they work with care home colleagues to give them the ‘know-how’ so that disabled people can exercise their right of sexual expression in a safe and legal way. Enhance the UK reports: “Disability can have a profound impact on your sex life, on the way you do it, and also the amount you have it. There are so many barriers facing disabled people who want to have an active sex life; self-confidence, self-esteem, finding a partner and overcoming physical and emotional barriers. “In fact, all those same barriers apply to anyone wanting an active sex life. The difference however for disabled people is that no one seems to want to talk about sex and disability.” The Exemplar Health Care training, which is being implemented across the group in a ‘train the trainer’ approach, is mid-way through its roll-out and already feedback is proving positive. “We’re proud to be offering this training. We know that some people find these conversations uncomfortable and difficult, which is why we have a team of clinical experts who are committed to supporting the programme and ensuring that we make real change for the people we support,” says Julie.

WE ARE ALL SEXUAL BEINGS – WE ALL WANT TO BE LOVED AND WE ALL CRAVE

“The whole idea is to start conversations and change people’s thinking around friendships, sexuality and disability. “We complete a feedback form at the end of each session, looking at what they had in mind at the start and did their opinions change. A lot of people admit they thought it would be about sex and nothing else, but there is so much more to this than sex. “For some residents it will be about sex, for others it is feeling attractive, making friends and acquaintances. “We’re already seeing that people are thinking a lot more about the subject. There is a lot of misinformation about the law for example, what people can do legally and what are the boundaries, so we’re helping with that awareness too, as well as the mindset. “We hope to embed this culture across the whole operation, in our recruitment, induction and supervision process.” As well as engagement with the 3,000 care staff, Exemplar Health Care is also helping to liaise with residents’ families on the topic. “Some family members may not be open to these ideas, but we have a lot of resources available to them to better explain the training and why we’re doing it,” says Julie. “Sometimes we have to bridge the gap between the resident and their family, as their wishes may be very different to what their family wants. “The consultations we have with our residents are confidential and very personal to them, and what we put in their care plans is done in collaboration with that person. They may not want their family or anyone else to know certain things, they may not want intimate information being seen by agency nurses, so we are guided by them. “Their privacy, and what privacy means to them, is so important. No matter how much we do, how much training we have, they are never going to have the same levels of privacy and dignity that they’d have at home. These are things we take for granted, but things they have lost. “With our training, and the change we hope to make as a result of that, we are trying to encourage a wellrounded look at the topics of sex, sexuality, intimacy and friendship - we’re not just going to ignore it.” Exemplar Health Care has 34 care homes across Yorkshire, the Midlands, North East and North West that provide specialist nursing care for adults living with complex and high acuity needs. For information, visit www.exemplarhc.com

INTIMACY AT TIMES

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THERAPY

The role of Arts Therapies in young people with Autism By Lucy Collings Pettit, Neurologic Music Therapist, Chroma

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THERAPY

For young people with an autism spectrum condition, the arts therapies (music therapy, art therapy and dramatherapy) can play a significant role in enabling them to express themselves.

In the earlier years, arts therapists will often focus on working with the core characteristics of the child’s condition, for example social communication, interaction and imagination. This can involve group therapy input in the school setting, with this type of intervention encouraging important social skills such as turn-taking, sharing, waiting and listening, and positive peer relationships. In working on an individual basis, an arts therapist will typically focus on a child’s non-verbal communication; this might involve intensive interaction and play-based interactions. There tends to be a pattern of need for young people with autism. As children get older, and adolescence sets in, pupils tend to start requiring more specialist therapy input in direct response to the emotional needs that often emerge at this time—typically, this might be a result of increased levels of change and transition—on educational, physical, social and emotional levels—leading to higher levels of anxiety and often limited means through which to express and manage their feelings in a positive way due to characteristics of their condition. Teenagers in general experience innumerable mood swings during puberty and young people with an autism spectrum condition are no exception—except they struggle further to express their emotions and, as a result, frustrations tend to grow and incidences of aggressive behaviour towards themselves or others may increase. This is where music therapy, art therapy and drama therapy can be implemented as accessible and valuable forms of psychological therapy. With so many emotions to explore and express, it is important to help young people to regulate their emotions and to be able to co-regulate in a safe space.

All arts therapies serve to help young people express, explore and better manage their emotions, allowing them to process their thoughts, feelings, experiences and relationships—effectively, providing them with a voice and a means of working in a therapy context— often in the absence of words. Different mediums can be used to help a young person with autism express themselves— such as image making, painting and role play. It is about using different art forms to enable young people to express themselves effectively, helping them to relieve their frustrations and anxieties, and make sense of how they are feeling. Importantly, this is achieved within the safety of a therapeutic relationship—with a highly trained arts therapist. Techniques that worked in the early years may not be suitable in adolescence, therefore interventions must be age-appropriate to be effective. The use of songwriting in music therapy is a great way to help young people structure feelings and make sense of the world around them, including their peers and relationships with others. It can also be a helpful way of addressing transitions during adolescence. Other young people may respond positively in art therapy sessions while some find expressing themselves through role play or small world play better helps them express and gain insight into their emotions. Arts therapists will always strive to adopt the best intervention for each individual child to help support their mental wellbeing effectively. It is all about the individual child. Arts therapies are always personcentred; whether in group or individual therapy, every child can benefit from a tailored therapy experience. For more information visit www.wearechroma.co.uk

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THERAPY

An ongoing expansion into specialist neurorehab Introducing Cygnet Health Care into the Neurological Rehabilitation sector has been an exciting journey over the last 3 years. Cygnet Health Care has long been recognised as offering a wide range of services for individuals experiencing a variety of mental health conditions. However what has not been so widely known is that since 2012 Cygnet has also offered a clinically led evidence based neuropsychiatric rehabilitation pathway provided by dedicated and experienced interdisciplinary teams. Cygnet offers those individuals presenting with behaviours that challenge as a result of an Acquired Brain Injury a safe place to aid recovery, in addition to offering a caring and supportive placement to help manage the progression of the more behaviourally challenging symptoms which some Neurodegenerative conditions can cause. Quietly establishing a number of sites across the country, Cygnet Health Care Neuropsychiatry services have provided a vital role within the neurorehabilitation pathway nationally. Originally under the name of Cambian, the first eight bedded service, The Lodge, was launched on the outskirts of Nottingham to great success. Its sister service the Grange opened a couple of years later providing a further 8 beds in the locality. Based on the successful outcomes achieved by those first service users came the inception of Cygnet Heathers - a 20 bedded service in West Bromwich. Struggling to find suitable and appropriate transitional services for those achieving their goals in the hospital setting

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drove the plans to develop Meadows Mews. This 10 bedded transitional service allows service users to firmly consolidate their new skills within the heart of the community, where participation in both social and domestic activities is vital for their quality of life, and long term future in the community. Residents at Meadows Mews continue to receive neuropsychiatric, psychological, occupational therapy and support worker interventions as required. Now rated by the Headway accreditation scheme, both Heathers (Outstanding) and Meadows Mews (Good) have established themselves firmly within the West Midlands Neurorehabilitation pathway. 2017 saw the development of Cygnet Brunel – a 32 bedded service in the heart of Bristol. The largest of the services Cygnet offers to support those requiring Neuropsychiatric Rehabilitation. Its establishment within the South West has provided a range of pathways open to service users requiring this specialised treatment. Now the NHSE Level 1 provider of Neuropsychiatric treatment for the South West, Brunel continues to expand its staff skill set to support those who need access to Neuropsychiatric rehabilitation within a matter

QUIETLY ESTABLISHING A NUMBER OF SITES ACROSS THE COUNTRY, CYGNET HEALTH CARE NEUROPSYCHIATRY SERVICES HAVE PROVIDED A VITAL ROLE WITHIN THE NEUROREHABILITATION PATHWAY NATIONALLY. 68

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POSITIVE BEHAVIOUR GOALS ARE FOCUSED ON DISCHARGE PLANNING TO SUPPORT SERVICE USERS TO RETURN TO COMMUNITY LIVING – EITHER WITH SUPPORT OR INDEPENDENTLY. of weeks of sustaining their neurological insult or injury. Four individual units within Brunel allow the service to offer specialised pathways within its walls; providing the flexibility of environment and staffing skill set to meet the varied and complex individual needs of all its service users. The latest addition to this pathway mix is the opening of a 6 bedded unit offering slow stream community rehabilitation – for those service users whose vulnerability and/or risks are just not quite at the point of supporting a successful discharge into the community, but who can explore all that independent living can offer, with carefully directed support and encouragement. An amazing space where quite often you find most of the service users out and about for most of the day. A great stepping stone to maximise successful discharges and something that offers a solution for those not quite ready to go to a community based transitional service. Not leaving the North of the country out, Cygnet embarked on developing services in the North East. February 2019 saw the opening of Cygnet St William’s providing a 12 bedded service located in Darlington. Small but perfectly formed this service has gone from strength to strength and suits those individuals who need a lower stimulus environment that’s based in the heart of the community. 69

Cygnet Pindar House located in Barnsley saw Cygnet Neuropsychiatry services launch in the heart of Yorkshire in February 2020. This purpose built 22 bedded hospital has the same focus; to create a therapeutic rich environment which engages our service users and offers them the opportunity to minimise their challenging behaviour and maximise their independence. All these services are for men only; until we opened Cygnet Newham House in July 2020. Located in Middlesbrough this purpose built service is based in the community offering 12 hospital beds and 8 transitional beds for females. A fabulous space that offers flexibility and a unique environment for women requiring Neuropsychiatric rehabilitation. What all services have in common is that they offer a wide range of activities and facilities to promote independent function; working with dedicated and experienced staff and clinicians. Positive behaviour goals are focused on discharge planning to support service users to return to community living – either with support or independently. Our services are able to accept individuals with complex physical health needs and all have en-suite bedrooms with some providing more accessible facilities for those with mobility impairments. Specific treatment pathways include: • Inpatient Neuropsychiatric assessment and treatment programmes offering both active goal focussed neurorehabilitation and slow stream neurobehavioural rehabilitation/longer term symptom management. • Fixed term inpatient bespoke assessment/review of behaviour management and Neuropsychiatric presentations. Interdisciplinary teams consisting of neuropsychiatry, psychiatry, psychology, occupational therapy, speech and language therapy, physiotherapy, nursing, therapy co-ordinators and support workers provide our inpatient

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THERAPY

neurorehabilitation assessment and treatment programmes. These teams are employed by Cygnet directly working collaboratively and ingeniously to develop bespoke programmes for our service users to adopt and make their own. A key focus for Cygnet Neuropsychiatry services as a whole is to embed the best of practice into daily treatment and support, and to ensure we never become so insular that we cannot support the wider initiatives within the world of Neurorehabilitation. We work hard as wider team to benchmark our service user outcomes with other services, look to organisations like the Independent Neurorehabilitation Providers Alliance to help us set high standards of service delivery whilst working with Headway to achieve an independent review of the programmes and environments we offer. Our national Cygnet Neuropsychiatry Steering Group shares best practice, determines quality standards whilst integrating national developments within the sector to our model of care and staff development programmes. Cygnet Neuropsychiatry invests back into the sector with partnerships developed with both UKABIF and Headway which we feel is vital to support the work that goes on to embed neurorehabilitation into the heart of the treatment pathways offered to those affected by brain injuries and other neurological insults. Cygnet sponsored the Time for Change report brilliantly developed through the All Party Parliamentary Group for ABI in collaboration with UKABIF. Key to this is to also ensure families and carers are involved and made aware of how a individual's brain injury may affect them in the longer term, which was a major part of the recommendations formed in this report. The Time for Change report and associated meetings and publicity also provided a voice for those who are not always heard by Ministers and MPs and the championing of its production was fully embraced by the Chair of the

APPG for ABI, Chris Bryant, who utilised this time to raise key issues across health, social care and welfare all of which affect people living with an ABI in the UK. It was key to us as an organisation dedicated to providing the best possible treatment and care to maximise individual's quality of life and recovery, that we assist in raising awareness of acquired brain injuries and seek improvements in support and services for those directly affected by an ABI through this vital sponsorship. Ensuring all our developed services are assessed and accredited with both INPA and Headway is the goal for 2021/22. It’s important that we are able to continue to learn and develop our own services and staff, collaborate with our service users and ensure that we showcase how Neuropsychiatry is delivered and what amazing outcomes our services users are able to achieve whilst they are with us. For more information please visit www.cygnethealth.co.uk/services/neuropsychiatric/ or contact Rachael Chamberlain (Business Development Director) on 07872 401048, rachaelchamberlain@cygnethealth.co.uk or rachael.chamberlain@nhs.net

A KEY FOCUS FOR CYGNET NEUROPSYCHIATRY SERVICES AS A WHOLE IS TO EMBED THE BEST OF PRACTICE INTO DAILY TREATMENT AND SUPPORT NRTIMES

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INTERVIEW

Craig Hospitalsetting global standards in neurorehabilitation With a global reputation for its work in brain and spinal cord injury rehabilitation, Craig Hospital has delivered life-changing outcomes for thousands of patients for 65 years. Deborah Johnson meets Dr. Jandel Allen-Davis, CEO of the pioneering US hospital, to learn more about its work With an unrelenting focus on rehabilitation, underpinned by world-leading technology and led by a team who pride themselves on being by their patients’ sides every step of the way, Craig Hospital has built a global reputation for its work. Having offered neurorehabilitation since 1956, supporting over 34,500 brain and spinal cord injury patients during that time, Craig is known the world over for its pioneering and brave programmes which empower patients and maximise their independence. From its base in Denver, Colorado, Craig attracts patients from across the United States - and often internationally, too - with its ‘Craig graduates’ routinely building a lifelong affection with the hospital and its team, forever indebted to the life-changing impact they have made. Led by Dr Jandel Allen-Davis, who became CEO of Craig in 2018, Craig’s reputation for pushing the boundaries of possibility for its patients through intensive rehabilitation is one she is committed to taking forward even further. “We work hard, we’re healing bodies, minds and spirits,” Jandel tells NR Times.

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“The people we care for woke up with one reality and went to bed with a very different one - but there is life after brain injury or spinal cord injury, and we will show them that is possible. “The interesting thing about Craig is that typically in United States acute rehab, you’ll get two or three hours a day (of rehabilitation). Here at Craig, it’s between four and six, and it’s usually six. “The day generally starts at 9 and ends at 4, and that hard work could be physical for brain injury and spinal cord injury patients, or cognitive for brain injury patients. “We only have 93 beds, so it’s a precious resource and there is way more demand than we have beds. “They have got to come here ready to work. On the first day here, we’ll get them fitted for a wheelchair if that’s needed, we start work on day one and work hard from there.” But the concept of hard work is something welcomed by Craig patients, with the outcomes of countless Craig graduates showing what can be possible for those living with brain and spinal cord injury. “We achieve stellar outcomes,” says Jandel. 72

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“In 2020, 82 per cent of our patients were discharged to their homes, and about 48 per cent of our SCI and BI patients returned to work or school within one year after discharge. “Our patients require significantly fewer hours of daily attendant care than those who don’t come here - we strive for independence. “I love it when I hear patients say ‘I do what I used to do, but now I do it differently’. Often they say they wouldn’t go back to their life before their injury - and often that’s because they have discovered new resilience and determination in themselves they had no idea existed. “It’s pretty remarkable and shows us every day there is life on the other side of spinal cord injury and brain injury, a good life.” With therapy programmes devised around the exact needs of each patient, Craig’s use of technology and equipment - partly funded by the “magical generosity” of donors through its associated Craig Foundation - is genuinely world-leading. Its work in transcutaneous electrical stimulation for spinal cord patients in particular is globally significant, having begun in pilot in 2019, and is now helping people 73

to regain the power of movement. “We are helping people to get their function and movement back, even years after injury, it is really amazing,” says Jandel. “But the physician in me totally believes and knows that technology is like a scalpel and pills, they are tools, enablers, not the be all and end all. “We start with the basics and then look at how technology can advance their rehab. It’s a holistic approach, of which technology is a part.” But the part technology plays is without doubt a key component in Craig’s offering - from exoskeletons to EyeGaze, VR to robotics, as well as gaming which proves especially popular in its Teen Rehab groups. And through its work in research and paving the way for new innovation, the potential for its patients - both current and future - is increasing all the time. “We have the most amazing equipment, there are some really cool things,” says Jandel. “It starts here at Craig where we have the most highlyskilled therapists who understand neuroscience and body mechanics, we’re learning more about neuroplasticity and the ability to regenerate. We have things being created on 3D printers by our therapists which can support people in living independently. “Human ingenuity and the quest for innovation will never be complete, and that thirst will never be quenched, thank God. “Neurorecovery is a big frontier in an exciting way, in the way that brain plasticity can recover, and neuroregeneration through spinal cord injury transplant

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INTERVIEW

I LOVE IT WHEN I HEAR PATIENTS SAY ‘I DO WHAT I USED TO DO, BUT NOW I DO IT DIFFERENTLY’. OFTEN THEY SAY THEY WOULDN’T GO BACK TO THEIR LIFE BEFORE THEIR INJURY - AND OFTEN THAT’S BECAUSE THEY HAVE DISCOVERED NEW RESILIENCE AND DETERMINATION IN THEMSELVES THEY HAD NO IDEA EXISTED. NRTIMES

of tissue - these things are super new, the data is not yet solid, but the cool thing is that as we have a research unit at Craig, we stay in the game all the way.” But for Jandel, while technology and therapy are of course fundamental in Craig’s offering, the factor that underpins its reputation, outcomes and work is the dedication of its team. “This place is so unique. I’ve never worked in a place which lives and breathes patient and family-centred care like this. A lot of places talk about it, but this is truly standout - and I can say this with 40-plus years in healthcare,” says Jandel, whose background is in obstetrics and gynaecology, and admits a move into neurorehabilitation was “completely off the beaten path”. “It’s team-based care. We have psychologists, PT, OT, speech and language and the ‘angels’ who are the clinical care managers. “I’ll have been at Craig for three years in October and it still feels new. I think that speaks volumes about what a difference it makes to bring your whole self to work, with team mates who bring their whole selves to work. It is a privilege and an honour to serve at Craig. “From the folks in the environmental services team, through to the frontline caregivers, everyone gives their all. Some of the leadership team have been here for 30plus years, they are Craig veterans, and everyone plays their role.” Leading from the front, Jandel is often to be found walking the floors at Craig, getting to know patients and their families and discovering the impact her team’s work is having on their lives. “I love walking the floors and talking to patients, they gush about this place and the relief that washes over them when they come here,” says Jandel. “We hear from families what a wonderful place this is, 74

INTERVIEW

and I say ‘It was like this when I got here’. “It’s not just about the patient; as with brain injury and spinal cord injury, they are probably going to need an attendant to help them. So we deliver family-centred care. “The patient and family are at the centre of a myriad of services and people that surround that patient, and we customise a care delivery programme. “When I’m walking around, I joke to patients ‘Did we beat you up today?’ They say we have and I say ‘Well, our work is done’. “Craig graduates always come back, many come to get their ‘tune ups’, get their wheelchair checked, and so on. But we offer lifelong care and support for patients and their families, so we do hope they will come back.” As a hospital working at the forefront of neurorehabilitation, but with only 93 beds, Craig is a great believer in the power of empowering people in their own homes and communities, with the COVID-19 pandemic highlighting the importance of enabling that. “I’m interested in what potential lies ahead for distanced medicine,” says Jandel. “With people living longer, we have to think about delivering care for everyone, it’s less about the ages and

stages. As an example, spinal cord injury patients do age more quickly, and there are parts that telehealth can enable. “Home health needs a huge lift, people live in tiny communities - how do they access the support and neurorehabilitation they need? This is where their life happens so it’s more natural for people if they can do this where they live. “If we can figure out how that works, then do we need to add a whole ton of new beds? We have to think about these sorts of things. The economics of it would enable us to lessen the burden on resources, while enabling people to be more independent. “Rehab is always going to be part of the deal, so we need to do the right things.” While Craig’s work continues to develop, with ongoing innovation and progress for its patients made by the day, it will continue to hold its place as one of the world’s leading neurorehab centres. But for Jandel, the ultimate dream is that no patients would need to access such a place, and that prevention could get to such a stage that such intensive neurorehabilitation would not be needed. “The big dream is that we wouldn’t need a place like this,” she says. “Nobody wakes up in a morning and says ‘I want to go to Craig’. “We’re in a space now where we’re thinking more about prevention, how to prevent sports injuries, workplace injuries. I think it’s so important to use our voice in the prevention space, alongside the work we’re doing now in treating.”

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TECHNOLOGY

Redefining dementia detection In the ongoing battle against dementia, pre-dementia symptoms can now be detected more quickly and cost-efficiently than ever before through the development of AI-led technology. NR Times speaks to Dr Sina Habibi, CEO of Cognetivity, about their groundbreaking work and how the pandemic has helped in the acceptance of remote-use technology Through the development of pioneering AI-led technology has come the power to reinvent dementia detection. Following years of R&D, successful clinical trials and medical approval, Cognetivity Neurosciences is now being used in both primary and secondary care to find pre-dementia symptoms through a simple test in a quicker time and at a lower cost than ever before. With its non-invasive, low risk tech system able to be used by patients remotely, as well as in a healthcare

UP TO HALF OF DEMENTIAS CAN BE PREVENTED THROUGH LIFESTYLE FACTORS. IT IS VERY EXPENSIVE FOR HEALTHCARE TO DEAL WITH THIS, BUT WE ARE WELL POSITIONED TO PLAY A ROLE IN TACKLING THIS BY DETECTING EARLIER AND ENABLING A HEALTHIER LIFESTYLE. NRTIMES

setting, Cognetivity is also helping to pave the way towards a digital future for healthcare, which has become much more widely accepted during the COVID-19 pandemic. Broadly, its technology works by showing a patient a series of pictures, to which they have to respond as quickly and accurately as possible whether they have seen a prespecified image category. AI algorithms then cluster test performance in terms of accuracy, speed and image properties, giving rapid and highly accurate results. The information can then prove crucial in determining next steps for patients, securing better outcomes, saving significant sums of money in care and examination costs, and offering “queue-busting functionality” in cutting waiting times and removing the need for potentially unnecessary appointments. Cognetivity, founded in 2013, is pioneered by founders Dr Sina Habiba and Dr Seyed-Mahdi Khaligh-Razavi. Combining their expertise and Cambridge PhDs in engineering and cognition and brain sciences respectively, the concept of Cognetivity was born through the discovery of a break-through idea from Dr Khaligh-Razavi’s research. “We started with a solution and then looked for the problem,” says Dr Habiba, CEO of Cognetivity. “In human vision, the eyes work like a camera and the brain makes sense of what happens. But he realised the ability to process visual information drops in time, as you get older it takes longer. They were very interesting observations, so thought let’s put this hypothesis to the test. 76

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“We wrote the code and put it in front of friends aged between 18 and 35, and we saw correlation between age and performance in the test. “We knew there was something in this and we had a very accurate means of assessing cognitive ability. “There is a huge problem with dementia detection. Half of people would not receive a formal diagnosis, so it is a major risk factor. “We went about collecting a lot of clinical data, but it was a bit of a chicken and egg situation - you need data to validate your solution, but without a validated solution you can’t collect data.” From the origins of Cognetivity in 2013, several years of validating the technology through clinical trials followed, with the team’s painstaking efforts leading to medical approval from regulators in 2019. Through the onset of COVID-19, research into the unassisted remote use of the technology by patients was delayed and is still ongoing, but it is very much in use in NHS primary and secondary care settings. In primary care, the setting Cognetivity believes holds most potential, it has been adopted by Sunderland GP Alliance, a federation of 35 practices in the North East of England. It is also being used by North Staffordshire Combined Healthcare NHS Trust, a specialist mental health trust. “Our technology is very much tailored to primary care use, this is where we see it being most effective. It can be five to ten times faster than other technology available, and five to ten times cheaper. It does both of these things while also being more accurate, saving GPs time in the process,” says Dr Habiba. “Historically, MCI patients have been abandoned because right now there is nothing to be done for them. In the absence of any treatment, lifestyle plays an important role and can delay the onset of symptoms, if applied at earlier stages of the disease progression. “Up to half of dementias can be prevented through lifestyle factors. It is very expensive for healthcare to deal with this, but we are well positioned to play a role in tackling this by detecting earlier and enabling a healthier lifestyle. “In secondary care, patients come in with a referral letter and we can use our technology to triage. It is much more accurate than the pen and paper tests. To be fully assessed is a long and expensive process, so we can help determine the ones who need to be seen as a priority, while also providing reassurance to the ‘worried well’ and telling them everything is fine, come back and see us in 77

a year’s time.” And while its ease of use lends itself to remote operation, giving independence to patients while removing the need for them to consult a GP in the first instance, COVID-19 has played a central role in popularising this mindset within healthcare. “We were telling clinicians ‘You don’t have to bring patients in for cognitive tests’ but many weren’t really open to change, it’s human nature not to want to change habits, but it can really help patients and in-person appointments can be a massive drain on resources,” says Dr Habibi. “COVID accelerated that change, everyone was then talking about not bringing people into hospital unless they absolutely had to and it was a matter of life and death, to bring them in for other matters could be very risky. “They tried to do pen and paper tests via the internet but didn’t succeed, they expected elderly patients to have the full-on kit with fast internet, headphones, webcam. This highlighted how important it is that we can do these things very simply, done remotely without any training or supervision, in a simple and user-friendly way. “We see the future of healthcare going this way. There is lots we can do with the technology and resources available to us. Through products such as ours, where tests can be done on a screen, it can save one day of consulting and travelling time.” With its effectiveness in dementia now recognised and the business progressing rapidly in the wider adoption of its technology, Cognetivity is continuing to innovate to apply its creation to more concerns within healthcare. “We are doing a lot of R&D work and are looking to collect data on other neurological disorders, including MS and other conditions, anywhere there is an impairment due to a medical condition,” says Dr Habibi. “We’re taking it to even the pre-clinical stages of disease, looking at how healthy adults can enter the phase of mild cognitive impairment and how we can detect that. “There is great potential there, undoubtedly.”

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INSIGHT

Through the use of technology, the potential for patients in both primary and secondary care to have dementia detected at an earlier stage than ever before is being realised. The development of the Cognetivity platform, which uses AI to conduct rapid cognitive analysis and can be completed by patients remotely, is supporting medical professionals by making the process quicker and simpler through the use of digital.

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The platform is currently in trial as part of a clinical study to screen patients for signs of cognitive impairment at Sussex Partnership NHS Foundation Trust, under the guidance of Dr Naji Tabet. The study has seen people taking Integrated Cognitive Assessment (ICA) tests both in-person and remotely through using an iPad, and is expected to be concluded within the next four months. However, Dr Tabet - an honorary consultant at the Trust and highly-respected figure in dementia studies, who has previously led clinical trials in advancing potential treatments for Alzheimer’s disease - already sees the potential for its use both remotely and in medical settings. “Technology can be very important for screening in primary care and simplifies the pathway of referral to secondary care assessment services,” says Dr Tabet, also director at the Centre for Dementia Studies at Brighton & Sussex Medical School. “There is more potential for treatment through using such early-stage tests. By being able to diagnose people earlier, it opens the door to hopefully earlier treatment. Such treatments current and future may work best, and may only work, in the early stages.” In a medical environment, the use of digital assessment platforms such as Cognetivity can be particularly effective in relieving pressure on already stretched resources, says Dr Tabet.

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“If you go to a GP surgery and say you’ve got a memory problem, the GP may use some very brief screening tools, and more likely than not the patient will be referred,” he says. “A GP needs screening that is easy to do - it is impossible to spend 30-45 minutes doing this with a patient, a GP does not have that time. Their time is valuable and they are under pressure. “This platform can be completed in five minutes while you’re waiting for your appointment, simply a patient can be handed the iPad to complete the assessment, there and then. “Once referred to secondary care, it can determine which patients are seen first. It’s sometimes good to use simple tests to prioritise investigation. “Dementia diagnosis is very labour intensive, there is a need for a brain scan, blood test, may be ECG, completion of cognitive assessment by a specialist nurse, psychologist, or occupational therapist. This assessment can take several hours, which can often be too much for a patient in one day, so they need another appointment. “Through the use of this platform and technology, the cognitive testing process is simplified.” And in addition to completion of the test in a medical environment, its potential for remote use is equally compelling to medical professionals and patients alike. “You don’t need a 45-minute clinic appointment to do a cognitive assessment if a person can complete the test at home. Patients may be monitored remotely and invited back to the clinic if results indicate a deviation from what is expected for that particular patient ” says Dr Tabet. “We’re collecting evidence in the real world, to supplement data collected from earlier clinical trials, and this is very important.

“The study is assessing patient acceptability of the platform and its role as a remote assessment tool. Patients can complete the digital assessment on their own without the presence of a professional. If they can access this on an iPad, then this will impact positively on follow up decisions”. Technology can be a valuable asset in the field of dementia, with digital-based cognitive tests helping to advance diagnosis and care. “It is a good thing that AI is integrated into the digital platform, it’s very helpful to gather information on a particular individual as an individual and over time, rather than simply comparing them to the norm,” says Dr Tabet. “If we are gathering information on a person and they are, for example, scoring 80 per cent and then that suddenly drops to 70 per cent, then that is meaningful. “A great advantage of digital cognitive assessments such as Cognetivity ICA is that there is no bias in relation to language, culture or education. With some tests, the more educated you are, the better you do”. “Another advantage is that the cognitive tasks cannot be learnt. Inevitably for patients with mild cognitive impairment or mild dementia, there is a tendency to remember the answer to some of the questions when you take the test repeatedly..” With the clinical study at the Trust now well underway “lockdown thwarted some of our activity, but it’s picking up now,” says Dr Tabet - the findings could help pave the way to the more widespread adoption of the digital platform solutions in the NHS. “We complete a wide range of research and studies focused on the quality of life of people with dementia, and the use of technology is absolutely important in the future,” he adds.

THERE IS MORE POTENTIAL FOR TREATMENT THROUGH USING SUCH EARLY-STAGE TESTS. BY BEING ABLE TO DIAGNOSE PEOPLE EARLIER, IT OPENS THE DOOR TO HOPEFULLY EARLIER TREATMENT. SUCH TREATMENTS CURRENT AND FUTURE MAY WORK BEST, AND MAY ONLY WORK, IN THE EARLY STAGES. 79

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INTERVIEW

Buying and selling a business - change alongside continuity After 19 years at the helm of AKA Case Management, Angela Kerr decided to sell her business to two of her team in an MBO. Here, Angela, alongside new directors Dawn Abernethy and Andrew Rose, share their story of completing the deal and why succession planning is key for a business owner “I’ll be honest, when I set up I naively thought I’ll be a lone worker, working at home - I never imagined I’d need a succession plan.” Like so many others who set up in business, Angela Kerr did not foresee the growth of her venture, AKA Case Management, when she set up in 2002. Having become one of the UK’s best-known case management companies, and with Angela increasingly in demand within the profession after being appointed chair of BABICM in 2016, she knew she needed to address the issue of the long-term future of her thriving business. And the solution lay in the form of Dawn Abernethy, a longstanding member of the AKA team, alongside Andrew Rose, who at that time was a new appointment to the business. With Andrew, a BABICM director keen to progress to a senior management role in case management, and Dawn knowing the culture and ethos of the business inside out, the combination of their respective operational and financial expertise came together in March this year to complete the MBO of AKA Case Management - five years after Angela first started to formulate such plans. For the 12 months leading up to the MBO, Dawn and Andrew had been leading the business in preparation for formally taking over, to allow Angela to concentrate on developing the Institute of Registered Case Managers (IRCM), of which she is chair, while giving them the space to develop their confidence as directors and being in the background for support if needed. Under their leadership, and despite the many challenges

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of the pandemic, the business has grown in the past year, continuing to add new people to the team as AKA heads into a new era. “I’ve always looked to bring in the right people to the business to support what we’re delivering and have tried to equip them to do the job well - but it was about looking for the rising stars who relished a challenge, and that is something I had to start looking at seriously when I took over as chair of BABICM,” says Angela, who is remaining with AKA as a consultant. “I had been approached some time previously about whether I wanted to sell to a national business, but that wasn’t for me, it didn’t feel right. We have built an ethos here, we have certain values, we’re like a family. An MBO seemed the right option, but it was working out how that would happen. “It was great to have Dawn and Andrew - Andrew was very clear in what he wanted to achieve, and Dawn had long been a mainstay of the business. We very thoroughly, over the course of five years, really planned out all the risks and challenges and how to mitigate that.” For Andrew, previously operations manager at AKA, he was keen to progress to the next level in his career, and believed AKA was the right place for him to do that. “Whilst working in Australia, I reflected that I had hit a bit of a glass ceiling in case management in terms of what I could do to influence things,” says Andrew, whose background is in psychology, including eight years as a university lecturer. “I knew I wanted to be in a position where I could

INTERVIEW

influence and change things when needed, and being in a senior management role was the way to make that possible. The company I was with previously had just been bought out and I knew I needed a change - I knew joining Angela and AKA, who shared the same values as I have, was the right move.” While Andrew was certain of his director-level ambitions, Dawn was rather less certain when Angela first approached her about leading the business. “It was a classic case of imposter syndrome, I didn’t know whether I could do it,” recalls Dawn, previously finance manager who first began working with AKA in 2008. “Angela had kindly invested over the years in business coaching, but when the moment comes you do question ‘Can I do it?’ Thankfully Angela was there to remind me that I could, but it’s a huge thing to take on. “I really love what we do here and the ethos of the business, but until that point it never occurred to me I’d one day be running it. It was a surprise when the MBO was first mentioned, but as we progressed I was certain it was the right thing to do and to help in guiding the future of the business.” With very different areas of specialism, Dawn and Andrew work well together, adopting a joint management approach with the key decisions taken together. “Right from the start, we have had very open and frank discussions about what is non negotiable for us both. We share out the managing director role between us both, it’s very equal in that way, but we continue to take the lead in our own areas,” says Dawn. Andrew continues: “Communication and transparency are the main things. We think horribly similarly, which makes things a lot easier, and we have very honest discussions. We’ve had daily meetings since before the MBO and we don’t make any big decisions independently, even if they are in our distinct roles, out of respect for the other business partner. “Nothing really feels different in terms of our roles, we’d been doing this for a year before the MBO and we asked the staff how they felt and they said they felt the same, 100 per cent nothing had changed for them. “Angela is a huge character and personality, and you do fear what the reaction may be - and we know some other companies had approached some of our staff once they heard about the MBO. But the reality is that not only did our existing staff want to stay, but we had new people approaching us as they see we’re different to other companies. We’re ambitious and will always look at opportunities to grow when they come along.” For Angela, stepping back after owning and running AKA

for almost 20 years - and having been in leadership roles for 30 - at the same time as stepping down as chair of BABICM, continues to be a challenge, she admits. “You prepare yourself for that time to come, but you don’t really know what it will be like. I must admit to feeling a little bit lost, I had to have a couple of weeks out just for decompression,” says Angela. “I’d say having a business is a bit like when you have a child and you take them through different stages of life - I suppose now, for me, it’s like they’ve gone off to university. “But I’m now chair of IRCM so am still in the industry, but in a different role and one that I do need to have time to engage with, so it is the right thing to do. And I’ll be here for Dawn and Andrew as long as they need me.” And for the new owners of AKA, the huge decision Angela has taken to pass on her business, and the trust she has invested in them is not lost on them - indeed, they have already given consideration to their own succession plans to ensure AKA continues to be in safe hands for years to come. “We talked about it even pre-MBO, we said if we are going to take this on, then what does our exit look like,” says Andrew. “For the original pioneers of businesses, who don’t know if there will be any value in what they are creating and are just doing a job, then it’s probably easy not to think of succession plans - but for Dawn and I, coming into an established business, having an exit strategy is very important.” “AKA has always been about our values and the service we deliver to people,” says Angela. “We want to maintain that as we move through the years and the changes that lie ahead, and sustaining our clients through that journey. Some of them have been there since almost the beginning and we’ll always be there for them. “People make AKA what it is, and Dawn and Andrew and the whole team have helped to build us to where we are now. It’s now in their hands for the future.”

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INSIGHT

'This is an exciting time in the future of clinical rehabilitation' For seriously injured military personnel, the options around rehabilitation are increasing further with plans for a new National Rehabilitation Centre. Matthew Tomlinson and Rachel Seddon, from the specialist military team at Slater & Gordon, discuss the importance of access to specialist support For the majority of readers, initial treatment for their serious injury or illness will likely come from our exceptional NHS’ regional acute hospitals. When clinical rehabilitation, to assist those seriously injured is required, it is widely recognised that timely and tailored support is necessary to maximise the potential to return to a quality of life, and minimise further problems down the line. This is significant in relation to an individuals’ physical and mental health. Getting people back to a meaningful life and capability following serious injury is a major policy area in Government. Return to work rates for people experiencing serious injury and trauma in England are below rates achieved in other European countries as well as rates achieved in the Armed Forces. For seriously injured military personnel, the Defence and National Rehabilitation Centre (or DNRC) in Loughborough will already be a familiar part of Defence Medical Services, which comprises, in addition to the national Defence Centre, Regional Rehabilitation Units (RRUs), Units embedded within NHS Trusts, the Royal Centre for Defence Medicine and mental health services such as the DCMH (Departments of Community Mental Health) network. The Defence Centre, or DMRC/Stanford Hall as it is known, is the state of art successor to the Ministry of Defence’s former Headley Court facility in Surrey. The facility, which is run by a Commanding Officer alongside

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uniformed staff and civilians employed by MoD, opened in 2018 and continues to treat and rehabilitate seriously injured members of the armed forces including those with serious neurological and spinal cord injuries. In addition, plans to develop a ‘National Rehabilitation Centre’ (NRC) on the Stanford Estate (next to the Defence Centre) are gaining momentum and will be a very welcome initiative bringing world-class clinical rehabilitation for civilian NHS patients, as well as providing a national hub for training, research and development. Recent reports suggest that, all being well, the greenlight should be given later this year for construction of this new facility, with a target for treating patients by 2024. This is an exciting time in the future of clinical rehabilitation and the NRC will extend the success of acute services and established major trauma centres by providing a national centre of excellence in both patient care and innovation. The recent and ongoing lessons of COVID-19 are showing the real value of excellent clinical rehabilitation in making a meaningful difference to an individual’s recovery and capability. For example, a specialist three-step rehabilitation programme developed at DMRC has been credited with saving the careers of military personnel with “long- Covid” (shortness of breath, fatigue, low mood and "brain fog"). The BBC recently reported that nearly all of the 150 patients that took part in the programme 82

INSIGHT

were able to return to work within three months. The plans for the NRC appear to offer a unique opportunity to drive new rehabilitation products and technologies and improve accessible state of the art rehabilitation. The NRC would provide patient care focused primarily on treating patients within the NHS East Midlands region with the potential to treat patients referred from elsewhere in the country similar to the Defence Rehabilitation Model. Already, the Defence establishment is acquiring new knowledge through, for example, Computer Aided Rehabilitation Environment and the cohort of patients treated at both the NRC and the Defence facilities must widen the opportunities for clinical research. The NRC facility itself aims to be transformative, leading in the testing and development of future treatments and techniques and the positives that can be derived from the Defence Rehabilitation Model and its collaboration with Defence Medical Services looks likely to bring about meaningful changes to injured individuals’ pathways. Good rehab after serious injury is often described as ‘like a relay race’. Taking for example, the experience of our client, Soldier X. X was paralysed from the midchest down and would be graded T4 complete ASIA A paraplegic. He suffers from residual neuropathic pain, increased tone, spasms, impaired sensation and loss of power below the mid-chest and loss of visceral function. He has to self-catheterise and manually evacuate the bowels, and within a few years of injury, developed a syrinx, which is, along with syringomyelia, likely to further progress. In the immediate aftermath of the injury, he went through numerous intensive and emotionally difficult stages of rehabilitation, including treatment at Stoke Mandeville NSIC. During X’s Naval Service Recovery Pathway with Hasler Company, and numerous inpatient stays at DMRC Stanford Hall, he has been able to access tailored rehabilitation which has included hydrotherapy, 1:1 83

specialist physiotherapy and psychotherapy, and he has had the opportunity to complete successful trials of the ReWalk exoskeleton. DMRC Stanford Hall has the feel of a military establishment in one sense and of somewhere very conductive to rehabilitation in a relaxed and personal manner. It has buildings and spaces specially designed to aid the recovery process including gyms, a range of swimming and hydrotherapy pools, a gait lab and “all the elements essential for its clinical purpose”, that is, to rehabilitate the most seriously injured members of the Armed Forces and also, importantly, return those who have been injured in the course of training back to work. He is making good progress with his physical rehabilitation but acknowledges his ongoing challenges in terms of bowel and bladder care, sexual health and fertility, pressure sores, syrinx management, and mental health and so continuity and quality of care remains vital both now and beyond his medical discharge. In due course, Soldier X will likely engage with the Recovery Career Services which was launched as part of the Defence Recovery Capability back in 2013 with the mission of getting injured and sick personnel competing in the civilian employment market. What the current Defence Rehabilitation Model seems to do very well is integrate all aspects of recovery including medical care, welfare, housing, education, reskilling, work placements, employment issues and opportunities. Whilst this remains an ideal care model and one that is decades ahead due to the combined efforts of the Services and the Service charities responding to carefully tailored individual recovery plans setting out a recovery pathway, if the NRC development plans can keep momentum, it presents a very exciting, and similarly patient-led opportunity to build the right environment for successful rehabilitation. For more information about Slater & Gordon’s specialist work with the military, visit www.slatergordon.co.uk

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INTERVIEW

Transforming care delivery through digitalisation Through the development of its care management software, Nourish Care is helping to support the rollout of digitalisation throughout the care sector. NR Times meets its founder Nuno Almeida, and discovers his unrelenting commitment to achieving the best possible person-centred care, and Nourish’s role in empowering care teams to deliver that

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INTERVIEW

espite being a co-founder of a hugely successful multi-national business, Nuno Almeida did not find happiness in that. Rather than being motivated by the many rewards associated with continuing to grow such a venture, which worked in defence and weapons systems, he realised he wanted to take a different course. “I was with that business for ten years and we grew it from four people to 350, working across four continents. Everyone was delighted with that journey, but somehow I wasn’t,” recalls Nuno. “I was waking in the morning and feeling dread, I knew there was a misalignment between my work and values. Coming from Portugal, where 95 per cent of people are Catholic, those values exist strongly and rub off on you whether you want them to or not. “Working in this business I wasn’t feeling I was going to be proud of my life achievements. I wanted to build a company where the values completely align with what I was trying to achieve.” And from that realisation, and the brave decision to sell his stake in the business at the ideal time in 2007 - “as Lehmann Brothers was collapsing, but before everyone realised there was a big crisis” - came the foundations 85

of Nourish Care, a care management software provider committed to delivering better standards to care providers, to enable them to better support the individuals in their care, through transforming their paper-based records into efficient digital systems. Since launching its platform in 2015, Nourish now works with over 1,600 care providers in the UK, serving over 30,000 people, and has just taken its first steps into international roll-out by moving into South Africa. More products are in the planning for the next two to three years as Nourish looks to support even more aspects of the sector, as well as expansion into new areas of healthcare where the company already supports a significant number of mental health hospitals, and with recent examples community and maternity care. And in building Nourish, Nuno has become a highly respected voice in care and the vital role digitalisation has to play, being appointed as an advisor to the All Party Parliamentary Group on adult social care, as well as being a founding member of the Care Software Providers Association (CASPA), an independent voice on software in care. And while Nourish was an established operator in digital

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care well before the COVID-19 pandemic hit, its impact and the resultant realisation from across the healthcare sector of how vital a role digitalisation, supported by data and analytics, can play has seen even more care providers turn to Nourish. It also strengthened its links with the NHS, with Nourish being one of only two software providers to be assured by NHSX for its DSCR (Digital Social Care Records) Digital Purchasing System (DPS) at launch, supporting its goal of all social care providers having access to a digital social care record by 2024. “We are demonstrating time and time again that if we design a digital framework that is centred around the person, we can use this platform in any health or social care setting. We can augment the ability a company already has to deliver better care,” says Nuno. “For a care worker, an eight hour shift might be seven hours of joy in spending the time in delivering the care, but an hour of dread in writing up all the notes. “Through paperwork, they are gathering so much information but doing so little with that information to improve the quality of care. “If a person feels their job is becoming more possible, then that gives them another lease of life. They can have that cup of tea and sit down for a break, they can spend

IF A PERSON FEELS THEIR JOB IS BECOMING MORE POSSIBLE, THEN THAT GIVES THEM ANOTHER LEASE OF LIFE. THEY CAN HAVE THAT CUP OF TEA AND SIT DOWN FOR A BREAK, THEY CAN SPEND MORE TIME LOOKING IN THE EYES OF THE PEOPLE THEY ARE SUPPORTING. NRTIMES

more time looking in the eyes of the people they are supporting.” Committed to delivering a solution to enable the creation of digital-led quality care, Nuno laid the foundations of his new venture in 2011 while looking into how his data science expertise, experience of running a successful business and focus on quality care could combine. “Social care was not the obvious focus at first, but it turned out that the sector was more amendable to innovation, they move faster and are willing to try new things - trying to do this in the NHS would have been very hard,” he recalls. “I volunteered in care homes and community services to see the true picture, and I came to understand that the main driver of the pressure on care teams was how much paperwork there is in delivering care. “The thought process was, if we could pull this off elegantly, we could reduce the burden of having to record all that information and bring the information alive digitally to improve care. “Care workers could be more empowered to deliver the best possible care, and they are even more able to put the focus for care delivery on the person and what is important for them.” And while its clients are routinely making cost savings through the implementation of efficient new softwarebased systems, Nuno is adamant that quality of care, rather than the financials, is the crux of Nourish’s offering. “That is how we market Nourish, rather than ‘This will save you X pounds on the balance sheet’. I remember very vividly how opinionated I was on this at first when we launched. It’s not about presenting a cost saving, it’s about helping to empower care teams,” he says. “We’re relentless in that focus on quality rather than how much it will save on the bottom line, that has never felt like the reason we exist, but I firmly believe that if you concentrate on the quality of care, then the financial aspects will stack up.” Nuno’s dedication to the quality of care stems, at least in part, from his background, and now extends throughout the entire Nourish team. He recalls growing up near a psychiatric hospital and a farm manned by people with both physical and learning disabilities - “I was lucky to grow up in this context and to see what I regarded as normal - these people were just human beings - but I later realised how that shaped me,” he says. “Computer scientists and care workers are among the clusters of professions which have a wide gap between

INTERVIEW

THERE HAS BEEN A SERIOUS AND FUNDAMENTAL SHIFT IN THE ENTIRE SECTOR AND WE CAN’T POSTPONE IT ANYMORE. WITH ONE OF OUR CLIENTS, THE CEO SAID THAT NOURISH WAS THE THIRD MOST IMPORTANT THING IN HIS OPERATION AFTER FOOD AND PPE.

them, but no such thing exists here. “We always ensure we attract care workers into the business, and more than 50 per cent of our team have social or healthcare delivery experience. “If you are creating something which is going to be exactly what our clients need, it cannot be just technology-led.” After years of investment of time and resource into the creation of a system suited to the exact needs of care providers, Nourish, like countless other digital business, was suddenly supported in the cause it had long championed with the onset of the COVID-19 pandemic. “The entire system realised how essential it can be to access good quality data when hit by a crisis,” says Nuno. “COVID allowed us to see a lot more value in how digital care could benefit whole organisations, and collaboration is really essential in taking that forward. “In many cases the digital platform was non existent, but in this crisis environment it became very apparent that all of a sudden CCGs, the NHS, realised they cannot ignore the fact that social care providers are paper-based because it is such an important topic. The complete focus went onto accelerating the option of digital-based systems in social care.” Over the past year, the level of care provider engagement with digital care planning has risen from around 33 per cent to 40 per cent - while still a long way to go, Nuno is encouraged. “There has been a serious and fundamental shift in the entire sector and we can’t postpone it anymore,” he says. “With one of our clients, the CEO said that Nourish was the third most important thing in his operation after food and PPE. In terms of endorsement, I’ve never heard anything as strong as that, but digital was really showing its value amidst huge pressure. “Operators were seeing in the first lockdown how much

more easily they could audit remotely, they could organise support digitally and it would show up at the entrance to the building with all the support they need, without the need for any phone calls. “The goal for NHSX, alongside the CQC, is that we want to see a fully digitised sector by the end of 2024. “We can be as cynical as we want about that, but even if we fail by two years it will still be a spectacular transformation across a very complex sector. We are talking about a wide range of care services, from specialist physiotherapists to complex care providers and everything in between.” Nourish is committed to playing an increasing role in that push towards digitalisation, with big plans of its own to fuel its growth. “We believe we have the best in breed when it comes to planning and co-ordinating person-led care and to be able to demonstrate that in a multitude of settings is really important. We are also able to support adjacent markets care services as long as we can do it with exceptional quality, as we have been demonstrating with numerous mental health hospitals, and more recently in maternity services,” says Nuno. “We do receive enquiries from overseas and have rolled out into South Africa and are now looking at other markets. It’s a fantastic demonstration that the impact we have seen in the UK can also help different care pathways around the world. “Data science will be a big topic for us over the coming years and we will continue to invest in engagement facilities for circles of care, which will lead to new products in the next two to three years. “Our goal has always been to empower families, care workers and care teams to deliver the best possible care, and we will always do all we can to achieve that.”

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THERAPY

Setting a new standard for neurorehabilitation

When it first opened its doors in March 2020, the Inspire Neurocare team had no idea about the following year's challenges. As the rest of the UK went into lockdown, Inspire Neurocare was faced with the task of launching a highquality complex care service whilst also ensuring the safety and wellbeing of people living with significant underlying health issues and its new staff team. NRTIMES

Fifteen months on, the service – just revealed as a finalist for Complex Care Provider of the Year in the Health Investor Awards 2021 – reflects on its approach and plans for the future.

Innovating for independence following a brain haemorrhage

Over the last year, Inspire Neurocare Worcester successfully provided care for individuals living with complex neurological needs, and the team continues to welcome new residents as the service enters its second year of operation. The 43-bed service, which includes an independent living apartment, is characterised by contemporary décor and open plan living. Taking every care to ensure accessibility, assistive technology and the ability to make personal choices was built into the design. Pull-down cabinets and adjustable height kitchen worktops, large, spacious therapy bathrooms with hoists and wide corridors and doorways throughout the service allow people to maintain and develop independence. Ensuite bedrooms are over twice the usual size in such services. Each is fully soundproofed and has independently controlled underfloor heating, so people can set up their living space just as they would in their own home. Service Manager Marc Russell said, "At Inspire, we place no limits on what people can achieve - the team never define people by their age or diagnosis. Over the last year, we supported many individuals to achieve life-changing outcomes, despite the challenges of Covid-19. From the beginning of the pandemic, ahead of Government lockdown, we proactively engaged with care commissioners and national regulatory bodies to ensure we could safely welcome residents to our new service. Our Enhanced Infection Control Pledge, increased protocols and continued commitment to protecting the people we support meant that we were the first choice for individuals and families requiring quality complex care in the Midlands."

Jay, aged 74, came to Inspire for a period of rehabilitation following a subarachnoid haemorrhage, further complicated by hydrocephalus in late 2020. On arrival into the service, Jay was experiencing problems with her balance, had left side weakness and found mobilising very difficult. She was unable to stand without support from the team members and a walking frame. The team worked with Jay and her family to create a rehabilitation plan to increase her independence. With physiotherapy focusing on restoring Jay's balance and increasing her confidence, she can now walk independently using a frame. Life Skills Facilitators also worked with Jay under the direction of the therapy team, using an innovative mobile app called Clock Yourself to improve her balance and mobility and increase her confidence outside of the physiotherapy gym. Jay is continuing to work with the therapy team as discharge planning gets underway. "I'm thankful that I'm still alive – it's down to the wonderful surgeons, and of course, the rehabilitation at Inspire, which has been fantastic. When I came here, I was on my back. I couldn't walk. I couldn't sit up, couldn't do anything. And here I am now – walking with my frame. The progress has been fantastic. The staff here are wonderful, so patient, and so caring. Those who saw me when I first came in – they say, what a transformation! I'm being taken home by the Occupational Therapist next week for a visit to make sure everything is in place for when I return home and if there are any other exercises I need to do because I want to live on my own. I want to be strong enough, and well enough and capable of continuing to look after myself, hopefully for another decade at least!"

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THERAPY

Developing an outstanding team

Expanding with confidence

Director of Clinical Excellence, Michelle Kudhail and Service Manager Marc Russell welcomed outstanding colleagues to the team over the last year, including Consultant in Rehabilitation Medicine, Dr Damon Hoad. Dr Hoad brings a wealth of experience in neurological rehabilitation to Inspire Neurocare, working for the service in addition to his roles within the NHS and Warwick University. Neuropsychologist Dr Victoria Baxter is joined in the interdisciplinary team by a neuro physiotherapist, a neuro occupational therapist and a speech & language therapist. The Clinical Lead manages Inspire's nurses, who are trained to very high clinical standards. Specialist nurses ensure that the service can meet patients' very complex care needs, from ventilated care and tracheostomy management, seizure management, and peg nutrition to bowel management and catheterisation.

Close partnership working with care commissioners influenced every element of Inspire Neurocare Worcester, from design and build to service development. This commitment to work in close collaboration with commissioners and stakeholders continues post-launch in Worcester and is ongoing in other parts of the country, with new developments coming soon to Basingstoke and Southampton. Work on these two new state-of-the-art services starts on-site in late 2021 and early 2022, intending to welcome residents from 2023. Reflecting on the year, Director of Clinical Excellence Michelle Kudhail said, "In an unprecedented year, Inspire Neurocare has thrived against the odds. After opening our first service amidst the challenges of the first wave of COVID-19, we have now firmly established ourselves as a leading provider of quality complex care and rehabilitation for adults. “The planned Inspire Neurocare services for Southampton and Basingstoke will allow us to achieve more for many individuals, in hopefully far less challenging circumstances for launch, and we are exploring options around the use of innovative technology to enhance therapy provision and increase intensity of practice to supplement what we already offer. “The future looks bright for Inspire, and I'm incredibly proud of the team for everything we have so far achieved together."

Life Skills Facilitators

Inspire Neurocare empowers its team members to excel, and with the Life Skills Facilitator (LSF) role is revolutionising the neurorehabilitation sector with an innovation that leads to outstanding patient outcomes. Enabling each person they support, LSFs increase people's capacity without limiting them. Under the guidance of clinicians and therapists, they administer medicine, carry out exercise and mobility programmes, sensory activities, orientation and memory tasks with communication aids and interactive equipment. LSFs facilitate daily tasks such as showering and choosing clothes, making a drink or meal, and taking an interest in people's lives, supporting them to continue or develop hobbies or social activities as much as possible. Their unique position sees Life Skills Facilitators working across nursing care, therapy, and wellbeing, allowing them to take a genuinely universal place in the lives of the people they support. Their work supporting occupational, physical, and speech and language therapy means therapeutic interventions are no longer confined to the gym or to a particular session with a therapist. With the individual's therapeutic goals and desired outcomes in mind every step of the way, Life Skills Facilitators amplify the rehabilitation process, facilitating and enabling daily living activities that increase people's independence, functional abilities, and confidence through every interaction, every day. Inspire Neurocare sees people achieve their rehabilitation goals more quickly through this continuous focus on reablement and independence.

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Cooking and rehabilitation a stroke survivor’s story Craig Pankhurst, founder, A Stroke of Luck There is nothing positive in having a stroke. But positive things can come from experiencing stroke. And one of the things which has helped my recovery is finding a place in the house where I feel relaxed, able to focus, and to try and be creative. And that room is the kitchen. I have always had an interest in food, mainly eating it of course, and have been fascinated by the creativity of chefs. I decided early in my rehabilitation that away from fitness and exercise, I needed something to focus my creative juices on to support the recovery journey from stroke. And with having zero talent in art and having a real appetite for food - terrible pun! - I knew the kitchen was going to be my place of solace. This month I will be celebrating my third anniversary of surviving my stroke by cooking a three-course dinner. As yet, I am undecided what the menu will be and how it will work out, but whatever the outcome, the process of cooking I thoroughly enjoy. Here, I share one of my favourite recipes with the readers of NR Times.

A simple Caprese salad is the base of this dish but adding fresh strawberries to the basil tantalises the taste buds! You are in for a treat.

Strawberry Salad with Balsamic Glaze

Method

July is the month of Wimbledon, and that is synonymous with strawberries and cream. So, I like to create summery dishes which range from easy to complex. This one in particular is very easy to do. And the key ingredient is sumptuous strawberries.

In a small saucepan, bring the balsamic vinegar to a high simmer over medium heat. Stir, then reduce the heat to low and simmer until the vinegar has thickened and reduced by half, about 8 to 10 minutes. Set aside to cool.

This dish is a perfect example of how fresh, in-season ingredients can combine to make a delicious dish in very little time. This strawberry salad uses under 10 ingredients, but it still has an incredible mix of textures and flavours. The peak-season berries are sweet and juicy, and a handful of soft summer basil adds a surprising fresh accent. Toss in a little cheese and diced avocado for richness, pecans for crunch, and a drizzle of tangy balsamic, and you have a mouth-watering summer meal. Best of all, it comes together in 15 minutes flat!

Place the strawberries, cherry tomatoes, mozzarella, avocado, pecans and basil in a shallow bowl or platter. Drizzle with olive oil, and season generously with salt and pepper. Gently toss. Drizzle with the reduced balsamic.

Recipe ¼ cup balsamic vinegar 1 cup sliced strawberries 1 cup halved cherry tomatoes 1 cup halved mini mozzarella balls 1 ripe avocado, pitted and diced ⅓ cup pecans, toasted ⅓ cup loosely packed basil, torn A drizzle of olive oil Sea salt and freshly ground black pepper 2 tbsp of lime juice 1 tsp soft brown sugar 2 loaves of bread, unsliced 2 tbsp of nut oil

This is a wonderful summery salad when partnered with a glass of chilled white wine - an afternoon treat! Good luck!

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NR Times issue 18

Articles inside

COVER STORY THE FUTURE OF ROBOTICS

DEFYING THE ODDS

REDEFINING DEMENTIA DETECTION

REDEFINING CARE DELIVERY THROUGH DIGITALISATION

LEADING THE WAY GLOBALLY IN NEUROREHAB

FUTUREPROOFING A BUSINESS

CHANGING THE REALITY FOR STROKE SURVIVORS