Neuro Rehab Times issue 25

NR TIMES

HOW BESPOKE TRAUMA SUPPORT HELPED MANCHESTER ARENA BOMB SURVIVORS

For our interactive digital edition visit nrtimes.co.uk

Editor's note

Happy new year!

For me, a new year always presents new focus, thoughts of what new challenges may await, what positive difference I can make both now and into the future.

And in my role with NR Times, speaking to the most inspirational of people who are making such profound impact on the lives of so many, the positivity I have always felt with the dawn of a new year is heightened further still.

Again in this issue, we are privileged to share stories of those who truly are making a difference to the world of neuro-rehab.

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

For advertising enquiries contact Gary Wilding, Head of sales gary@aspectpublishing.co.uk

Also on the NR Times team: Andrew Mernin, Founder / MD andrew@aspectpublishing.co.uk Chloe Hayward, Sales Sophie Dinsdale, Design Sorina Mihaila, Contributor Andrew Nealen, Contributor

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

Collaborative content

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

Our cover story focuses on a partnership made in the aftermath of the Manchester Arena bombing, when initial support for survivors dwindled and countless peoplemany of them very young - and their families were left struggling to cope with their unimaginable trauma.

Recognising the need for intervention, and despite no funding being in place, Hudgell Solicitors and Proclaim Care worked together to devise a package of bespoke support for scores of survivors - making an inestimable difference to their lives and their ability to look to the future.

The dedication of the team in creating something so needed - and where otherwise support was absent - is exceptional and was really humbling to write about.

Among the other highlights from this issue is the beautiful piece of writing from Danyelle Clarke. From being seriously injured in a road collision, she continues to make a phenomenal recovery and has shared her insight into the importance of the therapeutic relationship with our readers.

Her words are very valuable and I would urge everyone to take the time to read them. By sharing her thoughts and experiences so openly and honestly, Danyelle is helping to change relationships between therapists and clients for the better. Thank you, Danyelle.

I hope you enjoy this issue and, as ever, we very much welcome your feedback, thoughts, suggestions and stories. Please do get in touch, we’d love to hear from you.

In the meanwhile, I hope 2023 is a great year for all of you and your families and thank you for continuing to support NR Times.

Deborah Johnson

deborah@aspectpublishing.co.uk

The horror of what happened on May 22, 2017, has touched the lives of people across the world. Those haunting images of Manchester Arena in the aftermath of the terrorist atrocity are etched into the minds of millions - a night filled with such joy and delight turned into utter devastation in an instant.

Twenty-two people lost their lives. A further 1,017 were injured. And hundreds more, while physically unharmed, continue to live with the psychological trauma of what happened when they innocently went to see pop megastar Ariana Grande in concert.

The impact on the lives of those affectedmany of them children and young people - is beyond comprehension.

Initially, with the creation of The Greater Manchester Resilience Hub, dedicated support was on offer to protect the mental health of survivors, and donations came in from all corners of the world to boost resources. However, over time, sadly the access to support has diminished. The ongoing needs of many have meant they struggled to access treatment, and as 2020 progressed, the strain on the NHS as a result of the COVID-19 pandemic saw resources become increasingly scarce for survivors so badly in need.

But at a time when the support became harder to find, the need for it was only exacerbated. The independent public inquiry - the findings of which continue to be released in stagesrevealed hugely traumatic details around the missed opportunities to stop bomber Salman Abedi, the lack of security around the Arena, the huge delays in medical support, the nonexistent communication between emergency services.

Such revelations around what happened that dreadful night add further distress to those

already struggling with their trauma. For many survivors, they felt alone, unsupported, forgotten, their loved ones not knowing what to do or where to turn.

A vast proportion of those affected are young people, teenagers who should be experiencing the ‘normal’ concerns around puberty, school work, relationships, exams - but instead, are having to deal with the enormity of being part of a murderous suicide bomb attack.

For Rachel DiClemente, CEO of Hudgell Solicitors, this was all too apparent. The law firm is looking after over 150 survivors, whose legal cases cannot proceed due to the ongoing release of the findings of Sir John Saunders from the Manchester Arena Inquiry – meaning any chance of accessing funds for rehabilitation cannot be pursued until the inquiry is concluded.

But while the delay is sadly unavoidable due to the process, the need for action remained as urgent as ever.

“We had to do something, we couldn’t do nothing, that wasn’t an option,” Rachel tells NR Times.

“These were deeply traumatised people, many of them young people, and they needed help and support. We would meet with them often and we’d hear that they felt they’d been forgotten.

“You couldn’t just stand by and not help; we knew there must be something we could do.

“We did initially ask potential defendants to offer rehabilitation , but this was declined, and we didn’t know when their claims would be able to proceed due to the ongoing public inquiry - we still don’t.

“As any potential funding through civil claims was clearly some way off, we knew we needed to do something more urgently.”

From the unimaginable trauma faced by survivors of the Manchester Arena bomb in 2017 has come hope and progress, thanks to an innovative partnership to bring much-needed support where otherwise avenues had been exhausted.

“We had to do something, we couldn’t do nothing, that wasn’t an option”

In autumn 2020, Rachel approached Proclaim Care - a specialist rehabilitation case management company which works extensively in supporting people rebuild their lives after major injury and trauma - to investigate the possibility of them creating a bespoke programme for those supported by Hudgell Solicitors who were so badly in need.

“Rachel came to us and explained the situation, and we said absolutely, we will help,” recalls Neil Irwin, commercial director of Proclaim Care.

“We have a lot of experience in delivering a range of therapies, including psychological support after trauma, so we felt we could make a positive difference.

“There were no funds in place, but that wasn’t the priority. We needed to make this work for the young people who needed help, so we quickly got something together.”

The specialist team at Proclaim Care devised a bespoke screening assessment for each client, targeting urgent interventions for those most in need.

And showing their dedication to those who needed their support, Hudgell Solicitors and Proclaim Care agreed to jointly fund the initiative, enabling survivors to access the urgent assessment and treatment they had previously been unable to find, while also making use of signposting to other appropriate services to enhance the support further.

“We were really pleased we could come up with a way to ensure that rehabilitation was in place, in spite of the barriers to litigation,” says Rachel.

Linda Ingram, clinical team leader at Proclaim

Care, led the clinical efforts in the partnership. Under her guidance, each person was assessed by the rehabilitation team, and for those for whom such support was deemed to be appropriate - for some, they did not feel it was the right time, and for other very vulnerable clients, it was deemed more suitable they remain under NHS care - Immediate Needs Assessments were completed to enable the interventions to proceed without further delay.

A mixture of virtual and face-to-face support was used, both to accommodate the restrictions imposed during the pandemic, and to offer clients the option of accessing support in whichever way they wished.

“The effects of what happened affected whole families, often we might have two or three people in the same household receiving our support, there were a number of generations affected by this,” says Linda.

“It was very distressing, many of them had seen terrible things, and we saw PTSD, behavioural issues, and other kinds of problems affecting whole families because of what had happened.

“Things like going out into crowds and crowded places were an issue, they didn’t want to go out into these kinds of situations anymore, it was having a really big impact. Places like the school bus or the school dinner hall could have very negative effects.

“The period where they were seeing the public inquiry on the news every night was particularly distressing, and there was often press intrusion to deal with too. There were so many things that happened since that night, which made their situation even worse.

“We found that for many clients, they were just

glad, grateful, to have someone to speak to. To have someone to listen to them.

“They so badly needed the support, and while they may have had it initially from the Resilience Hub, they had been on their own for a long time.”

As well as direct interventions - which primarily focused around psychological support, behavioural therapy, physiotherapy and some benefits and vocational advice - a central resource was also created by the Proclaim Care team to share support services, charities and organisations they could potentially signpost to.

“It was about taking a really client-centred approach to what their needs were and finding ways to meet that,” says Linda.

“We were regularly assessing the work we were doing. We had regular calls with the lead solicitor on the case, monitoring the progress of each individual. We needed to make sure things were going in a positive direction for our clients.”

And as well as supporting clients, Proclaim Care also took steps to ensure its team were helped to manage the impact this had on their own mental health and wellbeing.

“The team were very tight, but we held regular debrief sessions to allow them to talk about what they’d heard. Some of the accounts can be quite graphic, and that can take its toll on those who are providing the support. We were very mindful of the effect it could be having on them, so addressed that throughout,” says Linda.

But for those survivors who were receiving the support, the outcomes are helping to show the impact of the partnership in changing the outlook for those who were struggling to cope.

There were no funds in place, but that wasn’t the priority. We needed to make this work for the young people who needed help, so we quickly got something together

Of an exemplar of six people who have completed their psychological therapy, the evidence is there to see.

“The pre- and post-therapy scores suggest these clients have received effective therapy at the appropriate time,” says Linda.

“One of the techniques commonly required was exposure to crowded places, which has reportedly achieved good outcomes. As part of the process, clients were to be equipped with tools and strategies to manage their psychological wellbeing through the ongoing public inquiries and longer term.

“The partnership has been very effective in helping to identify, support and achieve good outcomes for clients.”

The partnership has also received national recognition, being named winner of the partnership initiative of the year at the CMSUK Awards 2022.

Judges praised Hudgell Solicitors and Proclaim Care for creating such a lifechanging initiative, and for displaying a “willingness to find solutions in the absence of funding, alongside the incredible care and commitment shown to a vulnerable group of clients”.

“We’re so pleased we could help and put something together that enabled those who

needed the support to receive it,” says Rachel. “We hope that in the near future we will be able to proceed with the legal cases for our clients, to enable them to access the ongoing rehabilitation many of them need.

“But we are very pleased to have been able to work with Neil, Linda and the team in putting this together, at what was a very important time. For a long time, many had felt forgotten - the feedback we’ve received is lovely to hear, and makes you realise how important it is to persevere and find a way to make a difference.”

For a long time, many had felt forgotten - the feedback we’ve received is lovely to hear, and makes you realise how important it is to persevere and find a way to make a difference

Study looks at storytelling to support families after TBI

The impact of storytelling in supporting the wellbeing and ability of family members to adjust after traumatic brain injury (TBI) is being investigated in a new study.

The National Institute for Health and Care Research (NIHR), the research partner of the NHS, has awarded £140,000 funding to conduct a study to determine whether storytelling – specifically, the ‘Life Thread’ approach – can support families.

TBI can be life-changing not just for a survivor, but for their family and friends too, and its impact far-reaching. Survivors can experience a range of physical, cognitive, behavioural and emotional changes, which can leave families struggling to adapt or know best how to cope –and support post-discharge from hospital can often be hard to access.

In this study, led by Dr Charlie Whiffin of the University of Derby, the potential of storytelling will be explored for families specifically. Storytelling techniques can improve wellbeing and promote growth and have been used as a support mechanism in brain injury populations, but not their families. Therefore, a key outcome of this study will be to determine perceived benefits and help the researchers design a

larger study to test whether these benefits can be measured.

“While there is growing recognition of the importance of family members in the recovery pathway for the injured person, there is not enough attention given to how brain injuries change the lives of the uninjured members,” says Dr Whiffin, associate professor of nursing.

“This study will consider if a storytelling approach can be used to help family members

make sense of their experiences and promote positive adjustment post-TBI.”

In addition to her academic role, Dr Whiffin is also chair of Anchor Point, a special interest group driving change to improve the lives of families after brain injury.

She adds: “I am proud to have the support of Anchor Point on this project and hope this study will help drive the evidence base forward for this particularly vulnerable population.”

The study will begin in March 2023 and run for 18 months.

Alongside Dr Whiffin, the study is also led by Dr Fergus Gracey of the University of East Anglia; Dr Caroline Ellis-Hill of Bournemouth University; Dr Alyson Norman of the University of Plymouth, alongside two family members.

Commenting on the funding award, Dr Denise Baker, Pro Vice-Chancellor Dean of the College of Health, Psychology and Social Care at the University of Derby, said: “The College strongly believes that hearing from service users and carers can only strengthen our own and students’ understanding of the reality of Traumatic Brain Injury and its impact.

“We are delighted that the importance of this collaborative work has been recognised in this way.”

While there is growing recognition of the importance of family members in the recovery pathway for the injured person, there is not enough attention given to how brain injuries change the lives of the uninjured members

Lost for Words:

Chris Kamara documentary helps to spread apraxia awareness

After Chris ‘Kammy’ Kamara was diagnosed with apraxia of speech in 2021, the former footballer and manager turned reporter in an ITV documentary and opened up about life with the disorder.

Kamara’s professional playing career spanned 20 years, finishing at Bradford in 1995, before going on to manage them later that year. Kammy would take charge of Stoke for three months in 1998, but after his dismissal he’d find his new calling in helping to pave the way for the Soccer Saturday coverage football fans know and love today.

Full of life, Kamara never failed to bring smiles to those watching Soccer Saturday, his chemistry with ‘unbelievable’ Jeff Stelling was a match made in heaven, bringing historic moments such as ‘I dunno Jeff'.

However, in 2021 Kamara’s speech had become noticeably slower, and it became obvious this wasn’t the Kammy viewers were used to.

GOING PUBLIC

“I looked at my Twitter feed and people had noticed something was wrong,” says Kamara. "Some viewers quizzed ‘Are you drunk?’ And ‘are you having a stroke?’"

Kamara would go public about his diagnosis, and after fearing how his colleagues would view him, he was overwhelmed by the amount of support he received.

“It made me realise people were with me, not judging me,” he says.

Kamara’s son Jack, along with his partner Perdie, say that before his diagnosis Kamara knew there was something wrong.

“We started getting little bits and then he just stopped talking as much...we didn’t really know there was a problem,” they said.

MOVING ON FROM SOCCER SATURDAY

In May 2022, apraxia affected Kamara’s speech to the point he could no longer report on live television, and instead focused on pre-recorded television like Ninja Warrior UK. The ITV documentary shows a voiceover recording session for the show, in which Kamara is joined by friend and co-presenter Ben Shephard.

“When I do work and it’s Ben is involved, I feel safe,” says Kamara.

DAILY STRUGGLES

The documentary gives a true insight into the daily struggles someone with apraxia goes through; and for viewers some of Kamara’s quotes hit home hard, especially for those who have idolised him throughout his career.

“It doesn’t sound like me, it sounds slow, I’m embarrassed by it,” Kamara says during his Ninja Warrior UK recording.

Whilst speaking to Steven Bartlett on his podcast ‘Diary of a CEO,’ Kamara says: “I feel a fraud in terms of broadcasting”.

Fans of Kammy’s boyhood club

Middlesbrough responded to this with a banner that read ‘You are not a fraud, you’re unbelievable Kammy’.

In the documentary, Kamara is seen returning to Middlesbrough to speak at half time during their game with Bristol City and he thanks the fans for their support.

SPREADING AWARENESS

The main aim of the documentary is to help spread awareness of apraxia. Kamara meets 21-year-old Mikey, who was diagnosed at only two-and-a-half years old. He now campaigns to be able to help others with apraxia and dyspraxia, by spreading awareness.

Mikey highlights the lack of funding that children with dyspraxia and apraxia have, and shares how he has been campaigning for extra funding since he was 13-years-old.

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

You are not a fraud, you’re unbelievable Kammy

Nurses working in care homes during the COVID-19 pandemic continue to need mental health support to help them recover from the stress and trauma they faced, a new study has revealed.

A new report has laid bare how care home nurses were severely impacted by the unprecedented situation they found themselves in, and the lack of preparation or understanding of what was to come, after the onset of the deadly virus in March 2020.

Frontline workers need a mental health and wellbeing strategy to help promote recovery from the symptoms of trauma and moral distress they faced during that period, the University of East Anglia research team said.

Lead researcher Diane Bunn, from UEA’s School of Health Sciences, said: “Our work shows that care home nurses were completely unprepared for the extraordinary situation they found themselves in during the COVID-19 pandemic, and that this has impacted their mental health and wellbeing.

“They had to manage a highly infectious new disease, associated with high mortality, in residents already living with complex clinical conditions.

“They did this alongside staff shortages, constantly changing and conflicting guidelines and with minimal external professional support. “Health and social care staff are still very much in a recovery phase. They need time to recover from all that happened during the pandemic and many of them will need counselling and mental health support for some time.

“Supporting care home nurses to recover from the pandemic is essential to maintain a healthy, stable workforce.”

The research team carried out in-depth interviews with care home nurses about their experiences of the pandemic across homes for older people in England and Scotland. They particularly focused on the nurses’ resilience and mental wellbeing.

“All of the nurses we spoke to described being attentive to the needs of others, but less attentive to their own needs, which came at personal cost,” said Bunn.

“There are many lessons to be learnt to support their recovery and ensure appropriate policies are in place in preparedness for the next pandemic.”

The study highlights a range of strategies to help nurses accept and recover from their experiences, and suggestions for how to betterprepare for future pandemics. These include:

Bespoke mental health and wellbeing strategy for care home nurses in the current pandemic recovery period and ensuring that this is ongoing and adaptable for future pandemics and disasters

Wider professional and government recognition of the specialist skills required of care home nurses

Revisit guidance to better prepare for any future pandemics and disasters on care homes

Involvement of care home nurses in the development of disasterresponse policies in care homes

Consistency of guidelines, and research-informed methods for effective communication of guidelines.

“Support for care home nurses will likely benefit other care home workers either directly through wider roll-out, or indirectly through improved wellbeing of nurse leaders,” added Bunn.

A brain injury survivor is crowdfunding to enable his plans for a film to explore the realities of life after TBI to become a reality.

Ben Clench has lived with brain injury since 2010 and has written a book about the difficulties he faced in resuming life and in finding acceptance from wider society.

During COVID-19 lockdown, a short documentary film – Ben Again – was made about his journey as a TBI survivor.

Now, keen to build on this further, Ben is planning to create Follow the Patient, described as an inspirational film exploring the realities of healing after TBI.

The production will gather accounts from other brain injury survivors, as well as leaders in science and medicine, to give a comprehensive account of TBI and its impact.

To help it go ahead, Ben is appealing for support.

The crowdfunding appeal, which has two days left, has generated over £7,000 – but is aiming for its £10,000 target.

“One person in the UK has a brain injury every 90 seconds, this is a ridiculously high number which is not common knowledge; an unseen issue occurring in society,” says Ben.

“No one even knows just how a brain injured person might look differently to the next person; it’s not something you can necessarily tell from the outside.

“Those with a TBI could be the ones you think are drunk, or not acting in a way you think people should act; angry, ‘too friendly’, outspoken. However, they might have stories that are riveting and utterly unique. Every story is different.

“Brain Injury might have severe consequences, or maybe less so. We want to make a documentary looking into the different stages people have got to, where they are going, where they hope to be.”

Follow the Patient, which has already assembled its production team, will bring together a number of survivors to hear their accounts of how they have negotiated life since brain injury, and whether they have managed to resume their lives or be forced to re-evaluate.

A neurologist, paediatric neuropsychologist, criminality expert and trauma consultant from leading brain injury centres are also set to take part.

“Brain injury has left some people with an invisible disability; a hidden and unknown aspect within society which is more prevalent in the population than anyone realises, without receiving the huge press that other serious conditions get,” adds Ben.

“We want to touch on the differences in the process of healing in a real and personal way.”

To add your support to the crowdfunding appeal, visit: https://www.crowdfunder.co.uk/p/follow-the-patient-shortdoco

Care home nurses continue to need mental health support after pandemic

Can you help make TBI survivor Ben’s film a reality?

Shining a light on IPV and brain injury

Leading figures working in the fields of brain injury and intimate partner violence (IPV) have united behind tackling the issue of domestic abuse and its long-term impact on brain health.

The inaugural Drake IPV Symposium brought together academics, stakeholders and charities to discuss latest research, identify immediate priorities for action, and address the knowledge gap that exists around brain injury and IPC.

Around 21 per cent of the UK adult population have been subject to domestic abuse, with one in five of all homicides where the victim is aged 16 or older attributable to IPV.

But despite the amount of people who experience IPV – many of whom then live with the lasting impact of brain injury – little is still known about their lifelong brain health or ways offer bespoke support to them.

The Drake IPV Symposium, created by The Drake Foundation, was created in response to this, to help bridge the gap between research, practice and policy and to equip policymakers with an insight into the potential long-term brain health impacts of IPV.

The initiative builds on The Drake Foundation’s commitment to advance understanding in this priority area and follows the launch in 2021 of the Drake IPV Study investigating the long-term effects of IPV on brain health.

As a first step to addressing this knowledge gap, The Drake Foundation this week brought together leading academics, stakeholders and charities working in traumatic brain injury and intimate partner violence to discuss latest research and identify immediate priorities for action.

Featuring a series of research updates from some of the world’s leading academics, including Professor Willie Stewart – who cohosted the event with the Drake Foundation – Dr Eve Valera (Harvard Medical School, USA) and Dr Carrie Esopenko (Icahn School of Medicine at Mount Sinai, USA), the meeting also heard powerful testimony from broadcaster and writer Liz Fraser, speaking about her personal experience of intimate partner violence.

The meeting ended with an address from Jess Phillips MP, Shadow Minister for Domestic Violence and Safeguarding, and highlighted the

stark contrast between progress in awareness and understanding of brain injuries and lifelong brain health in sport compared to the relative neglect these issues have received in IPV.

To address this, delegates were in unanimous agreement that there is a need for immediate action, with the challenge set to return in a year and share progress; an event The Drake Foundation has already committed to support.

James Drake, founder and chairman of The Drake Foundation, said: “The Drake Foundation is incredibly proud to have cohosted our first IPV Symposium alongside Professor Willie Stewart, particularly during the UN’s campaign to End Violence against Women & Girls and on the day that the Queen Consort

herself shone a spotlight on this critical societal issue.

“It’s crucial that society continues to shine a light on the long-lasting emotional and physiological damage caused by intimate partner violence and that’s why we wanted to bring together some of the leading minds in research, practice and policymaking in this area.

“As a Foundation we’re committed to better understanding and improving the welfare of people impacted by head injuries across society. We’re beginning to see the positive impact of our work when it comes to brain injury in sport and we’re determined to have a similar impact in IPV.”

Around 21 per cent of the UK adult population have been subject to domestic abuse, with one in five of all homicides where the victim is aged 16 or older attributable to IPV.

Energise Health’s impact on health through education recognised with award

A programme which has delivered strong improvements to participants’ health through education has had its efforts endorsed with an award.

Energise Health offers facilitated online courses that enhance general wellbeing and recovery from injuries and long-term health conditions.

Its Energise Recovery Programme introduce participants to practical, scientifically proven strategies to help manage physical and psychological symptoms including pain, fatigue, lowered mood, poor sleep and reduced activity. Participants learn how to integrate the strategies into their daily lives to make beneficial and lasting changes. They typically increase their range of strategies from seven at programme commencement to 25 on completion.

Strong progress is also seen in participants’ understanding and confidence in how to manage their condition, significantly improved understanding of how to access resources and confidence in who to contact if they need support – all crucial components of self-management.

As one referrer said: “The Energise Health programmes is an innovative idea that fills an important therapeutic gap for its target participants. It provides a user friendly, easily accessible, cost effective way of empowering participants to selfmanage their situation / condition, by providing effective and practical tools and strategies”.

Now, its efforts have seen it recognised at the recipient of the rehabilitation innovation award at the CMSUK Awards 2022.

Business partners Victoria Collins, an occupational therapist and case manager, and nurse Dr Dee Burrows highlight that client motivation to engage in the programme is important, otherwise, there are minimal exclusion criteria.

“Our aim is to enable individuals to create sustainable change in their lives and routines so they can be embedded and truly make a difference,” says Dr Burrows.

Each programme takes six weeks with modules covering energy, recovery and bodily sensations; thoughts and emotions; movement and activity; sleep; My Energise Recovery toolkit; and Energising Your Recovery in the Future.

The courses draw from Recovery Facilitation (RF) models, which are best known in mental health, wellbeing and addiction services; they have a strong evidence base.

Two programmes are offered – an early intervention course for people who are six weeks to six months post injury/diagnosis and another for those who those over six months into their recovery journey.

One participant who was receiving a variety of clinical treatment when she attended the programme said: “I was very sceptical and extremely anxious, but I was left with an array of new "tools" I could use to deal with ongoing life stresses.

“Some tools I could use continuously some I could use as and when the situation required it. I was able to adapt certain ones depending on my physical and mental situation at the time. All the things I learned are with me today, either in the back of my mind for me to bring forward when the situation arises or written down for me to review and refresh when I feel it’s all getting too much for me.”

Energise Health is working with a number of organisations and case managers across the UK and has recently started offering Recharge Café’s so that programme “graduates” have an opportunity to review their strategies, problem solve and sustain their changes to enable them to live their lives as best as possible.

The Energise Health programme is an innovative idea that fills an important therapeutic gap for its target participants

Our aim is to enable individuals to create sustainable change in their lives and routines so they can be embedded and truly make a difference

Moves to introduce temporary concussion substitutes welcomed

Moves by three elite football leagues globally – including the Premier League –to introduce temporary concussion substitutes from next season have been hailed as a “progressive development”.

In a letter written to IFAB, it is hoped that the Premier League – along with Major League Soccer in the United States and France’s Ligue 1 – can become football’s first top-flight divisions to trial the protocol. The move, which is proposed to take effect from the start of the 2023/24 season, would be a major step forward in the protection of players, following a number of high-profile incidents which demonstrate the need for temporary substitutions.

While concussion substitutions were

introduced into the Premier League in 2021, they have been marred by controversy, with the first use of a concussion substitute –after a clash of heads between Manchester United’s Anthony Martial and Issa Diop, of West Ham United – was condemned as showing the protocol was “deeply flawed”. Calls for temporary concussion substitutions have only increased since then, with recent incidents in the World Cup 2022 –namely involving Iranian goalkeeper Alireza Beiranvand and Wales’ Neco Williams –strengthening the case even further. Among the vocal critics of the concussion substitutions is England legend Alan Shearer, who again called for temporary substitutions to be introduced, saying “What on earth are IFAB waiting for?”

Now, the application by the Premier League, MLS and Ligue 1 has been welcomed, with brain injury charity Headway – a prominent campaigner on the issue – highlighting its positive impact on players’ health.

“This would be a progressive development in better protecting the brain health of players,” says Luke Griggs, chief executive of Headway. “Headway has repeatedly called for football to bring in temporary substitutes and, if this is confirmed, it will be warmly welcomed.

“The evolving nature of concussion means that a ten-minute off-pitch assessment will never be fool proof. But it will allow medics more time to make better informed decisions, in the quiet confines of the dressing room, rather than snap judgements made on the pitch.”

Parliamentary reception to unite brain injury community

ABI Reception will also update on the progress of the ABI Strategy, with attendees able to invite their MP to learn more about brain injury and its impact

A Parliamentary reception is being held to bring together brain injury survivors and professionals with the MPs who represent them in the House of Commons.

The Acquired Brain Injury Reception will be held by prominent brain injury campaigner Sir Chris Bryant and Sir John Hayes, with MPs invited to attend to learn more about the current situation and efforts to make change for those living with ABI.

The event will be held on Wednesday, February 1, and will provide people who have a lived experience of brain injury, professionals working in the field and voluntary organisations with an opportunity to come together to aise awareness and support for the Acquired Brain Injury Strategy.

The Strategy, which is co-chaired by Sir Chris, was granted the go-ahead by the Government after the MP for Rhondda initially sought to secure a strategy via a Private Members’ Bill - the culmination of efforts from charities and voluntary organisations to change the reality for survivors across the country in securing more and better access to vital support.

The event, held in the Jubilee Room from 1pm to 3.30pm, will also enable MPs to meet constituents, hear about the progress of the ABI Strategy and join the All Party Parliamentary Group for Acquired Brain Injury.

People who would like to attend the reception can invite their MP to meet them at the event, with UKABIF creating a template letter on its website which can be adapted and sent.

This would be a progressive development in better protecting the brain health of players

World-first trial investigates stem cells in MS

A world-first trial is investigating whether stem cell transplantation could be used in patients with ‘aggressive’ multiple sclerosis (MS) as a first-line treatment.

The study will trial the pioneering therapy in patients with highly active MS which is not responding to drug treatment, or as a first-line treatment for patients with the aggressive form of the inflammatory and neurodegenerative disease.

The £2.3m StarMS study, launched by the University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, is already open to patients in Sheffield and is now being launched in 19 sites across the UK. It will be the first to compare how effectively autologous hematopoietic stem cell transplantation (AHSCT) is when compared with four other highly effective drug treatments which have shown great promise in clinical trials (alemtuzumab, ocrelizumab, ofatumumab and cladribine).

The trial will build on the results of the landmark MIST trial, which was the first in the world to show that stem cell transplantation could reverse disability in patients with MS. This trial also showed that AHSCT worked better than the disease-modifying drugs available at the time in reducing the risk of disability accumulation in patients with the

highly active form of the disease. However, advances in treatment options for patients with MS have been rapid since the initial trial, with the highly effective disease-modifying therapies alemtuzumab, ocrelizumab, ofatumumab and cladribine showing that they can reduce disease activity and disability accumulation in clinical trials. The new StarMS trial, funded through a National Institute for Health and Care Research (NIHR) and Medical Research Council (MRC) partnership, will pick up from where the MIST research trial left off, to compare the effectiveness and safety of AHSCT against these highly effective therapies. The trial will also determine the future place of AHSCT as a first-line treatment option for patients with ‘aggressive’ MS. When complete, the findings of the StarMS trial could revolutionise care for thousands of people who live with MS, the most common chronic inflammatory and neurodegenerative disease of the central nervous system in young adults which affects 100,000 people in the UK, and 2.3million globally.

Lead trial neurologist Professor Basil Sharrack, an Honorary Professor of Clinical Neurology at the University of Sheffield and consultant neurologist at Sheffield Teaching Hospitals NHS Foundation Trust, said: “Currently, there is no cure for multiple

sclerosis, but huge advances have been made in recent years, with the MIST trial offering renewed hope for people living with this devastating condition.

“We now want to bring this research up to date, by taking into account all the latest advances in treatments.

Prof Sharrack, who is also principal investigator at the National Institute for Health and Care Research (NIHR) Sheffield Biomedical Research Centre, added: “This could also provide us with the solid evidence we need to demonstrate that AHSCT can be offered as a first line treatment for those with the aggressive form of the condition.

“We are delighted to be using our internationally renowned expertise in stem cell transplantation to bring this latest research to the potential benefit of thousands of patients.”

Chief investigator John Snowden, Honorary Professor at the University of Sheffield and consultant haematologist at Sheffield Teaching Hospitals NHS Foundation Trust, said: “Autologous hematopoietic stem cell transplantation has been shown to be highly effective in stabilising, and even reversing disability, in certain patients with multiple sclerosis. But the treatment landscape in this condition has shifted since the original MIST trial.

“The trial will measure how good and safe AHSCT is when compared head-to-head with the latest leading treatments for multiple sclerosis.

“In this way, we hope to determine the exact place of AHSCT in the modern treatment pathways for patients with severe multiple sclerosis. Such translational research may also offer important insights into the fundamental immune system abnormalities that cause MS in the first place.”

Dr Sarah Rawlings, executive director of research and external affairs at the MS Society, said: “HSCT can be life-changing and some people with multiple sclerosis see their symptoms stabilise or even improve after receiving it. We currently don’t know enough about the benefits or safety of HSCT compared to other disease modifying therapies that are also highly effective but, like HSCT, can come with serious side-effects.

“The evidence from StarMS will provide vital information for people considering their treatment options.”

Novel inspired by family’s experience of dementia

An internationally-esteemed sports journalist has written her first novel, inspired by the experiences of her Scottish rugby and cricket international husband of living with dementia in a care home.

Golf writer Lewine Mair has released Tapping Feet, a fictional work loosely based on her husband Norman and his dementia journey, exploring his experiences from the point of view of the family.

Norman Mair achieved the rare feat of playing rugby and cricket for Scotland, and went on to become an award-winning sports journalist. He lived with dementia across his last eight years, before he passed away in 2014 aged 86.

The book includes a series of tales from the home where Norman spent his last two years, charting his love of sharing his sporting experiences with residents – an environment where “he took it for granted that his fellow patients were as obsessed with sport as he was himself” – and the residents’ love of Lewine playing the grand piano.

Tapping Feet will also be raising money for Head for Change, a charitable foundation which aims to ‘be part of the solution’ through pioneering positive change for brain health in sport through research and safer practice,

as well as supporting former players who are affected by neurodegenerative disease as a result of their professional sporting career.

“I have loved the challenge of writing more of a novel. I kept a diary while Norman was in the care home because I found it vaguely therapeutic during what was a tough time for the family,” says Lewine.

“My hope is that many of those who have friends or family members affected by Alzheimer’s or dementia, or both, will draw comfort from reading of the condition’s brighter moments, as well as its sadder side.”

Given the widely-publicised and growing connection between rugby and dementia, Lewine is donating a third of all profits to Head for Change, whose pioneering work in raising awareness has included organising the world’s first header-free football matches.

Judith Gates, chair and co-founder of Head for Change, said: “We are delighted that Lewine has chosen to partner with us on Tapping Feet and we are grateful that she has selected Head for Change as her chosen charity because of our commitment to positive brain health.

“There is some real momentum in the media on this important subject of dementia in contact sports.

“Hopefully, as well as being informative, this

book will provide a little comfort and light to those making the difficult decision to move their loved ones into care.”

Lewine was the first woman to work as the golf correspondent of a national newspaper, having been appointed to the role by the Daily Telegraph in 1997 which she held for over 12 years.

A mother of four, she currently holds the position of the first woman President of the AGW (Association of Golf Writers) and still covers men’s and women’s golf in Europe and the Middle and Far East for Global Golf Post. She has featured on the shortlist for the British Sports Writer of the Year on three occasions and has been a runner-up in the American Golf Writers’ News award. She has also won the Rolex award for sportswriting. Her previous books include the Real Monty, a biography of Colin Montgomerie; Carefree Golf, an autobiographical book with Laura Davies; The Woman Golfer, with Belle Robertson; The Dunlop Lady Golfer’s companion; and One Hundred Years of Women’s Golf.

One of the main events in the annual calendar for neuro-rehab professionals, Neuro Convention, is returning for 2023.

Neuro Convention will be held on March 22 and 23 at the NEC in Birmingham, and will bring together over 1,000 neuro professionals with 50 groundbreaking exhibitors and 50 speakers. The latest in neuro technology and innovation will be on display, with live demonstrations and in-depth presentations featuring over two days of education and collaboration.

The CPD-accredited content programme –which offers up to 12 CPD points – will be centred around two focus areas: > Rehabilitation and mental health –including occupational therapy, speech

and language therapy, music therapy, art therapy, physiotherapy, NHS Mental Health Service development and the newest rehabilitation technologies > Neurophysiology – brain and spine, treatments and innovations, spasticity, Parkinson’s and Multiple Sclerosis research, diagnostics, epilepsy, and movement disorders.

The speaker programme will span across two designated theatres, with the return of the Neuro Convention Keynote Theatre. The School of Health Professions team at University of Plymouth will provide unique, inter-disciplinary learning workshops for professionals who wish to advance their knowledge in the field of

neurological rehabilitation. Neuro Convention 2022 included topics such as the use of occupational therapy services for people with multiple sclerosis, pathophysiology and rehabilitation of hereditary spastic paraparesis, the art of dance to improve Parkinson’s disease, setting up a new Parkinson’s therapy service in the NHS and cerebellar ataxia: pathophysiology and rehabilitation.

To sign up for the free event and explore the latest innovations in research and technology, geared around improving patient outcomes in neuro-rehab, visit here

A ticket to Neuro Convention also provides free access to Naidex and UK Care Week, held simultaneously in the NEC.

Richardson Care Restructures to Provide Seamless Care Pathway

The Northampton-based care provider has six residential care homes and a long proven track record of delivering successful outcomes for service users. It remains an independent family business and Director Laura RichardsonCheater explained the reasons for the restructure: “We have always placed the service user at the centre of their care and the business has evolved to deliver different types of rehabilitation and therapy. We realised that by making some small changes, we could redefine our services to make them clearer for commissioners and take the business forward to a higher level of excellence.

“With six residential care homes, we have the flexibility to provide a seamless rehabilitation pathway. This enables the individual to progress within the supportive environment of the Richardson Care family.”

THE SERVICES ARE:

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

2. ABI rehabilitation & transitional service, The Richardson Mews

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

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

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

Laura continues: “Our admissions policy has always been to place an individual in the home that is most appropriate –both for their needs and the needs of the existing residents. This restructure has formalised that process while retaining flexibility.

“We have over 30 years of experience in supporting people with acquired brain injury and complex needs and have found that they need an initial period of stability before we can fully assess their needs. The Coach House is the ideal environment for this because it is self-contained and secure. After this period the individual may stay in the Coach House or move to our transitional or long-term community rehabilitation services. We are also planning to provide high-input supported living accommodation for people with acquired brain injury or learning disabilities.”

Richardson Care combines a unique homely environment with a therapeutic regime devised by an experienced multi-disciplinary team of therapists. The focus on community is clear in all of the homes where a wide range of activities are on offer. This supportive environment contributes to engagement in therapies with the ultimate goal of service users being able to live a happy and fulfilling life.

For more information call 01604 791266 or visit www.richardsoncares.co.uk

Richardson Care has restructured its specialist services for adults with acquired brain injury or learning disabilities and complex needs to provide a seamless and flexible care pathway.

"We have over 30 years of experience in supporting people with acquired brain injury and complex needs and have found that they need an initial period of stability before we can fully assess their needs."

MotusAcademy expands into Asia Pacific

MotusAcademy was established to support professionals in developing their careers in the fast-growing rehabtech sector, creating new leaders, supporting the progress of businesses and improving healthcare systems worldwide.

Headquartered in Zurich, Switzerland, its purpose is to connect healthcare professionals, engineers, clinicians and researchers through continuing education, knowledge sharing and networking in healthcare, rehabilitation, medtech and robotics.

Now, only months after its official launch, MotusAcademy has expanded into a base in Singapore, reflecting its commitment to delivering workshops, conferences and courses worldwide.

And MotusAcademy remains on track with its expansion plans, with impending hubs set to open in North America, South America, the Middle East and Africa.

The new Singapore hub will host educational seminars throughout the year specific to the region, catering to educational needs in Southeast Asia. With a permanent base specialising in real-world applications and training, partners can come together and share ideas across regional borders.

“MotusAcademy is founded on the value of collaboration with healthcare providers and industry partners to promote rehabilitation innovation, education and research. We believe in advancing rehabilitation technology through collaboration and education,” said Zen Koh, co-founder and executive director of MotusAcademy.

“We plan to offer a range of online certifications that participants can complete remotely through our extensive online library and other resources, which are continually updated and overhauled.”

Since its launch in May 2022, MotusAcademy has become the leading education platform for rehabilitation technology, bringing together some of the most experienced developers of cutting-edge robotics and other assistive technologies with the latest research and clinical evidence.

It has brought together professionals worldwide seeking accessible education on topics including robot-assisted gait training, robotic arm rehabilitation, brain-computer interface (BCI) control systems and more.

In addition to free learning opportunities, MotusAcademy’s roster of industry leaders provides unique access to experts offering insightful commentary in video podcasts recorded at their facilities around the globe.

We believe in advancing rehabilitation technology through collaboration and education

Building a better future for patients

Zen Koh, co-founder, and global CEO at Fourier Intelligence

co-founder and global CEO of Fourier Intelligence - one of the world’s fastestgrowing and dynamic rehabilitation robotics companies, which is pioneering life-changing solutions for patients to maximise their potential - Zen Koh continues to build a global profile as a leading tech entrepreneur and visionary.

Here, he reflects on his reasons for founding the business, the potential for Fourier Intelligence and the sector, and what motivates him to achieve further success

What was your ambition in founding Fourier Intelligence?

My primary motivation for co-founding Fourier Intelligence is to create the world's leading medical technology company for physical and cognitive rehabilitation with healthcare robotics and augmented intelligence systems. We aim to do so by integrating robotics, artificial intelligence (AI), Virtual Reality (VR), remote health monitoring, blockchain, and IoT to transform the rehabilitation industry into a transparent, more distributed and user-friendly one. Our goal is to improve and transform lives through technology, education, and empowerment and give back to those who need it most.

How has the rehabilitation robotics sector progressed since that time?

Fourier Intelligence has since become the leading rehabilitation technology brand. We routinely reinvest revenue from our products in research and development to advance our offerings and improve lives everywhere. Our goal is to create an ecosystem that supports everyone, empowering people with disabilities, patients with neurological conditions, or seniors and providing clinicians and caregivers with life-changing tools.

Our RehabHub™ has since become a standard service. It has been widely installed and is helping thousands of patients with complex needs in their daily lives. We succeeded by making the tools available and affordable so people can use them to improve their lives. Since our formation, we have established, strengthened and increased partnerships with medical institutions, universities,

insurers, and leading professional societies to achieve our mission better.

One notable example is the renewal of another five years, after the initial three successful years of collaboration, of research Memorandum of Understanding (MOU) with the Shirley Ryan AbilityLab. The Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago (RIC), is a not-for-profit nationallyranked physical medicine and rehabilitation (PM&R) research hospital based in Chicago, Illinois. Founded in 1954, the AbilityLab is designed for patient care, education, and research in PM&R. The AbilityLab specialises in rehabilitation for adults and children with the most severe, complex conditions ranging from traumatic brain and spinal cord injury to stroke, amputation and cancer-related impairment.

What is the potential?

Our goal is to create a healthcare technology ecosystem that will empower our users, change lives and improve society. Potentially, Fourier Intelligence's open platform system, EXOPS™ (Exoskeleton & Robotics Open Platform System, http://exops.fftai.com/) enables all suppliers to plug directly into the Fourier ecosystem to provide solutions with better results. This approach provides customers with more choices, better solutions and lower costs. Fourier's and other manufacturers' products are a stepping stone to the platform's real power: our must-have technology is geared towards empowering clinicians and patients during their rehabilitation journey using robotics and AI. Currently, we aim mainly at providing technology to the rehabilitation industry. Our product will set new standards in the field, benefiting patients and providers. We are committed and dedicated to researching and developing future technologies that will enrich everyday life before we consider commercialising them.

What are your highlights to date with Fourier Intelligence?

The Fourier Intelligence platform is designed to be a comprehensive, empowering solution for rehabilitation. It enables clinicians to consolidate what they already have, introduce new technologies and services to enhance their offerings and expand into new clinical offerings. We have since launched the EXOPS™, Group Therapy Concept, and RehabHub™ and completed successful technology transfer from our research joint laboratories. One highlight is the launch of the ArmMotus™ EMU through technology transfer arrangements with the Fourier-UoM (University of Melbourne) Joint Laboratory. The ArmMotus™ EMU is a 3D back-drivable upper limb rehabilitation robot that adopted an innovative cable-driven mechanism combined with a parallel structure of lightweight carbon fibre rods that reduces the device's friction and inertia for higher compliance in human-machine interaction. It has since won four global accolades: the Red Dot Design Award, the iF Design Award, the Medical Design Excellence Award, and the Good Design Award. Another highlight worth mentioning is that Fourier intelligence has successfully raised investment rounds from SoftBank Vision Fund 2, Saudi Aramco P7 Venture Fund, and the Yuanjing Vision Plus Capital. These investments signify endorsement and recognition of our work. The experience and capital that our strategic investors bring to Fourier Intelligence will help us rapidly realise global commercialisation and deliver innovative therapies to as many patients as possible.

What do you hope to achieve, both personally and for Fourier Intelligence?

I believe in creating a new rehabilitation technology world where everyone can access the tools and resources they need to achieve their dreams in supporting the advancement of the rehabilitation profession.

My hope for Fourier Intelligence is to bring individuals, institutions, and thinkers together in an open ecosystem to collaborate, productively and efficiently, toward their mutual benefit and harness technology's power to change patients' lives for the better.

We want to build a change-maker and are committed to creating a better future of inclusive, sustainable development through healthcare technology.

I strive to do so in my multiple roles as Global CEO at Fourier Intelligence, as Executive Director at MotusAcademy, and as the incoming President of IISART (https://iisart.org/)

I hope to invite more like-minded, passionate people to join our cause.

As

Discovering The Robotic Assisted Therapies At Sussex’s Most Exciting New Neuro Rehab Clinic

VIM Health has welcomed its first patients through the doors to experience a holistic high-tech approach to recovery with a focus on intensive rehabilitation and some of the best robotic assisted therapies currently available in the UK.

The innovative care model at VIM is made unique by the addition of an onsite accessible gym and a continuous approach to a patient’s entire recovery journey.

Blending technology with hands-on therapy, the multi-disciplined team (MDT) at VIM provides end to end care for people recovering from neurological illness or injury.

Founder and Clinical Director, Tom Taverner has a special interest in utilising technology to supplement hands on therapy and improve the outcomes and experience of patients. His understanding of how powerful the recovery environment can be, and the desire to create an accessible gym, pay tribute to how truly unique the rehabilitation space and service is at Vim.

High Tech Intensive Rehab

“From the inception of VIM, we knew our focus would be robotic assisted therapies and intensive rehabilitation packages,” says Tom. “Several studies have shown that for many conditions, such as Stroke, high-intensity rehabilitation training is the most effective way to promote recovery.”

“At VIM, our intensive rehabilitation packages are intertwined with the use of robotics as it is the most effective way to achieve the high intensity needed for positive neuroplasticity to take place,” continues Tom. “Our intensive recovery clients are accommodated locally so we can ensure they receive therapy at the right frequency, in high doses. The robotics and techniques we use are also designed to help patients carry out meaningful tasks that reflect their desired recovery outcome.”

The rehabilitation journey for patients at VIM begins with a detailed assessment by a specialist. From there, an intensive package is tailored to meet needs and recovery goals. For most people, this will include a combination of one-to-one therapy and intensive training with innovative technology, including robotic, sensor-based, and virtual reality devices. The tech at the clinic is impressive with some of the pieces of kit looking as though they have arrived straight from a NASA training centre!

From a REX hands-free robotic exoskeleton to a range of equipment from the leading brand, Thera, VIM has technologies to help a wide range of people with neurological issues.

From relearning how to walk, to being able to pick up a drink, VIM has invested in equipment that covers a wide range of functions.

Recovery Continuity

VIM clients do not only benefit from intensive packages and robotic assisted therapies, but the comprehensive approach at the clinic also means patients have access to a wider range of therapies than traditionally offered at rehabilitation clinics. From robotics to soft tissue therapy, mental health support and the use of an accessible gym, VIM understands the value of continuous care.

“Once a client is medically stable, they come through our doors and have access to everything they need to make excellent recovery progress.” Says Tom. “Being able to come through one space for all treatment, working with the same therapists, is invaluable to

patients. No information is lost going between different locations and we accurately chart progress which further encourages patients.” Where VIM does work with partners outside the business, such as orthotics and prosthetics specialists, Blatchford, the service is facilitated by VIM to ensure a continuous experience. This approach in continuity is even taken home by patients with access to a telerehabilitation service to encourage further exercises that can be undertaken in between clinic visits.

Healing Spaces

Just looking around the interiors of the clinic, it’s clear that VIM has set out to achieve not just a service that is conducive to recovery but an environment that is, too. “It has long been known that our environment can have a significant effect on our overall well being,” says Tom, “and a study published by Taylor and Francis online proves this to be especially true in healthcare facilities.”

This theory is apparent inside the 250 square metre VIM clinic, which doesn’t feel like a typical healthcare facility. You are greeted with soft light, warm yet calming colours, mirrors, and an abundance of indoor greenery to help purify the air and bring a touch of nature to the exercise spaces. The high-tech robotic equipment on display contrasts with the light interiors of the clinic, but it all works together to form a cohesive, calming environment.

A New Type Of Gym

The look and feel of the main clinic are carried through to the gym too. Although the gym does operate on the familiar subscription model used by gyms throughout the UK, that is about where the similarities end. VIM has created what they are calling a new type of gym, one founded in the desire to create truly accessible access to health and fitness.

Tom, who is a keen gym goer himself, wanted to create a gym with several key elements; inclusivity and a sense of community. Operating under the tagline ‘your health, your way’, the gym features adaptive equipment and is supported by clinicians so that people with disabilities or mobility issues have access to a safe space to work on their health whilst only paying standard membership fees.

The gym is used by VIM patients and integrated into treatment programmes but is also available on a monthly membership basis for anybody else that wants to join, opening the facilities up to a much wider range of people seeking a gym that operates a little bit differently.

Tom wants the newly opened gym to eventually provide more than an inclusive space to work out. Believing the healing power of exercise will bring together a like-minded community of people that will take advantage of the comfortable surroundings inside the gym, which includes spaces for mental health care and an honesty bar where proceeds are donated to relevant charities.

63-year-old

A man who was left with no movement in his left leg and limited movement in his right following a life-changing aneurysm, is well on track to independent living after he was told by doctors that he may never walk again following surgery — a rehabilitation journey that has tested his physical and mental guise to the limit.

former judo instructor who was told he may never walk again after suffering life-changing aneurysm is now well on track to achieving his dream of living independently again

Brian Walker,

Norfolk suffered an abdominal aortic aneurysm in November 2021 which caused immense swelling in both legs and admitted him to theatre for emergency surgery. As a former Judo instructor, Brian was used to pushing his body to the limit, yet a year ago, his life was turned upside down.

The first step was to get Brian back on his feet again and against all odds, and thanks to the specialist rehabilitation services of Askham Rehab, he was able to stand with the support of a frame within just a matter of months.

Brian arrived at Askham in February 2022 with a sense of determination that matched that of his care team to overcome the seemingly impossible task of regaining his ability to live independently.

Through a combination of specialist physiotherapy, hydrotherapy and mental health support, Brian started making progress far sooner than anyone anticipated.

One of the biggest hurdles in Brian’s journey was the anxiety induced by his situation — which was

only heightened due to family bereavement at the time. Despite this, he never lost hope and thanks to the specialist mental health services available, he was able to persevere and see that there was light at the end of the tunnel. Soon after his aneurysm, Biran was unable to carry out the simplest of domestic tasks and relied heavily on a hoist to help him. Thanks to the specialist rehabilitation he received, he was soon able to cook, garden and move around independently with the assistance of a walking frame — something that symbolised a changing of the tide in his journey to recovery. With a strict rehabilitation structure and the encouragement to act independently, Brian and his care team are now confident he will soon be able to live independently.

Commenting on his journey, Brian said: “I didn’t know which way to turn when I was met with the news that I might never walk again. There is nothing more alarming than the prospect of not being able to be independent and I think that's what has motivated me on this journey. I have always been a resilient character, yet this has been the biggest challenge of my life. Mentally, it has been exhausting and I have been met with an immense amount of anxiety. I feel like this is something that is often forgotten about in rehabilitation, yet the effect it has on your emotional wellbeing is massive. Thankfully, Askham has built its services around me, and the mental health support has been just as valuable as the physical treatment I have received.”

Throughout his time at Askham, Brian engaged with advanced robotics including the Omego

lower limb trainer for strength and endurance. He also took part in gait re-education through hydrotherapy and parallel bars — as well as plinth strengthening with weights and resistance bands. Askham Village is a family-run community with a rehabilitation service that has transformed the lives of many individuals, and its remote setting and person-centred approach is the perfect place to approach any personal challenge — big or small. With the latest robotic equipment and state-of-the-art gym and hydrotherapy equipment, it is leading the way in the local area for rehabilitation services — which, in Brian’s case, have restored his hopes of independence. Sara Neaves, Clinical Lead and Outpatients Service Manager at Askham Rehab, said: “When Brian first came to us in February, it was clear he was a determined and quick-witted man. Our relationship with him has blossomed and he has thrown himself wholeheartedly into his treatments. This has been evidenced by the immense progress he has made, which has far surpassed the expectations of us, the clinicians involved in his case and Brian himself. He is an absolute pleasure to be around and has integrated into the Askham community effortlessly. Community is what it's all about here and there is a sense of togetherness for every case that comes through our doors. When you suffer a life changing condition or injury, it is easy to lose hope, and this is one thing Brian never did.”

Commenting on his care team at Askham, Brian said: “My carers have been amazing with me, and nothing has been too much trouble. They have kept me motivated since the day I arrived, and I am truly grateful for this. We have such a good laugh and growing up in a rugby environment, I didn’t think they would be able to keep up with my humour — but how I was wrong!”

Sara continued: “He is now walking independently and engaging in everyday domestic activities. We are in no doubt that Brian will achieve his dream of living independently and to be part of his journey is a real privilege.”

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

Alternatively, to watch a video of Brian’s journey at Askham Rehab, visit

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

a 63-year-old former heating engineer from

Never underestimate the impact of the therapeutic relationship

I am Danyelle Clarke, a 35-year-old Traumatic Brain Injury survivor. Four years ago, I was involved in a horrific road traffic accident, where a lorry overturned our car, dragging it along on top of the crash barrier, before projecting it in to oncoming traffic.

I was the front seat passenger (thankfully wearing my seat belt) ending up unconscious and trapped hanging upside down in the car. I have no memory of the actual accident, only the conversation with my Mam moments before, where we were chatting away excitedly about the ‘girlie day’ that lay ahead of us.

Six weeks later I woke up in hospital having been in a coma, to the most horrifying experience of my life! I was completely paralysed down the right side of my body, with limited movement in the left side. I was unable to hold my head up, or retain my tongue in my mouth. I couldn’t speak and had blurred and double vision. I was however aware of my family and the people around me, and I knew I was in hospital. I was trapped inside my broken body, unable to communicate, absolutely petrified and isolated. I just couldn’t understand how or why I was in this state.

Prior to the accident I was a professional Latin dancer, regularly competing in national and international competitions. I was a dance and fitness instructor and was also in the final stages of completing an English master’s degree. A far cry from the position I now found myself in!

And so the long and complex recovery journey began.

“How long does it take for these pain killers to work, and this awful stabbing in my stomach and back to subside?”

I’m laid in my hospital side room looking out on to the car park, willing my parents to come. The door bursts open and I look round hopefully, expecting to see them, but in come two physios. “Come on Danyelle, let's have you up and sat on the side of the bed” one of them says. I tell them that I'm in a lot of pain today, to which the other one barks “Look you’ll be in pain whether you do this or just lay there, so you might as well do physio and be in pain!” They spin me round and position me on the side of the bed. The room is spinning, everything is blurred, and I feel sick. Panic sets in, I think I’m falling, I’m so dizzy.

By this time I’m crying, and desperately trying to tell them that I’m going to vomit. They lay me back down, and a sharp irritated voice snaps “well we tried!” I’ve never felt so vulnerable! The door opened again, thankfully this time it is my Mam and Dad, they heard the commotion and came in to see what was happening. In a much nicer tone of voice the second physio informed them “Danyelle’s refusing to do physio, she said she’s in too much pain. We’ll come back tomorrow...”

…WOW – COMPASSION AT ITS FINEST! Can’t wait for tomorrow!

How had I gone from spinning around Blackpool’s legendary Ballroom, to desperately clinging on to my hospital bed because the room was spinning around me?

This is a prime example of how a poor therapeutic relationship fails both the patient and the clinician. The foundation for a good therapeutic relationship can be as simple as getting to know your patient. Whilst this may seem like an idealistic approach in such a fast paced, time restrictive environment, spending those extra few minutes learning about the person, could be of significant benefit in the future.

Had the two physios’ treating me, actually known anything about me – the fact that I am a strong willed, determined person, with a disciplined sporting background, they might have taken my comments more seriously.

If they had listened to me, they would have realised that I had a real problem. Instead, they underestimated me, wrongly assuming that I was making excuses not to engage in physio. Therefore, a very clear vestibular disorder went undiagnosed and untreated for several weeks and left me spinning.

Situations like this can be avoided simply by approaching every patient with an open mind. Assumptions are effectively ear plugs they can often lead to miscommunication between the clinician and patient. Knowing someone’s clinical condition or diagnosis, is only part of the picture. Knowledge of the persons background, personality, intellect, awareness, capability, emotional state etc, are also major factors. Key information of this nature can be gained by connecting with and listening to the patient, whilst also talking to the family or carer, particularly if the patient is unable to articulate well, or at all. Making assumptions, no matter how well intended, often leads to underestimation. The patient may become demoralised and disengaged. Therefore, they are less receptive to the treatment or therapy that is intended to help them, resulting in missed opportunities. I experienced this first hand in one of my appointments in hospital, when my therapist presented me with a pre-school jigsaw puzzle. I noticed on the box it was recommended for age 3+. She then told me “I know you like dogs, so here’s a ‘Hello Kitty’ puzzle”. I was acutely aware that in a matter of weeks I had gone from sitting at a desk in the University library, researching ‘the evolution of romance literature from a feminist perspective’,

to sitting at a desk in a wheelchair in hospital, doing an infant's jigsaw. And ‘APPARENTLY’ I could no longer tell the difference between a cat and a dog!!! This completely shattered my already diminished self-confidence, making me question my own intellect, and how I was actually being perceived by others. I just wanted to go back to the ward, get back in to bed and hide from the world. A world in which I’d previously held a valuable role, compared to this inferior being – with the suggested intellect of a 3 year old. Where do I fit in this world now?

i.e., my physiotherapist and occupational therapist ask me to liken physical movements to specific dance moves, they then adopt the dance terminology and use it in relation to the tasks they are asking of me. They often play competitive dance music during my sessions, which I find emotive and inspiring. Obviously this is a very personal adaptation to therapy which has been tailored around me. Someone else with a similar background, in this situation may not find this helpful at all, and may even find it distressing to ‘tap in to’ the dance theme. Which is why patient led treatment and therapy, using the right approach at the appropriate time, is absolutely crucial!

Assumptions can and do create metaphorical barriers!

Connecting with the patient and showing genuine empathy will enable them to express their; fears, concerns, worries, hopes, wishes etc. By respecting the patients feelings you will build trust, and potentially break down any barriers that have inadvertently arisen. Therefore, emotional and psychological issues can be addressed before they have a negative impact.

Person specific treatment and therapy can be far more productive than a generic ‘ticking boxes’ approach, as my recent experience with my current therapists has proved. They have taken the time to get to know, and connect with me on a personal level, and don’t just view me as a series of problems that need to be worked on.

They are aware of my strong dance connection and use dance analogies as a therapy tool,

Throughout my ongoing recovery journey, I have experienced some very dark days. Fortunately, I now have an exceptional team of therapists, who all excel in their own specific field. The one thing they all have in common is, they appreciate the importance of a good therapeutic relationship, and have taken the time to develop this. I feel confident that my therapists know me ‘Danyelle, the person’. Which is why they are able to offer me support and ‘pick me up, dust me off, and put me back on track’ when I’m struggling. It is thanks to their knowledge and caring approach that I have been able to make the progress that I have so far, and hopefully will continue to do so. Any clinician working in the field of neurology knows that all brain injuries are different! All recoveries are different! Therefore, they should be mindful that, all patients are also different! With insight in to the patient's personality, background and history, the clinician has a clearer understanding of who, rather than what they are dealing with. Meaning they are ‘treating the person’ as apposed to ‘treating the condition’.

Contact Danyelle at danyellesrecovering@gmail.com

Assumptions can and do create metaphorical barriers!

The power of social interaction

Here, Dr Keith Jenkins, consultant clinical neuropsychologist at St Andrew’s Healthcare, discusses how care providers can make these opportunities happen, and how collaboration between professionals in this way can deliver hugely positive results for patients

After brain injury, one of the most common wishes cited by survivors is the desire to feel ‘normal’ again. To be able to do the things they used to do before their life changed forever, and to feel - as much as possible - like the person they used to be.

A core part of that is through social interaction. Many people living with brain injury find themselves lacking opportunities to do this; either through their own choice, painfully conscious over how they will be perceived, or through the devastating loss of the friendship circles they previously enjoyed.

All too often, this contributes to the isolation and loneliness felt by so many people after brain injury, which can seriously impact their ongoing neuro-rehabilitation and quality of life.

By addressing this, and creating opportunities for social interaction, the process of adapting to life after brain injury can be eased. Removing the taboo around returning to activities that used to be enjoyed and regaining the enjoyment of the company of others can greatly benefit mood and well-being.

“It’s about the opportunity to feel normal and to feel in touch with ordinary, everyday life,” says Dr Keith Jenkins, consultant clinical neuropsychologist at St Andrew’s Healthcare.

“These are things most of us take for granted, if we want to go out and do something social, we can. Whereas if you are living in a service and are dependent upon support workers, it’s not so easy”.

“But although it’s not easy, it’s very important - that feeling of normality is vital.” St Andrew’s, based in Northampton, has a longstanding commitment to recognising this and to creating and enabling opportunities for social interaction to happen.

Holding regular sessions for people living with brain injury and their supports in the evening - replicating the time of day that leisure-based social interactions most often take place - St Andrew’s offers a whole new level of support to its patients, in addition to the therapies that form their conventional neuro-rehab.

“It has a very big impact on mood, a positive impact, many of our service users are very positive the day after they have been to one of our clubs or sessions,” says Dr Jenkins, who has a long track record of establishing support and social opportunities for both people living with brain injury and their families.

“And with our upcoming Christmas lunch, we’ve had service users who wanted to book their place very shortly after it was advertised, to make sure they could get a place. That shows how much they look forward to it.”

Life after brain injury can be a lonely place, and while social opportunities - particularly with others living with brain injury - are hugely important, for many they are hard to find.

St Andrew’s was one of the founder members of the ROCK Club in Northampton - an acronym which takes the names of Richardson Partnership, Oakleaf, Christchurch and Kemsley (the latter being the specialist brain injury service at St Andrew’s) . The ROCK Club that came together in 2008 continues to thrive. As well as participants from all four founding services, people from other services in and around Northamptonshire also attend the ROCK Club sessions, which are held from 7pm to 9pm in the evening. Attendees can help themselves to soft drinks, tea, coffee and food, with the arms-length assistance of their support workers to enable them to enjoy their evening independently as much as possible.

“It is a great opportunity to be in a room full of people who all live with brain injury, who are all there for the purpose of having fun and socialising together, with low level support from the staff who need to come with them,” says Dr Jenkins.

“As well as the fact it’s a really good evening, there is also that comradeship and universalisation, the realisation that you are not alone”.

“Clearly these sessions have to be carefully and individually assessed, because in order to go out to a social event with lots of people, many from other services, you have to be sure that the people we take from St Andrew’s are going to feel safe and are able to cope.

“While it does give autonomy in an environment that is normalised as much as possible, it has to be carefully monitored. In a care setting, very often there are tight controls around meals, there are set times or set amounts that you can have. But at the ROCK Club, people are able to help themselves, it’s readily available. So we need to give support in developing that self-control and self-regulation, and the support workers are there to help with that.”

While social opportunities, particularly those ‘out of hours’, are of great importance, they depend to a great extent on the ability of staff to deliver these sessions.

“It depends very much on the motivation and goodwill of staff, because often useful social events happen outside the core working day,” says Dr Jenkins.

“Staff have to give up their own time, or stay on later than they would normally work, in order to help somebody go to an evening event. It very much relies upon staff staying beyond their normal shift.

“As a person living with brain injury, you don't want all of your social events to happen during core therapy working time, and none of us go to the bulk of our social events between nine to five, Monday to Friday. If we do go to things during the week, they'll be in the evening. That's normal adult social behaviour, so we've tried to offer that opportunity. But it remains so dependent upon staff goodwill, or the shift systems within care providers that enable that to happen.

“There are day services in Northampton and Headway groups locally, and we’ve offered the opportunity for them to come to our ROCK Club events too, but to date they haven’t taken us up on it, most probably because they don’t have the staff flexibility to come out in the evening.

“It really does rely on staff to go above and beyond their normal daily remit. In the ROCK Club, there is a very small group of us, including some volunteers, and some people who have been committed to this for a long time.

“We have one key volunteer called Alistair McCarter who used to work for Oakleaf, although he has been retired for several years he still comes along and brings friends as volunteers. He has also raised money for our events through a range of things he does in the community. People like Alistair see the need to put themselves out to help us deliver these opportunities, and we’re very, very blessed to have that.”

In addition to the regular ROCK Club sessions, there are two main events each year - a summer event and the upcoming Christmas lunch, which this year will be held on December 19.

“The beauty of the Christmas lunch is its sheer normality. It’s no different to a firm’s Christmas lunch, if someone saw it, they wouldn’t know any different.” says Dr Jenkins.

“Some years, we’ve had just under 200 people

coming along. It’s a sit down, three-course Christmas lunch, with a raffle and then a DJ for people to continue socialising after the meal. It’s a fantastic event because it’s just people having lunch, enjoying themselves, as people do at Christmas.

“From our ROCK Club events during the year, we are able to subsidise the Christmas lunch, so it’s an affordable price for anyone who wants to come.

“The money also supports our summer event, which is held in the local village hall. We do a whole day with a barbecue and entertainment, with stalls or activities, it’s indoor but is also able to spill over into the adjacent playing fields.

“These events are particularly well received and we know people look forward to them.” While St Andrew’s is a keen advocate of the need for social opportunities, Dr Jenkins admits he is aware that many other providers around the country do not take such proactive action, but stresses the benefits of them doing so and in working in collaboration for the benefit of those who need it.

“By working together with people that, in other settings, might be perceived as rivals or competition, to work aside from that to deliver social events and work together collaboratively, is really positive for the services individually and collectively.

“Most importantly, it gives people living with a brain injury the chance to go to a social event and see people that they're not living with all the time in their own hospital, care setting or home. It also gives that chance to a wide range of staff to mix together, so everybody really gets that sense of getting to meet each other, working together and in collaboration.

“And that's a really positive thing for everyone.”

Anatomical Concepts supports Paralympian to break Antarctica Records

On 12th December 2022, Paralympic athlete Karen Darke, and her team, will depart the UK to embark on a 150km hand-cycle and sit-ski across the Antarctic snow to create the ‘Pole Of Possibility’.

Inspired by a serendipitous connection to the number 79, Karen discovered that the co-ordinates 79°S, 79°W led to an area of Antarctica that no-one has been to. It is here that she wishes to create a new ‘Pole’ - The Pole of Possibility (POP). This World-First and Guinness World Record breaking journey aims to explore personal and planetary possibility around mindset, technology and sustainability.

Carolyn Jones of Anatomical Concepts UK Ltd (ACUK) explains why they decided to become key sponsors of this record breaking attempt.

“We recognised immediately that ACUK has similar values to that of POP. We firmly believe that human-spirit combined with

human-ingenuity can lead to results that are super-human. Karen and her team are perfect examples of this.”

At the age of 21, Karen had a life changing rock-climbing accident that left her paralysed from the chest down. Her spirit of adventure, and love for nature, helped her overcome adversity to become a GB Paralympic gold medallist and undertake numerous expeditions including hand-cycling across the Himalayas, and climbing one of the World’s biggest rock walls - ‘El Capitan’.

There is no doubt that the Pole of Possibility will be Karen’s biggest adventure to date!

Her paralysis means that she will traverse the terrain on a specially adapted ICE Trike with ZTrikes hand cycling mechanism, and a backup sit-ski if it becomes impassable.

This will be the first attempt by anyone to hand-cycle the frozen continent, and to make it even more challenging they will be crossing virgin plateau ice rather than the hard-packed road to the South Pole. Even if she has to switch to the sit-ski, Karen believes she will set the record for the longest Antarctic journey by a paraplegic.

“Nobody knows what the conditions will be like down there,” says Karen, “but hopefully with the right tools and the right team I can show anything is possible.”

Karen’s team on this journey into the icy Antarctic wilds is film-maker Mike Webster who will record the expedition through a documentary film, and Professor Mike Christie of Aberystwyth University, who will use the expedition as a research

platform to demonstrate the impacts of climate change on the Antarctic continent and how this has wider impacts to people and nature across the world.

Carolyn continues, “Every time I speak with Karen I’m in awe of her strength of mind, her ability to problem solve, and genuine desire to connect with people. Although we don’t work with her directly as a client, we recognise these qualities in many of the people we do work with - individuals, families, clinicians and legal teams. Its a privilege to be part of these conversations.” “Being part of the Pole Of Possibility, enabling this adventure, is also a privilege. Everyone at ACUK will be thinking about them over the Festive Period and we look forward to sharing their story of success in the New Year!”

You can learn more about Karen Darke and the Pole of Possibility on her website: www.karendarke.com/the-pole-of-possibility

This will be the first attempt by anyone to hand-cycle the frozen continent, and to make it even more challenging they will be crossing virgin plateau ice rather than the hard-packed road to the South Pole.

Fighting for and securing a client’s lifechanging care

and a full legal team was quickly put in place, with Stuart McKechnie KC and Nicola Greaney being instructed from an early stage.

Allegations of contributory negligence

Nick’s client was not wearing a cycle helmet and, whilst there is no legal requirement so to do, the insurers alleged that he had negligently contributed to his accident because of the absence of such protection.

The insurers also made additional allegations of contributory negligence, all of which were considered spurious. Although primary liability was admitted early on, the allegations of contributory negligence were heavily pursued. Had these allegations been made out, the client could have lost as much as 25 per cent from the value of his whole claim; including a 25 per cent deduction in the value of all future care and support.

Here, we learn more about the many obstacles presented - and how, over the course of four years, the legal team successfully overcame all of them to ensure their client now has appropriate care provision for life

Slater and Gordon recently secured a multi-million pound settlement, approved by the court in 2022, for a cyclist who was hit on a roundabout suffering a catastrophic brain injury for which he will require life-long care and support on a 2:1 basis during the day.

Case background

The client, whose case was concluded by Nick Godwin, a specialist catastrophic injury solicitor at Slater and Gordon with over 20 year’s experience of life-changing injury work, was cycling around a roundabout on a bright, sunny day, when the defendant driver negligently entered the roundabout and collided with him, causing him to be knocked from his bicycle and hit his head on the ground with considerable force.

It was clear from the outset, given the seriousness of the client’s injuries, that this was going to be a case of substantial value

So important was it to seek to defeat these allegations, the legal team decided to ask the court to order a split trial on the issue of contributory negligence, to run concurrently with directions to a quantum trial;

This was resisted by the insurers at an early court hearing but the judge found for the client, commenting that a split trial would “involve the resolution of an issue which may unlock a gateway to other resolutions especially potential settlement of this matter.”

Expert evidence was commissioned from a leading consultant neurosurgeon and a highly experienced cycle helmet expert / engineer.

In safeguarding a crucial long-term and full care package for a brain injured client, Slater and Gordon Lawyers faced extensive challenges and barriers in the case.

This evidence clearly suggested that wearing a helmet would have made no difference to the outcome of the client’s injuries, given the nature of the crash and the forces involved. But this evidence was disputed by the insurers experts so the matter was listed for a trial. just on this preliminary issue in 2021. Just a few weeks before that trial was due to take place, the insurers withdrew their allegations, resulting in 100 per cent liability on the part of the negligent driver and a 100 per cent recovery of damages.

Interim payments

An early voluntary interim payment was secured to enable a specialist brain injury case manager to be instructed who put together a multi-disciplinary team to support the client. His catastrophic brain injury caused him to experience extremely severe cognitive, communicative and neuro-behavioural difficulties, with his treating team being of the view that he required 2:1 support during the day, with a support worker on duty at night as well.

Unusually, for a number of case-specific reasons, the client’s family wanted to provide the majority of the support for him and the case manager put together a team comprising a number of support workers, some of whom were close family members. This was initially accepted as appropriate by the insurers, but their position shifted as the case proceeded and it was argued that this sort of support regime was detrimental to the client. Eventually, Nick and the team were able to secure expert and lay evidence to satisfy the insurers that, whilst unusual, in the particular circumstances of this case family input was understandable and appropriate and, moreover, they should not be paid at gratuitous rates.

As well as pushing hard for deductions for alleged contributory negligence, the insurers in this case also reached a stage where they declined to provide any further sufficient interim payments to enable the claimant to continue with the care regime in place. This stance was largely motivated by the insurers’ care expert, who asserted that one support worker was appropriate at all times during the day and night, despite the unpredictability of the client’s behavioural issues. With funds dwindling, there was no choice but to apply to the court for a substantial interim payment to safeguard the client’s care package. This led to a very hard fought, contested application; taking almost two days to hear the evidence and arguments. At the end of this hearing, the judge ruled in favour of the client, awarding substantial interim funds to ensure the client’s support team could remain in place as the case progressed towards a full trial. Masterful advocacy from Stuart McKechnie KC, one of the leading PI silks in the country, was critical to the success of this crucial application.

Issues between parties and settlement

The issue of the need for 2:1 v 1:1 care continued to be fiercely fought on both sides. So contentious was the issue that even when the parties came together for a joint settlement meeting (JSM), they could find no common ground on this issue. Whilst the balance of the claim was settled at the JSM, for a substantial lump sum, the issue of future care and case management remained very much alive.

An initial approval hearing dealing with all items save for future care and case management was ably conducted by senior counsel, Nicola Greaney of 39 Essex Chambers. This case was hugely document-heavy and Nicola provided vital support throughout the case and offered meticulous advice and assistance at various significant stages.

As the quantum trial approached (to deal with future care and case management), the insurers made a Part 36 offer at a much more competitive level than offers made at the JSM. This was considered carefully by the client and his legal team but the level of the offer was felt to be insufficient and rejected.

A counter proposal, which allowed for 2:1 support to continue for the rest of the client’s life (together with associated case management) was put forward in response and accepted by the defendant shortly before the offer was due to expire. The settlement based on this offer was then approved by the High Court.

Outcome

The settlement figure is confidential but comprises a multi-million lump sum and a very substantial periodical payment order together with provisional damages and a variable PPO in relation to post traumatic epilepsy. The care package is protected for the duration of the client’s life.

Testimonial from client’s litigation friend

After a lengthy legal process was concluded with a positive outcome for the client by Slater and Gordon, his litigation friend said: “We have seen how much you have all fought for us against difficult defendants and we are grateful.

“Your work to understand our situation and the complexities of it has meant so much to us and backing us up when you’ve been pressured otherwise we realise cannot have been easy but has been so appreciated.”

Assessment from Nick Godwin

“This was a very hard-fought case in which many key issues were defended robustly but, thankfully, our client succeeded on these key issues meaning his future is now more secure despite terrible injuries caused through no fault of his own.

“To secure the best outcomes in a case like this takes a huge amount of work on the part of the lawyers but also a huge amount of effort on the part of the family, who are already putting in so much effort trying to come to terms with what has happened and are trying to look after their loved one.

“I can't underestimate the importance of ensuring the instructed legal team in this specialist area of law have the requisite experience to run these cases to their full and proper potential. That is vital to ensuring the client receives the damages they need for the future.

“It’s also crucial that as well as having a very experienced legal team, you also have an experienced and specialist case manager, who then builds the team around the client.

"They need to understand the issues, how the client’s journey can be improved and where to focus rehabilitation, care and support.

"Only with this expertise can the client’s future be safeguarded for the long term.”

We have seen how much you have all fought for us against difficult defendants and we are grateful. Your work to understand our situation and the complexities of it has meant so much to us.

Dealing with boundaries when working in a private home

Professional Boundaries

The quality of a support worker’s relationship with their client is very important. It is essential to create a warm, kind, homely and friendly environment. Sometimes, however, this closeness can blur professional boundaries and cause misunderstandings and difficulties for the support worker and the parents of the young people in their care.

Many of our clients are young children and parents and family are the first point of contact on a daily basis with the support worker. It is really important that both the support worker and the parents work together to understand their roles, their limits and the employer’s policies.

Professional boundaries are the rules and limits that prevent the lines between the support worker and the client from becoming blurred. These boundaries are there to help maintain a safe working environment. It is important to set boundaries from the outset. Where parents are acting on behalf of the young person (the employer) they often

Cecily Lalloo, managing director of Embrace HR, assesses the importance of establishing professional boundaries and why they must be put in place

assume the role of informal team leader, and therefore need to draw the line between what is appropriate and what is not. There is a fine balance between being a supportive employer and having a personal affiliation between both employees and family members. It can be difficult differentiating between being a worker and being a friend.

Managing Boundaries

The key to managing many of these boundaries is understanding the difference between a professional and a personal relationship and ensuring that behaviour always remains on the right side of the line.

Professional relationships are time bound. Employees have a distinct role and purpose with some structure. The professional has a responsibility for the welfare of their client, and those family around them, and there are rules and boundaries that guide the relationship such as their contract, job description and care plans. Support workers are paid workers and not friends, although friendships can blossom, but when dealing with work issues, friendships

need to take second place. Relationships need to be professional not personal. Once a relationship has been allowed to stray into personal areas, it is much harder to maintain other professional boundaries. When a parent, on behalf of the employer, then does behave in a professional manner, employees may be surprised, unhappy and resentful as they could have been expecting a personal response.

Examples of boundaries

It can be a tricky balance to know how much personal information to share with an employee. It is acceptable to talk generally about family and personal life if it helps to build a relationship with the support worker and vice versa.

Here is a non-exhaustive list of potential issues that can cross boundaries:

> Not respecting the each other’s privacy;

> Visiting outside of contracted working hours without an invitation;

> Buying, selling or lending personal items or money;

> Discussing personal issues at length;

> Postings on personal Facebook or other personal social media outlets without explicit consent;

> Accepting or giving gifts other than at special occasions such as Christmas or birthdays (gifts should be of a nominal value);

> Treating each other with respect and without favouritism.

Communication

It is challenging to find where that boundary should be, especially where the line may already have been breached. But, with open communication about how parents want boundaries to work in the family home, and with support from deputy’s offices, case managers, and HR advisers, the right professional boundaries can promote much healthier relationships that are respectful, safe and meaningful.

If you would like to discuss this subject further, please contact Cecily Lalloo at Embrace HR Limited.

T: 01296 761288 or contact us here. If you would like to receive our newsletter, please sign up here.

Based in Aylesbury, Buckinghamshire, Embrace HR Limited provide a specialised HR service to the care sector, and small businesses, from recruitment through to exit.

Boundaries are there to help maintain a safe working environment. It is important to set boundaries from the outset

Staying mobile: how Thomas used GripAble to safely rebuild his strength

After sustaining a fall in his garden, 94-year-old Thomas, who had experienced two ministrokes and four right knee replacements, reported that he was having trouble gripping onto his required walking aids, and was therefore disregarding professional advice to use them for support and stability.

Further investigations showed he had very poor lower and upper limb strength, and that he was feeling unmotivated and wasn’t engaging with the physiotherapy exercises he had been prescribed with.

Thomas’ occupational therapist knew an alternative approach was needed and introduced him to GripAble and its set of interactive games.

Here, we discuss how Thomas used GripAble to get moving again and be independent and safe at home using his walking aids.

Lacking motivation

Thomas was a keen gardener and enjoyed tending to his fishpond at the home he shares with his 89-year-old wife. But after experiencing two transient ischemic attacks (ministrokes) – the most recent being four years ago – and having four right knee replacements due to infection complications, his mobility was significantly affected, and he was advised to use a walking frame outdoors and a walking stick indoors.

But he disliked his walking aids as he reported that he struggled to grasp them due to poor hand function and felt safer without using them.

After his fall, he was admitted to hospital after several hours of lying on the ground. He

was medically stable and MRI scans confirmed he had not suffered a stroke or a ministroke, nor had he suffered any fractures. However, his lower and upper limb strength were found to be very poor.

Thomas reported he was not completing his lower limb physiotherapy exercises as “he didn’t see the point.” He had also not engaged with the recommended hand exercises to improve his grip to assist with using his walking frame. Although Thomas was clinically stable and encouraged to transfer out of bed to mobilise around the ward with staff support, he remained disengaged. When his occupational therapist assessed his hand function, he was found to have full range of movement but very poor grip strength.

Getting to grips with staying motivated

Following an assessment by a physiotherapist, Thomas’ walking frame was adjusted to the correct height and an ergonomic palm grip walking stick at the correct height was supplied. He was also provided with larger diameter cutlery to improve his grip and enhance his independence with eating.

Thomas was then introduced to GripAble and shown how to engage with its interactive games. His therapist supervised his single maximum grip strength and identified that his right mean grip strength was 1.8kg, and his left was 1.1kg.

To begin with, Thomas was encouraged to complete 20 repetitions of grip and release on each hand using a GripAble activity when he felt motivated to do so. When Thomas was seen the next day, he reported that he had completed this task and had even tried a completely different GripAble game on his own!

Thomas was seen daily for the next two weeks by his occupational therapist while he remained an in-patient and his physiotherapists encouraged him to engage with his global lower limb rehabilitation and mobility. The number of daily repetitions was gradually increased and by the time he was discharged, he was completing 100 repetitions bi-laterally.

Building strength safely

After two weeks, Thomas’ grip strength was reassessed, and he was informed that his grip had improved. This increased his confidence, and he was mobilising safely around the ward unsupervised using his walking frame and was able to safely complete the stair assessment with the use of one grab rail and one walking stick. When Thomas was discharged home, his right-hand mean grip strength was 4.3kg, and his lefthand mean grip strength was 2.5kg. He took GripAble home to continue his rehabilitation and was monitored remotely over the next month by his occupational therapist. The community physiotherapist team completed home visits on discharge to monitor his progress. When GripAble was returned one month later, Thomas was reported to be independent and safe at home. He was moving around using the recommended walking aids both indoors and outdoors and had returned to tending his garden pots and feeding his fish. In addition, he had also gained weight and reported that his grip strength was continuing to improve. Thomas’ family are looking to buy him his own GripAble to help him maintain his motivation and continue his grip strength building journey.

Affordable remote rehab

GripAble is a mobile assessment and training platform which includes bespoke hand-held sensors, mobile hardware, software, in-built gamification and data services, to enable home-based rehabilitation for patients with a wide range of neurological and musculoskeletal conditions including upper limb spasticity. GripAble’s unique handgrip sensor connects to a mobile app, allowing users to partake in specifically designed activities selected by their therapist, to train core hand and arm movements.

GripAble has been designed with remote rehab at its heart to enable ongoing training at home, even when face-to-face therapy isn’t possible. With the cost of living hitting many hard, GripAble has launched an affordable monthly rental option for homebased customers. At less than £1.50 a day, the rental has no minimum contract, making it an ideal option for people with short-term rehabilitation or training needs.

Chat to our friendly team of experts to request a trial or purchase a GripAble: www.gripable.co/buy-try-now/

For more information, visit: www.gripable.co

To begin with, Thomas was encouraged to complete 20 repetitions of grip and release on each hand using a GripAble activity when he felt motivated to do so.

Meeting the growing demand for specialist care services

With the numbers of people living with complex disabilities and dual diagnoses rising, the pressure on care homes to deliver appropriate care is growing significantly.

Meeting the need

This rocketing demand has been a key factor in the significant and ongoing growth of Exemplar Health Care. The specialist care provider, known for its capability in supporting those with high-acuity complex needs and behaviours of concern, is aiming to open ten care homes during 2023 across England, to help increase provision for those for whom resource is scarce.

The ten planned for next year follow two recent openings - Cheshire Springs in Ellesmere Port and Edgewater in Wallasey - which are helping to bring additional provision in their local areas to ease pressure on NHS resource.

To help meet this demand, and ensure people receive the specialist nursing care they need, Exemplar Health Care is embarking on a programme of expansion to bring significant new resource across England. NR Times learns more.

With significant and mounting pressure on NHS wards as the peak winter months arrive, many much-needed hospital beds are often taken up by people who have recovered from the reason they needed urgent medical intervention, but who continue to need ongoing care.

For many people with complex needs, they are not able to be discharged to live independently - but neither do they need to occupy a hospital bed, a resource already at a huge premium in an under-

pressure health service.

The lack of provision nationally in this area is a significant problem - and one which can see people remain in acute environments for far longer than they need to be, due to a shortage of places in specialist care homes which can meet their needs.

And this huge demand on resources is set to grow in years ahead - statistics show that in 2020/21, there were more than 1.9million requests for adult social care, particularly among those of working age. Furthermore, Council for Disabled Children research shows there are growing numbers of children with complex needs, who will go on to need adult services in future years.

All of the new homes will follow the format of Exemplar Health Care’s current portfolio of homes, which pride themselves on their person-centred approach to care and high staffing levels - with an average of one nurse for every six health care assistants on each small unit.

The first new homes of 2023 are set to be unveiled in spring, with the openings of Roseside in Liverpool, Woolston House in Warrington and Tees Grange in Stockton.

“Finding the right environment for someone after leaving a hospital setting is an ongoing problem, and particularly for someone with complex care and health needs,” says Rachel Calladine, business development director at Exemplar Health Care.

“There is a lack of suitable care homes which have the expertise to provide this type of care, and within the care homes that do exist, there are very few beds available.

“This problem exists all year round, but particularly as we saw during the COVID-19 pandemic, and then the annual winter pressures, it is very much heightened at this time of year.

“The pressure on the NHS and social care is very significant at present, and combined with the recruitment challenges and impending nurses’ strike, the pressures on the system show no signs of relenting.

“Looking into the future, this is only going to increase - the number of people living with more complex health issues is increasing, and we have an ageing population and growing numbers of people with dual diagnoses. The need for complex care is only going to increase. “And that is why services like ours, which provide very specialist nursing care for people with complex needs, are so vital. Not only can we help to relieve some of the pressure on NHS frontline resources, but we can ensure that people are being discharged into the right environment for them, which is crucial in avoiding the distress of a failed placement.”

Overcoming the challenges in finding a placement

Increasingly often, in the desire to discharge those from NHS settings, people can be discharged into environments which are not entirely appropriate for the complexity of their needs - leading to problems further down the line and, in many instances, a failed placement. Cost pressures can be an issue for commissioners and can prove a barrier in some cases, says Rachel, but placing someone in the right placement, that meets their complex needs, the first time round, is critical to breaking the cycle of failed placements, that often leads to their needs being exacerbated.

For Exemplar Health Care, their track record in supporting people who have experienced one or more previous failed placements is particularly strong. Over 60 per cent of their service users come to their homes following a failed placement.

“It’s hugely important that people receive the right level of care and support for their needs. Where possible, we’re committed to ensuring that people receive this care close to home and their loved ones, in the communities they’ve always lived in,” says Rachel.

“Understandably, at the times, this is difficult, which increases our commitment to providing specialist nursing care in more locations across England.”

New provision to help relieve mounting pressure

The new openings - a combination of purpose-built developments and extensive refurbishments of existing sites - see Exemplar Health Care strengthening presence in existing counties like Yorkshire and Merseyside, while establishing presence in new areas across the North including Sunderland, Leicester and Telford.

“It’s very much demand-led, and in several of the areas, we are answering specific demand that we know exists in that area after speaking with local commissioners,” says Rachel.

“We are building new homes in response to that, and our refurbishments are so extensive they are fully refurbishing the entire building to ensure they are totally fit-for-purpose, so we’ve remodelled the interiors to make sure that the bedrooms are big enough for people with ventilators or use large wheelchairs, or those who might need the rails on the ceiling for bariatric care.

“We have specialist nursing capability which means we’re able to provide support for people living with very complex care and health needs. This includes those with conditions such as brain injuries, dementia, neurological conditions and spinal injuries.

“Often, the care we provide would otherwise only take place in hospital, such as tracheostomy and respiratory care, and these are done in the homes by our in-house teams, it isn’t done by community resource.

“In addition, we are creating more bespoke environments to care for people with complex behaviours of concern.

“We are able to provide them with the appropriate environment and support that ensures wherever possible, there is not a revolving door scenario back into secure settings. “Our schedule for opening is continuing during 2023 and 2024, but we realise the level of demand and need for us to help meet this, and it’s very exciting that we can play our role in delivering the high quality, specialist care that is needed to help give people a better quality of life while also relieving pressure on the frontline.”

Specialist support that enabled Ben to defy the odds

Having initially been given little chance of survival after a brain haemorrhage, with the support of Nottingham Brain Injury Rehabilitation Centre,

Here, we learn more about his journey and why the support of the team at the specialist centre has enabled the young survivor to look to the future

“I was in hospital and literally everyone was told the machines were being switched off.

“But my consultant barged in like an ex at a wedding - I’ve been told it was actually a phone call, but I like my version better! - and to cut a long story short, he saw something in me to let me live. “My life was saved by this man, but my life was given back to me by the team at Nottingham.”

From the trauma of Christmas Eve seven years ago has come a near-miraculous turnaround for Ben - a survivor who has refused to give up at every step of his long and ongoing journey to recovery, and who continues to be indebted to the team at Nottingham Brain Injury Rehabilitation Centre for their support in that.

Aged only 17, Ben was admitted to Nottingham’s Queen Medical Centre with symptoms including headaches, vomiting and he had also collapsed at home.

Medics diagnosed a right cerebellar bleed and intubated Ben, who remained in a coma until February. Despite the initial bleak outlook, and thanks to the intervention from his consultant as his machines were set to be turned off, Ben began to make progress that defied all expectations.

He was admitted to Nottingham Brain Injury Rehabilitation Centre’s high dependency Fernwood Unit in March. The centre, owned by Active Care Group, is a specialist neuro-

rehabilitation site for adults with brain injury or neurological conditions.

An assessment found that Ben was in a vegetative state, unable to interact with his environment or communicate by any means. Multi-disciplinary specialism, alongside nursing and care expertise, combined to devise a route to recovery for Ben - laying the foundations of the life he now enjoys today.

Ben underwent a tracheostomy to help his respiratory function and received percutaneous endoscopic gastrostomy (PEG) for his nutrition and hydration. He was completely dependent on the care and nursing staff at Nottingham Brain Injury Rehabilitation Centre - and through bespoke support, multi-disciplinary treatment and

rehabilitation support, he continued to emerge from his vegetative state. Reassessment gave a diagnosis of Minimally Conscious State Minus (MCS-) from which he continued to progress both physically and cognitively, with the support of his dedicated team.

His tracheostomy was weaned on site, and was successfully decanulated in August. As he continued to go from strength to strength, Ben was moved to Millwood Unit of Nottingham Brain Injury Rehabilitation Centre, a specialist in slow-stream rehab, for ongoing neuro-rehabilitation.

With the support of his occupational therapists, he joined a local wheelchair basketball club. This gave Ben an important activity to be part of, both physically and emotionally, and he became a vital member of the club in supporting others in their ongoing journey of recovery.

Happily, later that year, Ben was discharged back home to live independently in the community without a formal care package. He now only requires minimal assistance with his daily care needs and is able to prepare and eat a normal diet, communicate verbally and is even looking for opportunities to return to work.

For more information about Nottingham Brain Injury Rehabilitation Centre: To enquire about referrals, contact referrals@activecaregroup.co.uk or 01732 779353.

Ben now lives independently and continues to rebuild his life.

Meet Michael Jones, Head of Therapies at Nottingham Brain Injury Rehabilitation Centre

Michael began his career as an assistant psychologist, working as an activities coordinator, and has been supported to retrain as an occupational therapist and work his way up to his current position. Here, we find out more about his role, the work of the specialist service and what motivates him in both his personal and professional life

Can you tell us a bit about your career background and experience?

I’m originally for Shropshire and first came to Nottingham in 1997 to study psychology at Trent. When I graduated, I stayed in Nottingham with plans to continue my studies after a short break from education to get some hands-on experience of working with people. That is why I joined the organisation, and began working as an activity coordinator having applied for assistant psychology posts up and down the country.

During my seven years in this role, I began working with OTs and something clicked. They were using elements of cognitive psychology alongside practical interventions within a framework of function, and it just made sense and this was the unexpected fork in the road that set me off on a different path than intended. The company supported me through re-training in Occupational Therapy at Derby University. Unfortunately at the time of qualification there were no available OT positions within the Nottingham area, so I briefly left the company to begin my OT practice. Two years later an opening for a OT became available at Nottingham Brain Injury Rehabilitation Centre, which I applied for and thankfully was successful. I’ve worked my way up through the bandings to a band seven position, and then an opportunity arose to cover the Head of Therapies role, initially through a colleague's maternity leave, but eventually on a permanent basis.

Please give us an overview of the services that are provided at Nottingham Brain Injury Rehabilitation Centre

Nottingham has three units - Fernwood, our high dependency unit, where we treat individuals with high nursing needs. They may present with a disorder of consciousness, have respiratory problems, tracheostomies or vents.

We also have Millwood, a slow stream neurological rehabilitation unit, and Rosewood, a long-term neurological care unit.

What is your favourite thing

from patients with tracheostomies and vents to high functioning patients whose primary difficulties are cognitive, so the scope and range of treatments we offer keeps everything fresh.

The thing I enjoy the most is the people I work with and the atmosphere in the centre, we have some fantastic staff here which is really important when you’re working with very complex residents which can present some challenging situations.

What

is your vision

for the

service in the short to midterm future?

We have some exciting plans to reshuffle elements of our environment to better suit our residents’ needs, provide clear treatment pathways for residents to progress and move through the centre as part of their recovery journey. I’d really like to see those come to fruition and for us to work towards being recognised as a centre of excellence for neurological care and rehabilitation both locally and nationally.

Finally, what do you like to do in your spare time?

about

working at Nottingham Brain Injury Rehabilitation Centre?

I love the variety and that everyday is different, we have a wide range of individuals presenting with everything

Spare time?! I’m a proud father of two children (a two-year-old and a six-month-old) so as you can imagine spare time is a little on the short side at the moment!

When I’m not being a dad, I’ve got a passion for photography and travel, both increasingly difficult now with a young family, but I’ve been lucky enough to travel to some very exciting countries and have some wonderful experiences, Cambodia probably being my favourite to date, but for the time being I’ve swapped backpacking in East Asia for long weekends at Center Parcs and I couldn’t be happier!

We plan to work towards being recognised as a centre of excellence for neurological care and rehabilitation both locally and nationally

My life was given back to me by the team at Nottingham - survivor Ben

ONWARD tech shows potential for blood pressure regulation after SCI

The first ten people treated with implantable ARC Therapy showed immediate improvements in blood pressure, a benefit sustained for the duration of the follow-up period.

Participants, part of the HEMO study, also reported improved quality of life, increased energy and vitality and reduced dizziness. Those who were taking an anti-hypotension drug prior to entering the study were able to significantly reduce or discontinue their medication.

Low blood pressure is a major issue for people with SCI that impacts cardiovascular health and quality of life, and is one of the targets for ONWARD in its introduction of its ARC therapies in improving the future for those living with spinal injury.

Over 40 per cent of people with SCI –approximately 262,000 people in the US and Europe – are thought to experience hypotension, a condition which may limit active participation in physical rehabilitation programs and facilitate the deterioration effects of immobilisation and development of undesirable secondary medical complications.

“Low blood pressure has long been a hidden complication of spinal cord injury that often goes unrecognised and leaves people feeling unwell. It also potentially predisposes them to cardiovascular disease,” says Dr Aaron Phillips, associate professor at Cumming School of Medicine, University of Calgary, and the principal investigator of the HEMO study.

“The results reported today with ARC Therapy are compelling and may open a new avenue to help people with spinal cord injury truly feel better, while also addressing heart health.”

Dave Marver, CEO of ONWARD, said: “We are excited by these highly promising outcomes, which reinforce our plan to further develop and bring ARC-IM to the market for this important indication.

“Today, there are limited and ineffective options for treating people with low blood pressure after spinal cord injury, and our therapy has the potential to address an issue that significantly impacts their quality of life.”

The interim clinical outcomes are the latest step on ONWARD’s ongoing commitment to the SCI community and to restoring independence and function through its spinal cord stimulation technology.

The huge potential of its ARM-IM therapy in terms of regaining movement was demonstrated through the STIMO-BRIDGE study, which enabled three participants to regain the ability to walk, swim and run after living with paralysis for a long period.

Its ARC-EX non-invasive device is set for commercialisation next year following the success of international trials through the Up-LIFT pivotal study, which showed strong potential for the device in improving arm and hand function.

The LIFT Home Study showed its further potential for remote use by people in their own homes.

Based on the promising interim outcomes from feasibility studies to date, ONWARD said it is preparing to initiate further clinical trials to include US participants in 2023.

Pioneering spinal cord stimulation technology from ONWARD has shown its potential to improve blood pressure regulation after spinal cord injury (SCI) through the results of a new study.

Chroma therapists are adapting to provide more targeted support to families

By Seren Grime, senior dramatherapist therapist and diversity lead, Chroma

Choosing a therapist is one of the most important parts of a therapy process. Children are more likely to open up to a therapist if they can identify with that therapist in some way.

Children are referred to therapy for a number of reasons, for example, behavioural issues. A child’s behaviour may be particularly volatile and the parent and child may struggle to understand each other at home and therefore struggle to connect. Often a child’s behaviour is actually a form of communication, which needs to be understood by the care-giver adults in their life.

Connection is important as it allows the child to feel safe and secure in their environment.

Identity is a common theme during therapy sessions with adopted children. More often than not, there is an identity struggle that needs to be addressed. This may be difficult for parents to discuss but Chroma therapists know it is important to be able to be open and talk about it as a family.

For example, in trans-racial adoption, a black child may struggle to identify with their white family. Having a black therapist could help the child better connect and improve therapy outcomes. Similarly, a transgender child may respond better to a therapist who is also transgender. The bottom line is, if the child can identify with the therapist sitting in front of them, they will be more comfortable to speak their mind.

Commonality is key because then the child can just ‘be’ with that person. This can be difficult for parents to admit but if families do not have these conversations, how can we understand each other and have an attachment?

Through data from the Adoption Support Fund freedom of information coupled with their own data capture of clients, Chroma recently discovered a high percentage of their adoption referrals were for white children aged between 0-16 years old. In addition, a recent internal survey of Chroma therapists revealed that their workforce was predominantly white females aged between 45-54 years.

As a company, they recognise there is work to do to become a diverse workforce, and have

put new processes in place to help achieve that, so future clients and therapists from minority groups feel included.

Chroma’s referral team continue to make careful judgements taking into consideration new diversity information when matching therapists to families. The referral and clinical teams are supporting therapists to become more knowledgeable about diversity and the issues that can arise surrounding it. The next step is to help support therapists to have difficult ‘diversity’ related conversations with the families because helping therapists to develop their practice and knowledge would ensure diversity is integral to their work.

What does it take to deliver a successful neuro conference?

In 2019, the team at Elysium Neurological decided we were at a point where we would like to host a national conference to explore some themes linked to the services and pathways we provide and to network with professionals in the field of brain injury and neurological conditions.

The conference finally came to fruition in November 2022 and was a great success with excellent feedback. We have taken some time to look back and reflect on what we did that made the event work so well.

Firstly we needed to decide if we were going to organise the conference ourselves. We have a talented marketing team who organise internal conferences and events to a very high standard but we felt this event needed to be developed in partnership with a specialised conference organiser.

We have been attending successful ABI Solutions conferences and events for years and I had previously been involved with sponsorship for the Head First conference which had opened my eyes to the possibilities of the conference scene.

We approached Jason and Helen at ABI Solutions to ask if they would be prepared to work with us on our first national conference and they agreed, with some conditions…. They were very clear that there are certain things that they insist on in order to partner for an event of this type. The main things we discussed right at the beginning were music to my ears and we found an immediate synergy with our organisational values, drive and intentions.

THE FIRST THINGS JASON AND HELEN SAID WERE:

1. Content is the most important thing, linked to meaningful learning outcomes. Delegates want to go away from a conference or CPD event with new ideas that positively impact on their own practice or that they can use in reflective practice.

2. Expert speakers are a must – people who have something new and interesting to share that promotes discussion and debate.

3. Attention to detail and a drive to deliver an excellent overall conference experience for the delegates makes the process more enjoyable and ensures people go away feeling that they have been valued as a delegate.

So, we chose a venue that we had used before, 1 Great George Street. It is a beautiful setting for a conference and makes people feel great as soon as they arrive. The lobby and entrance to the hotel are stunning and the conference theatre is well laid out with good acoustics to allow delegates to relax and easily engage with the content.

ABI Solutions have an extensive database of neuro specific contacts to offer the conference to and they also approached a range of exhibitors to come along and provide great networking opportunities for the delegates. Irwin Mitchell agreed to sponsor the day. They were approached as we felt that they have similar values and aspirations to Elysium in relation to education and learning and we were delighted that they agreed.

We set about thinking about the content for the day and felt that it was important for the day to reflect the different service pathways

Elysium Neurological offer across the country. However, these service pathways can be quite diverse and specialised (from neurobehavioural to supporting people with complex physical needs such as tracheostomy and ventilation) so we needed to find a golden thread to ensure the day made sense, had a good flow and that there was a relevance for everyone in the audience to connect with.

We decided that whatever the pathway, our specialised services all support people who face significant challenges, so we plumped for an overarching theme for the day of; “Rising to the Challenge”. To describe more about what people might expect, we added the description, “Managing the diverse challenges in the field of brain injury”.

This conference was not about Elysium Neurological promoting our range of services. It was intended to be a learning platform for people to share, debate, discuss and reflect on

different elements of challenge in neurological services. We did have some content from expert clinicians who work with Elysium to start us off, so we had early discussions to explore possible themes.

We had some other expert speakers in mind who we had seen deliver excellent sessions in previous conferences that we felt would fit well with our core content so ABI Solutions contacted people to discuss the possibility they might present on the day.

This process was blown off course a number of times in the intervening years due to covid restrictions as we were unable to run the face-to-face event. We stayed in touch and whilst there were a couple of tweaks to the conference programme in the end as we had to ensure we were still fresh, current and relevant to the audience, much of the original programme survived.

ABI Solutions handled all the technical and organisational areas of the conference. They have been doing this for years and they have a very slick and effective method for bringing high quality neuro conferences to life. Their attention to detail was second to none and we knew that they would have thought of everything, right down to making sure that the speakers were able to travel to the conference with ease on the day and looking after individual dietary requirements.

We had a dinner the evening before the conference with the speakers so that people who had not met before could be introduced and feel more at ease. People discussed their presentations during the meal which resulted in the discovery of similar points or themes. This enabled people to refer to each other’s content when they spoke which gave a more seamless feel to the day.

On the day we had around 300 delegates arrive at 1 Great George Street. The lovely ABI Solutions team were set up at the front of house and registered the delegates, handing them their delegate bag containing everything they would need for the day.

There was time to have a coffee and network with each other as well as interacting with the exhibitors before the first session.

The day was jointly managed and hosted by Elysium and ABI Solutions and it is this genuine partnership working that was at the heart of making the conference a real success.

As the delegates gathered before the first session, there was a palpable optimistic energy in the room and many people commented what a relaxed and positive vibe they felt. This continued throughout the day with much smiling, laughter and genuinely

interested dialogue between people. We opened with a welcome from the conference sponsor Sarah Griggs, Partner, Irwin Mitchell and the conference was introduced by Professor Quazi Haque, Executive Medical Director, Elysium Healthcare & President of IAFMHS who reiterated the importance of CPD and learning and networking. Paul Mooney, Clinical Director Elysium Neurological chaired the day with a relaxed style making people feel comfortable and getting the most from questions that were posed by the audience using Slido, an interactive app to support audience interaction.

The printed conference programme informed people not only of the order of the day, speakers details and content but of useful information such as wi-fi facilities, the conference hashtag (to share their experiences of the day on social media), the lunch menu and post conference arrangements.

ABI Solutions conferences are always CPD Registered and the conference was accredited by APIL training which is a great help to clinical and legal professionals who need to demonstrate their learning in appraisals and revalidation processes.

We had a special edition of the NR Times printed for the event that contained the most recent articles published by Elysium Neurological and an index of previous articles for people to refer to. This is also available on the post conference website available to all those who attended.

We wanted to find something to add to the day that people would remember and we decided to have an energiser sessions after lunch to uplift people’s spirit and focus their mind for the afternoon session. We approached a musician, Adam Pickard and he came along and ran a fabulous interactive session with audience participation with a competitive

edge. The engagement with the session was impressive and the group rendition of ‘Brown Eyed Girl’ was shared a number of times on social media as people expressed their enjoyment of something a little bit different.

The feedback from the conference really speaks for itself. All the feedback forms reflected scores of good to excellent for every aspect of the day. Some of the general comments people left: “Wonderful conference - speakers exhibition stands and appreciated opportunities to network”

“All was fantastic - well done!”

“Fantastic agenda! Held my interest all day. I have left with much to think about. Thank you” “Very useful and informative event!”

“Brilliant day! Thank you”

“Excellent day, thank you all very much”

“Overall great topics and well run conference. The whole programme was very educational.” “Opened my eyes in a lot of ways.”

The comments and feedback for the individual speakers were also incredibly positive.

So the lessons learned? Make sure you have content that people want to engage with and think about what they can take away from the day.

Focus on all the small details that ensure the overall experience really values the delegates and gives them value for money.

Work in partnership with each other, respect areas of expertise and really listen to each other when you are talking about what is proven to work.

The first Elysium Neurological conference is now available as a virtual event for people who mauy have missed it or not been able to attend. We are looking forward to presenting some focussed CPD events throughout 2023 and hope to deliver another national neuro conference in Spring 2024. How we will top the first one will be a challenge in itself, but we like a challenge!

Reconstructing Lives : A Case Manager's ToolKit

By Vicki Gilman

Case managers often work with clients whose injuries have brought great complexity to their lives and where on initial assessment, there seems to be a plethora of aspects to capture in the initial report plus a raft of recommendations to put forward to support progress toward agreed goals or objectives. It is not a surprise therefore, for clients and families who may be faced with reading the reports to themselves feel quite overwhelmed by their complexity.

Then comes the point where recommendations and costs are agreed, and the case manager can start working with the client and their family to improve their situation. Sometimes the start point is clear but a lot of the time it can be hard to know where to begin. There is an implicit expectation and need for change and progress to happen quickly across many aspects of the client’s life. For some clients, the reality of being able to start planning to engage in some rehabilitation or to pursue a new work or social avenue does not feel easy. It is certainly harder for most to turn their goals into reality than it is to discuss them in the abstract. it is not uncommon that the client may themselves find it hard to get motivated to overcome barriers. The case manager can feel a weight of responsibility to create some difference, to act, to implement… after all, they wrote a report with recommendations – a ‘clinical promise’ of sorts. Their notes and progress reports will of course be scrutinised along the way.

Many case managers began their careers in health or social care settings where there is a limited timeframe to make a difference for

each person – patients in an NHS rehabilitation unit or on a ward predictably have to move on so that each service can take new patients and focus what it offers to best effect across a population of patients. Unavoidably, this creates pressure to support as much achievement and progress as is possible in whatever time can be had. This is the way many of us became used to working and the shift in focus when becoming a case manager can feel exciting but very different.

Working as a case manager in the independent sector offers a different opportunity, where what is provided can be shaped around each client and where the timeframe and approach can be tailored to the individual’s needs, aspirations, and abilities.

Alongside the experience, skills, clinical and professional knowledge exemplified in the CVs of case managers it is important to utilise powerful ‘tools of the trade’ including

TIME AND PACING – for many and often very individual reasons recognising the value of time, grading, and pacing in the pursuit of positive change is important.

DEGREE SHIFTS AND INCREMENTAL CHANGE – one small shift of the right kind carried forward can result in great change down the line. Very small, stepped changes can be a powerful way to build progress.

QUICK WINS AND LOW HANGING

FRUIT – targeting priority areas which can be quickly and effectively addressed helps to build momentum. It also, importantly creates motivation as well as trust and belief in the case manager and the process of case management.

INDIVIDUAL AND COLLECTIVE THINKING - case managers often either form or join the MDT around the client. Apparently, it was Aristotle who coined the phrase “The whole is greater than the sum of the parts”. Never is this more so than with an active and free-thinking MDT where the case manager can promote and facilitate collaborative thinking, whilst supporting the development of individual ideas and plans and bringing this all together to benefit each client.

CURIOSITY AND INVENTIVENESS –an open minded and constant curiosity, coupled with innovative approaches which flex in response to individuality and context are needed in order to provide unique and tailored solutions to enhance a client’s rehabilitation progress.

That mountain of potential for change, documented in the case management assessment report, does not all have to be conquered immediately. After all, as mountaineers know, making it to basecamp is an achievement in and of itself.

The ascent can be tackled another day, with good strategy and in small stages. Success may be positively impacted by waiting until the time is right, careful pacing, alternative routes, and a creative methodology. A team approach to tackle the journey with an inquisitive, innovative, and hopeful, but realistic outlook that balances the risks helps stack the chips toward a safe and positive result.

Vicki

of

Gilman Founder

Social Return Case Management and BABICM Advanced Case Manager

The case manager can promote and facilitate collaborative thinking, whilst supporting the development of individual ideas and plans and bringing this all together to benefit each client.

The ascent can be tackled another day, with good strategy and in small stages. Success may be positively impacted by waiting until the time is right, careful pacing, alternative routes, and a creative methodology.

Meeting the experts in brain injury rehabilitation

NR Times learns more about Dr Maria Stein, programme manager for Reach, about her background, career and current role, and how she spends her free time

Doctor Maria Stein PhD, MSc, PGCert, LTHE, dipCOT, FHEA, is a highly qualified and experienced occupational therapist and clinical researcher in neuro-rehabilitation, and programme manager for Reach, helping head injury survivors to reintegrate back into community life.

Maria currently holds an academic post at Canterbury Christ Church University. Previously, Maria held clinical, teaching and research posts at Brunel University and East Kent Hospitals NHS Trust. We asked Maria if she would give us a small insight into the journey that has spanned her life and career.

I had a humbling childhood, learning qualities and values that I have retained as I got older and brought up my own family. Growing up in Malta as the eldest of three siblings, I come from a very close-knit family where faith is important, elder generations are valued and respected, and helping others is seen as a virtue. I worked as a volunteer helping institutionalised children and young people with profound learning disabilities become more independent in activities of daily living. The first in the family to attain a degree, I qualified in Occupational Therapy at the London School of Occupational Therapy in 1982 and I have a career spanning more than 40 years.

I am well travelled, having lived and worked abroad with my husband for many years, mostly in Europe and the Middle East (Qatar, Oman, Bahrain and Syria), where we also raised our young family.

During this time, I balanced my family life and my career, helping to establish occupational therapy in remote regions, amongst the indigenous people of the countries that hosted me. I worked alongside international organisations to provide professional services in a number of different settings, including acute hospitals, schools and residential institutions, sometimes in places that were not always very easy to reach!

In areas that may treat disability as a taboo, I strived to minimise the stigma associated with disability around that time, educating those around me and ensuring that everyone was treated with dignity and respect, regardless of their own culture, ethnicity or religious background.

I have very fond memories of this period, it helped me to appreciate what I had, learn to work with very limited and local resources, become increasingly resilient and proud to be helping others using all my occupational therapy skills. In return, I gained a wealth of experience, knowledge, and practical skills in the field of occupational therapy and client-centred neurological rehabilitation. Research and knowledge exchange.

I have special interests in rehabilitation research, clinical and patient outcomes, and knowledge exchange, and I have a research track record that dates back to 1999, a time when rehabilitation research in occupational therapy and among allied health professions was still in its infancy.

I have collaborated and led on various clinical and educational projects throughout my career in research and academia, with the two most recent being ADAPT and MOTION.

I was instrumental in developing and writing training packages for both projects, which were funded through Interreg Europe, one of the EU’s key funding instruments for cross border co-operation and development between member states.

I regularly peer-review for international journals, such as the Journal of Medical Internet Research, and the journal Disability and Rehabilitation, in addition to a number of occupational therapy journals. I find this to be an excellent way of keeping up to date with current advances in the field of rehabilitation practice and research.

I have also presented at local and international conferences, and have published work in a number of peer reviewed journals. I have ethically reviewed several internal and external research applications, and have statistical expertise in the analysis of serial,

longitudinal data using multi-level models. As a strong advocate of research informed teaching, as well as the transfer of research into evidence-based practice, and blended learning, I enjoy both the research and teaching aspects of my work. I particularly enjoy the supervision of post graduate students and mentoring early career researchers. I have always enjoyed learning and studying and will continue do so, long after my career is over. On the rare occasion that I am not busy, you will most likely find me in the garden tending to the flora, otherwise I may be baking or cooking a meal, people say that I am a very good cook! As a vociferous consumer of literature, I often immerse myself in anything from newspapers to biographies, with the latter being a favourite. I love to read about real people and their life stories, their successes and failures, their experiences and learnings, and their travels. I too confess to have the travel bug and very much enjoy traversing the globe, meeting new people, experiencing different cultures, seeing new sights and scaling great heights! I will often combine as many of these as possible, with recent trips to hike in the Canadian Rockies and to southern Italy, which were both fabulous! I have two boys in their early 30’s and I like to travel with them at least once a year. This ensures quality time for us to spend together, as I don’t see them as often as I would choose. One of my sons has just left to work and travel in Australia, so one doesn’t need much of an imagination to see me travelling in that direction very soon.

One of my other great passions is dancing, which I find to be a great way to unwind. It is my weekly feel-good medication, a prescription that I would recommend to all.

Maria is a member of our highly experienced team of neuro-occupational therapists, serving Reach to provide both remote and home-based neuro-rehabilitation services for those with minor to catastrophic acquired brain injuries. Please direct initial enquiries to our team by email at info@reachpersonalinjury.com or call us on 01423 326000.

Functional Electrical Stimulation A

SPECIAL REPORT

Maintaining long term health with FES training

Physically disabled people are the least active group in society but make up around a fifth of Britain's population - almost 14 million people.

According to Sports England, disabled people are twice as likely to be inactive as able-bodied people and this creates a multitude of health challenges. Fitness can reduce and the risk of health complications and illness are likely to increase. In this Q&A we speak to Dr Derek Jones of Anatomical Concepts, to explore how to exercise paralysed limbs despite having experienced a spinal cord injury or other neurological condition (including stroke, MS, Transverse Myelitis and more) using Functional Electrical Stimulation.

HOW DOES FES CYCLING WORK?

Whilst motorised bikes that can move paralysed legs with passive cycling are popular and they do help prevent joint contractures, the addition of FES ensures that exercise is active and this has a more powerful health benefit. For example, various combinations of leg muscle groups - at least the quadriceps and hamstrings - can be activated in order to achieve an effective cycling action. Each muscle group is "switched on" during only part of the 360 degree crank rotation, to ensure that stimulation of each group results in a positive crank moment. This is achieved by synchronising the delivery of muscle stimulation to the movement of the bike pedals.

An FES bike typically monitors the speed of the pedals and the effort generated by the user and uses this information to modulate the stimulation delivered to the muscles.

Products like the RehaMove system allow the user to set a target cycling speed and level of resistance to pedalling. This allows the user to get stronger over time. Most products are available in a form that will also allow upper limb exercise too and utilise the arm and shoulder muscles if these have been affected by the condition.

There is even a version that allows a person lying in bed and in intensive care to use FES Cycling and there are many benefits of this.

YOU MENTIONED USING A STIMULATOR WITH OTHER FUNCTIONAL EXERCISE. HOW DOES THIS WORK?

Some clients will use the FES unit of the RehaMove system independently from the bike, with software called Sequence Mode, that allows other forms of exercise to be augmented with FES.

Instead of the stimulator reading data from the bike to know when to turn on or off the stimulation, we can set the unit to run on a sequence set by the number of seconds of stimulation of each channel, or programme a sequence to a manual button press.

For example, clients often use the RehaMove stimulator to aid in sit to stand work.

Usually the client would set up in a standing frame, then use a standing programme which would activate the quadriceps to get to standing, followed by a short activation of the glutes to add stability.

These would then turn off, followed by an activation of the hamstrings to allow a controlled return to the seated position.

This sequence can be set to run automatically on a loop, or with further control using a manual trigger press.

Whilst motorised bikes that can move paralysed legs with passive cycling are popular and they do help prevent joint contractures, the addition of FES ensures that exercise is active

Clients find this to be very engaging and challenging to perform.

We can use this software in lots of ways including things link shoulder stabilisation, dorsiflexion, hand flection and torso stabilisation, and there are preset templates with the software.

We see therapists getting creative and integrating cable machines, bands, and other gym equipment for challenge.

Equally, using every day objects such as forks, cups etc to work on movements that help clients work towards feeding themselves or brushing their hair.

FES can really cover the bases of a device that can aid in every day functional health (cycling) and specific rehab goals (sequence mode).

HOW MUCH ELECTRICITY IS BEING USED?

The amount of electricity is very small.

Technically, the electrical waveform used will normally be a bipolar, rectangular pulse.

The maximum current will be around 130 mA. The FES unit that makes the muscles contract delivers stimulation to the surface of the limbs via two surface electrodes placed on the limb segments with a gap between them.

The current flows in to the tissues via one electrode and out via the other one and in doing so, providing the amount of energy is sufficient, activates the nerves that bring about a muscle contraction.

There are other stimulation parameters to consider beyond current; namely pulse width and frequency.

An FES bike typically monitors the speed of the pedals and the effort generated by the user and uses this information to modulate the stimulation delivered to the muscles

The combination of current, frequency and pulse width can be varied by the FES unit to influence how strong the muscle contraction will be.

Some products will vary some of the parameters automatically within safe limits and of course allow the user to make changes.

WHO CAN AND CANNOT USE FES CYCLING OR SEQUENCE MODE EXERCISES?

Although most commonly practices by people with a spinal cord injury, FES Cycling is also used successfully in people with upper and or lower-limb dysfunction in a range of other neurological populations such as Stroke, MS, Transverse Myelitis and in children with cerebral palsy.

Just as with any medical product there are also contraindications and some cautions to using them.

These include things such as active fractures in the limbs being exercised, joint contractures that prevent a cycling action, pregnancy and the presence of certain types of implanted medical devices.

Contraindications will tend to vary over time and with developments of the technology but these should always be checked in each individual case.

When the upper limbs are to be exercised with FES it is important to verify the integrity of the shoulder joints.

When indicated, this exercise can be fine tuned to preserve shoulder function and prevent contractures in the upper limbs.

WHAT DOES FES FEEL LIKE?

Many of our clients have an injury which means they have little or no sensation in the area in which the electrodes are applied. So nothing is felt.

This doesn’t mean that you can make the stimulation as strong as possible as there are other things to consider.

For example, you need to be aware of skin irritation at the electrode sites and provoking muscle fatigue resulting in a metabolic insult, by having the intensity of stimulation too high.

With some users who have sensation, the level of stimulation can be reduced to diminish any discomfort.

We have met some people who find it

difficult to tolerate useful levels but this is quite unusual.

With some levels of injury, (above T6 level) care must be taken, especially at the beginning of use, to avoid autonomic dysreflexia.

Most people who might be susceptible to this condition will have learned to recognise how the onset of this feels at an earlier stage of rehabilitation.

If someone feels unwell when using a FES bike this should be halted immediately. It's also good idea to ensure that bowel and bladder are clear before exercising.

WHAT ARE THE OTHER BENEFITS TO FES CYCLING AND TRAINING?

A range of physiological benefits has been observed in clinical studies of subjects with spinal cord injuries, including improvements in cardiopulmonary fitness, muscle strength and bone density.

Sometimes FES Cycling helps to calm muscle spasms.

Stimulating the gluteal muscles during cycling can help reduce the risk of pressure ulcers and the stimulator can also be carefully used to assist with wound healing.

Of course there are also psychological benefits of exercise and regular activity. Some clients also report that they feel positively about retaining / improving their muscle mass for aesthetic reasons.

CAN YOU BUILD MUSCLE WITH ELECTRICAL STIMULATION?

Regular training with a RehaMove system or other FES bike will definitely encourage growth of the leg muscles and fight off muscle atrophy.

By varying the stimulation parameters, lower limb muscles can be conditioned for endurance or power.

Although the technology has improved over time, it is less efficient to trigger a muscle contraction using FES than it is for the body working "naturally".

The body has a much more efficient process for recruiting muscle fibres to contract.

It is unlikely that someone starting to use an FES bike for the first time will generate much power.

It takes time and patience - think - more of a marathon than a sprint.

DOES ELECTRICAL STIMULATION RELAX MUSCLES?

Some users have troublesome spasms in the legs. These can be a nuisance and often medication is offered to try and reduce these.

Unfortunately, oral medication is not always effective, can make the patient drowsy or lose its effectiveness over time.

Some patients elect to use an implant which can deliver precise amounts of medication to manage the spasms.

An FES Cycling intervention can help a majority of persons to damp down their leg spasms.

Sometimes these get worse initially as the legs get stronger but in these cases the stimulation parameters can be fine tuned to help. Also stretching, and leg massage prior to a session can help.

HOW DOES SOMEONE GET STARTED WITH FES CYCLING OR TRAINING?

Functional electrical stimulation in general and FES Cycling in particular is a safe and widely used modality with a good evidence base for supporting long term health. We would always encourage exploring the various options and thinking carefully about the possibilities.

The technology available from ourselves and other suppliers will fundamentally attempt to do similar things but with differences in the user interface. Our approach to working with the RehaMove FES Cycling system asks potential clients to complete a short risk assessment.

Providing the client is safe and suitable to use FES, we ask a therapist to visit the client with a system to talk over their specific goals and give a full demonstration.

We then follow up with a report which details the discussions, the exercise programmes that were demonstrated, and a recommendation on how they may adopt the system into their routine.

In an ideal world, FES Cycling and FES Training would be utilised daily to simply help individuals stay active, reducing the risk of longer term ill health or complications.

With driven clients and therapist input it can also help improve targeted, rehabilitation outcomes.

Can you stimulate a denervated muscle?

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

A related question, of course, might be ‘why would you want to’ - we will get to that shortly. Denervation of skeletal muscle can occur following a spinal cord injury affecting the low lumbar and sacral regions, or with peripheral nerve injuries.

The many nerves that fan out at the end of the spinal cord are known as the cauda equina, due to its appearance being likened to a horse's tail.

The spinal cord actually ends at the upper portion of the lumbar (lower back) spine but the individual nerve roots at the end of the spinal cord that provide motor and sensory function to the legs and the bladder still continue further along the spinal canal. Damage to these by trauma, tumour, or other origin can cause many "red flag' problems including a flaccid type of paralysis. Peripheral nerve injuries are commonly seen and can also be difficult and frustrating to manage.

These result from contusion, crushing, stretching or cutting of nerves such as the axillary nerve at the shoulder, the radial nerve in the arm, the ulnar nerve at the elbow, and so on.

The "traditional" approach to dealing with peripheral nerve injuries has tended to focus on limb positioning and the prevention of contractures through passive or stretching exercises.

WHAT HAPPENS WHEN A MUSCLE IS DENERVATED?

Following an injury a denervated muscle alters its structure in many ways, and over time the normally excitable and contractable muscle fibre tissue is replaced with collagen and fat. This tissue becomes less capable of contracting as this process takes shape. The muscle atrophy and changes that rapidly follow denervation can make any intended rehabilitation process an extremely difficult task.

If reinnervation is a possibility, this opportunity is lost without effective intervention. Reinnervation cannot complete if the former

muscle's structure is lost and no longer supports contraction.

As these effects progress, the loss of muscle bulk and tissue quality lead to a poor general trophic situation.

HOW DO YOU DEAL WITH MUSCLE ATROPHY?

Electrical stimulation can now be used to stimulate denervated muscles and to cause contractions that prevent or reverse atrophy, as well as possibly supporting the regeneration of peripheral nerves - if this is to be expected.

Once upon a time there was concern that using electrical stimulation could actually deter reinnervation but now evidence suggests that this should not be an issue.

The whole topic of using electrotherapy for denervation has been controversial over the years.

It is a fact that forms of electrical stimulation have been used with denervated muscle since the mid-1800's.

In 1962, "The Denervated Muscle", edited by Ernest Gutmann was published and this work is still not a bad place to start when you wish to learn about this phenomenon.

Gutmann and his collaborators were conducting research on long-term denervation of skeletal muscle beginning in the 1940's

and his work is still widely cited even today. Of course, this research was largely descriptive and what was possible was limited by the technology available at the time.

Even in the 1990's though, using electrical stimulation with cases of denervation has been controversial with fears that the level of intensity needed would lead to the potential for skin burns.

In our experience, providing good methods are followed, the risks are very low.

In Europe the multinational European RISE study and the work of Helmut Kern in Austria and many others has helped to change the minds of many on the safety and effectiveness of electrotherapy for denervation.

The RISE study used specially developed electrical stimulation equipment and showed that it could be used safely by clients at home who had complete denervation.

The equipment could be used to rescue the muscle tissue bulk and quality even with clients many years after their injury.

The researchers also developed protocols for application which guide our own practical work today. This study utilised the equipment which has evolved into the RISE stimulation unit we use today.

WHAT STIMULATION PARAMETERS ARE NEEDED?

The type of FES we see used with any of the FES bikes on the market such as the RehaMove 2, will not work with denervated muscle.

This is because the electrical energy delivered by these systems relies on the presence of intact motor nerves.

Muscle stimulators that rely on an intact nerve structure will typically deliver bipolar rectangular pulses with waveforms described by three parameters - frequency, pulsewidth and current.

You would expect to see these deliver pulses in the ranges 20 - 50 Hz (frequency), 0 - 130 mA (current) and 100 - 500 microseconds pulse width.

When the nerve structure is intact these parameters are sufficient to excite the muscle fibres to contract.

In contrast, the RISE Stimulator can still deliver a bipolar waveform but the stimulation parameters are very different.

We may use frequencies as low as 1 or 2 Hz, pulse widths of up to 200 milliseconds, and currents as high as 200 mA.

With spinal cord injuries resulting in a flaccid paralysis of the legs we would today use large electrodes (either specially designed safety electrodes or wet sponge bags with carbon rubber) that cover as much muscle tissue as possible.

This is because the aim is to make the muscle fibres contract directly, rather than rely on the (absent) nerve structure that would typically

be used by commonly available electrical stimulation units.

Two protocols are typically used - one that is low frequency and seems to induce a twitch in the muscle and a second protocol that produces a tetanic contraction.

The first protocol encourages a normalisation of the muscle structure, and the second protocol strengthens what has been recovered.

THERAPY PROGRESSION

In starting to use this equipment it is possible that a twitch contraction can be elicited but not a tetanic one.

Period testing can be used to verify when a tetanic contraction can be generated and a feature is built into the RISE unit to allow this.

Clients will generally have to use the unit 5 or 6 days a week at the beginning.

As therapy progresses to use tetanic contractions these can produce leg extensions and ankle weights can be utilised for resistance if desired.

With peripheral nerve injuries we can quite often find that we have muscles with preserved innervation alongside denervated ones. We then do not want to overload the normally innervated muscles.

The fact that the paralysed muscle has lost its normal accommodation ability allows for selective stimulation of denervated muscles.

We do this by changing the waveform shape to a long exponential (triangular) pulse rather than a rectangular one.

We can therefore achieve selective contraction of the paralysed muscles.

SPECIALIST EQUIPMENT

There are a number of hand-held units on the market that in general terms can generate the parameters suitable to elicit a denervated muscle to contract.

However, these rarely generate the current intensity or range of parameters necessary to cover all applications. Typically these units are okay with smaller upper limb muscles but not adequate when dealing with quadriceps, gluteal and other larger muscles.

The RISE use has two channels and is very simple to use. The unit can have the settings fine tuned via an easy to use interface and then the unit can be placed in a "home user" mode which prevents accidental changes to stimulation parameters.

The user need only then understand how to secure the electrodes and rotate a control knob to set the stimulation intensity.

As outlined earlier, consistency is key to producing effective results, and the user will need to commit to a regular schedule to see the benefit although this can be reduced once a strong foundation has been established.

YOU CAN. YOU SHOULD. HERE IS WHY.

One of the real drivers for clients to use electrical stimulation has been the resulting appearance of their legs.

Stimulation builds muscle, and this has aesthetic benefits that users care about. Denervated stimulation can support the user to add 3 to 5 cm of muscle girth to their thighs. Clients (or therapists) should be encouraged to take measurements at regular intervals to provide markers for progress, and provide motivation to continue with therapy.

It is also important to remember that developing muscle bulk and quality reduces pressure ulcer risk and improves local circulation.

Anatomical Concepts have extensive experience working with & training both clients and therapists in the stimulation of denervated muscle.

Following a short risk assessment they can offer client demos anywhere in the UK, and regularly provide onsite or remote clinical training in the practicalities and expectations of working with the RISE stimulator.

For those seeking support with neuropathic or nociceptive pain, they also provide support and guidance on using the Stimulette Edition5 S2X.

Find out more about Anatomical Concepts at anatomicalconcepts.com

L300 Go: The stimulating and stabilising drop foot solution

Amy McColm is an Orthotist and Academy Clinician at Ottobock - a worldleading manufacturer of prosthetic limbs, wheelchairs and orthotic supports.

The company is a worldwide distributor of the FES device, the L300 Go.

The hugely popular drop foot stimulator works by delivering a charge through the nerve and the belly of the muscle, making it contract so the leg can move more naturally.

The device has improved quality of life for countless patients across the globe, from stroke survivors to Parkinson’s and multiple sclerosis patients.

Amy says:

“The L300 Go massively reduces their risk of trips and falls, enabling many people to walk independently.

“We've seen incredible results for patients who don’t have to rely on walking sticks anymore. This can massively increase their confidence.”

The wireless device is strapped around the calf, with a single electrode that clips into the cuff, and up to two channel stimulation delivering a charge.

This design eliminates the need for a foot switch, making the L300 Go lightweight, comfortable and easy to use.

Amy says:

“Standard orthotics and AFOs have their place, but patients often find these bulky and heavy, and you have to be able to fit a shoe over the top.

“While a standard solid ankle AFO will hold the ankle in one position, the L300 Go supports movement, which can lead to improved range of motion at the ankle.”

The L300 Go can be tailored to the individual’s needs, with settings altered throughout the day and through the course of rehabilitation.

The clinician will assess the patient to set the level of intensity required to get the muscle to contract.

They can then alter how rapidly the charge is triggered, tailored to the patient’s walking pattern.

The device also offers a training mode, again programmed to the patient’s requirements.

Amy says:

“Instead of passively stretching the foot, the patient can sit down for 30 minutes with the L300 Go lifting their foot for a set number of seconds, and then a period of rest, repeating until the end of the program.

“The physios can tailor that to the patient’s needs. It can be very specific.

“Every time it's set up, it's completely individual. And everyone will have a different tolerance threshold, and a different muscle contraction threshold. So it's set up for each individual user.”

“So all of that is reallyspecific to each users requirements..”

The L300 has evolved considerably over the years, with Amy and the wider Ottobock team continually looking at ways to improve it.

One recent addition is the thigh cuff.

This is used on the upper leg to control the bending or straightening of the knee and can be paired with the lower leg cuff or used as a standalone.

A mobile app allows gives patients control of the output, allowing them to slightly increase or decrease the intensity.

“If we set the level of intensity in clinic, there is a small amount of adjustment for the user to

change throughout the day depending on the need or fatigue level.”

This is particularly useful for things like MS, where the patient may get tired throughout the day.

The app can also measure activity, such as the number of steps taken, allowing the wearer to track their progress.

This innovation has become increasingly indemand across the rehab space, as patients become more tech-savvy and engaged with their rehab.

Amy says:

“People want to be able to control their own rehab.

“You've had a lot of the control taken away from you. It's nice to be able to give some of that back.

“As technology is improving, mobile apps are becoming more and more useful.

“We are continually doing research and development to improve the product.

"We work closely with the manufacturers and have a community of experts to talk through any challenges.

“Customer feedback is really important too. We have a global community helping us to shape the product.”

Learn more about the L300 Go at Ottobock.com

Every time it's set up, it's completely individual. And everyone will have a different tolerance threshold, and a different muscle contraction threshold. So it's set up for each individual user

Odstock Medical Limited (OML) - FES pioneer

Functional Electrical Stimulation (FES) uses small electrical impulses to stimulate muscles weakened by damage to the brain or spinal cord in adults and children.

The technique is used to assist walking, improve hand and arm function and assist other bodily functions.

Odstock Medical Limited (OML) is a major innovator of FES in the UK. Based at Salisbury District Hospital, the company provides clinical services, equipment and training.

OML is also researching into new applications of FES, for example, FES to reduce the some symptoms of Parkinson’s disease, improving the recovery after total hip replacement and the treatment of constipation in neurogenic bowel conditions.

Paul Taylor is co-founder and clinical director at OML.

A biomechanical engineer by background, Paul’s journey with OML began in 1986, with funding from the Department of Health to investigate electrical stimulation for the rehab of spinal cord injury.

“FES isn't a new thing. The concept goes back to the early ‘60s but it failed to make it into service back then,” Paul says.

“I designed a new kit, worked out clinical methods for using it and provided courses for teaching other people how to use it.

“We made a device specifically for stroke patients that was shown to improve walking.

“More patients got referred, more devices were made and it soon became clear that more and more conditions could benefit from FES.”

Despite promising research and routine use of FES in the former Yugoslavia, globally, the technique was slow to take off.

Paul and his team were one of the first to bring the FES into the clinic in the UK, with the aim of making it a routine application for patients at Salisbury and further afield. While early investigations explored FES for spinal cord injury, it soon became clear that people with stroke and MS could find significant benefit.

Paul explains: “We originally investigated FES to provide standing for people with spinal cord injury.

"If the equipment stopped working, they would muddle through and get around to telling you at some point.

“But if the walking stimulator for drop foot stopped working, the patients would be banging the door, wanting it replaced as soon as possible because it made such a huge difference.”

“This certainly shows that patients experience improved quality of life and improved activities of daily living.

“And for some, it's the difference between walking and not walking at all, so it does make a big difference.

“It's not one-solution-fits-all. We have a suite of solutions to suit individual patients for their individual needs.

“Likewise, we can use FES to improve knee and hip movement.”

NICE guidance from 2009 established FES as routine NHS treatment for drop foot due to brain or spinal cord injury.

Also, national guidelines for how FES is implemented in clinical practice have recently been published by the Association of Charted Physiotherapist In Neurology.

To access NHS treatment, patients have to be referred by a GP, MS nurse or neurologist. But whether NHS or privately-funded, FES has been shown to be a long-term cost-effective treatment.

Although the orthoses were cheaper, the adherence rate for FES was about double that of the AFO, and the improvements and quality of life benefits were greater overall

Paul says: “The latest independent study showed that FES is cost-effective in comparison to ankle foot orthoses (AFOs).

“Although the orthoses were cheaper, the adherence rate for FES was about double that of the AFO, and the improvements and quality of life benefits were greater overall.

“In fact, one of the patients from our original randomised controlled trial is still using their FES device 30 years later.”

OML’s technologies are now helping countless patients across stroke, brain injury, cerebral palsy, Parkinson’s disease and beyond, with new innovations currently under development.

Paul says: “We're developing a new stimulator device to give hand movement to people with tetraplegia. It's called Tetra Grip.

“We are also waiting to hear if we’ll get further funding to develop a new generation of stimulator, designed to extend the range of disabilities that can be helped by FES."

Despite significant evidence for FES, there are still areas of the country where it is not routinely funded by the NHS.

This year the MS society has launched a campaign to improve access to FES.

You can join their campaign at www.mssociety.org.uk/care-and-support/ professionals/evidence-professionals

Find out more about OML at odstockmedical.com

‘We’ll never be standing still, that’s for sure’

ambition of A Chance for Life in planning for the future.

“I'll always be looking for opportunities for us to do even more, go even further,” says Louise.

“My mum had her own market stall business and I was brought up on there from a very early age. I had all sorts of businesses before I was even 16, so it’s just in me, I think.

“We’ll never be standing still, that’s for sure.”

The background that inspired a business

From starting life in the spare bedroom of Louise Chance’s home in 2002 as a means to continue her love of supporting people with brain injury, case management company A Chance for Life has grown beyond all expectations over the past two decades - not least Louise’s.

“It was just me, the plan was never to employ anybody,” recalls Louise.

“But then as I got busier, my next door neighbour came in and did a little bit of secretarial work, and that was it.

“Gradually you realise you need support. There were some peers who asked to join me and we formed a very small team, which has gradually expanded over the years to where we are today.”

Now, A Chance for Life Ltd has a team of around 80 people across the North of England and Scotland, with case managers, occupational therapists, physiotherapists and rehabilitation support workers working with adults and children with complex life-changing injury. Having celebrated its 20th anniversary in 2022, the progress of the Cumbria-based business shows no signs of slowing down, with its acquisition of Neurocare Physiotherapy in 2021 and the impending creation of its OWL Barn service to continue to improve lives through specialist rehabilitation both highlighting the

Having worked as an occupational therapist since 1988, Louise had become an established name in brain injury rehabilitation in and around Manchester. Working at key sites including the renowned neuro-rehab specialist Highbank Centre in Bury, with the turn of the millennium, Louise began looking for her next move.

“I loved working in brain injury, I absolutely adore brain injury, but I realised I wanted to fulfil more of what I knew I could do without being constrained by somebody else’s business model,” says Louise.

“I didn’t want the constraints of a manager or organisation with goals or targets, it was about me setting those myself and knowing what I needed and wanted to deliver.

“I felt I had a good clinical background and was very privileged in some of the places I had worked, and in 2002, it felt like the right time. It wasn’t an overnight thing, but over time I could feel things coming together.”

By the early 2000s, case management was becoming more known and accepted within the world of personal injury, having previously been prominent in the United States, but not widely adopted within the UK.

“There was really quite a buzz in the brain injury and medico-legal world at that time,” says Louise.

“There was a real explosion in research from the late 1990s, which meant we knew and understood much better what we could achieve

in rehabilitation.”

“So it was a very timely way of starting my business, there was a lot of good energy around and it felt like the right time.”

Initially based at Louise’s home in Bolton, supporting clients in an increasingly wide geographical area, A Chance for Life took on its Cumbrian roots when Louise was tasked with producing an acquired brain injury pathway for Lancashire and Cumbria.

“This really showed me that there was a need for more training, some co-ordination, we needed more specialists in Cumbria for the treatment of ABI in particular,” she recalls.

“While it is a very challenging place to start a small business, in a rural area without much infrastructure, it was clear the resource was very much needed.”

Specialist support across the North

In moving to Penrith, A Chance for Life has brought vital and much-needed provision in brain injury and complex care to Cumbria and the wider North of England.

With a team of specialist case managers and therapists, and a separate team of rehabilitation support workers, the business has worked with clients as far afield as Inverness, the Isle of Man and everywhere in between to bring high quality, person-centred support and rehabilitation to those living with life-changing injury.

Its core case management business continues to win new clients based on the strength of its reputation; a reputation which is shared by the specialist occupational therapy and neurophysiotherapy services the team also offer.

The business is also a stand-out name in the sector through its provision of in-house, CQC-registered rehabilitation support work, with its specialist team established in 2011. In 2021, the team delivered 52,660 hours of rehabilitation support.

As A Chance for Life marks its 20th anniversary, NR Times learns how the case management and rehabilitation business has grown into a leader in the North of England, and continues to grow and develop as it enters its third decade

While many working in healthcare struggle to find support workers amidst the ongoing recruitment crisis and growing pressure on resources, the fact A Chance for Life has its own dedicated team means they regularly work with a host of businesses across the sectorincluding other case management companies. “I saw an opportunity to develop the support side of the business, and directly employ our own support workers, driven by need. If we hadn’t, we would struggle to carry out the therapy and the case management with some of our clients in Cumbria, because we were lacking that skillset,” says Louise.

“We provide anything from 24-hour packages to smaller packages of around 16 hours a week, and that has now grown into about half of the business. I’m very proud of the work we do here, and the need we are helping to meet through the excellent work of our team.”

While the business has developed over the past 20 years, so too has its team, with several longserving members of staff who have grown and developed with A Chance for Life.

“We've been able to provide career progression for our support workers in particular, there are a number of staff who have progressed as they gain skills and experience, they move into team leader positions in areas of responsibility,” says Louise.

“We have one person who started as a support worker, she went to team leader, and she's now my registered manager. We believe in supporting our people to develop their skills and do the best they can in their role and their careers.”

And as well as its team and clients, Louise is also keen for her business to support its local community in Cumbria by becoming an advice and signposting resource for anyone who needs it.

“With the Cumbria hub, I want people to pick up the phone and say ‘I’ve seen this on your website, can you tell me where to find this, can you help with this?’,” says Louise.

“I’ve always wanted us to be an organisation where people can ask us something and we’ll signpost and point them in the right direction. I want people to use our expertise to help them and their families when they need it.”

The challenge of - and response to - COVID-19

While the challenges along the way in building a business are many and frequent over the past 20 years, Louise points to COVID-19 as being the most significant.

“While in the early days of the business, when I was setting up our Cumbria hub in a very rural area with little resource to support our service and a lack of infrastructure, that was a challenge. I’m very pleased I did it, but it was a huge challenge,” says Louise.

“But with COVID, it was a challenge like no other, like nothing any of us had seen, and beyond anything we could have planned for. It was certainly the biggest test for me as a businesswoman and as a clinician.”

When the pandemic hit in March 2020, many businesses closed their doors, others retracted or condensed services, and countless more struggled to cope with the unprecedented challenges and guidance that changed almost by the day.

But for Louise, it demonstrated the strength of the infrastructure of the business, and how well shaped it was to respond to the most unforeseen of circumstances.

“We were able to maintain our service throughout COVID. Our office was open, we were issuing PPE left, right and centre - in the early says paying £100 for a box of gloves! - and making sure our staff were safe, our clients were safe, and our service was still being delivered,” she says.

“The admin team were in every day, offices rearranged and meeting rooms repurposed to allow for distancing, the rotas were all managed, nothing slipped. That is the backbone of our whole operation and because that was strong, our service remained strong.

“I am so proud of the work we did. We had over 100 clients out there relying on us, we had 24hour packages that were maintained all the way through. If we had a client who needed overnight care who got COVID, then our staff would stay with them throughout.

“It was a privilege to be able to be with our clients during that time, it was very humbling. We were able to support clients through COVID during times when families were not able to visit, we were playing a very privileged role.

“But we got through it with real teamwork. Teamwork within the business and then, once we could work with the families again through the creation of support bubbles, teamwork with the families.

“It was quite phenomenal and it does make me emotional thinking about it. The responsibility for staff livelihoods, for client and staff safety, was

huge, but despite the challenge, we did get through it. I am a big believer in looking after each other and am really proud of the work we did during that time.”

Continuing to grow and develop

Having marked its 20th anniversary year - with celebrations continuing until May 2023, which will raise money for the Great North Air Ambulance - A Chance for Life has taken a welcome opportunity to reflect on its many achievements. But with so many exciting plans yet to come, the achievements look set to continue.

With the acquisition of Neurocare Physiotherapy, which has worked across the North West since 2003 - and whose own 20th anniversary is this year - A Chance for Life broadened its offering further, building on its core services to now be able to offer highly specialist physiotherapy treatment for people with a wide range of neurological conditions including stroke, multiple sclerosis and Parkinson’s disease. Work is also underway to create the OWL (Onward With Life) Barn in Cumbria. This will be a social enterprise, which will focus on a range of recreational activities to support rehabilitation including cooking, horticulture, woodwork and animal husbandry.

“It’s going to be somewhere for people with complex injury for assessment, treatment and a social community. All of our work will be therapy-led, underpinned by clinical reasoning,” says Louise.

“This is a very exciting project, we’ve been planning it for a long time and work began just before COVID hit, so it has taken a while - but we are looking forward to unveiling it in the coming months.”

And while A Chance for Life continues to develop its resource, the now 20-year- old business is also concentrating on the development of its own infrastructure to help lead it into the years ahead.

“I think when you get to this stage, you do have to look at the sustainability of the business, building up the skill mix so we can carry on for many years to come,” says Louise.

“We’re building the infrastructure and increasing the skillset at a leadership level, so it is not reliant on me. We have the systems in place now and I’m keen to carve out a bit of time so I can do some research.

“But we will continue to look for the opportunities, like I’ve always done, and continue to do what we do for our clients.We’ll never be standing still.”

I'll always be looking for opportunities for us to do even more, go even further

‘Next step – walking with crutches!’

“I’m a very active person, I’ve run halfmarathons in the past, I love walking and hiking. So facing the prospect of never being able to walk again hit me very hard.

“But Miss Lee and the staff on Horsley ICU were excellent in looking after me and keeping my spirits up.”

Since the injury, Jamie has been receiving intensive physiotherapy in the community to help get back on his feet and is so far up to walking with a Zimmer frame.

Recently, he returned to The Walton Centre to visit Miss Lee and the teams that helped save his life and mobility.

Jamie said: “Progress is slow and I’m using a wheelchair mainly for the moment, but considering the extent of the damage I’m grateful to be this far along. I was so happy to come back and see the staff and Miss Lee to show them my progress.

“I’m determined to carry on my rehabilitation and walk unassisted again. Next step – walking with crutches!”

Miss Lee said: “With an injury like this, initial treatment is to stabilise the spinal column so we can mobilise and treat the patient safely.

Jamie Hardesty fell 30ft down Mount Tryfan in Snowdonia in April this year while on a solo hike – part of an adventure holiday to North Wales with his wife Sammy – and was airlifted to hospital.

Medics at the Major Trauma Centre at Ainrtee University Hospital in collaboration with The Walton Centre found that he had broken his chest, ribcage, back in three places, and had collapsed both of his lungs in the fall.

“I knew I was in a bad way, but I didn’t know to what extent,” recalls 31-year-old Jamie.

“I couldn’t move my legs, so I thought that I’d badly broken them. I was confused when I got to A&E because I was pleading with them not to amputate my legs, not knowing that it was referred pain from the damage done to my spine.”

During the initial assessment in the Major Trauma Centre, consultant spinal surgeon Miss Maggie Lee assessed Jamie and conducted the complex spinal surgery he needed.

Jamie, from Newcastle upon Tyne, continued: “Miss Lee was amazing at calming me down in those initial conversations. I was in surgery for a long time while she was reinforcing my spine. “When I woke up I had no sensation below my hips, the damage was that extensive.”

Jamie had sustained Thoracic-level spinal damage, which affected his mobility, but as the injury was classed as an ‘incomplete spinal cord injury’, it means that there is potential for recovery.

“I remember being very upset after the surgery because of the lack of feeling in my legs,” Jamie recalls.

“The initial trauma causes the spinal cord to be inflamed and swollen, preventing the nerves from functioning properly and this can be devastating, as at times, there may be no function, there can be loss of sensation, loss of movement or loss of control of body functions.

“As this settles, nerves can regain some function, especially with an incomplete injury and individuals may recover some function as late as 18 months after the injury.

“It is important to remember that all patients are individuals and outcomes can differ.

“Jamie had a great positive attitude, which plays an important part in his rehabilitation. He is surrounded by his supportive family and a great team of therapists.

“I only played a small part in his journey; he is an inspiration to other patients with spinal cord injury. I am so pleased to see how far he’s come in six months. I hope he continues to recover well.”

A man who feared he may never walk again after sustaining a serious spinal injury while hiking is now looking to the next phase of his rehabilitation by targeting walking with crutches.

The importance of working with clients and their families

and frequent contact with the case manager and other health professionals?

This is what our clients have to go through when they instruct a solicitor to pursue a claim for personal injury.

On one visit, many years ago, I was told that the couple only faced up to the reality of what had happened when I visited. They otherwise tried to mask the enormity of the change in their lives and lived tandem lifestyles which left the client feeling isolated by his wife and not supported.

From high-flyer to carer

I worked with a client who sustained a spinal injury and whose wife had a very well-paid senior role. She was used to being in charge of matters and delegating tasks to others. She enjoyed her job and had worked hard to achieve her position.

When her husband was injured, she wanted to be as involved as possible in his care and support which jeopardised her work prospects. As a result, she reluctantly decided to leave her job. She made this decision with real sadness, and it was a source of deep frustration for her. I quickly needed to ‘tune in’ to what the client’s wife needed from me as the case manager. She was highly organised, time focussed and, frankly, quite intimidating!

enjoyed, and with the help of an Occupational Therapist, agreed goals were drawn up to help him overcome the barriers he was now facing in doing what he used to enjoy.

Thankfully, we were able to establish a working relationship where the client’s wife felt supported by me as case manager for the benefit of her husband’s rehabilitation.

Anger needing to be managed

On another case, my client was a father of four children. He was living with extreme pain following a road traffic accident in which he was injured. Despite being safe to be left on his own for short periods, he demanded that his wife stayed with him rather than go to work.

His children were not allowed to have friends in the house, for fear of him becoming angry with them, and he had a low tolerance to auditory stimuli meaning that the TV and any other form of noise had to be kept to a minimum at all times.

Here, Virginia Bowley, case manager with ILS Case Management, discusses how this can be difficult to achieve – but the end result can be hugely beneficial for all parties

Being a case manager, I have often wondered how I would react to having health professionals coming into my life and talking about many aspects of my personal and private life, with the details then being reported to others.

What would it be like to give up any control over what I did because someone else thought it might benefit me? How would my partner react to time-consuming meetings

I decided to have a meeting with her to talk about what aspects she wanted me to do, and which she wanted to be in control of. I realised, to make this work and to avoid duplication of tasks, that excellent communication between us was of key importance.

The client was struggling to come to terms with his catastrophic injury and sadly became very depressed, as a result it was difficult for him to engage with anything proposed. His wife was very keen to find something that might capture his attention and help him in his recovery. The difference in their personalities was stark.

Given that I was my client’s advocate, and that I was not working for the client’s wife, I needed to reflect on what approach I needed take to effectively move things forward. We decided to work on hobbies that the client previously

The controlling behaviour had a devastating impact on his wife, who eventually stated that unless he accepted paid care support, she would leave him. The anguish my client’s wife was feeling was clear to see, as she had aspirations to progress her career in the educational field. However, the anger and determination in my client was also evident as he seemingly wanted to keep his wife from having any freedom.

I had to carefully navigate my way through their seemingly unsurmountable differences in order to get the best result for my client and his family. It took time to resolve, but the wife’s ultimatum stirred my client into action and he did begin to realise that not only would he have lost the life he used to have, but he stood to lose his family as well.

He reached a point where he was able to accept the importance for his wife to be able to return to work part-time, and he agreed that we could arrange for external paid carers to support him whilst she was at work.

While the role of the case manager is to support their client, the involvement and needs of their partner and family can be fundamental to the situation being a success.

Breaking through barriers

I have also worked with a client who required 24-hour care. He understood and accepted the need for care, but his partner constantly denigrated the staff and criticised their work. The client enjoyed an active social life often staying out very late which the carers accommodated.

However, when it came to escorting the client on holiday to a music festival, the client’s partner stated clearly what she wanted to do with the time away which differed from the client’s expectations. This caused tension within the care package as the client wanted to experience the festival environment with his partner, which she did not always want to do. I worked closely with the team leader to try and resolve the issues raised by the partner, but there was always a deep sense of resentment from her regarding the cost of the staff, and a sense that she did not value them. I reflected on this and decided to talk to the partner to try and break through the barriers to her having a harmonious working relationship with the care team.

It was a subject that required re-visiting several times and the care team required much support when they felt undervalued. However, through ongoing conversations and sensitively raising the issues with my client’s partner, progress was made and tensions between her and the care team gradually lessened.

Overcoming resentment

Another client I have worked with lived with his girlfriend who had become his full-time carer. She had become deeply resentful of how she was being treated by him and decided she wanted to leave. My client desperately wanted her to stay, but the more he tried to persuade her to do this, the more aggressive he became, which had the effect of pushing her further away.

My task was to reduce the highly volatile feelings that were developing whilst not aggravating my client who had a quick temper. I could see the desperation in his partner’s demeanour, and could sense the sadness in my client when he realised that he had shown no respect for his girlfriend and had treated her so poorly. He was so keen for her to reconsider and stay.

Sensitive and timely discussions had to take place with both my client and his partner to enable them to both feel supported, listened to and to enable a way forward for them both.

Understanding grief

When I volunteered for Cruse Bereavement Support, I studied how grief can affect us, and through my work as a case manager, I have observed that clients and their partners all appear to go through the different stages of bereavement for many years after the accident or injury has occurred.

In my role, I have always found it beneficial to take time to ‘tune in’ carefully to the dynamics of the relationship between clients and their partners and loved ones whenever I am in contact with them.

Often, an email from a client’s partner can sound like there may be more they want to say, but they cannot or will not commit their thoughts to writing. In such cases, I will call them to allow them to talk things through more freely, and this gives me an opportunity to gain a clearer understanding and gauge what is troubling them. It can also convey the important message that as the case manager, I am eager to have as good an understanding as possible of the depth of feeling that both clients and their partners have. I often explain that if partners can say how they are feeling it can free up the client and others to speak more openly.

Supporting couples to become stronger

Through my 20 years’ experience of working as a case manager with clients who have partners and loved ones, I have found that it is essential to ease into the relationship respectfully, to actively listen to their concerns without judgement, and to be mindful of the language I use to ensure it is not alien to them.

Over the years, I have learned of the importance of working at the client’s pace and to give them and their partners time to come to terms with a different way of living that might be very difficult for them to accept.

As case managers, we may well have a vision of how therapeutic interventions and care and support could help our clients, but they are often managing pain, confusion, discomfort, immobility, loss of freedoms and social isolation which can result in a variety of reactions to case management which always demands careful consideration and an open mind.

I have learned of the importance of working at the client’s pace and to give them and their partners time to come to terms with a different way of living that might be very difficult for them to accept

‘

Life is for livingthat’s what we help our clients to do’

Established to make a difference to the lives of people living with complex needs, Premium Care Solutions has grown to support clients across the country in living in their own homes, finding solutions to the many challenges that may present.

NR Times finds out more about the business, its focus on independence, and how and why clients are central to everything it does From a desire to promote independence and enable people with even the most complex needs and disabilities to remain in their own homes has come a fast-growing national care provider which is dedicated to putting clients at the core of its whole operation.

Premium Care Solutions (PCS) supports people across the UK in being able to live as independently as possible, assembling a bespoke care package and hand-picked care team to deliver exactly what the client needs to be able to maximise their potential and enjoy their life.

Since its foundation in 2005, PCS has expanded from its base in Kettering to work

with commissioners on a national basis, enabling people living with the most complex of care requirements - often requiring 24-hour care - to be discharged from acute or rehabilitation settings to live in their own surroundings.

Established by brother and sister team Amrit Dehal - managing director of PCSand clinical director Jin Garcha, the care provider benefits from the expertise and insight of lawyer Amrit and Jin, who has over 30 years’ experience in healthcare, who jointly share a commitment to doing all they can to deliver a truly client-centric service. And a key part in doing so is how PCS assembles each care team. Every teamwhich works solely with one client, routinely over the course of many years - and each

member within it is chosen based on the final say of the person they will be supporting. “I think so many people have a vision that they want to be in their own home, their own environment, and that’s what we want to do for them. We want to enable that to happen in as many situations as possible, no matter how complex their needs,” says Jin, who has worked in complex care for over 22 years.

“We are absolutely committed to doing all we can for every client, we’ll always go above and beyond. If there’s something they want to do, we’ll look at every way we can make that happen. If a client wants to go on holiday, then whatever challenges we face in doing so, we’ll bust a gut to get them on holiday.

“Life is for living - and that’s what we want to help our clients to do.”

Client-focused care

Back in 2005, seeing the lack of dedicated, bespoke support for clients with particularly complex needs in being able to live in their own home, Amrit and Jin took the decision to create a specialist provider which would deliver exactly that.

“We saw the gap in the market, we felt we could do something different and a little bit better,” says Jin, who also has experience in case management.

“Providing a really bespoke service that is one-to-one and tailor-made for the client, so they can get the best out of their life and achieve what they want as far as possible, was what we really wanted to do.

“Being at home is a big part of that for so many people. Being able to achieve going back home might seem unlikely in some situations - but we wanted to do absolutely everything we could and look at every option so that it could be possible.

“If they can’t return to the home they used to live in, then we’ll work with the MDT in finding their ‘forever home’ and moving the team over there. That’s the next best thing and gives so much more independence than being in residential care, which is very important to clients and their families.”

Developing a specialism in supporting people living with brain injury and spinal cord injurythe business is a trusted partner of the Spinal Injuries Association, among other endorsements - PCS assembles expert teams to handle the most complex of requirements, from ventilator dependency to trachaeostomy care. It also has a dedicated service for young people. And it is the delivery of such specialist care, and the way it goes about it, which PCS believes is so important in how it works with clients.

“We will always do all we can to get any client home and will assemble the team to support that. Very often, we’ll support the client for life, so we want to get everything in place for us to enable that,” says Jin.

“We say we put the client at the centre of what we do, and that’s what we do. It only works if the client completely gels with a member of staff and has had a say it who's going into their own home.

For a full package, there could be anything between six to eight people on their team to cover a 24-hour care package, so they need to be involved in knowing who these people will be. “We will go and visit the client first, to get an understanding of who they are and who they would like on their team. We’d never just recruit without the client being involved.

“Each team is recruited specifically for that client, we won’t send that team to other people. We’ll look at matching interests with the clienthave they always enjoyed gardening, or reading, or whatever else it might be? We’ll look for what similar interests we can find and try and recruit on that basis.

“We have three stages to our recruitment process - we do telephone screening, video screening, and then at the last stage, we’ll put those individuals in front of the client. They get to meet them before we complete the process and they always get the last say.”

Making a difference

Established to make a difference in the marketplace, what does PCS believe makes it stand out from the crowd? Jin points to its commitment to quality.

“I know anyone can say that, and I do feel a bit clichéd saying it, but we are absolutely committed to the quality of what we do. We care about our clients and that makes us want to do the absolute best we can,” she says.

“When we’re taking over failed care packages, and you speak to people about why these packages have failed, the lack of attention to detail comes up all the time. The lack of supervision of staff, the lack of support of staff, the lack of support of clients.

“But with us, we do what we say. We say we offer a 24-hour on-call service to our staff and clients, and we do. We offer the clinical support as well. It isn’t just that the 24-hour service is for emergencies only, it’s there for whatever.

If someone’s just a little bit worried that the client doesn’t look too well, it might just be a bit of help or advice they need, but we’re here for whatever it might be, anytime.

“We also want to do everything we can, go above and beyond. If we can make something happen, we will. It might not be a straightforward process at all to take a client on holiday, for example, but life is for living. And if we have to take some little, measured risks to enable people to get the best out of their life, then we’ll assist in whatever way we can.” The team, throughout the business from director level down, takes a proactive approach

to client care.

“We're not hands-off managers, we're very hands on,” says Jin.

“We visit our clients very regularly, we’re frontfacing managers because we believe that staff and clients both need to see us and see our faces. It’s never ‘Here’s the team, now off you go’ and we move onto the next one.

“Our manager-to-client ratio is typically about eight clients per manager, we don’t have big case loads. We believe if you have a smaller case load, you’ll get a better quality of care.”

Training is also a key feature in delivering the service it does, says Jin.

“We do all of our own training in-house, nothing is outsourced,” she says.

“There is classroom training, hands-on training, we do the clinical competencies to make sure they understand the individual’s needs. It’s quite robust and in-depth, so that every member of staff is completely geared up to totally understand the situation they are working in.

“If a client is spinal cord injured, they’ll come to understand the components of that injury; if they have a brain injury, they’ll understand the components of a brain injury and how that affects that individual on a day-to-day basis. It’s very bespoke to each client, because each injury can affect different clients in different ways.

“Our care packages are nurse-led, and we’re very clinically-focused, we have a lot of clinical oversight of our teams from in-house support.”

Ongoing growth

With clients currently covering the whole of the UK - from Cumbria to the Isle of Wight, and over into Northern Ireland - the PCS caseload continues to grow, meaning the business is always looking to add to its team.

“I think our steady growth over the years is testament to what we do. We don’t necessarily go out looking for work now, it just comes naturally, which I also think speaks volumes,” says Jin.

“We’re looking for new clinical case managers nationally, we’ve got a network right across the country so we’re always looking for the right people to help us support more clients.

“We’re in a very good position and have a good reputation and that’s credit to our managers. Support workers, and of course our fantastic clients too.

“We will keep doing what we are doing, supporting the clients we are very fortunate to work with, while also having the ability to support even more in achieving something so important in their lives - their independence.”

"If we can make something happen, we will. "

Revealed – the lonely reality of life after stroke

Almost three quarters of stroke survivors spend less or no time socialising with their families and friends after their stroke, new research has revealed, highlighting the devastating and often hidden social impact it can have on survivors’ lives.

Furthermore, four in five survivors – 83 per cent – also spend less or no time on their hobbies, with 79 per cent admitting to giving up a hobby altogether.

The findings strengthen existing evidence around the loneliness and isolation experienced by stroke survivors – of which there are around 1.3million in the UK, with more than 100,000 people experiencing stroke each year – and has renewed calls to tackle the situation.

The survey, from the Stroke Association and Buzz Bingo, also finds:

> Almost three quarters (74 per cent) of stroke survivors experience tiredness and fatigue since having a stroke

> Over half (52 per cent) of stroke survivors say they have lost their confidence since their stroke and around a third (32 per cent) have experienced changes to their personality

> Around one in four struggle with their mental health (26 per cent) and/or feel lonely/ isolated (23 per cent)

> Before their stroke around a third engaged in a hobby daily (38 per cent) or three to four

times a week (31 per cent). Popular hobbies pre-stroke included exercising, reading, gardening and watching TV

> Spending less time or giving up a hobby has left many stroke survivors feeling a loss of confidence (29 per cent), a lost sense of purpose and identity (24 per cent) and impacts their wellbeing (23 per cent)

> Over a third of stroke survivors (40 per cent) would like the chance to socialise more since their stroke and to go to clubs and societies.

> For Tracy Hughes, 52, from Manchester, her stroke meant she had to give up her fit, active and sociable lifestyle.

Tracy, who was 46 at the time, attended British Military Fitness (BMF) classes four times a week – and it was at one of these classes when her stroke struck in 2016.

Tracy said: “I was at BMF in a park at Leeds, when I started feeling funny and the floor looked blurry. I sat down and my whole left hand side went weak and I started slurring her speech.”

Thankfully, being at an organised event, paramedics were nearby and suspected Tracy was having a stroke. After attending hospital and confirming this, doctors gave Tracy Thrombolysis drugs to address the blood clot. She went on to spend five days in hospital in Leeds and later Manchester.

“It was quite surreal coming out of hospital, I had no idea what was going on, I was confused as to what had happened,” she recalled.

Tracy was still very weak on her left side and had to have support to walk. Her speech was slurred, which took a short time to come back, and she spent most of the days resting. Despite feeling lucky in her recovery, it was the loss of attending BMF and the social life this gave her that has had the biggest effect on Tracy and her mental health.

“I had made a load of friends at BMF, we were a family and doing exercise made me feel so good. I was someone who did a lot of exercise but then I just couldn’t do what I used to,” she said.

“The coaches always want me to come back but I know the pace is now far too much for me. I still think about the classes all the time and I want to go but my body just lets me down –that’s really affected me mentally.”

The Stroke Association and Buzz Bingo are working together in a three-year partnership to help combat loneliness and isolation felt by so many people like Tracy.

“Bingo has really been a God send, it’s my night out. Me and my daughter now go which is my

‘me time’ and we really enjoy it,” said Tracy. “I also now have a personal trainer who knows me really well and he knows what I’m capable of and what I can’t do. I struggle with it even though I really want to do it.

“Some days I really don’t want to get out of bed, it all depends on how I feel mentally but I’m persevering.”

As part of the partnership launch, radio and TV legend Chris Tarrant – himself a stroke survivor – and son Toby hosted a Bingo event for stroke survivors.

Chris Tarrant said: “Eight years ago, completely out of the blue I had a life-changing stroke. It was incredibly frightening and it made me realise how fragile life is.

“I know how scary and tough life after a stroke can be, so I was shocked to learn that so many stroke survivors spend less time with their loved ones and many have given up their hobbies.

“Having the support of my family and friends was crucial to my recovery and spending more time on the things I love really helped my wellbeing. I’m so grateful to have had such fantastic love and support from those close to me but I know this isn’t always the case for everyone, which is why I would encourage you all if you can, to find your passion again or enjoy a new hobby.”

Saul Heselden, head of corporate partnerships at Stroke Association, said: “Stroke strikes every five minutes in the UK and changes lives in an instant.

“Stroke has many impacts, some are visible whilst others are hidden, but the effects are equally devastating and can become obstacles to recovery. Many stroke survivors stop seeing family and friends or are forced to give up their hobbies, this may be as a result of struggling with their confidence or mental health or due to fatigue.

“Socialising and enjoying previously loved hobbies are really important to mental health after a stroke. Without this stroke survivors can lose their confidence, hampering their well-being and potentially leaving them without a sense of purpose and identity.

“We are excited to announce our new partnership with Buzz Bingo which will help to raise vital funds for much-needed specialist support, research and campaigning and will go a long way in supporting more stroke survivors to live the best possible life after a stroke.”

Mark Fletcher, head of brand communications at Buzz Bingo, said: “We are delighted to be partnering with the Stroke Association and to help raise awareness of the isolation and loneliness many stroke survivors experience.

“Over the next three years we aim to raise £200,000 for the Stroke Association, through special events and fundraising initiatives, like our event with Chris and Toby Tarrant. As part of the partnership, we will also be working closely with the charity to provide volunteering opportunities for our colleagues and train them to better understand stroke and its impact.”

Socialising and enjoying previously loved hobbies are really important to mental health after a stroke

I know how scary and tough life after a stroke can be, so I was shocked to learn that so many stroke survivors spend less time with their loved ones and many have given up their hobbies

need qualified carers or life isn’t worth living’

“My partner can no longer cope. He is going to have a breakdown if I don’t do something, so I have looked at care outside,” says Lynda.

“My mum is sick, and I don’t have extended family close by, but he can’t manage anymore mentally. I can’t go without care for one day as if my catheter bag isn’t emptied, I suffer from something called autonomic dysreflexia which could be fatal.

“Sometimes I think what am I going to do, you can’t make a loved one care for you 24/7 without a break.

adult social care, and the impact the ending freedom of movement has had on the sector’. It contained a total of 19 recommendations relating to pay and conditions and immigration policy for social care, that would help to ease the burden on employers and migrants alike which have so far been ignored.

The Migration Advisory Committee (MAC) has reported there are around 70,000 more vacancies in social care now than before the pandemic – an overall vacancy rate of 11.1 per cent, and a level which continues to grow. The recruitment crisis – much of which is down to the ending of free movement through Brexit, says the MAC – is impacting severely on those who need care, and has been described as a matter of ‘life or death’ for many.

For 51-year-old Lynda Yu, who lives with paralysis after a road collision in 2004, she is fully dependent on 24/7 care. Such are the complexity of her needs, she would end up in A&E without such support.

However, Lynda is struggling to have her care requirements met, and has confessed the situation has left her feeling suicidal.

“I need qualified carers or life isn’t worth living. I know I should stay alive and fight it but how can you fight it if you don’t have anything to fight with?,” she says.

Her partner Michal has stepped in to deliver the care she needs in the absence of access to dedicated carers, but the stress on him as Lynda’s full-time carer has become intolerable. Michal has not had a single day off work for the past seven years. It takes him around three to four hours just to get Lynda ready for the day, which includes carrying her from bed to the shower chair and undertaking her bowel management routine.

“I do have to recruit but if I can’t then I have even considered ending my own life, I know I have been given a chance to live again after the accident, but every day I worry about it. How can I tell my eight-year-old niece that I can’t visit her because I have no carer to help me?”

Every care agency she has contacted has told Lynda a similar story; that they’re short on carers and cannot take on any new assignments, provide respite cover or offer regular care, citing the problem with recruitment through new immigration rules.

“The government must allow overseas carers to come and work in the UK again so they can care for and support people like me to lead a fulfilled life. Care, and especially intimate personal care, is a difficult job. It takes a special kind of person to do it well,” says Lynda.

In July 2021, the Government commissioned MAC to ‘undertake an independent review of

In this week’s annual report, MAC expressed its disappointment stressing that the cost-of-living crisis is particularly severe for social care workers, given that their pay remains tied to insufficient government funding and that they’re generally not well compensated for their fuel costs.

Following recent announcements by the Chancellor in his autumn statement for increased funding available for the social care sector MAC stated in its report:

“The conditions now faced by the social care sector are unsustainable. Despite calls from the Health and Social Care Select Committee, the Public Accounts Committee, the NHS Confederation, Care England and numerous other organisations alongside the MAC, the Government appears to have no ambitions to raise pay in a material and properly funded way.”

For Lynda the stress of finding appropriate care has become overwhelming: “It keeps me awake at night and I have to rely on sleeping pills which I have been on for three years.

“How am I supposed to live this life when I can’t afford to get the care I need? People don’t realise how hard it is to access decent care and the danger if you don’t receive any help.”

Spinal Injuries Association supports many like Lynda in their battle to access the care they need. CEO Nik Hartley OBE said: “It’s a source of deep frustration and disappointment that the Government still hasn’t responded to the MAC report on the impact of the ending of free movement on the care sector.

“Our engagement with MAC was crucial in helping to shine a light on cases like Lynda’s and ensuring MAC understood about spinal cord injury and the critical importance to SCI people of being able to use skilled care workers irrespective of their country of origin.

“We hope the MAC annual report helps to prompt the government to do so as a matter of priority.”

The crisis in social care has worsened, a Government advisory committee has warned, with people in need of support struggling badly to access the care they need.

‘I

This ground-breaking conference will take place in Leeds on April 27th 2022, bringing a casemanagement-run conference to the north of England by a team of experienced event -planners.

This ground-breaking conference will take place in Leeds on April 27th 2022, bringing a casemanagement-run conference to the north of England by a team of experienced event -planners.

The fundamental tension embedded in the challenge to identity that catastrophic and life changing injury can bring and the desire to move forward without losing the sense of self, will be explored through our presenters who will highlight collaborative practices, new approaches, experiential learning and opportunities for change.

The fundamental tension embedded in the challenge to identity that catastrophic and life changing injury can bring and the desire to move forward without losing the sense of self, will be explored through our presenters who will highlight collaborative practices, new approaches, experiential learning and opportunities for change.

A fresh approach to content presentation will immerse the audience in the client experience and the learning experience for delegates will be enhanced.

A fresh approach to content presentation will immerse the audience in the client experience and the learning experience for delegates will be enhanced.

Presenters include;

Presenters include;

• Clinical psychologist and author Dr Graeme Flaherty Jones

• Clinical psychologist and author Dr Graeme Flaherty Jones

• Science communicator and researcher James Piercy

• Science communicator and researcher James Piercy

• Financial planner Thom Harrison

• Financial planner Thom Harrison

• Clinical psychologist Dr Melanie Lee

• Clinical psychologist Dr Melanie Lee

• Service development director Lucy Fallon

• Service development director Lucy Fallon

• Speech and Language Therapist Matthew Nakonesky

• Speech and Language Therapist Matthew Nakonesky

The day will bring together the network who serve those whose lives are irrevocably altered by injury with opportunities for delegates, exhibitors and sponsors attracting an audience of rehabilitation providers, nurses, therapists, social workers, psychologists, case managers, researchers, personal injury solicitors and Court of Protection deputies. There will be a carefully curated exhibition with stands showcasing services and providers that will be useful and relevant to event attendees.

The day will bring together the network who serve those whose lives are irrevocably altered by injury with opportunities for delegates, exhibitors and sponsors attracting an audience of rehabilitation providers, nurses, therapists, social workers, psychologists, case managers, researchers, personal injury solicitors and Court of Protection deputies. There will be a carefully curated exhibition with stands showcasing services and providers that will be useful and relevant to event attendees.

A conference with a difference, this is the one not to miss!

A conference with a difference, this is the one not to miss!