22 minute read
MAKING REHAB FUN, ACHIEVABLE AND HIGHLY EFFECTIVE
INPATIENT REHAB
Advertisement
A new NHS rehabilitation centre, the first in the UK to incorporate digital technology and virtual reality into its rehab offering, is helping to redefine rehab as we know it.
The purpose-built ward at Castle Hill Hospital in Hull has 12 beds and a range of facilities, including a gym, therapy room and garden area, to enable a comprehensive rehab offering to be delivered. It also becomes the first NHS inpatient rehabilitation unit to incorporate digital technology, including virtual and augmented reality into its rehabilitation programme, after Hull hosted the UK’s first successful clinical trial of the GEO robotic gait trainer in 2017. The project marks a significant investment and the first purpose-built NHS specialist rehabilitation centre across the Humber, Coast and Vale area and neighbouring Lincolnshire. “This new building brings rehab into modern life. Previously to this, we had our rehab unit as part of the cardiac ward, and more recently in the oncology section, but the limitations of not having a dedication rehab ward became obvious,” says Dr Abayomi Salawu, consultant in rehabilitation medicine at Hull University Teaching Hospitals NHS Trust. “Our role in rehabilitation is to help restore function and enhance quality of life for people with complex health needs so that they may go on to live fully and meaningfully, not just exist. “Normal hospital ward environments aren’t generally suited for this purpose, especially in the case of patients with acquired brain injury or physical and cognitive deficits. “This new ward gives us the space and the facilities we need to provide specialist rehabilitation input to the highest level, and will also deliver an environment which is more conducive to patient recovery. “We have 12 beds, we do need more, but while acute clinical care and public health have both received significant investment for many years, but rehabilitation - the third pillar upon which the NHS is built - has sadly lagged behind. “So our new rehabilitation ward is a really significant development and definitely a step in the right direction.” Redefining the traditional definition and practices of rehab is something Dr Salawu has long been committed to, and that extends into the ethos of the Castle Hill ward. “We offer complex rehab, if the nurses or staff on any ward think they have a patient who could benefit, then they can come to the new ward,” he says. “Life has to be about more than going to the toilet and the whole ethos of being able to conquer that starts by conquering your first environment, which is hospital. “The approach that has always been taken often makes a patient more poorly, in a way. I’m not underplaying physical injury, but in an NHS hospital, the first thing we do is give someone a bed, even if they walked in. A lot of people become deconditioned when they are hospitalised, and that’s making patients worse.
INPATIENT REHAB
INPATIENT REHAB
“If you can get a patient as physically fit before surgery, through ‘pre-hab’, then that can make things so much better before and after. With our amputation patients, we do the ‘pre-hab’ work with them and it’s so successful we can then pick them up after surgery as an outpatient. We haven’t used our rehab beds for amputation patients for four or five years now. “Another thing in rehab is that there isn’t always a cure, but that doesn’t say you can’t live life well and meaningfully. If, for example, you have a child with Cerebral Palsy, then that condition isn’t going to be reversed - so let’s move on and find out what we can do. How can we enable them to do things and how can we support them in that?” One key way of engaging patients is through technology, believes Dr Salawu. In addition to the therapy work of the MDT, Dr Salawu is a firm believer in the power of virtual and augmented reality, and is so invested he is even leading the development of new apps. “I’m a firm advocate and believer in technology, I’m totally sold that this helps rehab. I always look for whatever low hanging fruits we can use, and technology is something we can use. It’s easy, quick, achievable and doesn’t cost a massive amount,” he says. “We use virtual reality and augmented reality and we have linked in with Hull University to develop a virtual kitchen app, which patients can interact with virtually and then use their skills to replicate the tasks with their OT in the real-life kitchen. “It’s all about practice, practice, practice. That’s what helps recovery and that’s what rehab is about. But practice is boring, for a lot of people rehab isn’t exciting, and that’s the problem. “If you want someone with a paralysed limb to practice moving it, if they try a few times and their limb doesn’t respond, even the most motivated patient will give up. But if you translate that into a virtual environment, where you can move your virtual limb in a virtual world, then that might give the opportunity for some recovery - and psychologically can be very important. “The more opportunities you give to the patient to practice rehab, so they can maintain or recover their function, the better. That’s why VR works so well, because it’s fun it makes rehab more engaging. “That’s where we should be pushing, to empower patients to take over their own rehab. “I said to the computer scientists that I hear video games are addictive, could they please create some addictive rehab for my patients so they would become addicted to their practice! “But we also have a quiet room in the new unit, where patients can use the immersive environment of a VR headset to be calm, de-escalate, become less agitated. We have developed the Brain Recovery Zone app, which is very calming and soothing, and can be used by patients in their own homes as well. “Through putting on a headset and being in that calm environment, that can also be very important in rehab. “For my patients, iI say ‘Whatever floats your boat. Try things in rehab, see what you enjoy and what works’ and we’ll see what we can achieve. I want to empower patients to take control of their rehab however they can, and by using these pieces of technology, we’re seeing great results.”
THERAPY
Knowledge, Understanding and Empathy: What Award-Winning Dementia Training Looks Like
The Dementia Care Awards recognise and reward the first-class services, and very best people, who work in the field of dementia care. Through showcasing excellence and innovation, the awards celebrate the provision of outstanding care for people living with dementia. At the 2020 awards, the team at Elysium Healthcare’s Adderley Green Care Centre, in particular colleagues at Gladstone House, saw off high-quality competition from across the social care sector, to win the coveted Best Dementia Training Initiative 2020.
THERAPY
In this article we chat with two of the main therapists from the team behind the training, Psychology Lead, Dr Darren Perry and Physiotherapist, Damien Humphreys. We discuss why dementia training is so important, what good dementia training looks like and the positive impact that it has both on residents and the care team that support them.
Hi Darren, Hi Damien, would you mind introducing yourselves for our readers. “Hi, I’m Darren Perry. I’m a Consultant Clinical Psychologist and Psychology Lead at Adderley Green Care Centre. Prior to being appointed by Elysium, I worked for 20 years in NHS Neuropsychology, Physical Health and Older Adult Mental Health Services. During that time I helped to establish and refine assessment and diagnostic pathways within Older Adult and Young-Onset Dementia services. The consistent theme across all my clinical experiences has been a focus on psychological adjustment to changes in neurological and physical health. “Working together with Damien and the team, we set out to develop a training package that would enable all our colleagues to feel properly informed about dementia and equip them to provide the best possible care for residents.” “Hi, I’m Damien Humphreys and I am the Lead Physiotherapist at Gladstone House, Adderley Green Care Centre. I’ve worked in a variety of settings over the past 10 years in neurological rehabilitation and management of musculoskeletal conditions. I have a specialist interest in dementia. Thanks both. Let’s start at the beginning. Can you tell us more about your award-winning training? Darren: “The training is really comprehensive. The first section looks at the functions and organisation of the brain. We then focus on how the main types of dementia disrupt the normal functioning of the brain and how this underpins the emotional, cognitive and behavioural changes that people affected by dementia may experience. “We wanted to provide a good foundational knowledge whilst pitching the training at a level that engages all staff. We feel that it is important for staff to understand that changes in the brain, which are beyond the control of the individual, are a key factor in most of the difficulties they face. “An awareness of how neurological decline might affect any one of us if we developed dementia is crucial in helping staff to de-personalise challenging aspects of behaviour and encourages empathy as a starting point in all the care interactions they deliver.’’ “In the afternoon session, we build on this theoretical knowledge by focusing on the technical skills needed to provide excellent care for people with dementia. We draw on experiential learning exercises to really emphasis the core principles of care provision that we aim to instil in all our colleagues.’’
THERAPY
“We wanted the training to be as comprehensive as possible so we run it over the course of a full day. Setting aside that amount of time is quite unique and not always possible for other dementia care services, but at Adderley Green it something that we have prioritised and both residents and our team are seeing the benefit of it.’’
So in addition to being thorough and providing in-depth knowledge, what else do you think stands out about your training? Damien: “We take a dynamic approach to learning and include numerous exercises and activities in our training. I think that if you want participants to actually put the training into practice when they’re on the units supporting residents, then you need to make sure the learning can be applied practically and isn’t just words that stay on the page. “Our training includes interactive sessions throughout the day, ranging from icebreakers to trust-building exercises and group tasks. When training is a shared experience between the attendees, with higher engagement levels, then more information is retained. They can connect more with the material and are more open to learning.” I imagine that is particularly important for team members who are new to care? Damien: “Yes exactly. Many individuals who are new to care don’t have prior experience of supporting someone living with dementia and often only have limited understanding of how the condition affects a person’s capacity to complete daily tasks. “To help team members improve their knowledge and develop empathy for how day to day experiences are impacted by dementia, the training also includes a sensory deprivation exercise, which uses aids and specialist equipment to reduce a person’s sensory capacity. “Participants wear gloves to inhibit their sense of touch and tactile experience. They use ear defenders to reduce their hearing levels and special goggles to limit their vision. We also get them to wear particular shoes that are difficult to walk in and will then ask them to complete the simple functional task of putting on an item of clothing, like a jacket. “We then follow this by asking a care worker to support them to complete another functional task without telling the participant what that task is. The care worker in this scenario then assists the participant to go and make a drink at a nearby table. “It isn’t possible to fully replicate the effects of dementia but by withdrawing much of the sensory input it can give team members some understanding of the difficulties that our residents may face. The purpose of the exercise is to demonstrate the importance of empathy and how we can use that to regulate our own emotions or feelings in sometimes challenging scenarios. “We get lots of positive feedback from the participants about this particular exercise and it seems to have an impact on people.”
And what have been the benefits of your training for staff? Darren: “We find that the more knowledge and awareness our team have of what is happening for the individual, the more confident and compassionate they are in providing care. “For example, people living with dementia often experience difficulties creating memories for recent events and this leaves gaps in their day-to-day awareness. They might make sense of the here and now by drawing on autobiographical memories from the past to fill in the gaps in their understanding. So, for instance, an individual
THERAPY
may think that they have to go to work when they awake in the morning, despite having retired many years ago. If a carer confronts them too abruptly with the reality of their current circumstances, this can add to their confusion and anxiety. “After completing our training, participants understand the need to be careful and considerate with their communication so they do not cause unnecessary distress for the person. We encourage them to acknowledge and validate the emotion that the individual is experiencing and then attempt to engage them in conversation. In our example, they would start with a conversation about the person’s previous occupation and gradually evolve this into a wider discussion about their past life. The individual can often be diverted away from their initial anxiety and gently refocused on aspects of the here and now.”
So it requires a more flexible, empathetic approach? Darren: “Yes that’s right, and to do that I think there are three main factors to consider. First of all we encourage our team to get to know each person that we support as an individual and understand that they have unique needs that are specific to them. Everything we do should be person-centred. “Secondly, we think about stepping into their shoes, putting ourselves in their place and understanding the world from their point of view. This is particularly important if we are supporting individuals who exhibit challenging behaviour. Yes, the physical behaviour can be challenging to the care professional but we ask staff to flip their thinking about challenging behaviour around. Rather than see themselves as the person being challenged by the particular behaviour, they should view the behaviour as an indication that the person with dementia is feeling challenged by some aspect of their circumstances or environment and this is their only effective way of communicating their frustration or distress. “This perspective, coupled with their greater understanding of how dementia affects cognitive, motor and sensory functioning makes colleagues less likely to respond negatively to the behaviour and allows a calmer and more caring attitude. “Then finally, we advocate an engagement-focused approach which adapts all activities to the appropriate level of stimulation and interaction for each individual. It is vital that colleagues are adaptive and tailor their communication style and their overall approach to suit the cognitive, communicative and sensory-motor level of the dementia-affected person. “The three factors we emphasise are interconnected, hence the more we get to know a resident, the easier it becomes to understand their behaviour in context and the better able we are to find activities that will be personally meaningful and more engaging for them. This means that whatever we are doing we always place the needs of each person first and our overall aim is to support their sense of wellbeing.”
It’s clear that the training has a really positive impact both on participants and the people that you support, so how did it feel to win the award? Damien: “It was a fantastic feeling when they announced that we had won the award. We are all passionate about providing the highest level of care that we can for our residents. It was very much a team effort and a lot of time and energy was invested into making the training interactive and engaging for the participants. We are all very proud of our achievement.” Darren: “We would also like to thank Ronan Flood, Elysium Neurological Training Manager, for his input in the early stages. He really helped us to think about the way training is delivered in order to make it as interactive and easily digested by the participants.’’
And to conclude the interview, do you have any thoughts about how you might develop the training in the future? Damien: “Following the success of the dementia awareness training we have plans to employ the same approach for a brain injury awareness training. We hope to support our colleagues to provide the same flexible and empathetic approach by providing the knowledge and skills to care for people with brain injuries.” Darren: “I think the award prompted us all to feel an even greater sense of ownership and investment in the dementia training. We regularly review the package after we have delivered it and make minor adjustments and additions to it. In this way, we feel we are honing it and keeping it fresh which helps us to stay actively engaged each time we deliver it.’’
COMMUNITY REHAB
Award to recognise schools’ commitment to supporting ABI
Schools are to be recognised for their commitment to supporting children with acquired brain injuries (ABI) and their families through the introduction of a new accreditation.
The Child Brain Injury Trust has created the ABI Aware School Award, to help both primary and secondary schools develop best practice around brain injury and its often hidden consequences. Research has shown that, on average, in a class of 30 children, three will sustain a brain injury at some point in their childhood, with at least one being a serious injury. Each year, at least 35,000 children will be taken to A&E with a head injury, although the actual number of those sustaining ABI is thought to be up to 60,000. However, due to the ‘unseen’ nature of many of the effects of ABI, the true effect of this on children’s lives is often underestimated or not recognised, and in many cases a child’s brain injury is undiagnosed. To help support such children, as well as their families, the Child Brain Injury Trust has put together a framework comprising seven overall topics and 39 individual criteria for schools to address, which they will be supported to achieve ahead of their assessment for the award, with reaccreditation being required every three years.
COMMUNITY REHAB
The framework covers a spectrum of aspects from identification and awareness of ABI, to transition or return to school, and how the individual child and their family are communicated with. Teachers will be able to access free CPD-accredited training online, alongside pre-prepared lesson plans to enable them to support pupils in developing their awareness of ABI. The ABI Aware School Award has been in the planning for several years, and went into trial last year, with one academy school in Herefordshire set to become the first in the country to secure the award in the coming months. It is now set to be rolled out nationally. The Child Brain Injury Trust has collaborated with the Eden Dora Trust for Children with Encephalitis on the development of the award. “The vast majority of children return to mainstream school after ABI. For adults, they may need to go to specialist rehabilitation, but for children and young people, their ‘rehab’ takes place in school. While teachers are experts in teaching children, they are not equipped to deal with brain injury - and that is the reason for the Award,” says Louise Wilkinson, head of information and learning at The Child Brain Injury Trust who is leading the initiative. “The Child Brain Injury Trust has always promoted awareness of ABI within education because it’s so important, but there is a still a lot of work to do. I would liken ABI to being regarded how ADHD was five to 10 years ago. I you go into a school now, everyone knows
what ADHD is, and that’s where we want to get to. “We felt the best route forward was to produce something free to encourage schools to grasp the nettle and be proactive in learning about ABI. Even if they don’t think they know of any children who have a brain injury, statistically there probably will be, so it’s about recognising the signs and supporting them from there.” Through the specialist training provided and identification of areas to look out for with children’s behaviour and the support they need, schools can play a vital role in getting to the root of causes of behavioural or learning issues, says Louise. “When a child has a head injury and goes to A&E, the majority of parents are told their child has made a full recovery. Often they’re given a concussion letter and off they go home, and in some NHS Trusts it isn’t recorded as a head injury if they’re not admitted for two nights or more,” says Louise, a past winner of the UKABIF Stephen McAleese Award for Inspiration by an individual in the field of ABI. “They’re walking wounded, they look fine, sometimes an injury is never picked up at all and these problems can then lead into the youth offending system. Maybe physically they have made a full recovery, but it’s the unseen impact which is often not recognised. “It can be much later when things are noticed - I remember one family with a 14-year-old son who started going off the rails, his parents were beside themselves and paid for a private paediatric clinical neuropsychologist. They opened the file and asked ‘Is this anything do with with the fractured skull he sustained aged two?’ “Through the Award, we’re trying to create much greater awareness of child brain injury, and increase the knowledge of how to recognise the signs and what to do if they are there.” The Award is expected to be a 9 to 12 month process for most schools, with Louise and the Child Brain Injury Trust team supporting schools throughout, with ongoing feedback being given on the application process. “We don’t want anyone to fail and will do all we can to get every school to succeed. It may well be a case of them having to implement new processes to be given the Award, or simply of giving us more evidence to show what they’re doing, but we will work with schools to help them become ABI Aware,” says Louise. “We want the whole school team to buy into this and would urge any school who would like to be part of this to get in touch.”
NEWSNR
Brain injury survivors, and the professionals who support them in their lives, are being educated in the risks of using the internet and how to maximise safety when going online by the UK’s only cyber safeguarding specialist of its kind.
Cyber Spider was created to support vulnerable adults in their digital use, assessing the needs and capabilities of each individual and preparing a bespoke plan of recommendations for their unique circumstances. Working closely with legal teams, Court of Protection and social workers, Cyber Spider can prepare Digital Care Plans, and is also set to launch an online Internet Capacity Assessment resource, which can give insight into a person’s understanding of the risks of being online. And to help increase the support of vulnerable people by professionals, Cyber Spider - which works nationally from its headquarters in Rotherham - also delivers training and education directly to those working in brain injury care, and works with case managers and social workers throughout the UK. With demand for its services growing strongly, in the wake of a surge in online use during the pandemic, Cyber Spider is adding new people to its team around the country, continuing the growth it has seen since being established in 2017. “For people whose brain injury came through illness or injury, they will have had a life before that, and with that will be a digital footprint. But now, how capable are they of managing the threats and risks that go with being online and being on social media?,” says Jeff Goodright, co-founder of Cyber Spider, whose background is in family liaison work and cyber crime with South Yorkshire Police. “While the risks of something serious happening may be low, there is still a risk. And what would the impact be on an already vulnerable person? That’s why it’s so important we do all we can to prevent that happening.” Cyber Spider carries out individual assessments of each person and their unique needs and circumstances, and makes recommendations around the threats and risks. “We’re passionate about trying to put people in a better place. It’s difficult for us all to navigate the cyber world - but imagine trying to do that with a brain injury. There are so many things to consider,” says Jeff, whose co-founder Garry Kelsall has expertise in assertive technology and websites. “By becoming more aware of the risks and what we can do to protect vulnerable adults, we can stop this from happening.” And as well as supporting and assessing individuals, Cyber Spider’s training for professionals is proving equally valuable. “It’s really important the professionals working with vulnerable adults are aware of the risks so they can do something about it. We do a lot of training, and the word of mouth recommendations we receive are increasing, it’s such a vital aspect of a client’s safety,” says Jeff. “We also try and tie in with the MDT on assessments, the findings can be very valuable. “If professionals better understand how to put cyber safeguarding measures in place, then they can offer better levels of safety to their clients.”
