Brain & Spinal Injury Handbook - 23/24

Brain & Spinal Injury Handbook

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WELCOME

Dear Reader,

Welcome to the 2023/2024 edition of this essential publication for case managers, legal professionals, neuro rehab providers, patients, families, friends, healthcare professionals, and all those affected by brain or spinal injury.

The Brain & Spinal Injury Handbook is an indispensable publication for occupational therapists, lawyers and other healthcare professionals, who will no doubt agree that this annual handbook creates an important platform for sharing knowledge and experiences, as well as raising awareness around this field of medicine, related law, recovery and rehabilitation.

We would like to thank all of our contributors to this issue. If you have something to share about brain and/or spinal injury, please email the editor: lee.gatland@sevenstarmedia.co.uk

Until next year. The B&SI Handbook Team

key to great design is capturing the spirit of the client and THE ESSENCE OF THE SPACE.”

At PLG we involve the client in every aspect of the design of their own home so their input and spirit is not only captured but celebrated. But designing adaptations to a property for a person with disabilities takes a very special kind of skill. At PLG we have an expanding team of architects, who specialise in doing just that, led by Head of Architecture, Andrew Vallis (M.Arch).

esigning adaptations to a property is primarily about meeting the individual’s clinical needs and ensuring their comfort. At PLG we work on a multidisciplinary basis throughout the process getting involved right at the beginning of the client’s journey to create their forever home. This means that when considering what may make a suitable forever home we are able to offer an invaluable view from the architectural perspective from day one. ”

We believe at PLG that this is vital to make sure that not only can all needs and comfort be met, but that we know from the outset whether a property is suitable for adaptation and, crucially, an informed view of what the cost will be. With a quantity surveyor on the team we are able to assess costs of a project from the start and employ a rigorous 3 stage cost estimate to ensure that the project, however ambitious, remains affordable. Our design team adopt the innovative and problemsolving approach which has become PLG’s trademark, approaching each project in a bespoke fashion, sensitive to the client’s needs now and in the future. Andrew says,

“Ddo this during the original adaptation process than later on when the building work is all complete. This is future proofing our clients’ properties, making sure that their needs are not just met now but will be in the future.”

Energy efficiency and achieving the best temperature control throughout a home is not only a consideration from a comfort perspective but also when looking at running costs. New build properties are generally more energy efficient but can also provide better solutions for clinical needs. That is why PLG will consider all options when looking at a forever home including designing a new build on a pre existing plot if this provides the best solution for the client.

This demonstrates again the multi award winning PLG approach to design: innovation, problem-solving, quality, and honesty. ■

Tel: 0333 577 0809 | Email: hello@plg.uk

LinkedIn: PLG-Consultants-uk | Twitter: PLGConsultants Web: www.plg.uk

“We always want to ensure that if, for example, a hoist or carers en suite is not required now, it may be in the future and therefore the building is designed to allow for easy and straightforward installation and infrastructure at a later date. It is easier and cheaper to

“The

We are often asked to design and adapt a property for a young person whose circumstances will evolve over time. It is often overlooked that the needs of a child are not the same as the needs of a teenager and certainly not those of an adult.”

Andrew Vallis

a place to call home

Inclusive. Inspiring. Honest.

PLG approaches every new client and every new project with these values in mind which is why we are a multi award winning market leader in finding, acquiring, project managing and architecturally adapting disability property. We design to suit every client’s individual needs winning several regional LABC ‘Best Inclusive Building’ awards.

Proactive. Innovative. Thoughtful.

And we love what we do. We pride ourselves in providing excellent service and supporting our clients every step of the way. We create inspirational new homes for our clients and their families in a uniquely supportive and flexible way always putting our clients’ needs and aspirations at the centre of what we do.

We work as a team with our clients, their legal and clinical teams to address and solve all of their property related needs.

Executive Editor Lee Gatland lee@sevenstarmedia.co.uk

Art Director Richard Hejsak richard@sevenstarmedia.co.uk

Sales Team Claire Hollingdale & Joanne Lewis 01959 543 659 sales@sevenstarmedia.co.uk

All other

The Link Between Sleep, memory AND MENTAL HEALTH

By Dr David R Lee, Clinical Director at Sleep Unlimited Ltd, and author of ‘Teaching the World to Sleep’, Routledge

ow we think and feel not only affects our waking lives, but also has a significant impact on our sleep, especially our ability to initiate and maintain the sleeping states. There has long been an established link between a large number of “mental health” conditions and poor sleep. Mental health conditions and insomnia almost universally seem to come hand-in-hand - with insomnia being a core diagnostic feature of many mental health conditions (major unipolar depression, bipolar depression, Lewy Body Dementia and so on). We also have good evidence for effective co-treatment (particularly for depression with co-morbid insomnia) and emerging evidence for the co-treatment other conditionsfor example, people living with chronic pain and co-morbid insomnia.

Dr David R Lee

There is an emerging school of thought that many mental health conditions - notably those which tend to be acquired (e.g. depression and anxiety) rather than those to which people are more genetically predisposed (e.g. type 1 schizophrenia) - can be regarded as disorders of memory.

HTo expand and taking depression as an example of this: we know that people with depression are prone to a certain thought processes that are involved in the development and maintenance of the condition. Depressed people will tend to focus on negative situations or stimuli more than on positive or neutral situations or stimuli (selective attention), and they will tend to see situations as more desperate than people who do not experience depressive symptomatology (cognitive bias). These two phenomena interact and contribute to the maintenance of a depressive episode; and so lead an individual into a persistently and deeply depressed state of mind. This process is almost always accompanied by poor sleep.

THE MEMORY AND THE FORGETTERY

Our mental health is driven by how we remember, and forget, things that happen to us in our everyday lives, and sleep is critical in these processes of the “memory” and the “forgettery.” When we are in deep sleep the brain is quiet and acquiescing, with the exception of the hippocampus, which is at its most active in the 24-hour cycle. We know from a large number of studies that the hippocampus is critically important for the consolidation of memory.

Deep sleep is considered critical for the consolidation of memory and here is a useful analogy: If you imagine that the inside of your head is a busy office, and that every thought that you have

during the day generates a piece of paper in that office. During the course of a day we have many thoughts. Some of these are important, such as ‘I need to call the mortgage adviser’, but others, like ‘which socks shall I wear today?’ may be less so. However, each of these generates a piece of paper. Then we sleep and our secretary - the hippocampus - comes into the office and starts to organise things. This organisation consists of sorting through all the paper and throwing out the rubbish (“socks”); and prioritising the important things (“call the mortgage advisor”) i.e. encoding this into the cortex as something to be remembered and not forgotten. If we sleep well, we will do a good job of organising our office and it will be tidy again by the morning, if we do not, then the office will be a mess.

We know from a large number of studies that learning is much improved before and after good sleep, and seriously impeded after poor sleep (and especially after no sleep).

Deep sleep is essential for the consolidation of memory, but REM sleep may be critically important in the forgetting of irrelevancies. Forgetting some things may be just as ‘useful’ to us as remembering others.

Firstly, our schemas are not as well organised as they could be, and this “cluttering” potentially aids in the precipitation and maintenance of a depressed mood; and secondly, that we begin to build new schemas that may be selectively attending and cognitively biased towards negative situations or stimuli, and so the depressive state becomes self-perpetuating. People with depression will be developing schemas that selectively attend, and are more cognitively and emotionally biased towards, negative, threatening situations and events, which contributes further to their depression and to the strengthening of these schemas.

People with insomnia often regard the bed as a place of arousal and distress rather than of solitude and rest, and they attend to sleep-related stimuli more so than people who sleep well.

So if mental health conditions can be seen as a disorder of memory, and if memory is schematically organised, driven and arranged; then sleep, which has such a pivotal role in that schematic organisation and arrangement, must be regarded as fundamental to the maintenance of our mental health, whether that be healthy or poorly, and everywhere else in between. ■

Celebrating 20 years of Sleep Unlimited

Further information is available in “Teaching the World to Sleep” by Dr David R Lee. 2017. Routledge, London.

www.sleepunlimited.co.uk

Sleep Unlimited Ltd – the largest private company of sleep experts in the UK - specialise in the assessment of people who have sustained a life changing injury – and our reports have been used by many legal practitioners in successful litigation.

We also offer highly acclaimed training in CBT for insomnia to healthcare professionals, corporate training and consultation, both apnoea testing and assessments for insomnia disorders, and Bond Solon trained expert witness testimony.

Please see our website for further details, or contact our friendly team - we look forward to hearing from you.

info@sleepunlimited.co.uk | www.sleepunlimited.co.uk

If we do not get enough good quality sleep to arrange our memories effectively during the night, then the consequences of this are

Care After Concussion

Each year, around 1.4 million people in England and Wales attend emergency departments with a recent head injury, and it is estimated that between 33 per cent and 50 per cent of these are children under the age of 15. Children and young people are thought to take longer to recover from a concussion than adults, and to help people supporting them, The Children’s Trust have developed a new resource: Bumps Happen.

UNDERSTANDING SYMPTOMS

A concussion is a mild Traumatic Brain Injury (mTBI) which can be caused by a blow to the head or something that makes the head and brain move quickly in different directions. Common causes are falls, sports injuries and road traffic collisions.

Often, there are no immediate signs of concussion: symptoms can appear a few hours or even days after the injury and usually include headaches, confusion, nausea, changes in mood, difficulty with concentration and memory, and cognitive fatigue.

In the immediate aftermath of a child sustaining a head injury, seek medical advice by contacting your GP, calling 111, or in an emergency, calling 999. In the days that follow, it is important to understand these symptoms and how to provide support.

THE FIRST 24 HOURS

During the day following a mTBI it is important to provide a calm and quite environment, and to speak to children in a calm voice. A head injury can affect the way children process what’s going on and they may feel overwhelmed if there is a lot happening around them. Give your child or the person you care for time to rest in order to heal, during this time they may have difficulty remembering or thinking clearly.

You may have to remind them what has happened, and if they have questions, answer them with simple and direct answers where possible. Try to make sure there isn’t more than one thing happening at a time, and if you can, limit the amount of screen time, music, noise and movement around them.

THE FOLLOWING DAYS

In the days following a concussion, some time off school can be of benefit to a child or young person, along with limiting contact sport and excessive physical activity. A GP may advise that they need medication for their symptoms if they are experiencing pain. When they are feeling better, plan a gradual return to school and activities.

During this time, continue to observe your child for any changes and don’t hesitate to seek guidance if you need it. If you are unsure of what to do, or you spot new symptoms, contact your GP or call 111 and explain your concerns, or visit Bumps Happen to read more about signs to look out for and action you can take to support your child’s recovery.

FOR MORE INFORMATION

To access more Bumps Happen guidance, or to find out more about The Children’s Trust, visit /bumps-happen

thechildrenstrust.org.uk/bumps-happen

Research suggests that children and young people can take three times longer to recover from a concussion than adults.

Most children and young people make a full recovery after a head injury, however, some experience longer term complications or difficulties.

That’s where our website can help.

Bumps Happen is an online resource for parents and carers of children and young people. We share the signs to look out for, and steps to take, in case your child has had a concussion.

If your child has had a head injury, or you’d just like to know more, visit Bumps Happen for help and guidance.

How Neurologic Music Therapy SUPPORTS NEUROREHAB

perception, production, and performance of music and how music can influence and change non-musical brain and behaviour function.1

It involves a collection of techniques that use music’s perception, production and performance to stimulate, shape, and change movement dynamics, speech and language skills, and cognitive skills.

By Daniel Thomas, Managing Director and Neurologic Music Therapist at Chroma

An acquired or traumatic brain injury devastates the survivor’s emotional, physical and mental well-being. Effective neuro rehab intervention is required from the very beginning of the rehabilitation journey for the best possible functional, cognitive and motor skills outcome.

The survivor will typically be assigned a multidisciplinary team made up of physiotherapists (PTs), speech and language therapists (SLTs), occupational therapists (OTs) and any other specialist necessary to help support their speech and function. Thankfully, more and more cases are also being referred to arts therapies services that, as an integral part of the MDT, are able to support the rehabilitation goals.

Arts Therapies providers such as Chroma deliver Neurologic Music Therapy (NMT) sessions all over the UK to brain injury survivors through an effective referral system in partnership with social workers, case managers, healthcare teams and education establishments.

NMT is a research-guided clinical model that is driven by advances in neuroscience and the understanding of the

The technique uses musical elements such as rhythm, melody, or pitch to treat diseases and injuries of the brain across the cognitive, sensorimotor, speech and language and affective domains to try to change the brain’s impairment.

WHAT TECHNIQUES EXIST, AND HOW DO THEY WORK?

Oral Motor and Respiratory Exercises (OMREX) is often used to support speech and language. This technique uses a mixture of familiar music and improvisation, enabling the client to work on breath control and increase the duration of play. The addition of this exercise within an MDT plays a fundamental role in Speech and Language sessions. 2

Rhythmic Auditory Stimulation (RAS) is implemented for functional outcomes and uses music pulse to guide movements as well as help improve balance. RAS links the brain to a beat and tempo, helping the client to work on gait and balance, which helps improve their walking ability over time.3

Therapeutic Instrumental Musical Performance (TIMP) exercises focus on reaching toward an instrument to challenge core strength, improve sitting balance skills and extend the range of movement. 4

Implementing NMT into a multidisciplinary team offers the best neurorehabilitation outcome for brain injury survivors.

Dan Thomas

Patterned Sensory Enhancement (PSE) uses musical patterns to structure and control movement to movements that are not typically rhythmical such as rhythmically cued training in upper limb function. 4

The addition of these exercises within an MDT plays a fundamental role in PT outcomes.

WHAT NEW RESEARCH REINFORCES THE USE OF NMT IN NEUROREHABILITATION?

Researchers are continually conducting new studies concerning the use of NMT for neuro rehab. Researchers recently found that stroke survivors could move their paretic limb using TIMP and technology to assess movement. 5

Following an extensive review of studies concerning the use of NMT in children with Cerebral Palsy, researchers determined that techniques such as RAS, TIMP, and Pattern Sensory Enhancement (PSE) do benefit gross and fine motor skills in patients with Cerebral Palsy. 6

Studies also concurred that RAS does help improve gait, balance and step cadence in those with functional gait disorders.7

Arts Therapies, and in particular NMT, have become renowned within the healthcare sector for their abilities to motivate rehabilitation as well as improve psychological well-being and functional outcomes of those living with a neurological condition.10

Creative Arts Therapy providers like Chroma are becoming considered to be integral to the MDTs who support people living with a neurological condition within residential care homes, supported living, hospitals, educational settings and through referrals from case managers.

CASE STUDY – EFFECTS OF NMT IN REAL LIFE

(Name changed to protect identity)

Matt was referred to Chroma for NMT following a road traffic accident. He had sustained a traumatic brain injury (TBI), was hospitalised for several months then moved into supported living. He had a significant general cognitive decline and frequent outbursts of anger.

As he had a background in music and liked to rap, the MDT decided to implement music therapy into his rehabilitation journey to help his executive cognitive functions, reduce his anger outbursts and support his psychological needs.

During each session, Matt would participate in music-making, playing simple chord patterns on the guitar or repetitive movements on the drum. Matt would practice rapping whilst the music therapist played the guitar, with a tempo to match his speed of speech. As sessions progressed, it was possible to increase the tempo.

Over time, Matt was able to freestyle lyrics, occasionally referring to the accident, his injury, and his life now – which led to discussions about the trauma and loss he had experienced.

Songwriting helped his executive functions such as planning, attention, prioritisation, and prospective memory skills to encourage emotional expression. Playing rhythms on the hand drum encouraged limb activation engaging his brain’s spatial and motor maps, and aiding his left-field neglect.

During the course of the sessions, his cognitive and executive functions had improved through songwriting; his mood elevated, and he had significantly decreased outbursts of anger. For Matt, an increase in playing music directly correlated to a decrease in outbursts.

CONCLUSION

Music and the use of NMT techniques benefit those who experience functional and behavioural problems following a TBI. It also supports executive functioning, depression and anxiety following a TBI. 8,9

PTs and OTs work closely with the patient/client to effectively support their functional outcomes, and SLTs for speech support, but if the patient has poor mental health (which is typical following a brain injury), music therapy and NMT can play a vital role in supporting the psychological needs of the patient. The techniques implemented serve to help improve the rehabilitation goal outcomes set within the MDT.

Integrating Neurologic Music Therapy into the multidisciplinary team is the best option for those living with a brain injury to attain their rehabilitation goals.10 ■

For more information about Chroma Neurologic Arts

Therapies within neurorehabilitation settings, please contact: Daniel Thomas, Chroma via daniel@wearechroma.com or 0330 440 1838

www.wearechroma.com

REFERENCES

1 The Academy of Neurologic Music Therapy. [Available at: https:// nmtacademy.co/key-elements-of-nmt/]

2 Zhang, X. Y., Song, Y. C., Liu, C. B., Qin, C., Liu, S. H., & Li, J. J. (2021). Effectiveness of oral motor respiratory exercise and vocal intonation therapy on respiratory function and vocal quality in patients with spinal cord injury: a randomized controlled trial. Neural regeneration research, 16(2), 375–381. https://doi.org/10.4103/1673-5374.290909

3 Thaut M. H., McIntosh G. C., Rice R. R., Miller R. A., Rathbun J., Brault J. M. (1996). Rhythmic auditory stimulation in gait training for Parkinson’s disease patients. Mov. Disord. 11 193–200. 10.1002/ mds.870110213

4 Braun Janzen, T., Koshimori, Y., Richard, N. M., & Thaut, M. H. (2022). Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives. Frontiers in human neuroscience, 15, 789467. https://doi.org/10.3389/fnhum.2021.789467

5 Loria T, de Grosbois J, Haire C, Vuong V, Schaffert N, Tremblay L and Thaut MH (2022) Music-based intervention drives paretic limb acceleration into intentional movement frequencies in chronic stroke rehabilitation. Front. Rehabilit. Sci. 3:989810. doi: 10.3389/ fresc.2022.989810

6 Seoyon Yang, Jee Hyun Suh, SuYeon Kwon, Min Cheol Chang (2022). The effect of neurologic music therapy in patients with cerebral palsy: A systematic narrative review . Front. Neurol. 13:852277. doi: 10.3389/fneur.2022.852277

7 Hebb C, Raynor G, Perez DL, Nappi-Kaehler J, Polich G. The use of rhythmic auditory stimulation for functional gait disorder: A case report. NeuroRehabilitation. 2022;50(2):219-229. doi: 10.3233/NRE228005. PMID: 35213331.

8 Vik, B. M. D., Skeie, G. O., & Specht, K. (2019). Neuroplastic Effects in Patients With Traumatic Brain Injury After Music-Supported Therapy. Frontiers in human neuroscience, 13, 177. https://doi. org/10.3389/fnhum.2019.00177

9 Hegde S. (2014). Music-based cognitive remediation therapy for patients with traumatic brain injury. Frontiers in neurology, 5, 34. https://doi.org/10.3389/fneur.2014.00034

10 Thompson, N., Bloska, J., Abington, A., Masterson, A., Whitten, D., & Street, A. (2022). The Feasibility and Acceptability of Neurologic Music Therapy in Subacute Neurorehabilitation and Effects on Patient Mood. Brain sciences, 12(4), 497. https://doi.org/10.3390/ brainsci12040497

Changing the face of Neurorehabilitation, Vim Health is fresh on the scene, and they COULD BE JUST WHAT THE INDUSTRY NEEDS

independently, alongside and after completing an intensive rehab program.

“Using the word ‘clinic’ for our rehabilitation centre almost doesn’t feel right as we have created an environment to deliver Neurotherapy that doesn’t feel like a typical clinical setting.”- says Tom Taverner, co-founder of Vim Health.

“Walking into VIM, you will immediately notice how different it feels to other rehabilitation clinics, despite many high-tech robotic therapy devices on show. The overall atmosphere is light, calm, and conducive to productivity.

Rehabilitation technology plays an integral part in neuroplasticity and body function, reconnecting the neuro-pathways through high levels of repetition.

What sets them apart? A combination of two essential things: The latest innovative technology and their fully kitted out accessible gym. Vim Health enhances the rehabilitation experience through robotics whilst empowering people to continue their journey in the gym

“Most of our clients are wheelchair users or have physical disabilities. The centre is fully accessible with an easy-touse adapted lift to our mezzanine gym area and disabled parking right by the front doors. Being inclusive and making various adaptations hasn’t stopped us from creating a stylish-looking space.”

WHILST VIM HAS ALREADY BEGUN MAKING WAVES, THEIR VISION IS STILL VERY MUCH AT THE FOREFRONT OF THEIR SIGHT: Creating a space that is not just accessible for all but a comfortable and enjoyable experience has been our focus. And whilst we may have successfully brought the space to life, it’s now about getting Vim’s name out there as much as possible.

“We plan to work closely with the community, case managers, NHS commissioning and social prescribers, so that as many people can access our services as possible.”Tom Taverner, co-founder of Vim Health.

The centre itself is a joy for all the senses, with beautiful bathrooms and changing rooms carefully curated by an accessible design company known as Motionspot. From the natural lighting, well-placed plants, appeasing scents, and uplifting playlists to their ‘honesty bar’ fully stocked with healthy local produce, the ambience there is something you must see and feel for yourself.

Having opened their centre in the heart of Sussex at the end of last year, their attention to detail has not gone a miss. Delivering intensive rehab programs with healthcare professionals in a non-clinical setting; has certainly shaken things up for the better.

Walking into VIM, you will immediately notice how different it feels to other rehabilitation clinics, despite many high-tech robotic therapy devices on show.

Katie Macqueen, who has a neurological condition, recently visited Vim Health and said:

“Going into VIM healthcare was like a breath of fresh air. A modern and calming environment which feels really dynamic too. The staff are brilliant - friendly and knowledgeable. The biggest thing I came away with, though, was a sense of hope and empowerment.

“I live with a neurological condition, and the pandemic saw me lose function and motivation. With a thorough assessment from Bex, I was given advice and signposting on exercise opportunities where I live (London), and online resources, for tentative plans for a block of rehab later in the year.” - Katie Macqueen.

THE TECH

Few centres around the UK offer the extent of equipment available to the people who attend Vim Health. Their centre has a robotic gait trainer called the LYRA from THERA-Trainer. This device enables users to simulate the walking motion with their feet secured to foot plates and their body weight supported by a harness, which means users can perform up to 40 times the number of steps compared to standard treadmill training. Using Robotics such as the LYRA, therapists can offer a higher therapeutic dose with more consistency and frequency.

FUN THERAPY

Gamification has also played a big part in their rehabilitation centre, with pieces like the BALO from THERA-trainer used for postural control and core stability or Tyro station from TYROMOTION. These devices combine interactive activities with sensors, improving upper limb function, balance, and core stability. Gamification brings an element of fun to the session, distracting the users whilst carrying out repetitive exercises.

Considering each person’s needs and desires, the team at Vim do their very best to make each session as enjoyable as possible. A game of table tennis or Jenga during an intensive session if it’s relevant to the rehabilitation person’s needs. In Piers’ case, one of his goals was to play snooker again.

STANDING FRAMES

Many people that visit the centre spend a lot of time seated in their wheelchairs. Standing frames, such as the EasyStand glider, the Balo and the REX, improve circulation and bone density whilst reducing the risk of secondary complications such as pressure sores.

The exoskeleton from REX Bionics has enabled gym members living with a spinal cord injury to be upright and weight-bearing whilst working up a sweat in the gym.

Physical exercise such as cardio and resistance training can aid people that use wheelchairs, in helping them to reduce secondary complications, maintain mobility and mental well being. Historically, there have been limited resources and exercise plans for people that are unable to bear weight or walk. By using REX, Vim’s gym members have immediate access to a much more comprehensive range of activities.

THE TEAM

Co-Founders of Vim Tom Taverner, Jon Graham and Crispin Simon, met whilst trialing clinical research with exoskeleton

company REX bionics and forged a partnership from there. Whilst qualified physiotherapist and co-founder Tom Taverner has been the frontman driving this idea from conception to reality, the support of a well-experienced team has given the business its wings. Since opening its doors in November, Vim Health’s team has grown, with two new physios joining this month (March).

A GAME CHANGER

Channel 4 TV presenter and disabled rights activist, Sophie Morgan, was among the first to visit the centre; when asked in a recent interview what makes Vim Health so unique, she said:

“Being able to visit a gym that is completely geared towards people with disabilities is brilliant; I would love to see gyms of this standard in more places around the country.

“The gym is run by physiotherapists, has equipment that works for everyone and is designed so beautifully. It’s such a game changer for me, and it’s why I keep going back.”

SO WHAT’S NEXT?

It’s still early days for Vim Health, but whilst things are moving steadily in the right direction, their main goal is just to continue to establish themselves and improve their service as they do. You will find them at the Disability Expo at the London Excel in July. In the meantime, if you’d like to stay in the loop with all their latest happenings (and the occasional exclusive offer), we’d recommend you head to their website and join their quarterly newsletter. ■

For more information contact us on: info@vimhealthcare.co.uk or call: 01273 037 400 Web: www.vimhealthcare.co.uk

Fixed fee Specialist Rehabilitation Occupational Therapy programme providers

How we use our fixed fee programmes to meet our clients’ needs and support them in getting back to their lives after serious and catastrophic injury

“Occupational Therapy is truly a combination of science and art in my opinion” says TT1st Managing Director (and Occupational Therapist) Penny Wosahlo. Occupational Therapy is about assessing the individual, the every day things they need and want to do (tasks or activities of daily living) and the environments and contexts, and then work out what’s preventing that from happening.

Often after serious injury there will be physical and/or cognitive limitations. Brain and spinal injuries require focus on restorative rehabilitation. Occupational Therapists use activities the person needs and wants to do as the therapy intervention!

HOW WE WORK

At TT1st we first complete an RNA - Rehabilitation Needs Assessment - where therapy and personal goals are identified together with the client and a treatment programme is devised based on graded functional rehabilitation. Our programmes use physical, cognitive and psychological functional therapy interventions to address issues and when required compensatory strategies or equipment/adaptations.

Identification of other clinicians and services is standard to provide a Multidisciplinary Team approach to facilitate the best recovery for the client. Our programmes allow us to look at what the client needs

and we use our experience and knowledge of the types of injury sustained and where the client is currently, to estimate the time needed for each goal/programme element. The way our OT’s work, utilising meaningful activities, offers the best potential for rehab and our programme interventions can overlap from goal to goal - this means there is the opportunity to transfer learning from one task and goal to another.

We use our own algorithm to establish the level of rehab need for the client which indicates whether we deliver therapy with a High, Medium or Low Intensity approach. We apply the relevant intensity to a monthly cycle of therapy.

WHAT OUR THERAPY INTENSITY MEANS

High Intensity is up to 3 sessions per week with the therapist (for that monthly cycle), usually face to face but on occasion, for some clients, remote sessions can be used effectively. Medium Intensity is up to 2 sessions p/w and Low Intensity is up to one session p/w. We look at the goals and therapy programme and determine what intensity will be needed and for how long. On average our programmes are between 8 and 12 months and our aim is to finish any SROT programme with 3 months of Transition Support to ensure function is maintained and sustained once therapy reduces. If there is a Case Manager involved, they can monitor that instead.

Identification of other clinicians and services is standard to provide a Multidisciplinary Team approach to facilitate the best recovery that the SROT and client coordinate together.

FIXED FEE BUT FLEXIBLE!

Our fixed fee structure provides flexibility to use sessions for the maximum benefit of the client and their recovery depending on the client and their tolerance threshold plus the goals being addressed.

OUR THERAPY IN PRACTICE EXAMPLE

A Traumatic Brain Injury. Often cognitive rehab and errorless learning will be needed. The client goals, the therapy programme and the full proposal of work recommended from the assessment informs the therapy intensities and durations expected.

Showing a month of therapy sessions and what they entailed gives a real insight into the science/art of Occupational Therapy that we believe is crucial to long-term rehabilitation.

INJURIES: Right temporal haematoma with poly trauma affecting right side (including renal injury, right haemothorax, multiple rib fractures, liver and splenial laceration).

POST INJURY DIFFICULTIES: Significant fatigue, reduced memory functioning specific to attention and working memory. Additionally, deficits to frontal lobe areas responsible for executive functioning. Moreover, the client experiences low mood and performance anxiety, experiencing fearful expectations of failure.

LAST MONTH’S THERAPY LOOKED LIKE THIS: Work on client’s therapeutic project of bringing her greenhouse into productive use - client and SROT cleared rubbish, jet washed and weeded the greenhouse. Client planted early potatoes as a first crop. This worked on physical stamina, planning, problem-solving and decision-making. The greenhouse was previously very important, so motivation is high.

Working collaboratively with SROT to investigate what steps needed to be taken to obtain driving licence (it lapsed on recent 70th birthday). Initial work began with regards to graded exposure. Client progresses to sit behind the wheel for the first time since the index event - no trauma response triggered (functional psychological rehab).

Community rehab focused on shoppingthis activity was graded, with client initially going around the supermarket with SROT to retrieve items from a pre-prepared list. Now, client completes shopping independently and consistently, but further work is required with problem-solving when at the till, so this is still in progress.

Graded outdoor mobility practice - client and spouse are keeping up with this outside of sessions and client has repeatedly now managed journeys of 1.5 miles.

Cooking practice - graded in complexity. Client was able to cook a chicken pie with support of SROT. ■

TREATMENT PROGRAMME INCLUDES:

Functional skills practice and development using a neuro rehabilitative approach to optimise progress and outcomes to reverse deconditioning and improve strength and stamina - Neuro-Physiotherapist and SROT

Graded participation in an overarching therapeutic project (garden project) to improve functional skills, stamina and confidence - SROT

Cognitive rehab; errorless learning, processing, problem solving, decision making and memorySROT and Clinical Neuropsychologist

Psychological rehab to assess safe driving skills, to gain further insight and understanding to tailor the rehab approach and optimise success with driving - SROT and Clinical Neuropsychologist

Fatigue and anxiety management education and functional practice - SROT

For further information contact: Stephanie Fleet, Head of Service Development & Customer Relationships

Email: enquiry@tt1st.co.uk

Tel: 0203 535 0973

Web: www.tt1st.co.uk

Our fixed fee structure provides flexibility to use sessions for the maximum benefit of the client and their recovery and means funders know what costs to expect.

We use local Occupational Therapists and have Nationwide coverage and on average our programmes are between 8 and 12 months with most people back to work and their leisure activities at discharge.

Be In-Control of Your Own Support at Home To CQC Standards

If you choose HomeCareDirect, you would be In-Control of your own support at home and working to the principles of ‘Personalisa@on’:

You will have the op.on to:

- Interview and select your own support team

- Work in partnership with us to create your own Care Plan

- Agree your own teams hourly pay rates

- Agree your own teams shiF @mes to fit your life

- Arrange who fills each shiF on a day-to-day basis

HomeCareDirect (HCD) will:

- Provide what support you need to make your Care Plan work for you

- Train and act as the legal employer of the team you have selected

- Invoice you monthly and pay your support team, on your behalf, and take care of the team’s Income Tax, Pensions and Holiday Pay

- Support you and your team to Care Quality Commission Standards with ongoing HCD employed qualified nurse visits to you at home

- Manage your funding (FOC) in an individual bank account in your name with 3-monthly reports to you and the funder

Informa(on from HomeCareDirect about all you support op(ons

1. Choose a Local Care Agency for your support

2. Choose a Personal Health Budget (PHB), cash from the local NHS Funder, to enable you to select your own team and be their legal employer

3. Use a ‘3rd Party OpIon’ to manage your funding and help with your team’s income tax, pension and holiday, whilst you remain the legal employer of your team

4. Choose a specialist local Nursing Home for your support

5. Choose HomeCareDirect which will give you all the choice and control without all the paperwork and legal responsibility of being an employer

HCD can be seen as the ‘PHB Third Party Op(on to CQC Standards’ A Na%onal Service

Please talk to your Social Worker about the ‘Third Party Op8on to CQC Standards or give us a call.

Riverside House, Hady Hill, Chesterfield, S41 0DT 0345 061 9000 – Ext. 223 New Client Enquiries

Flex Health CASE STUDY

Flex Health was established in 2015 by two physiotherapists who had a passion to change the face of physiotherapy on a national scale.

Flex Health was established in 2015 by two physiotherapists who had a passion to change the face of physiotherapy on a national scale. Rehabilitation and physiotherapy have evolved and changed dramatically over the last ten years due to advances in understanding complex conditions, seeing incredible examples of patients making significant recoveries.

JAMES – SPINAL CORD INJURY, CLINICAL NEGLIGENCE

James had a routine operation for C4/5 in 2019 with complications following the operation which resulted in a second emergency surgery. He spent 4 months in Pinderfields and attended Motion Rehab in Leeds for intensive physiotherapy but after 3 months of robotic passive rehabilitation, found it was not helping towards his goals of improving function and ability to walk unaided. After seeing one of our patients in the paper, he attended in June 2020 for intensive rehabilitation starting within the first few weeks of switching from a wheelchair to crutches practicing gait re-education and has continued to progress in strength, function, and neuromuscular control. He has been able to gain back independence by having the ability to drive, do things at home and take his kids to sporting events.

A consultant has recently commented on his recovery saying he ‘is amazed and not sure how he is walking and still able to do so’

James has told us how coming to us and the journey so far has immensely helped, it is what he needs to work towards walking unaided and it has helped him rebuild his life.

HARRIET

Harriet is a 4 year old girl who has been attending for physiotherapy sessions at Flex Health for the past 18 months. She was diagnosed at a few weeks of age with Moebius Syndrome – a rare birth defect which mainly affects the muscles controlling facial expression and eye movement due to the absence of the 6th and 7th cranial nerves. Harriet has right sided facial palsy and is blind in her right eye and deaf in her left ear. On first attending Flex she had poor sitting balance, was very unhappy laid on her front and required a lot of assistance to stand or attempt to walk.

Following weekly sessions at Flex, Harriet is now confidently sitting, crawling, bottom shuffling, standing and walking unaided. She absolutely loves attending for physio and her face lights up every time she enters the paediatric room. She adores completing a variety of obstacle courses, ‘dinosaur hunting trails’ and ‘mini car races’ plus loves winning the ball activities and blaze pod activities each session. Harriet really is an inspiration; her parents are thrilled at her amazing progress and are delighted she has defied the odds, recently being accepted to attend mainstream school from September.

FACILITIES

In July 2022 we moved into our new state of the art purpose built facilities where we provided the highest standards of treatment and education to those who come through the doors. With numerous treatment rooms, open gym space, outdoor area, and specialised paediatric room we can utilise the space in a way that fits in with the needs of the patient and the things they enjoy. Those who enjoy the sunshine and sport side of things we can incorporate this during warm days in our private outdoor area.

A consultant has recently commented on his recovery saying he ‘is amazed and not sure how he is walking and still able to do so.

ANTI-GRAVITY TREADMILL

The anti-gravity treadmill uses differential air pressure technology and air collaboration system based on the users body weight. It reduces gravitational load and body weight enabling patients to be able to move unrestricted and pain free. It is used within sessions to improve areas such as range of movement, function, strength, and gait patterns with those with musculoskeletal injuries and neurological conditions.

GULDMANN HOIST

The ceiling hoist is effective in lifting and moving those who struggle to tolerate full weight baring or the ability to stand without support. It allows a great amount of freedom, allows the patients to move with care and provides support during exercises. It is used for functional drills to develop daily active living movements, aid in assisting with strength exercises, balance and gait re-education. There are different modes we can use and different slings for use in standing and lying with adults and children. The hoist is set in an area which includes the parallel bars, open space and ability to enter the antigravity treadmill.

FUNCTIONAL ELECTRICAL STIMULUS BIKE

Functional screening stimulus bike is used in early stages of rehabilitation following a neurological diagnosis and provides the appropriate electrical stimulation to the targeted muscles causing muscular contractions that allow patients to pedal or use the band bike following a neurological injury/ condition which include different levels of tone.

PAEDIATRIC ROOM FILLED WITH PURPOSEBUILT EQUIPMENT

The paediatric room is filled with made to measure fitted and colourful padded mats, filled with equipment, toys and sensory lights to help stimulate the child’s senses and achieve goals set out between clinician and parents. With a wide range of equipment, we can assess and carry out sessions to obtain and develop developmental milestones and much more in a safe and fun environment.

FUNCTIONAL EQUIPMENT

CUSTOM MADE WEIGHT SQUAT RACK

Our custom made squat rack is like no other it consists of 5 elements which include; area for use of barbells, smith machine, cable machines, leg curl adaptation and elevated pads for unilateral work. We can use all these features at the same time and implement the use of it into our sessions to get the most effective progressions.

KEISER

The Keiser is a pressurised cable machine, due to it being controlled through air pressure it is beneficial for neurological rehabilitation as its easy to adjust and for progressions to be made for individuals and their goals. It is also comfortable for the use of an active hand (grip assisted support).

BLAZE PODS

Reactive, portable, adaptable. These can be used in many ways for physical and cognitive development. Easy to use and fun for all.

SKIERG

This equipment is used for developing capacity and used as cardio as either just upper body or full body. This is small area of patient rehabilitation but important neither the less. ■ Tel: 01482 966 006

Regaining control with NEURO PILATES

Aneurological condition can often cause the body to move in different ways or prevent movement all together. This can affect a person’s ability to perform common functional movements or their ability to balance without risk of falling. Movements become less efficient, tiring and frustrating, effecting mental health and wellbeing.

Experienced Chartered

Physiotherapist Jane Raleigh from SP Therapy Services treats patients from across West Yorkshire & East Lancashire. Part of her treatment toolbox is utilising the Neuro Pilates method of exercise therapy.

Here Jane takes us through the basics of Neuro Pilates, explaining the huge benefits of including this into her regular physiotherapy sessions. She explains how this is improving the quality of life of her patients, assisting her in integrating her patients back into the community and preparing them to take responsibility for their health and wellbeing post brain and spinal injury.

MORE ABOUT JANE RALEIGH, CHARTERED PHYSIOTHERAPIST AT SP THERAPY SERVICES

Jane qualified as a Chartered Physiotherapist in 2010, her passion has always been working with patients with brain injury. Jane has specialised in working with patients in the community, as it gives her the opportunity to challenge and progress her patients beyond their capabilities at hospital discharge. Jane strongly believes that treating patients in real-world environments gives patients the motivation for rehabilitation and improves quality of life.

Jane qualified as a specialist Neurological Physiotherapist with a specialist interest in Neurological Pilates, incorporating not only the benefits of increased strength, endurance, mobility and balance, but also integrating breathing control and mindfulness which she knows to be such vital elements in successful neurological rehabilitation.

WHAT IS NEURO PILATES AND HOW DOES IT DIFFER TO REGULAR PILATES?

Improving one’s core stability is a term commonly used within the fitness industry to target strength within the

abdominal region however, Neuro Pilates will refer to the term ‘postural control’ which will address core stability, but also integrates the importance of shoulder and pelvic girdle stability to enable a person to gain central strength and mobility in order to challenge their upper and lower limb movements. This enables us to perform day-to-day functional movements with more purpose and efficiency.

Think of the body like a house. If the house foundations (core, pelvis) are built strong, then the rest of the house will stand tall and strong. This enables the windows, doors and electrical wiring (arms, legs and nerves) to function with purpose and ease.

Unstable house foundations (core, pelvis,) will result in a crooked house, meaning that windows and doors (arms and legs) are slanted and restricted in movement making them less efficient and lacking purpose.

Neuro Pilates will often take place at a slower pace, which is more beneficial for neurological patients with issues of cognition. It will often involve a more ‘hands-on’ approach than regular Pilates which allows for greater guidance. Therapy sessions include the active assistance of the Neuro Pilates Therapist. This type of exercise therapy is especially beneficial for people living with a variety of neurological conditions.

WHAT ARE THE 5 KEY ELEMENTS OF NEURO PILATES?

1 Head and neck posture

2 Neutral pelvic positioning (centring) by engaging your deep core muscles

3 Ribcage placement

4 Shoulder blade placement

5 Lateral breathing control

These elements are vital to enable a person to give postural control to enable more efficient arm and leg movements resulting in more efficient and purposeful functional movement.

WHAT ARE THE BENEFITS FOR PATIENTS USING NEURO PILATES?

Patients with neurological conditions often find functional movements that used to be second nature very difficult e.g., sitting to standing, walking or bringing hand to mouth to eat. This may be because of difficulty with physical factors such as muscle weakness, poor co-ordination, reduced sensation and inflexibility of soft tissues but also as a result of cognitive difficulties such as concentration, sequencing and ability to plan and relearn a movement pattern.

Neuro Pilates follows the principles of motor relearning. Motor relearning involves the repetition and practise of a movement pattern to make the desired movement more automatic. Motor relearning requires the process of segmenting whole movements into smaller movements. These smaller movements are practised in a slow and controlled manner guided by hands on facilitation, verbal cues and visualisation to help guide movement and once refined, put together to complete the whole movement pattern with more fluidity, efficiency and purpose.

A neurological condition often results in a person neglecting one side of their body. The use of mind body connection encouraged within Neuro Pilates helps a person to create an awareness of the muscles and limbs required to perform a movement well. The slow and controlled method of repetitive movements will help them to re-engage neglected limbs to promote more normal patterns of movement.

In addition to the physical difficulties, having a neurological condition can greatly impact upon a person’s emotional health and well-being and ability to engage in diaphragmatic breathing control and relaxation. Neuro Pilates also addresses these areas helping to improve a patients breathing control, mindfulness and ultimately their well-being.

PATIENT CASE STUDY

To the outside world Miss M appeared to be doing quite well and had no obvious movement difficulties. But Miss M had experienced brain injury as a result of a road traffic incident, and this resulted in Miss M struggling with muscular weaknesses and orthopaedic injuries causing her to adopt a very stooped posture. Alongside this, Miss M experienced breathing difficulties and dizziness which affected her ability to generate a strong voice and cough by appropriately engaging her diaphragm during breathing. Her overall confidence with activities of daily living was significantly reduced. Miss M had previously been fit and was keen to increase her level of

physical activity however, these factors prevented her from doing so.

Jane started addressing this with the 5 key elements of Neuro Pilates, this enabled her to gain a better starting posture with which to further challenge her strength, endurance and mobility. This improved postural control also meant that Miss M could access a better breathing pattern as her previous stooped posture prevented her from being able to use her lungs and diaphragm to their full capacity/ efficiently. This resulted in improved oxygen delivery throughout her body, enhanced relaxation and wellbeing and ability to cough to clear her chest to prevent chest infections.

Jane initially worked with Miss M within the securities of her own home. This enabled her to become more confident in the basics of Neuro Pilates and gave her the confidence to attend group Pilates classes, which is great for social interaction and the reintegration into activities of daily living that she once experienced pre-brain injury.

Working with Jane and taking part in Neuro Pilates has made such a difference to my rehab. I’ve noticed a massive difference in my strength and being able to move much more easily. I would never have considered a Pilates class before, but now I feel confident attending the group sessions and I really look forward to it every week. I’ve made some great friends there.

QUOTE FROM MISS M

ABOUT SP THERAPY SERVICES

SP Therapy Services are a team of chartered physiotherapists who are neurological specialists, providing community-based physiotherapy across the regions of Lancashire, Greater Manchester and Yorkshire.

The physiotherapists are specialists in treating both adults and children with acquired brain injury, spinal cord injury and complex neurological conditions.

2023 marks the 25th Anniversary year of SP Therapy Services providing community physiotherapy, helping patients to improve their quality of life and integrate into their communities. This is achieved with the support of an experienced and highly specialist team of dedicated chartered physiotherapists. ■

If you wish to know more contact us on info@sptherapyservices.co.uk Web: www.sptherapyservices.co.uk

Reimagining Rehabilitation for individuals with LIFE CHANGING INJURIES

Founding Director and Head of Business Development, Jules Shiel-Boulger, explores the methodologies that underpin STEPS Rehabilitation’s pioneering approach to treating individuals with life changing injuries.

STEPS Rehabilitation has a rehabilitation offering like no other. Forged in the steel city of Sheffield, the facility delivers intensive residential rehabilitation for people recovering from brain injury, spinal cord injury, traumatic amputation, stroke, and complex trauma injuries. Widely cited amongst medico-legal professionals as the ‘Rolls-Royce provider of rehabilitation services’, STEPS has surpassed their original goal to become one of the most highly regarded rehabilitation facilities in the UK, and now has a place on the world-wide stage for its pioneering work.

“STEPS’ innovative approach lies in the way we deliver a unique and wide-ranging blend of medical treatment, therapies, and rehabilitation technology to clients all under one roof” explains Jules. “Because we’ve built our facility from scratch, we’ve been able to integrate cutting edge rehabilitation technologies with traditional therapies to create a wholly individualised approach for clients based on their unique rehabilitation needs. There is no one else in the UK able to provide such a personal solution, and we’re immensely proud of our fantastic team who collaborate daily to optimise a client’s recovery.”

HOME TO WORLD-LEADING REHABILITATION TECHNOLOGY

In 2021 STEPS opened the first UK Fourier Intelligence ‘RehabHub’, a suite of cutting-edge rehabilitation technology invented by a Singapore-based technology company that develops pioneering rehabilitation robotics. It focuses on both upper and lower limb robotic therapy, as well as cognitive training, providing a unique solution for neurorehabilitation. In 2023, in another first, STEPS added to its RehabHub suite of technologies by becoming the first facility in Europe to trial the ground-breaking ExoMotus and EMU.

STEPS is also one of only three UK facilities offering clients access to the MindPod as part of the range of pioneering digital neurotherapeutics from MindMaze, developed in Switzerland. The MindMotion GO and MindPod Dolphin are part of a neurorehabilitation therapy system that comes with a large variety of animated gamified engaging activities covering motor and task functions.

Aquatic therapy

Acupuncture

Art psychotherapy

Amputee specialists

Massage

Neurologic Music Therapy

Neuro technology

Nutrition advice

Orthotic review and provision

Occupational Therapy

Physiotherapy

Pilates

Podiatry

Prosthetics review and provision

Psychiatry

Psychology

Consultants in Rehabilitation medicine

Robotic technology

Scar management

SCI Specialists

Speech and Language Therapy

Solution focused hypnotherapy

Specialist nurses

Tai chi

Yoga

Wound care

365-DEGREE APPROACH TO REHABILITATION

“Our unique set up enables us to take a 365-degree approach to a client’s rehabilitation. From nutrition, to devising new ways of combining multiple therapies in one session, to creating a living environment that creates a collegiate atmosphere, no aspect of a clients rehabilitation is left to chance” says Jules.

It’s this attention to detail and fully integrated approach that has enabled STEPS Rehabilitation to achieve a reputation for delivering tremendous results and helped to secure a multitude of industry accolades for its work over the past 6 years. ■

Tel: 0114 258 7769

www.stepsrehabilitation.co.uk

Jules Shiel-Boulger

Meet Jenny de Canha, the new HEAD OF CLINICAL SERVICES AT QEF

Delivering integrated rehabilitative care after an ABI, stroke or neurological illness.

Y role is Head of Clinical Services at QEF’s Care and Rehabilitation Centre and I am a neuro physiotherapist. I enjoy working as part of a wide MDT and my focus is to deliver integrated rehabilitative care through an evidence-based, goal directed and individualised approach across our 4 client pathways.

Having worked in the NHS and private sectors, my experience spans from the acute setting through to the community. I have completed advanced Bobath training; a physiotherapy concept used to promote efficiency of movement and we recently held the first of two Advanced Bobath courses at QEF.

QEF’s centre is unique, providing space and resource to treat clients in a range of environments. The large therapy gym means individual or group sessions can be held and several professionals can work collaboratively to maximise

the outcome of every session. The interactive room is fantastic for managing sensory overload and the OT kitchen means people can practice key daily life skills. Plus the accessible technology in bedrooms enables clients to feel as independent as possible.

MStaff play a vital role empowering clients to move forward when they face seemingly insurmountable challenges. They get to know each client individually to understand what’s important and brings value to their life. This helps determine rehab steps, how to motivate clients and support families. Staff are passionate, dedicated and hard working. It is visible to see the desire to learn and develop not only individual client outcomes but the service as a whole. People come into this profession because they care and want to make a difference; that is very evident at QEF. ■

Jenny de Canha

The value of a combined MDT process and having MULTIPLE VOICES ROUND THE TABLE

By Sara Neaves, Clinical Lead and Outpatient

Services

Manager at Askham

Rehab

He was assessed by all four of Askham’s multidisciplinary teams; clinical psychology, physiotherapy, occupational therapy, and speech and language therapy, before working with them to design an individualised therapy programme. Eventually, Josh was able to return to the airwaves and regained his voice — and in some ways, his identity.

The MDT process is also beneficial in addressing any potential complications that may arise, and as brain and spinal injuries can have unpredictable effects, they can work together to monitor the patient’s progress and adjust the treatment plan as needed — identifying the cause and developing a plan to overcome this and push forwards.

At Askham Rehab, Multidisciplinary Teams (MDTs) are an essential part of our rehab model, bringing together specialist team members to collaborate in the assessment and management of patients.

This approach is widely used in the rehabilitation of patients with brain and spinal injuries, as by bringing together experts from different fields, a MDT ensures that a patient receives comprehensive care.

MDTs can include specialists such as neurologists, physiotherapists, occupational therapists, speech and language therapists and clinical psychologists — each bringing a unique perspective when addressing differing and complex needs.

Brain and spinal injuries can have wide-ranging effects, and a collaborative approach allows you to consider all aspects of the patient’s condition, including physical, cognitive, and emotional wellbeing — before developing an optimal rehabilitation plan.

After assessing a patient, MDT’s might also set SMART (Specific, Measurable, Attainable, Relevant, and Time-Bound) goals, which again, is a fundamental way of maintaining a positive improvement trajectory.

A shining example of this rehab model in action is Joshua Donlon, a Cambridgeshire community radio presenter who lost his ability to project his voice due to a rare brain tumour.

However, while this multidisciplinary approach certainly creates better outcomes for patients, it comes at a cost. Intra-discipline communication together with holistic reporting and shared goal setting takes more time than it would if done in a siloed fashion.

At Askham Rehab, our ethos recognises this explicitly and we are transparent in allocating time to facilitate this highly beneficial way of working. This ensures that patients, therapists and funders are fully committed and reap the benefits throughout the Askham journey.

There is no doubt that the MDT process can improve the quality of life of patients, therefore, where possible, having this framework in place should always be a priority. Whether it’s a speech therapist that identifies issues with communication, or an occupational therapist that identifies issues with self-care — understanding your patients’ needs is everything in our world, so why not explore this through multiple lenses. ■

To see more examples of what we have been able to achieve with this approach, please visit: www.askhamrehab.com

Excellent Services and Sustained Outcomes

Inpatient Outpatient

Patients are welcome to stay at our state of the art facilities, receiving rehabilitation therapy on a more intensive basis, within the comfort of our fully accessible, purpose-built accommodation.

If your goal is to remain at home whilst receiving rehabilitation therapy, we will support you to ensure this is possible.

About Askham Rehab

All patients at Askham Rehab can benefit from our robotics and sensor assisted equipment working across all disciplines of physiotherapy, hydrotherapy, occupational therapy, speech and language therapy and psychology.

Please get in touch with us to discuss your specific rehabilitation needs and we’d be happy to work on a treatment plan personal to you.

SEAMLESS CARE PATHWAYS

Richardson Care provides a seamless and flexible care pathway for adults with acquired or traumatic brain injury and complex needs.

The Northampton-based care provider has a range of rehabilitation services which enable individuals to progress within the supportive environment of the Richardson Care family. Individuals may be admitted from secure or acute inpatient services to the ABI assessment and complex diagnosis unit. This purposebuilt facility in a converted Coach House enables residents to settle in to a homely environment. It gives them a period of stability where their needs can be fully assessed by a high-calibre multi-disciplinary team of neuro specialists - including Consultant Psychologist, Consultant Psychiatrist, OTs, Physiotherapist, SaLT. This may take three to six months, or longer. After which, they may continue their rehabilitation at The Coach House or move to another service within Richardson Care.

Richardson Care is unusual in that it combines a community residential setting with MDT support

ABI Rehab & Transitional Service

Adjacent to The Coach House, The Richardson Mews provides larger, more open accommodation where individuals can continue their rehabilitation and increase their independence. This service focuses on cognitive rehabilitation and behaviour/risk management to improve individuals’ quality of life.

Long-term Community Neuro-rehab Service

We also offer a long-term stable home environment/ home for life in a community setting for individuals who are unable to move into independent accommodation. This may be in an all-male setting (144 Boughton Green Road) or at The Richardson Mews. The focus is on longterm rehabilitation, quality of life, development of daily

living skills and behaviour/risk management.

Continuous Brain Injury Rehabilitation

Someone with a severe brain injury may have already spent time in various rehabilitation settings, but brain injury rehabilitation is a long-term process. The rehabilitation pathway provided by Richardson Care enables continuity of care: people can receive the care that they need within the most appropriate environment, and without the disruption and cost involved in moving to a completely new setting. Although a brain injury is expected to have life-long consequences, at Richardson Care we can demonstrate that the right care and intervention can lead to a sustained improvement in the quality of life for someone with a severe brain injury. We aim to enable them to fulfil their potential, increase their autonomy and their own sense of fulfilment. In many cases, it is possible to achieve this several years after they have sustained their brain injury. We can demonstrate positive outcomes for service users with a wide range of complex needs and behaviour that challenges: these outcomes are measured in terms of functional ability, behavioural considerations and endplacement. ■

Email: admissions@richardsoncares.co.uk Web: www.richardsoncares.co.uk

Supporting recovery with NOURISHING MEALS IN A SAFE TEXTURE

Following a texture-modified diet after a brain or spinal injury can be challenging. Making sure the food you are eating is both nutritious to aid recovery and appropriately textured to ensure safety is difficult, and often results in meals lacking flavour and visual appeal.

Following some brain or spinal injuries, you may experience swallowing difficulties, also known as dysphagia, that require you to modify your diet.

Preparing meals to the correct texture at home can be a real challenge. Cooking and blending ingredients can take a lot of time and equipment whilst also trying to ensure the food remains suitably hot, providing a stressful experience for the individual and often resulting in a visually unappealing meal.

Furthermore, the nutritional density of the meal can be significantly reduced through home blending due to the addition of water or other fluids. Whilst this helps ensure a safe texture, it can hinder an individual getting the correct nutritional intake to maintain a healthy weight.

For those experiencing swallowing difficulties, Wiltshire Farm Foods has developed a Softer Foods range, providing excellent nutrition and delicious flavour in a safe texture.

NUTRITIOUS AND SAFE

Meals within the Wiltshire Farm Foods Softer Foods range have been expertly developed in line with the latest IDDSI (International Dysphagia Diet Standardisation Initiative) guidance, ensuring they are a suitable and safe texture for those with swallowing difficulties. The range offers a wide selection of meals, snacks, and desserts to suit those requiring a Level 4 Puréed, Level 5 Minced or Level 6 Soft and Bite-Sized diet.

All the meals at Wiltshire Farm Foods are developed by chefs and registered dietitians, ensuring they not only taste great, but the nutritional content is carefully considered and controlled to aid recovery.

EFFORTLESS AND ENJOYABLE

For many, mealtimes are as much a social and emotional experience as they are a means to adequate nutrition. For those living with swallowing difficulties, this enjoyment and positive association with the dining experience can be significantly impacted.

David Jones tried the company’s meals after suffering two strokes simultaneously; “Eating a meal in the correct texture allows me to have everything I enjoy eating, without the worry of food going all over the place. It makes what was once an unpleasant experience, pleasurable again.”

Wiltshire Farm Foods’ Softer Foods range strives to bring back joy to mealtimes, with a belief that everyone should have access to a delicious, nutritious, and safe meal, regardless of their dietary needs. Through understanding the importance of visual appeal in improving the quality of mealtimes, Wiltshire Farm Foods ensures that meals look just as good as they taste; with special moulding and beautiful browning to replicate the appearance of their regularly textured equivalents.

A perfectly convenient option for those recovering from injury, Wiltshire Farm Foods deliver straight to your door and the pre-prepared meals can be cooked directly from frozen in the microwave or oven. ■

To find out more visit: www.wiltshirefarmfoods.com/softer-foods

Food is one of life’s greatest pleasures – just because someone is living with a swallowing difficulty, it doesn’t mean they should compromise on the flavours they love.

Enjoy good food every day in a texture that’s right for you with the Softer Foods range by Wiltshire Farm Foods. Carefully created meals for those experiencing swallowing difficulties.

Made by award-winning chefs from quality ingredients, we have something for every meal of the day. Each dish is nutritionally balanced and made in line with IDDSI guidelines, so that you can eat with confidence.

Just simply cook from frozen and serveit’s that easy.

Available in three textures, Puréed, Minced and Soft & Bite-Sized.

Over 85 delicious dishes in flavours you know and love.

Delivered straight to your door by friendly local drivers.

Easy to order by phone, online or with your driver.

No contract. No commitment.

Navigating the challenging POST-COVID PROPERTY LANDSCAPE

Design for Independence offers a unique combination of skills under one roof.

When times are tough, it pays to have a helping hand from an expert. That’s why private housing occupational therapy (OT) company Design for Independence (DfI) has a carefully selected team of experts in everything from property sales and lettings to building adaptations –alongside its OT specialists.

With properties in short supply and the cost of building materials going through the roof in the wake of the pandemic and Brexit, it’s more challenging than ever to find and adapt homes for the less able. But it’s all in a day’s work for the DfI team.

UNDERSTANDING SECOND TO NONE

A network of relationships with sales and lettings agents is crucial to overcome the first hurdle of a shortage of properties to buy or rent. Competition is fierce when a new property comes on to the market – so acting fast is essential. And when it comes to rental properties, the DfI team faces the added complication of discussing with the landlord any adaptation work required to accommodate a client’s disabilities – and highlighting the value it could add to the property.

That’s why DfI employs a sales and lettings manager whose understanding of the housing market is second to none after 20 years in the industry. She understands the importance of keeping in regular contact with agents and being flexible enough to attend one-off viewing days at short notice. And her negotiating skills play a key role in securing forever homes or interim rental solutions for clients.

THINKING OUTSIDE THE BOX

Property searches and adaptations are tailor-made to accommodate the specific requirements of DfI’s clients –adults and children with brain and spinal injuries, as well as amputees. But the speed at which scarce properties are now being snapped up means the team will often have only a 15-minute viewing slot to decide what needs doing. The extensive OT experience of the DfI team makes quick decisions possible as everyone fully understands the care and rehabilitation that is going to be required for each client.

The property shortage and escalating building costs mean thinking outside the box is required more than ever when it comes to adapting properties for each individual client. Knowing where compromises can safely be made to keep within budget is also vital. To keep things on track, DfI has a design and build expert who liaises with case managers, solicitors, equipment suppliers and trades people. From coordinating quotes and reviewing plans to supporting clients during the adaptation process, he ensures the work is completed on time and within budget.

SOLUTIONS FOR TOUGH CHALLENGES

The ‘one-stop-shop’ approach of DfI is designed to help clients and their families navigate the challenge of finding and adapting a home as individual as their own care and rehabilitation goals. The company has been doing just that for more than a decade, with a team that takes pride in coming up with creative solutions for even the toughest challenges. ■

ACCOMMODATION EXPERT

Anava Baruch

Managing director Anava Baruch acts as an accommodation expert under part 35 of civil law. Her background in occupational therapy gives her a holistic view of a client’s accommodation needs.

Property searches and adaptations are tailor-made to accommodate the specific requirements of DfI’s clients – adults and children with brain and spinal injuries, as well as amputees.

The housing occupational therapy specialists

Design for Independence is a private housing occupational therapy company, searching, designing and adapting homes for the less able. We cover all areas of physical, sensory and cognitive disability, and work both nationally and internationally.

These are just some of the services we offer:

Property search for suitable accommodation

Creating specifications for the building work required

Sourcing all equipment fixtures and fittings for the client

Sourcing and liaising with building professionals

Working closely with the contractors during the adaptation work

Sourcing contractors for internal work

LV Rehabilitation TAKE THE FIRST STEP TOWARDS YOUR RECOVERY

Rehabilitation is a specialised neurological and trauma rehabilitation service located on the south coast. We offer customised care for individuals who have suffered from brain and spinal cord injuries, conveniently situated near two national spinal cord injury and neurosurgical units.

Our experienced team of therapists provides personalised rehabilitation solutions to empower our clients to unlock their potential for neurological recovery. We work collaboratively with legal teams and case managers and offer the option of home-based therapy in addition to our excellent gym facility.

We focus on return to function for day-to-day life, as well as supporting individuals to return to sports or hobbies with necessary adaptations. Our team integrates therapy with return to sport by linking with sport and

TAKE THE FIRST STEP

activity providers, ensuring that rehabilitation remains a fun and engaging experience.

We are committed to providing the highest level of care to our clients, their families, and case managers. Our approach to rehabilitation is second to none, and we believe in empowering our clients to achieve their goals. If you or someone you know requires neurological or trauma rehabilitation services, please contact LV Rehabilitation. ■

Tel: 01243 943023

Web: www.lvrehab.co.uk

Email: info@lvrehab.co.uk

We believe that our approach to rehabilitation is second to none!

BIS Services

BIS Services provide high calibre, quality rehabilitation assistants who work collaboratively to increase function and develop independence. Our award winning team are raising the standards in cognitive rehabilitation provision throughout the UK, enabling clients to reach their own goals and develop their skills.

We are committed to providing a person centered quality service to individuals living with cognitive deficits acquired through brain injury and neurological illness, with an innovative and practical approach to cognitive rehabilitation. Our interventions enable reintegration into the community, work or vocational environment and promote independence in activities of daily living.

families, allowing for immediate feedback and metacognitive skill building, in a variety of settings. Our high level training to all RAs ensures that clients and teams are assured of a highly specialised service, with exceptional feedback and report writing skill. Complemented by clinical supervision with a clinical psychologist, our assistants are able to provide a high quality, bespoke approach to cognitive rehabilitation.

Goal setting and attainment is key to our input and is a collaborative process with the client, their families and treating therapists. We work closely with case managers, solicitors, and therapists to ensure dovetailing and a coordinated approach to client rehabilitation and support programmes. Our CQC registered service is monitored continuously for quality and outcomes.

Building on our expertise in delivering packages for independent living trials, BIS Services have developed The Link. This pioneering project is designed to bridge the gap between acute medical settings and return home, allowing for a 12 week period of independent living assessment, providing detailed feedback of support need for future support requirements ■

Recognising the complex needs of FAMILIES LIVING WITH BRAIN INJURY

Clinical Director, Jo Throp of Krysalis Consultancy, providers of Neuro Occupational Therapy, considers the role of the neurological occupational therapist in supporting brain injury survivors and their families.

Family members find themselves living with the complexities of brain injury, often with no prior experience. The meaning of family and the experience of being part of our own family are unique to each of us. But having and belonging to a family unit, in any form or size, is something we all share.

Brain injury is a catastrophic event that affects a family unit’s stability and its everyday roles and routines. The

Krysalis’s approach is totally centred around the individual and their needs, giving them the support and encouragement to move in the right direction. The result is that they are left with an empowering sense of achievement.

consequences of a brain injury are far-reaching, often having a significant impact on the individual’s family relationships. Brain injury survivors require substantial emotional, physical, and practical support. Providing this often falls to a close family member, such as a parent or spouse.

The support provided by family members to a relative affected by brain injury is often unconditional. However, it does come at a price. Family members may find themselves wrestling with overwhelming feelings of grief, loss, or guilt. Adjusting to a new way of living can be painful. The consequence is a complex mixture of emotions.

Recognising and acknowledging the needs of each unique family are essential parts of the rehabilitation process. Neuro occupational therapists at Krysalis work hard to create a therapeutic environment where both the brain injury survivor and their family feel ‘listened to’ and ‘safe’, enabling them to express their inner thoughts and feelings.

We help survivors to realise their potential and families to adapt to a new way of living. We assist them with their new routines and roles and support them in facilitating positive relationships and regaining hope. ■

‘Onwards and upwards’ is often declared when the small thing becomes part of the big picture.

Mother of ABI Survivor

Neurons that fire together, wire together HARNESSING THE POWER OF NEUROPLASTICITY AFTER BRAIN INJURY

6. Interference – neuroplasticity is not always positive. The brain is shaped by an individual’s environment, and we must consider the impact of stress and other daily activities being carried out.

7. Repetitions – the more repetitions of a movement, the more neuroplastic changes will be laid down and strengthened. Dose and duration also play a role, with the best results delivered through high-intensity therapy over a short period of time.

8. Intensity – it is important to get the intensity of the activity ‘just right’ and gradually increase it through ‘growing’ the challenge, combining increased coordination, sensory input, and strength to create a demand for better performance and achieve systematic progression.

One of the key concepts underpinning neurorehabilitation is neuroplasticity. The more a neural network is used, the stronger it becomes and the more resilient it is to deterioration.

THE 10 PRINCIPLES OF NEUROPLASTICITY

1. Use it or lose it – neural circuits that are not actively used will deteriorate, and the brain can ‘forget’ how to use the affected hand or limb.

2. Use it to improve it – repetition of movement is needed for long-lasting neuroplastic change.

3. Time since injury – there is a window of great opportunity for neuroplasticity in the sub-acute phase but changes can also be seen years after injury.

4. Age – it is thought that neuroplastic potential declines with age, and changes may become slower and less profound.

5. Transference – the effects of neuroplasticity can spill over into other areas of the brain.

9. Specificity – making exercises task-orientated helps ensure they are relevant, interesting, challenging, and goal-directed for the patient.

10. Salience – being able to gain and maintain a patient’s attention, motivate them and induce a sense of ‘flow’ are also key factors that can influence neuroplasticity.

To harness the power of neuroplasticity, therapists seek to promote high dosage movement therapy for those who will benefit from it. Neurotechnological devices that are accessible, enable repetitions, and encourage adherence can support clinical outcomes. ■

Underpinned by the fundamental principles of neuroplasticity, GripAble translates key hand and wrist movements to engaging game play, which promotes multiple repetitions for people with upper limb impairment. The highly sensitive handheld sensor means that even those with profound impairments can engage in gamified neurotechnology.

Tel: 0207 661 4018 | Email: hello@gripable.co Web: www.gripable.co

Getting back on your feetSTATE-OF-THE-ART TECHNOLOGY RESTORING THE ABILITY TO WALK

TRAINING FROM THE CONFINES OF YOUR BED WITH THE THERA-TRAINER BEMO.

In addition to the THERA-Trainer lyra, REHAHAUS has also purchased the THERA-Trainer bemo, an over-the-bed cycle for circular passive, assistive or active movement of the arms and legs. This device is specifically aimed at promoting mobility in bedridden and severely affected patients.

The main goals of this therapy are: : to stabilise pulmonary function to reduce complications in intensive care to activate the metabolism to improve the patient’s functionality

This device is also very effective in the early mobilisation of patients in intensive care.

The latest technology can help. With this in mind, the Rehabilitation Centre “REHAHAUS” in Germany has purchased a THERA-Trainer lyra, an outstanding robotic end-effector gait trainer that has been developed specifically to help patients with neurological disorders regain their ability to walk.

Specifically, it’s all about: regaining the ability to walk increasing walking speed improving stamina and gait

The device mimics the natural human walking pattern through a patented mechanism that can be individually adapted to each patient.

The natural but mechanically supported walking movement is intended to recall the patient’s “muscle memory”. This increases the chance of regaining the ability to walk.

The number of repetitions is hugely important for the effectiveness of the training. In this respect, the THERA-Trainer lyra is clearly superior to conventional treadmill or manual gait training. The direct ground-level access allows quick and easy transfer, even for patients with severe disabilities. The settings, such as step length, height of the handrails and weight relief, can also be adapted to each patient in no time at all. After the gait trainer has been adjusted to the patient, all of the important training parameters are displayed on the touch screen and can be configured accordingly.

ORIGINAL SOURCE: Der Buchholzer. Mitteilungen des REHA-HAUSES Buchholz, Dithmarschen, December 2021

To find out more about the full range of THERA-Trainer products, speak to their friendly team based in Milton Keynes on 01908 564100 or email info.uk@thera-trainer.com. You can visit their showroom (by appointment only) or book a free, no-obligation demonstration in your own home. Clinical settings can trial the equipment free of charge. ■

People affected by a serious accident or illness such as brain haemorrhages and strokes, often have to learn to walk and talk again. Besides the loss of speech, walking upright is one of the biggest challenges in rehabilitation.

EXPERT REHABILITATION CASE MANAGEMENT SERVICES

EXPERT REHABILITATION CASE MANAGEMENT SERVICES

EXPERT REHABILITATION CASE MANAGEMENT SERVICES

Proclaim Group is the UK’s foremost independent provider of rehabilitation case management, treatment and diagnostics services.

Proclaim Group is the UK’s foremost independent provider of rehabilitation case management, treatment and diagnostics services.

We are recognised by solicitors and insurers as independent and expert in what we do.

We are recognised by solicitors and insurers as independent and expert in what we do.

We are recognised by solicitors and insurers as independent and expert in what we do.

We employ a diverse range of health professionals with extensive clinical experience to allow us to match the case manager to the client’s specific needs.

We employ a diverse range of health professionals with extensive clinical experience to allow us to match the case manager to the client’s specific needs.

We employ a diverse range of health professionals with extensive clinical experience to allow us to match the case manager to the client’s specific needs.

Our innovative approach to working with clients impacted by brain and/or spinal injuries include a dual case manager approach; this combines different health professionals, with differing skills and expertise aligned to the needs of a client throughout the duration of the case.

Our innovative approach to working with clients impacted by brain and/or spinal injuries include a dual case manager approach; this combines different health professionals, with differing skills and expertise aligned to the needs of a client throughout the duration of the case.

Our innovative approach to working with clients impacted by brain and/or spinal injuries include a dual case manager approach; this combines different health professionals, with differing skills and expertise aligned to the needs of a client throughout the duration of the case.

Uniquely with Proclaim Care, rehabilitation services can be seamlessly co-ordinated for the client through our specialist sister services; Obair Associates and Resolve Health. This joined up multi-disciplinary approach delivers to the clients, their families and their representatives, a simple and clear rehabilitation journey. Client surveys evidenced the value that this approach brings in achieving the clients goals and the best outcomes.

Uniquely with Proclaim Care, rehabilitation services can be seamlessly co-ordinated for the client through our specialist sister services; Obair Associates and Resolve Health. This joined up multi-disciplinary approach delivers to the clients, their families and their representatives, a simple and clear rehabilitation journey. Client surveys have evidenced the value that this approach brings in achieving the clients goals and the best outcomes.

Uniquely with Proclaim Care, rehabilitation services can be seamlessly co-ordinated for the client through our specialist sister services; Obair Associates and Resolve Health. This joined up multi-disciplinary approach delivers to the clients, their families and their representatives, a simple and clear rehabilitation journey. Client surveys have evidenced the value that this approach brings in achieving the clients goals and the best outcomes.

Obair Associates provides a full range of Occupational Therapy and Vocational services, with the consultant working hand in hand with the case manager to achieve the desired goals and outcomes.

Obair Associates provides a full range of Occupational Therapy and Vocational services, with the consultant working hand in hand with the case manager to achieve the desired goals and outcomes.

Resolve Health Treatment and Diagnostic Service offers a joined up approach to co-ordination of treatments, therapies and other required clinical services recommended by the case manager.

Obair Associates provides a full range of Occupational Therapy and Vocational services, with the consultant working hand in hand with the case manager to achieve the desired goals and outcomes.

Resolve Health Treatment and Diagnostic Service offers a joined up approach to co-ordination of treatments, therapies and other required clinical services recommended by the case manager.

Resolve Health Treatment and Diagnostic Service offers a joined up approach to co-ordination of treatments, therapies and other required clinical services recommended by the case manager.

Proclaim Training Academy regularly delivers CPD accredited training courses and workshops to our case managers to make sure their knowledge and skills are kept up-to-date with the most recent clinical developments.

Proclaim Training Academy regularly delivers CPD accredited training courses and workshops to our case managers to make sure their knowledge and skills are kept up-to-date with the most recent clinical developments.

Proclaim Training Academy regularly delivers CPD accredited training courses and workshops to our case managers to make sure their knowledge and skills are kept up-to-date with the most recent clinical developments.

The client is placed at the centre of everything we do, and this has been recognised by CMS UK, where Proclaim Care’s Katie Gardiner was awarded Clinical Case Manager of the Year and Proclaim Group won the Partnership Initiative of the Year with Hudgell Solicitors.

The client is placed at the centre of everything we do, and this has been recognised by CMS UK, where Proclaim Care’s Katie Gardiner was awarded Clinical Case Manager of the Year and Proclaim Group won the Partnership Initiative of the Year with Hudgell Solicitors.

We have a team of clinically qualified and highly experienced Rehabilitation Case Managers located throughout the UK ready to support your clients. ■

The client is placed at the centre of everything we do, and this has been recognised by CMS UK, where Proclaim Care’s Katie Gardiner was awarded Clinical Case Manager of the Year and Proclaim Group won the Partnership Initiative of the Year with Hudgell Solicitors.

We have a team of clinically qualified and highly experienced Rehabilitation Case Managers located throughout the UK ready to support your clients. ■

We have a team of clinically qualified and highly experienced Rehabilitation Case Managers located throughout the UK ready to support your clients. ■

For further information please call on 01698 207 755, or email helpis@proclaim-care.co.uk or visit proclaim-care.co.uk

For further information please call on 01698 207 755, or email helpis@proclaim-care.co.uk or visit proclaim-care.co.uk

For further information please call on 01698 207 755, or email helpis@proclaim-care.co.uk or visit proclaim-care.co.uk

We are an award-winning Specialist Rehabilitation Case Management company. Our case management services support people across the full range of illnesses and injuries categories from the less complex to the most catastrophic.

We are an award-winning Specialist Rehabilitation Case Management company. Our case management services support people across the full range of illnesses and injuries categories from the less complex to the most catastrophic.

Our rehabilitation case managers work in the specialist areas of acquired brain injury, amputation, complex orthopaedic and psychological trauma with adults and children.

Our rehabilitation case managers work in the specialist areas of acquired brain injury, amputation, complex orthopaedic and psychological trauma with adults and children.

Obair Associates is a specialist Occupational Therapy and Vocational Rehabilitation company.

Obair Associates is a specialist Occupational Therapy and Vocational Rehabilitation company.

The standard of our vocational assessments and vocational case management services are recognised as market leading and used by case managers, personal injury insurers and solicitors, disability insurers and occupational health providers.

The standard of our vocational assessments and vocational case management services are recognised as market leading and used by case managers, personal injury insurers and solicitors, disability insurers and occupational health providers.

Occupational Therapy services are delivered to personal injury insurers, solicitors and case management companies.

Occupational Therapy services are delivered to personal injury insurers, solicitors and case management companies.

Resolve Health is Proclaim Group’s specialist Treatment and Diagnostic Service. We offer the full range of physical and psychological therapies, diagnostics and hospital services. Many services can be delivered through virtual technology. We focus on delivering the easiest access to services for the client, with the highest quality of service. With a focus on self-management, the service is outcome focused.

Resolve Health is Proclaim Group’s specialist Treatment and Diagnostic Service. We offer the full range of physical and psychological therapies, diagnostics and hospital services. Many services can be delivered through virtual technology. We focus on delivering the easiest access to services for the client, with the highest quality of service. With a focus on self-management, the service is outcome focused.

Our Academy of Rehabilitation and Vocational Expertise was established in 2018 to offer CPD training to Proclaim Group and the insurance, corporate and case management market. We have a passion for providing education to the industry to enable the maximum benefit to be achieved through the use of rehabilitation and vocational services.

Our Academy of Rehabilitation and Vocational Expertise was established in 2018 to offer CPD training to Proclaim Group and the insurance, corporate and case management market. We have a passion for providing education to the industry to enable the maximum benefit to be achieved through the use of rehabilitation and vocational services.

Proclaim Group is the UK’s foremost independent provider of rehabilitation case management, treatment and diagnostics services.

BABICM Continues TO LEAD THE WAY

As the UK’s leading membership organisation in brain injury and complex case management, BABICM continues to go from strength to strength and remains a guiding influence within the case management industry.

Ajoint founder of the Institute of Registered Case Managers (IRCM), BABICM provides a framework of professional standards for case managers across the UK and provides essential training, support and best-practice guidance to its members. With a further increase in membership, BABICM can look forward to another busy yet exciting year as they strive to meet the demands and needs of their current members while meeting and exceeding their new member’s expectations. They continue to recognise, promote and share knowledge and excellence in brain injury and case management among their members. They also shape national policy and procedures through collaborative working between its members and other professionals and organisations within the case management industry. BABICM is also dedicated to maintaining the highest professional and ethical standards and delivering an effective service to ensure the organisation’s sustainability.

BABICM continues to lead the way in promoting research and evidence-based practice relevant to individuals with complex needs, with much of that responsibility falling to BABICM’s working groups which play a major role in the organisation’s continued success. This work, carried out by the groups, ensures BABICM remains a national leader within the brain injury and case management industry.

THE GROUPS THAT STEER BABICM’S DIRECTION

BABICM are supported by a Council of volunteer members who create the strategic plan that feeds through to the working groups, which in turn shape the organisation. Overall this creates direction, momentum and a clear vision for the future. They work closely together to support the chair and directors to deliver BABICM’s purpose and objectives for the year ahead. Members of the working groups continually look ahead at the current trends and keep up to date with the ever-changing world of case management, ensuring that members are fully supported and guided in all aspects of case management.

FORMULATING THE STRATEGY FOR THE FORTHCOMING YEAR

To set out its strategy for the forthcoming year, BABICM Council members meet for two days each September. Within this meeting, the Council creates, prepares and agrees on the strategy and commitment to its members for the year ahead. Amongst the topics agreed upon at the last meeting involved ways to increase the benefi ts of BABICM membership, a commitment to improve inclusion and belonging across the organisation, enhancements to the website to make it more user-friendly and incentives for research-related work.

DELIVERING THE STRATEGIC PLAN

As a key role in supporting BABICM’s annual strategy meeting, the Company Strategy Group meet to discuss how best they can deliver, support and develop the organisation’s strategic planning, which is one of the main objectives of the group.. The group also has an ongoing remit to long term objectives include identifying and promoting BABICM’s identity within the industry, supporting relationships with other member bodies and the protection of the public through the opening of a register with the Institute of Registered Case Managers (IRCM), as well as promoting and championing membership of BABICM itself.

Reports for all of this and the other working groups of BABICM are presented at the AGM which is held in the summer at the same me as the annual conference. To promote transparency for members, all reports can be found in the member’s area of the BABICM website.

PROVIDING MEANINGFUL TRAINING & EDUCATION

The Training and Events Group (TEG) is the knowledge and education hub for case managers. It consists of current case managers from many disciplines, including Speech and Language Therapists, Social Workers, occupational therapists as well as Personal Injury solicitors. The aim of the group is to arrange forums, one-day workshops and remote seminars that play a vital role in the professional development of members and professionals that work with people who have suffered catastrophic and life-changing injuries.

The group are enthusiastic and passionate about identifying trends, delivering to their members and securing experts who are leaders in their individual fields to speak at events. Feedback from the events plays a huge role in the planning and shaping of future events and the group values the responses it receives from its

members. “We read every piece of feedback from our members, which is reviewed at the next meeting. We discuss what our members want to see from the training and events group and look to meet their needs,” says Sue Brown - current TEG chair.

BABICM continues to lead the way with brain injury and complex case management research through extensive programmes and surveys. The Research Group plays a vital role in case management to help promote and encourage further research in the field of brain injury. The group offers a combined twenty plus years’ experience in understanding and explaining the many techniques, challenges and advances within the context of brain injury and complex case management.

The Research Group also encourages all members to partiticipate in research and is open to discussion on projects and ideas from case managers, as well as encouraging members to create posters to be showcased at its annual conference. This helps to guide case managers in the right direction to progress their own research in addition to providing academic references of interest.

SETTING THE STANDARDS FOR CASE MANAGEMENT

The work of the Professional Practice and membership Group (PPMG) encompasses all aspects relating to the practice, registration and defi ning of standards and competencies to support members. The BABICM Standards and Competency Framework set the principles for the behaviours, values and expectations of its members and has been devised and updated by PPMG. This framework provides an overall view for new and existing members of what excellence in brain injury and complex case management looks like, and the standards can be used as a tool for case managers and their supervisors to assist the focus within clinical practice.

The Standards and competencies are also used by Advanced Membership Assessors when assessing a member for Advanced Membership status. To determine competency, each of the seven core areas’ competencies are divided into separate components, with three levels of experience that demonstrate the range of skills and experience of the case manager.

THE SEVEN CORE AREAS FOR EFFECTIVE PRACTICE:

Communication Strategy

Coordination and management

“Our standards and competencies framework creates a common language and understanding about standards and competencies within case management. It is an excellent framework to help review and reflect on one’s work as a case manager, it can be a useful tool within supervision, it can support conversations with managers, referrers, clients and families to discuss what is expected and delivered. It is central to the practice of myself and my colleagues and I wholeheartedly recommend it.

”

Vicki Gilman (BABICM Chair)

BABICM MEMBERSHIP TYPES

Charity Associate Fellow Students

Corporate Associate

Affiliate

BABICM’s continued growth within the fi eld of brain injury and complex case management has seen its annual membership rise by 13%, a testament to the hard work, dedication and devotion of its Council, volunteers and directors that make up the working groups that help determine and shape its path.

If you are interested in joining BABICM or would like more information on volunteering to join in with the work of its Council or groups, do get in touch and discuss the type of membership or role that will meet your needs. ■

For further information, please visit www.babicm.org or janette@babicm.org

Breakthrough Case Management ‘CASE MANAGEMENT WITH CARE’

Breakthrough Case Management’s co-founders, Annabelle Lofthouse and Catrin May, know what high quality case management and effective rehab provision looks like.

Establishing the Southwest based company in 2018, each with over 30 years of clinical experience, they set out with a shared set of values and a clear vision – to keep the client at the heart of everything they do and provide an all-encompassing, responsive service to law firms and solicitors.ice to law firms and solicitors.

As the company has grown, in size as well its geographical coverage, (recently branching out in the Northeast, Northwest, Midlands and South of England), so too has its reputation for excellence. In a recent survey, both clients and solicitors rated the company’s ability to respond effectively in a timely manner as outstanding.

Life’s greatest difficulties happen before life’s greatest breakthroughs

At Breakthrough Case Management we support and guide individuals and their families who have experienced a catastrophic injury – to realise their full potential and improve their quality of life. With an ever-expanding cohort of case managers, all highly experienced experts in their fields, including spinal cord injury, acquired brian injury and amputee rehabilitation, Breakthrough prides itself on its ability to tackle each and every eventuality in any case.

Case Management with Care

Rated Outstanding, our CQC registered complex case management and ongoing care and rehabilitation service exists to empower people. We give our clients the practical and emotional support they need to feel in control, right now. And the purpose and energy to move

towards a positive future.

Breakthrough’s Case Management and Care services co-exist to significantly reduce the outsourcing so often associated with complex personal injury cases. Serving as a single point of access to a network of highly experienced professionals, the Breakthrough care model ensures quality care provision alongside continual functional rehabilitation and evidences measurable outcomes.

Our case managers keep abreast of the very latest developments in rehabilitation technology, trialling innovations and emerging digital solutions to secure transformational outcomes for their clients. We work closely with our allied clinical colleagues, including rehab assistants; neuro physiotherapists; occupational therapists; nurses; psychologists and the wider multi-disciplinary team to identify every resource out there that will support the best possible outcome for their clients. All this with a steadfast personcentred approach that keeps the client at the heart of everything we do. ■

web: www.breakthroughcasemanagement.com

Annabelle Lofthouse: 07703 103843

Catrin May: 07595 226097

Annabelle Lofthouse

NJ Case Management Ltd provides full circle CASE MANAGEMENT:

Initial care needs assessment for medico legal purposes

Initial care and rehabilitation expert witness reports and case management reports

Recommendations with SMART goals

Holistic approach and collaboration with legal teams, ICB’s Local Authority, Insurance companies

Court of protection assessments and deputyship for clients

Specialised neuro rehabilitation, brain injury and spinal injury training for families, health professionals and care providers

Care plan formulation

Clinical supervision

Rota management

Specialised recruitment

Incident reporting and investigations

Assessment of properties and recommendations regarding suitable properties, purchase of a property or modification of a property Equipment recommendations and assistance to purchase adequate and most suitable vehicles and equipment

Mental health support and referrals

Hospital discharge planning and reintegration in the community

International case management

OUR UNIQUE APPROACH:

Our case managers are multilingual and speak 5-7 different languages and understand multicultural individual needs and expectations.

NJCM team consist of case managers with mixed skills such as extensive experience in brain injuries, medical negligence and birth injuries, catastrophic injuries and holiday injuries/ claims.

We provide case management in a collaborative approach and two of our most adequate case managers are allocated to each case/client to ensure all individuals needs are met and the recommendations are bespoke and specific to suit our clients and their families.

EXAMPLE CASES:

The client is in the community and his legal case is settled following an RTA. He sustained C4 complete spinal cord injury with many challenges with the

CCG and care agencies. CCG refused to continue to provide CHC funding due to behavioural issues and his mental health deteriorated at the time of our initial meeting.

As case managers for our clients in 6 months we managed to negotiate with the CCG to approve his CHC funding in the first month of our involvement. The CCG decided to transfer the case to us as the main PHB holder and more importantly the client is happy and contempt.

Client’s family reported that he went out and interacted with friends and family in the last three months more than he has done in the last 2 years.

Find it rewarding and I am enthusiastic about appropriate use of resources and effective communication.

Our client was referred to us by his solicitors following an RTA. At the time of the initial assessment, the client was in Hospital and the discharge report stated polytrauma.

With our involvement and recommendations and proactive approach and collaboration with the legal team, the client attended private inpatient rehabilitation and had several spinal injury assessments and neurology assessments which confirmed cauda equina and frontal lobe injury which explained his cognitive decline.

His house was not accessible, and he was confined into one room.

Within 4 months of our involvement, the legal team managed to secure intermittent payment for private rent whilst his house was adapted to suit his needs and he has regular physiotherapy and occupational therapy as well as psychology support for the client and his family.

We are in month sixteen of case management and the vocational support commenced for the client to return to work in an alternative role and PIP approved with adapted vehicle in place. ■

CASE MANAGEMENT

Tel: 07859 931 422

Email: natalija@njcasemanagement.co.uk

Web: www.njcasemanagement.co.uk

CASE MANAGEMENT

We provide a full and comprehensive service as case managers for people with complex care needs. We serve solicitors, insurers, medical legal teams, and other parties involved in a complex case and provide full complex care case management for both adults and children, disability applications and courts of protection.

Our case management services...

Our case management services

For Complex and Catastrophic Injury Case Management, our team of expert case managers will take care of every aspect of your case.

Care & Rehabilitation Expert Witness:

We provide Expert Witness Service for courts of protection, legal teams and clients.

Initial Needs Assessments:

In the course of our complex care case management, we carry out CC (Common Criteria), CHC (Continuing HealthCare) and DST (Decision Support Tool) assessments and reviews.

Capacity Assessments: We carry out DoLS (Deprivation of Liberty Safeguards), Best Interest and Mental Capacity Assessments.

PIP Applications & Disability Benefits Consultations:

We assist clients in making their Personal Independence Payment claims, and Disability Benefits claims, making sure they do not miss out on their rightful care funding.

07859 931422

In

The lesser-known symptoms of TBI and SCI TACKLING THE EFFECTS AS A TEAM

or

disruption of menstruation and signs of diabetes insipidus. If identified, hormone replacement therapies and lifestyle modifications can help, but recognising the symptoms is vital. The challenge with NED is that other conditions present similar to it, therefore differential diagnosis is key to offer the appropriate medical and therapeutic interventions. This can be achieved through good communication and regular feedback shared amongst the MDT. Of equal importance is the rehabilitation case manager’s ability to build a strong and trusting relationship with the client, so they feel comfortable sharing these details.

Claire MacLaine, Clinical Lead for TBI and Rachael Chadwick, Clinical Lead for SCI at HCML, explain what the symptoms can be and how a multidisciplinary team (MDT) approach can help identify these symptoms and ensure they are managed effectively as part of a bespoke rehabilitation programme.

The rehabilitation case manager’s role is to assess, advise, coordinate and oversee all treatment and interventions in a rehabilitation client’s recovery, along with an MDT. Not all conditions are reported by the client, therefore the MDT may have to rely on other presenting symptoms to identify underlying conditions.

THE

UNEXPECTED SYMPTOMS OF TBI

Neuroendocrine dysfunction (NED) is where the body produces too many or too few hormones which can negatively impact vital bodily functions. It can be triggered by TBI and symptoms are often missed as the signs can be very subtle.

This is why it’s important for the MDT to discuss with the client symptoms such as fatigue, sexual dysfunction, mood disturbance, headaches, visual disturbance, muscle weakness,

Triggers and symptoms to be aware of in SCI

Autonomic dysreflexia is a common condition in SCI above the level of T6 and affects the nervous system. The condition can cause a sudden onset of excessively high blood pressure, resulting in symptoms such as headaches, light headedness, dizziness, heavy sweating, anxiety, slow heart rate, blurry vision, confusion and trouble breathing. The condition can be triggered by a host of factors, including some that are seemingly harmless, but present a real threat to the health of a SCI client. These can include having a full bladder, an ingrown toenail, constipation, pressure sores, menstrual cramps or tight clothing.

It’s not only important to educate the MDT to spot the symptoms, but also identify any potential triggers and ensure these are flagged within the whole team to mitigate the occurrence of the condition. It’s also particularly important to discuss the triggers and symptoms with the rehab client so that, where possible, they can manage their condition and alert the MDT to any possible symptoms. ■

traumatic brain injury (TBI)

spinal cord injury (SCI), specific clinical interventions are vital to address the symptoms and the effects of the injury. But there are other, lesser-known symptoms that can have a profound impact on recovery.

Claire MacLaine

Rachael Chadwick

It’s not only important to educate the MDT to spot the symptoms, but also identify any potential triggers and ensure these are flagged within the whole team to mitigate the occurrence of the condition

We’re passionate about rehabilitation case management and achieve extraordinary outcomes for people who have experienced life-changing injuries.

Clinical expertise and unrivalled clinical governance.

Encouraging early intervention and speed of access to rehabilitation through market leading funding solutions. Driving collaboration across services and stakeholders to deliver truly bespoke rehabilitation programmes.

Working together TO BUILD A BETTER FUTURE

Based in the West Midlands, SJ Rehab is an independent case management company providing bespoke, high-quality Case Management services to adults and children that have sustained life-altering and catastrophic injuries.

Samantha Jobling, Director of SJ Rehab is a Registered Nurse with over 20 years of experience looking after clients in both the hospital and community setting. SJ Rehab has built up a reputation for excellence, delivering highquality case management and became part of the 3HUB Case Management Community in 2021.

SPECIALISMS INCLUDE:

Brain Injury

Birth Injury

Poly Trauma Complex

orthopaedic injuries

Clinical Negligence

Challenging

Behaviours

Mental Health

TESTIMONIAL

“I enjoyed working with Sam and found her to be a thorough and conscientious Case Manager. She communicated clearly by phone and email and organised regular multi-disciplinary team meetings so she could coordinate and oversee the therapy being provided to her client. She took the lead in assuring the client’s rehabilitation was goal focused and she acted as the link between the clinical and legal teams. She showed an excellent understanding of the medico-legal process. I found Sam to be an excellent team player and she demonstrated a good understanding of rehabilitation and the roles of the team members.” Specialist Neuro Occupational Therapist ■

For further information please visit our website at www.threehub.co.uk/case-managers/sam-jobling

For over 20 years TBL have provided Expert Witness, Case Management, Rehabilitation and Specialist Clinical Services for both adults and children.

We offer a nationwide service with our consultant clinicians and case managers located across the country (including Scotland), all of whom are highly experienced with considerable skills to work alongside clients with complex cognitive, physical, emotional and behavioural needs.

For more information visit us at www.taniabrown.com, email us teresarey-salomon@taniabrown.com or call us 01257 473967.

A Comprehensive Approach to Rehabilitation: THE PSYCHWORKS ASSOCIATES DIFFERENCE

At PsychWorks Associates, we know that rehabilitation progress and recovery is complex work. That’s why we take a comprehensive approach, focusing on the individual, the family, the professional network, as well as the mind and body.

We understand that achieving rehabilitation goals is a long-term process, requiring a sustainable approach for both client and clinician. Our integrated, coordinated, and collaborative approaches allow the professional support to be greater than the sum of its parts, maximising the gains for the client. We also understand that every client and clinician

brings their own story to the system.

That’s why our trauma-informed services are tailored to respect the unique needs of each client, regardless of their background, with a professional team that represents diversity.

At PsychWorks Associates, we proactively support individuals and families in their own contexts to achieve the highest quality of life possible. If you’re looking for services to aid in your client’s journey towards rehabilitation, contact us today to learn more about how we can help. ■

A collaborative, creative and integrative approach to emotional and physical rehabilitation

For more information, contact PsychWorks Associates today to learn more about how we can help your clients achieve their goals.

Email: admin@psychworks.org.uk

Web: www.psychworks.org.uk

EOTAS and the role of CASE MANAGEMENT

Education other than at school (EOTAS) is often a last resort for local authorities, put in place when a suitable school within an area deemed acceptable for the child to travel to cannot be found.

EOTAS differs from standard ‘home learning’ because the local authority remains accountable for and funds the student’s learning, and learning is not dependent on parent teaching.

WHY EOTAS

My client has physical and executive function difficulties arising from a traumatic brain injury. She was well integrated at primary school. She attended a secondary school that was accommodating of her needs, yet she developed high anxiety, became fatigued from the physical and cognitive demands of negotiating the environment and timetable, and socially isolated because she could not move so fast as peers and needed time-out to meet medical and therapeutic needs. A local authority (LA) educational psychologist recommended that she attend a school with smaller class sizes, but those in her local area were inaccessible. Another solution was needed, and case management together with independent educational psychology, and an education solicitor enabled EOTAS to be put in place.

CASE MANAGING EOTAS

In many ways, implementing EOTAS is like a bespoke care and multidisciplinary team package. A budget was forecast by the case manager and closely monitored in liaison with the local authority (LA). A Personal Assistant (PA) was recruited and managed by the case manager, to ensure that the EOTAS package was successfully implemented with the client in addition to therapy goals. Independent tutors were also researched and sourced and a package of tailored education was set up for the client.

The independent educational psychologist and I continue to work collaboratively liaising with the client, family, PA, tutors and therapists to ensure the package meets the clients education needs whilst promoting her rehabilitation. Therapists are invited to help integrate rehabilitation and awareness with learning. Timetabling can be a challenge but has been achieved. Other challenges are ensuring exam provision and GCSE syllabus are clear and determined by the LA.

The PA’s role is closely monitored through Mach forms and contact with me and the educational psychologist. I chair termly meetings with tutors, educational psychologist and the client’s parent. If relevant key therapists attend depending upon the area being discussed. Minutes are taken of meetings which form part of the evidence I send to the LA regarding the provision of EOTAS, the effectiveness in meeting the client’s needs and any budget changes. The educational psychologist and I ensure that the package is tailored to the client’s needs. The LA case worker would usually chair EHCP reviews in the absence of a SENCo.

A dedicated learning environment was created in an accessible garden room at the client’s home. This was funded privately and overseen by myself and the client’s treating occupational therapist. The client has a desk and chair specific to her needs, and a bespoke curriculum which includes GCSE study, plus qualifications in subjects that she is interested in, alongside therapy sessions and personal training. In addition, she attends a social group, where she can mix with peers and participate in rural crafts, cooking and outdoor activities.

The PA works 30 hours a week. She is fantastic in helping to promote the client’s learning and independence. She is directed by the case manager / parent and implements the recommendations of the educational psychologist and therapists in addition to taking the client to tutor sessions. In this case, the PA is employed throughout the year, maintaining on-call availability to support the client during holiday periods: private funds supplement LA funding.

HOW THE STUDENT BENEFITS

My client is thriving with her EOTAS package. Her anxiety has decreased significantly, her learning has regained momentum, her therapy goals are on-track and her social contacts remain positive. This is one example of the person-centred innovation and collaboration with client, parent, educational psychology and her therapy team that we pride ourselves on at SSCM. ■

When no school placement can be reasonably found to meet a person’s needs, there is a solution. StanleySmith Case Manager (SSCM) and Director, Heidi Stanley, discusses implementing EOTAS with a SSCM client.

A dedicated learning environment was created in an accessible garden room at the client’s home. This was funded privately and overseen by me with advice from the occupational therapist.

HEIDI STANLEY, CASE MANAGER AND DIRECTOR

Heidi Stanley

We’re here to help you bring all the pieces together.

Our ethos is to lead case management through a tailored, collaborative approach with clients, families, professionals and services involved, promoting autonomy.

We are a friendly team of highly experienced HCPC registered Therapists and Case Managers with over 10 years experience, knowledge and skills to steer case management so that it is individual to the client’s needs. We underpin our work by promoting quality of life, rehabilitation, vocation and recreation.

The Case Management Community

If you are an experienced case manager and a qualified health professional looking to become self-employed then 3HUB provide you with the clinical, business and practical support you need to help you make that step.

You can enjoy the financial and practical benefits of being independent while being part of a dynamic, collaborative, supportive and well-governed community. Some of the benefits of 3HUB membership:

Work/Life Balance

Excellent earning opportunities

Choose your caseload capacity

Referrals

Support with sourcing new client referrals from 3HUB and wider 3HUB community

Networking opportunities

Retention of your clients

Clinical Support

Supervision from highly experienced case managers

Peer Support

Share knowledge, ideas and training to keep your

practice current and relevant

Instant access to specialist, local knowledge

CQC

Comprehensive support with CQC registration, compliance and governance

Regularly reviewed and updated CQC library of templates and policies

Training

Access a comprehensive training programme included as part of the 3HUB membership

Business Support

HR and payroll teams, admin and invoicing support

Tools to meet your professional standards

Including a full range of clinical templates & policies

Cloud based case note and storage systems

Virtual Office

Access to meeting rooms

Office telephone number & address

Other Services

Services including admin, proofreading, annual leave & sickness cover

3HUB membership starts at just £25.50/hour

3HUB Community - Going independent together

Kindred Minds, KINDRED SPIRITS

Kindred Community: offering something different! writes Kathryn Howard

Kindred Community is a CQC registered Case Management and therapeutic healthcare community, grounded in ethical working that changes the way Case Managers and therapists work with each other and their clients.

We offer a comprehensive, holistic, and transparent approach to Case Management and therapy provision. Our unique ethos enables professionals to deliver highly personalised care and support.

Our highly skilled professionals offer a range of services which include;

Case Management

Therapeutic services such as Neuro-Occupational therapy, Neuro physiotherapy.

Counselling

Clinical supervision and business delivery support. Training for rehabilitation support staff teams. Initial needs assessments.

KINDRED CONNECT

Kindred Connect business and connection services for CQC registered independent Case Managers. An excellent space to share good practice and keep up to date

After many years working in Case Management, we know what’s needed to make life easier and ensure we have financial transparency, cost-effective and responsive provision, alongside a cohesive and collaborative approach based on developing excellent working relationships.

As a small company, we put our clients at the heart of everything we do. With client-centered, professional, and empathic provision of service, and a human connection.

Our team are highly qualified, well supervised, audited regularly, and demonstrate empathy in all they do. Our case managers and therapists all have small caseloads to ensure clients of their full attention. Having a healthy work life balance and being part of a supportive team that works together means there is always someone on hand who knows the client well for any out of hours or crisis management. ■

For more details, referral or interest in working with our team please email: admin@kindredcommunity.co.uk or call Kathryn Howard on: 07387 771 220

ABI Case Management Ltd

Covering the Midlands, North West, North East of England and North Wales, ABI Case Management Ltd is a dedicated and professional service providing specialist case management to clients with acquired brain injuries, spinal injury other catastrophic injuries.

Taking single or joint instruction from Defendants, Litigation Solicitors, Court of Protection Deputies, lay Deputies or the client themselves - we provide assessment and ongoing case management services assessing and facilitating support for our clients from the post-acute and rehabilitative stages of recovery through to ongoing maintenance and longer-term support programs.

COURT OF PROTECTION DEPUTY

Our case managers have extensive backgrounds and clinical experience in neuro-rehabilitation and the longterm management of the health, medical and social needs consequent of head injury and spinal cord injury.

Our innovative and dedicated team of case managers

include specialist occupational therapists and nurses who adopt a collaborative, proactive and needs led approach to supporting our clients through their rehabilitative journey to maximise their recovery, potential and reclaim their lives ■

For further information please visit our website at www.abicasemanagement.co.uk

For referrals, please email Ann Unsworth at admin@abicasemanagement.co.uk

Specialist Case Management

Occupational Therapy and Nursing Assessment

For Acquired Brain, Spinal and Catastrophic Injury

For referrals and information please email Ann Unsworth at admin@abicasemanagement.co.uk

Or visit our website - www.abicasemanagement.co.uk

I have had nothing but positive experiences with ABI Case Management - who continue to work collaboratively with my client(s) and their families and support team to help them to achieve their goals.

Signs a parent may be struggling AFTER CATASTROPHIC INJURY

Parents who have a child living with a catastrophic injury may face a range of emotional and psychological challenges, including depression, anxiety, and PTSD. While these challenges are normal and understandable, parents need to recognise when they may be struggling and seek help when necessary.

There are several indicators that suggest a parent may be struggling and Bush & Co case managers are not only clinicians and specialists in supporting children and young people, they are selected based on their experience of working with families; to ensure the child can reach their full potential at a time when others may feel that potential is lost.

EMOTIONAL DISTRESS

One of the most common signs that a parent may be struggling is emotional distress. This may include feelings of sadness, hopelessness, anxiety or anger. Parents may also experience changes in their mood, such as irritability, crying spells, or a lack of interest in activities they once enjoyed.

SOCIAL ISOLATION

Following a child’s injury, parents may feel isolated from their friends and family. They may feel that they cannot relate to others who do not understand what they are going through.

DIFFICULTY COPING

Parents may also struggle with day-to-day tasks and may feel overwhelmed by the demands of caring for the child. They may struggle to keep up with household chores, manage medical appointments, or navigate the healthcare system.

CHANGES IN PERCEPTION

Some parents start to see the world through a different lens when coming to terms with traumatic events. What was once a place of dreams and aspirations can be viewed as negative and scary where no hope of a return to happiness can be found.

SLEEP DISTURBANCES

Another common sign that a parent may be struggling following their child’s injury is sleep disturbances. They may have difficulty falling asleep, or staying asleep, or may experience nightmares or other sleep disturbances.

CHANGES IN EATING HABITS AND PHYSICAL SYMPTOMS

Following a child’s injury, parents may experience changes

in their eating habits. They may have a loss of appetite, or they may turn to food as a source of comfort and overeat. Physical symptoms such as headaches and fatigue may also be present.

A DIFFICULT JOURNEY

Caring for a child with an ABI can be a difficult and challenging journey for parents. By taking care of their own emotional and psychological well-being, parents can better support their child and family through this challenging time.

Bush & Co case managers and behaviour therapy service see the whole picture of the family dynamic and can easily identify where a parent’s inability to cope may be impacting a child or young person’s rehabilitation. To find out how they can support your client and their family contact hello@ bushco.co.uk. ■

CLIENT’S FAMILY – APRIL 2023

To find out more about more Email: hello@bushco.co.uk Web: www.bushco.co.uk Tel: 01327 876210

Having a caring and supportive Case Manager has helped us through a very difficult and stressful time and has been a reliable contact in times of difficulty, and the need for advice and problem solving. She has acted in our best interest and supported the welfare of the team providing the ‘care support.

Bush & Co case managers and behaviour therapy service see the whole picture of the family dynamic and can easily identify where a parent’s inability to cope may be impacting a child or young person’s rehabilitation.

A failing care package THE WARNING SIGNS

CASE: “Eleanor” – Brain Injury with Tracheostomy – Paul Ritson, Clinical Case Manager

With support of a 24 hour 2:1 care package, Eleanor resided in her own home. She was dependent on carers for all aspects of daily life. Care was provided by a company appointed by tender.

In December 2022, Eleanor was admitted to hospital with pneumonia and septicaemia. She received antibiotics and was fit for discharge after 19 days. During admission a ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) order was applied after discussions with family.

Pre-discharge, attempts were made to engage the care company in planning with limited success. Information was provided to them as requested, however as each issue was resolved another arose. This delayed discharge by 13 days leaving Eleanor at risk of hospital acquired infection.

After discharge, the Case Manager visited Eleanor. It became apparent that carers had not received any information or plan regarding the DNACPR, new urinary

catheter or changes in tracheostomy care. Eleanor’s care plan had also been removed, so carers had no point of reference when orientating staff. Upon further investigation, the company had ceased ‘out of hours’ clinical cover leaving carers alone if problems arose. Family also expressed concerns over staffing and continuity of care before hospital admission.

During attempts by the Case Manager to facilitate safe care, they were informed that the company was increasing their fees by 20%, necessitating the package costs be reviewed by the Integrated Care Board (ICB). ■

The Case Manager was involved at all stages ensuring that the client’s safety and welfare remained central to any decisions.

Web: www.brownscasemanagement.com

Email: info@brownscm.com

Tel: 01257 686070

Dave Ralph, a former garage owner, suffered a prolapsed disc at work, but carried on working, and unfortunately he severely damaged his spinal cord as a result.

Dave realised that he needed extra help when going to the toilet.

“It was getting more and more difficult to clean myself, as I couldn’t get my hands behind my back. I wouldn’t expect my wife to wipe my bottom: it’s embarrassing!” explains Dave.

A friend told him about Closomat Wash and Dry toilets, so he spoke to his Occupational Therapist; and under a Disabled Facilities Grant, a Closomat Palma Vita was installed. Dave says, “I am so grateful I have it. It is brilliant. I just push the pad with my elbow, and the toilet does the rest.”

To find out more about how life-changing a Wash and Dry Toilet from Closomat can be, visit closomat.co.uk.

The Closomat Palma Vita Wash and Dry toilet.

“

I am so grateful I have it. It is brilliant.”

Working together to change lives ACROSS THE UK

importance of knowing the communities in which we work, which is why we provide our services through our small, locally-based, specialist businesses. We take pride in collaborating with our partners in a close-knit and supportive way, whilst also working as one City and County team to change home care for the better and brighten the lives of everyone we provide bespoke care for.

National service, local focus

As a trusted leader in care, we take pride in our responsibility to influence and innovate. We’re transforming care by working smarter and supporting our people to deliver vital care every day. We’re bringing even more flexibility to our services by giving your clients the choice to control any sensitive information in their homes though a secure and user-friendly digital technology. As well as enabling our teams to react quickly to changes, your client will retain control of their personal data, with the choice to easily share it with family or other health professionals.

Our group of care providers has one of the broadest range of specialisms in the UK with all the experience and expertise that brings, but we also understand the

We provide specialist nurse led, homecare services enabling people with a diverse range of complex needs. Our dedicated teams give your client the support they need to live independently at home, take part in family life, stay in work and education, and have active and fulfilling social lives.

By working alongside our teams, you’ll be benefiting from over 40 years’ experience of UK wide complex care planning and service management. Our broad range of services are delivered by care service experts that can assist you and your clients to identify and appoint the right service for them, based on choice.

Whatever the situation, our local network will be onhand from the second you contact us, assuring you and your clients a reliable single point of contact, whatever your query. They will manage a comprehensive assessment of your client’s requirements and build a bespoke support package unique to them, recruiting expert care staff who match your client’s lifestyle.

At City & County Healthcare Group, we know that dignity matters. That’s why we’re passionate about supporting people to live as independently as possible in their own homes. Whatever level of care they need and wherever they are in the UK.

Broad skills, focussed specialisms

Complex needs should not be a barrier to achieving your goals and full potential. We will work with you to understand your aspirations and develop strategies to make them a reality.

We recognise and embrace the individuality and unique needs of those we support, through nurse-led, complex care for clients with a range of conditions. We support adults and children throughout England and Wales, enabling them to live their lives as they choose from the comfort of their own homes.

We also work closely with the children and young people in our care, their parents, and their families to provide clinical care of the highest quality. We support children with a range of complex needs, including cerebral palsy, severe genetic conditions, spina bifida, brain injury, spinal injury, Down’s syndrome, hydrocephalus, and congenital conditions.

We recruit care staff to cover a wide number of specialisms, including critical care, spinal cord injuries, neurological conditions, community nursing and domiciliary ventilation. This wealth of experience encompasses the care for clients who require clinical interventions in their own homes.

Our clinical nursing team provide bespoke clinical training for care staff, to cover a wide number of specialisms, including critical care, spinal cord injuries, neurological issues, community nursing and domiciliary ventilation. This wealth of experience encompasses the care for clients who require clinical interventions in their own homes. These include tracheostomy care, gastric feeding, invasive bowel management and urinary catheterisation. We also understand the importance of training and on-going support to ensure the well-being and safety of both our staff and clients.

We’re also proud of our longstanding partnerships with leading specialist support services around the country. Your client can be reassured that our nurses work collaboratively with hospitals and the Spinal Injuries Association – ensuring that our frontline care teams have the latest skills and training to support their needs.

MEET OUR TEAM ADVANTAGE HEALTHCARE

When you client needs a fast turnaround, the friendly team at Advantage Healthcare are ready to mobilise their care package quickly and with maximum flexibility. Through their local branch network, our care managers are already connected

to a wide range of support services enabling them to deliver care to adults and young people, with a team of health care assistants and or registered nurses.

TOTAL COMMUNITY CARE

Total Community Care was formed in 2006 to create an organisation that was truly client centred. Today, the team are focussed on case managers supporting people living in England with spinal injuries and neurological conditions.

COMPLETE CARE AMEGREEN

Complete Care Amegreen pride themselves on their relationships with organisations such as the Spinal Injury Association. By working in partnership to support the spinal injury community, the Complete Care Amegreen team have built a reputation as true spinal injury specialists who deliver care for both children and adults.

INDEPENDENT COMMUNITY CARE MANAGEMENT

ICCMs’ network of complex community nurses is ready work with your client, their family, and the wider professional team to create a bespoke care plan. Our in-house nurses sign-off each assessment individually, with your client taking a key role in choosing the care that suits them or their child.

NOBLE LIVE IN CARE

As National Live-In Care provider, Noble will provide truly personalised care and companionship and will be entirely focused on you and your client’s needs. Work with both funded and private pay clients. we support with long term, respite, rehabilitation, and end of life care needs for people from the age of 18. We have access to an expert team made of over 50 of registered nurses and governance experts, supported by their own dedicated Local Care Manager and a digital care platform. ■

FIND OUT MORE

Not sure who to contact? No problem. Our complex care hub in Telford are ready to take your call and direct you to the most appropriate team for your client. We’re happy to talk through any questions you have and help get your client the support they need. Call us today on 0330 121 5301 and quote B&SI. Web: www.candchealthcare.co.uk

Get a local focus with Advantage Healthcare

Get a local focus with Advantage Healthcare

Work with one of our local care service managers today to get an assessment of your client’s needs and a bespoke support package.

Work with one of our local care service managers today to get an assessment of your client’s needs and a bespoke support package.

Speak to our team to find out more about your local regional contact:

Speak to our team to find out more about your local regional contact:

West Midlands: 01952 278 291

West Midlands: 01952 278 291

Nottingham: 01623 727 660

Nottingham: 01623 727 660

North West: 01706 759 511

North West: 01706 759 511

Cardiff: 029 2192 1620

Cardiff: 029 2192 1620

London: 020 8256 1990

London: 020 8256 1990

Hove: 01273 121 518

Hove: 01273 121 518

Colchester: 01206 228 333

Colchester: 01206 228 333 advantagehealthcare.com

They’re an important part of every aspect of my life. Whatever independence I have, it is facilitated by my team.

They’re an important part of every aspect of my life. Whatever independence I have, it is facilitated by my team.

Get your client’s care package off to the perfect start.

Get your client’s care package off to the perfect start.

Our vastly experienced team of management staff are all passionate about providing the best care possible to people in their own homes.

Our vastly experienced team of management staff are all passionate about providing the best care possible to people in their own homes. Contact us today to get the best outcome for your client: 0333 121 5301 referrals@totalcommunitycare.co.uk

Contact us today to get the best outcome for your client: 0333 121 5301 referrals@totalcommunitycare.co.uk

Working together to bring clients peace of mind

Working together to bring clients peace of mind

We enable individuals to overcome or manage life changing injuries and health conditions by providing adult and paediatric services, support from hospital to home and specific services for those living with:

We enable individuals to overcome or manage life changing injuries and health conditions by providing adult and paediatric services, support from hospital to home and specific services for those living with:

9 Spinal cord injury

9 Spinal cord injury

9 Acquired brain injury

9 Acquired brain injury

9 Respiratory requirements

9 Respiratory requirements

9 Cerebral palsy

9 Cerebral palsy

9 Stroke (CVA)

9 Other neurological conditions

9 Other neurological conditions

Contact our team today to find out more

Call: 0333 121 5301

Call: 0333 121 5301

Visit: completecare.co.uk

Imagine life with 24/7 care and support in your own home – living life your way to your schedule, out socially, at work and on holiday.

Imagine life with 24/7 care and support in your own home – living life your way to your schedule, out socially, at work and on holiday.

Imagine the possibilities!

Imagine the possibilities!

We support older people, adults with long-term health conditions, physical disabilities and learning disabilities nationally. We offer long-term, respite, palliative and end of life care. With our help, you can live a full, independent life at home. to find out what’s possible

Call

possible

B&SI adverts 2023 - V1.indd 1 05/05/2023 08:28:23 69 2023/24 sevenstarmedia.co.uk COMPLEX CARE

“Thanks to Noble I’moutandaboutforthe firsttimeinyears.”

Rehab, Respite & Rock’n’Roll SUPPORTING CLIENTS TO ACHIEVE THEIR GOALS

festivals. In more recent years, we have developed our service even further to enable us to support clients on these trips, which includes extensive research, planning and preparation.

Our reputation amongst various professionals has grown, and we are renowned for providing bespoke, rehab-based care and support packages throughout England & Wales, for individuals who have sustained an acquired brain, spinal or other life changing injury. Our packages can range from 24/7, 2:1 support, to a few hours each week. Steps Ahead now have a Clinical Lead, meaning we can offer care and support to clients with more complex needs.

One of our main aims is to promote independence and to safely reduce the level of input we provide. We do this in a structured, progressive and safe way, which is always guided by clients and their ability, as well as the wider MDT. We work with clients to enable them to achieve their goals and aspirations and love to celebrate our clients achieving their goals, regardless of how big or small each goal is considered.

As Steps Ahead focuses on completely individualised and tailored care and support, making sure that our recruitment reflects this is paramount to what we do. One of the most important things to us is that we work with our clients to develop a bespoke and committed team. We always take into consideration personality, interests and rehabilitation goals to ensure our clients have fulfilling working relationships with their Rehabilitation Assistants.

FESTIVAL FUN

Recently, a client’s mum approached us to help arrange the trip of a lifetime for her son to Download Festival. An incredible amount of planning behind the scenes went into the trip, from finding accessible, and appropriate, camping (not as easy as it sounds!) to writing countless risk assessments, and arranging VIP viewing, although our client ended up in the main crowd anyway! Through sheer determination and an incredible team, we made this happen for our client and his family and we enjoyed every second of making their dream come true!

Steps Ahead have provided me with a few different Rehab Assistants over the years, both for care at my home and for holiday trips I’ve been on. Thankfully, they continue to support me for holiday trips away, which I’m extremely grateful for, so thank you Steps Ahead

FORMER CLIENT

EXPERIENCES FOR EVERYONE

Over the years, we have had people who don’t receive support from us approach us to deliver this service. Making sure that we inject fun into any client’s rehab journey is central to what we do– we believe this is what keeps clients engaged and aids motivation to make every journey a success.

Whether a client or not, we will work tirelessly to make anyone’s goal a reality. ■

HQ: 01752 547257

We understand that for a lot of clients, it may be more difficult to access holidays abroad, staycations or gigs and

Email: admin@stepsaheadsupport.co.uk

Web: www.stepsaheadsupport.co.uk

Since 2009, Steps Ahead continuously evolves to ensure we are always meeting the needs of our clients

Superior Healthcare: THE ROAD ACCIDENT THAT CHANGED EVERYTHING

Superior Healthcare was born out of personal experience. In 2001, our founders, Stewart Thorp and his father Charles, had their world turned upside down. Stewart’s brother and Charles’ son, Alex, was knocked from his bicycle whilst cycling along a country lane by a driver using his phone.

Alex suffered a severe head trauma and was placed on life support. Upon waking, he went through an intensive period of recovery and rehabilitation before returning home. Stewart and Charles gained first-hand experience in providing complex care at home as they had to adjust their lives to suit the needs of a family member with an acquired brain injury.

Together with Sarah Richards (the registered nurse assigned to Alex) they identified the need for a specialised care service that would close the gap between independent care providers and national organisations – soon after, Superior Healthcare was brought into existence.

Having had personal experience of delivering complex care in a family home, we know what it’s like to find a care team that’s a great match. We understand how significant the relationships between families and care teams are, and we focus on matching carers who don’t just have the relevant clinical skills - but who have the mindset and personality to fit seamlessly into the home too.

When it comes to competency and experience, carers will vary. Therefore, it’s of utmost importance that our care teams are provided with correct, up-todate training. Because of this, we ensure all our staff are trained to the highest level with our courses mapped to the Care Certificate. We manage this by providing our own in-house training conducted by experienced

care for a

nurse educators and trainers. In addition to classroom-based learning, Superior Healthcare ensures team members complete shadow shifts while receiving support and mentorship from Nurse Managers and Field Care Supervisors. Superior Healthcare’s additional and specialist courses are always CPD accredited.

As we’ve been through the unexpected and the unknown ourselves, we understand the challenges and uncertainty that come with finding the right complex care for a loved one. It’s for this reason we provide a nurse-led service, with experienced nurse managers overseeing our packages, managing all areas of our clients’ care and giving support to both clients and care teams.

Knowing the right carers and nurses are by our clients’ sides really does make all the difference. For us, it’s personal. ■

Contact: Superior Healthcare

Tel: 01227 774873

Email: care@superiorhealthcare.co.uk

Web: www.superiorhealthcare.co.uk

As we’ve been through the unexpected and the unknown ourselves, we understand the challenges and uncertainty that come with finding the right complex

loved one.

MAPLEWOOD INDEPENDENT LIVING BESPOKE CASE MANAGEMENT, SPECIALIST CARE & SUPPORT

Maplewood Independent Living creates bespoke rehabilitation and enrichment options and services for individuals in your community. Our goal is to facilitate positive outcomes for those who have suffered life altering injuries.

We genuinely believe that all people should lead as fulfilling and independent a life as possible, which is made a reality with the right support in place.

Every aspect of what we do is undertaken in a personcentred way and all case managers, care and support staff are matched to the individual as no two people are the same. Our multidisciplinary approach is second to none and ensures each individual fulfils their needs and aspirations.

It is our belief that mental health is just as important as physical wellbeing, and we recognise the important link between the two.

We provide case management, clinical assessment and input, rehabilitation, care and support services, including palliative care, to both adults and children who suffer from complex needs, such as those arising from an acquired injury, inherited condition, other life limiting condition or following surgery, for example:

Brain Injuries Spinal Injuries

Cerebral Palsy Motor Neurone Disease

Multiple Sclerosis Multi-Sensory Impairment

Stroke Amputations

Orthopaedic Injuries

Multiple Complex Injuries

Mental Health Clinical Negligence

A bespoke and comprehensive service is provided from initial assessment, planning and management, through to the ongoing rehabilitation and day to day care and support, and encompassing all steps in between; whether for a determined recovery period or lifelong.

We manage all aspects of the case management, care and support under cover of a case manager, CQC registered branch manager and the care and support teams and we work seamlessly with multidisciplinary teams where necessary.

Management, recruitment, training, supervision and compliance are all undertaken in house, so everything is in one place ensuring our high standards and continuity of service are maintained.

We have over 25 years’ experience, are CQC registered, and all staff are enhanced DBS checked and undergo regular and comprehensive training and assessments. We pride ourselves on the high standards we consistently deliver to those we support. ■

CASE MANAGEMENT SERVICES

We provide high quality tailored case management, care and support services across Essex, Su olk, Hertfordshire and Cambridgeshire from our o ces in Great Dunmow and Bury St Edmund's.

Bespoke Specialist Case Management, Care & Support Services

Brain Injuries, Cerebral Palsy, Multiple Sclerosis, Stroke, Orthopaedic Injuries, Mental Health, Spinal Injuries, Motor Neurone Disease, Multi-Sensory Impairment, Amputations, Multiple Complex Injuries & Clinical Negligence

Person Centred Support Tailored to Individual Requirements

Complete In House Service-Case Management, Care Management, Care & Support

Skilled, Dedicated & Reliable Management & Support Team

01371 877707 or 01284 634114

Basic Home Help through to Complex Care

Complete Service including Tailored Reports

Consistently High Standards with Over 25 Years' Experience

CQC Registered

All Sta Enhanced DBS Checked

Comprehensive Sta Training & Assessments

Annual Leave and Sickness Cover to maintain Continuity of Service

Promoting Independence

info.essex@maplewood.org.uk or info.su olk@maplewood.org.uk

www.maplewood.org.uk

Bathroom Adaptation Benefits FOR SPINAL INJURY CLIENTS

If you work with clients disabled due to a brain or spinal injury or illness, a bathroom adaptation can greatly improve their life quality and independence.

With the wide range of assisted bathroom products now available and the technical expertise of specialist bathroom adaptation companies such as EA Mobility, clients can continue to enjoy the comfort and familiarity of their own home.

For people with limited mobility, an accessible bathroom is essential. Here are some examples of what it means in practice:

A wash handbasin plus a smart toilet help with independent care of basic hygiene needs. A level access shower or wet room give wheelchair access to the shower area while a nursing bench or a body dryer are useful for drying and dressing afterwards.

ENABLING & RESTORING

CLIENT’S INDEPENDENCE

EA Mobility is a nationwide provider of accessible bathrooms, kitchens, and home adaptations, operating within the care sector. Typically, adaptations are carried out by general contractors whose expertise aren’t specifically tailored to dealing with those with bit extra to ensure that care goals are met, and clients’ experience is

Our mission is to ‘enable and restore independance’ and we understand that the whole customer journey requires an empathetic approach right from the initial concept through to completion.

A bath lift will enable clients to get in and out of the bath without assistance and can be easily fitted to an existing bath.

Having a walk-in or assisted bath supports more complex care needs.

Features like slip-resistant flooring, a shower seat, grab rails and automatic night light enhance safety and reduce accidents.

Bathing can become less of a chore and more of an opportunity to relax and enjoy good, regular hygiene. This can have a positive effect on mental well-being as well as physical health enabling clients to bathe or shower whenever they want or need to, without trying to fit around the carer’s schedule.

The best bathroom adaptation will depend on clients’ preferences combined with medical advice from case managers or occupational therapists. Choose a provider that can create a bespoke client-centered solution and give you professional and unbiased advice, rather than being focussed on selling specific off the shelf products. ■

Employed installation workforce

EA Mobility directly employs all our installers to ensure everyone is trained to a high standard to deliver a first-class quality service to our clients.

Fast lead times

EA Mobility work to a 4–6-week lead time from signed order to commence our projects.

Expert advice and project ownership

We dedicate a project manager to every project, regardless of the size to ensure that communication is at its highest level with the various stakeholders, such as, OTs, Case Managers and Legal teams.

Rated 4.8 / 5

Live independently with THE SUPPORT YOU DESERVE

We have been recruiting friendly carers and nurses since 2005 and now have a network of more than 50 branches nationwide. We work with a variety of healthcare professionals, legal teams and case managers offering a bespoke service to clients requiring visiting care, Live-in care, night support, 24-hour care and respite care.

At Nurseplus Care at home, we understand these challenges; our experience and expertise can help provide the care and support you and your family require during these changing times.

The flexibility of Care at home and one-to-one companionship is designed to enable you to live safely and independently in the comfort of your own home. We will work closely with you and your loved ones to create a tailored support plan that fits your health and lifestyle needs. We handpick your carers, so that you can genuinely connect with your support team who will make sure you’re able to continue doing all things you love.

We aim to empower clients with full control over their support plans

We aim to empower clients with full control over their support plans. Together, we can build a schedule that enables our clients to live a full and independent life at home. ■

Sustaining a brain or spinal injury can be a life changing and often daunting process requiring major adjustment for all of those involved. Returning to your home from hospital can provide many physical and mental challenges.

There’s no place like home

There's no place like home

Whether you are looking for care for yourself, or you are a case manager, medical professional, or family member, you may need to find care for someone who is recovering from a life changing accident or someone living with a long-term condition.

Whether you are looking for care for yourself, or you are a case medical professional, or family member, you may need to find someone who is recovering from a life changing accident or someone living with a long-term condition.

Spinal Cord Injury or a Brain Injury has life changing consequences including the hidden impact on mental health for both the person being cared for, and for their families.

ALianna Harris Project & Marketing Administrator for Eximius

Whether you are looking for care for yourself , or a person you are supporting, Eximius is a safe alternative to a nursing home, or rehabilitation centre, and allows you to stay living comfortably within your own home.

Eximius was founded in 2016 and is an OUTSTANDING provider of 24hr Live in Care. Eximius offers a bespoke complex care solution that is fully tailored to your lifestyle. Our dedicated team of carers enable people living with a spinal cord injury, or long term condition, to remain living independently and safely, in their own homes, surrounded by their own comforts & memories, whilst safely being supported to do so.

ASpinal Cord Injury or a Brain Injury has life changing consequences including the hidden impact on mental health

exceptionally managed service will always go above and beyond to meet the needs of our clients.

Putting the right care in place is paramount for helping people return to the highest level of function and independence as possible. We believe person-centered care should be at the core of everything we do.

for both the person being cared for, and for their families.

We have an experienced and fully qualified team, so you can be confident you, or someone you’re supporting, are always in safe hands.

Whether you are looking for care for yourself , or a person you are supporting, Eximius is a safe alternative to a nursing home, or rehabilitation centre, and allows you to stay living comfortably within your own home.

Eximius was founded in 2016 and is an OUTSTANDING provider of 24hr Live in Care. Eximius offers a bespoke complex care solution that is fully tailored to your lifestyle. Our dedicated team of carers enable people living with a spinal cord injury, or long term condition, to remain living independently and safely, in their own homes, surrounded by their own comforts & memories, whilst safely being supported to do so.

Our carers understand how much of a huge impact a B&SI can have on a persons physical, emotional & mental wellbeing, which is why the level of support each individual receives, must be specific to their own needs and the reason we provide our bespoke service. This allows all individual’s living with a B&SI to thrive in their own environment which is safe, accessible and familiar. This also ensures overall benefits such as continuity, privacy, as well as a boost in confidence, thus enabling their own positive, mental wellbeing being fully met. Our service users have stated that by keeping the same routines and daily structure, with the support of a carer, they have still been able to fulfill their wishes and desires, ever since sustaining their long term injuries.

Every complex need is different so we always ensure to provide a fully tailored service, with the individual at the heart of their care. We’re here to support our clients and to offer a solution to people living with a complex care need, so they can still live life to the full, despite their injuries or condition. Our

Our carers understand how much of a huge impact a B&SI can have on a persons physical, emotional & mental wellbeing, which is why the level of support each individual receives, must be specific to their own needs and the reason we provide our bespoke service. This allows all individual's living with a B&SI to thrive in their own environment which is safe, accessible and familiar. This also ensures overall benefits such as continuity, privacy, as well as a boost in confidence, thus enabling their own positive, mental wellbeing being fully met. Our service users have stated that by keeping the same routines and daily structure, with the support of a carer, they have still been able to fulfill their wishes and desires, ever since sustaining their long term injuries.

Every complex need is different so we to provide a fully tailored service, with at the heart of their care. We're here clients and to offer a solution to people complex care need, so they can still live despite their injuries or condition Our managed service will always go above meet the needs of our clients.

WHY CHOOSE EXIMIUS?

SPACE FOR IMAG E

Eximius is a NATIONWIDE company providing exceptional 24 hour Live-in care & we have been rated ‘OUTSTANDING’ by the CQC.

NOTE: Placement and size will at the designers discresion.

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We have been providing care to clients with a brain or spinal injury since 2016 and are only one of 5% of care providers in the UK to have been rated outstanding, which we are all incredibly proud of.

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Eximius Live-in Support Ltd is also a proud trusted partner of the Spinal Injuries Association and we work closely with the organization to continually develop our service, which gives ongoing support to our users.

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Eximius has access to a private GP and an in-house Clinical Lead, this ensures the care we offer is always of the highest standard and gives our clients, and their families, full peace of mind that our clients are receiving the highest quality of care, all in the comfort of their own homes. ■

Putting the rig is paramount fo people return level of function independence believe person should be at the everything we We have an expe fully qualified be confident y you're support in safe hands.

Why choose

Eximius is a N company providing 24 hour Live-in been rated 'OUTSTANDING' the CQC.

We have been providing clients with a brain injury since 2016 one of 5% of care the UK to have outstanding, which incredibly proud

Eximius always go that extra mile to make my life more enjoyable

Tel: 01494 424222 or: 020 3794 9933

Web: www.eximiussupport.uk

Eximius Live-in Support Ltd is proud trusted partner of the Spinal Injuries Association and we work closely with the organization to continually develop our service, gives ongoing support to our Eximius has access to a private GP and an in-house Clinical Lead, this we offer is always of the highest standard and gives our clients, and peace of mind that our clients are receiving the highest quality of care comfort of their own homes. ■

Email: info@eximiussupport.uk

424222

794 9933

Eximius always go that extra mile to make my life more enjoyable.

Linna Harris, Project & Marketing Administrator for Eximius

Supporting individuals to remain living in their home with a Neurological condition or Spinal injury.

Eximius live-in care is a bespoke complex care solution that is tailored to your lifestyle. For many people who need complex care support, being in your own home is crucial to your own well-being as you can continue to keep your chosen routines and schedules.

We are a nationwide 24-hour provider of live-in care, rated Outstanding for caring by CQC.

At Eximius, we provide highly trained, dedicated carers for those individuals recovering from a life changing accident or living with a long-term condition so they can remain safely in their own homes, surrounded by their own comforts and familiar routines. Whether you are a Case Manager, Health Professional, family member or anyone looking for clinical care at home, then please get in contact today, to see if we’re the right care solution for you.

Our dedicated team can support you with:

■ Liaising with health professionals and discharge teams to ensure a comprehensive care plan is in place prior to the discharge

■ Work with physios, OT’s and community nurses to ensure that rehabilitation and physical development plans are adhered to

■ Manage all aspects of daily care including personal care, medication, peg feeding and bowel management

Our fully trained carers are fully trained in the areas of:

■ Acquired brain injury and neurological conditions

■ Autonomic Dysreflexia

■ Bowel Management

■ Continence care, including Catheter care and Bladder wash

■ Emotional and Mental Health changes

■ Medication and administration

■ Paralegia and Tetraplegia

■ PEG tube, or nasogastric feeding

■ Pain Management

■ Respiratory Care (Including Tracheostomy and Ventilation)

■ Tissue Viability

Eximius Live-in Support will create a bespoke daily care plan, based on the individual’s needs, providing both physical and emotional support. Our carers are fully vetted and recruited in-house by our Recruitment team and trained by our In-house Training Manager, alongside a Specialist Nurse who carries out practical sessions of Bowel Management, which is then managed by our team of Complex Supervisors so you can be sure that you are receiving exceptional care, all in the comfort of your own home.

Call us today for a confidential chat to see how we can support you to live your life, exactly the way you want.

Delivering hope and help to those WITH COMPLEX NEEDS

Active Care Group (ACG) is a complex care provider operating neurological rehabilitation services, and delivering hope to individuals like Tony, who have suffered devastating injuries

Our multi award-winning teams achieve life-changing, evidence-based outcomes for adults with neurological conditions resulting from injury, illness, or disease. Our services specialise in brain injury rehabilitation, neurobehavioural rehabilitation, and spinal injury rehabilitation – aiming to maximise independence and equip service users to return home or to a supported living environment.

Tony, father to young twins, was left frustrated with the lack of progress he was making in his neuro-rehab following his motorcross accident in February 2022. Tony was in hospital for 8 months after the incident and was transferred to a specialist spinal unit mid-way through, but it was only after his discharge that the real gains came.

TONY MAKEPEACE, SPINAL CORD INJURY PATIENT, MARCH 2023

It was only when his partner, Louise, researched neurorehab options to support Tony’s journey to rebuild his life, did she come across Neural Pathways - ACG’s specialist centre in Gateshead which has delivered life-changing outcomes for people after neurological injury and illness since 2003.

“I thought when I left hospital that this was me done, I thought this was my life. I couldn’t transfer independently, and I felt like I was totally reliant on other people.”

“Coming to Neural Pathways has genuinely changed my life. The progress I have made here in a few months has given me hope again for the future.”

Neural Pathways used the ExoMotusTM M4 – a lower limb robotic device supporting the rehabilitation of patients with spinal cord injuries and lower limb impairments – to support Tony’s rehab. The exoskeleton is one of only two robots in Europe which enables people who cannot walk to perform routine functions like standing, walking on level surface, and walking on mildly sloped surfaces.

“Using that was life-changing for me because I hadn’t walked for a year at that point. Being able to stand again, to have that standing position where you can look directly at people, to feel your feet hitting the floor, was just amazing. The mental side of that for me was massive.”

All Active Care Group facilities, including Neural Pathways, are goal-focused, developing rehabilitation programmes that are tailored to individuals like Tony, and delivered by highly qualified practitioners. Our teams include nurses, physiotherapists, occupational therapists, speech and language therapists, clinical psychologists, social workers, GPs, and consultants.

The clinical teams are fully supported by rehabilitation assistants and technicians, administrators, housekeeping and catering staff, and a maintenance team. Our teams work closely together to ensure that every team member is working towards the same practical, clearly defined, agreed goals and that all therapies are focused on the areas that will enable patients to achieve them, so others like Tony have the best chances of re-establishing their lives after injury. ■

Find out how we can help you and your loved ones achieve their own goals by calling:

01732 779353 or emailing referrrals@activecaregroup.co.uk Web: www.activecaregroup.co.uk

I’m on cloud 9! Just when I had lost all hope this happened!

I never thought I would experience the feeling of walking again but 30 minutes in the device and my legs feel like they used to after riding my motorcross bike for 20 minutes.

Without Active Care Group I wouldn’t have made the remarkable recovery I have. They have supported me every step of the way, helping me to recover and get better until I was ready to return home. I honestly can’t thank them enough.

Robert Service User

We're specialists in care and believers in people. We make sure people requiring rehabilitation are surrounded by the collaborative, holistic and expert care and therapy they need to achieve maximum recovery potential and a brighter future.

01732 779353

referrals@activecaregroup.co.uk

activecaregroup.co.uk

The care and support I receive from Active Care Group allows me to live the best life possible. I started off in a specialist rehab facility and eventually moved back home with a full-time live-in carer to help me with my daily needs. It’s the best support I could have possibly asked for!

Graham Service User

We're specialists in care and believers in people. We make sure people with complex needs are surrounded by the collaborative, holistic and expert care they need and the kindness they deserve to live a brighter future.

01732 779353

Jane James and Associates, Expert Witness Reporting FOR OVER 35 YEARS

We are an independent expert witness company producing highly regarded clinical negligence & personal injury reports for the Court, for over 35 years.

As an independent expert witness reporting company, we provide professional reports in the fields of clinical negligence and personal injury.

We work with both claimant and defendant legal representatives. Our associates are highly experienced clinicians.

Our quantum reports are succinct, robust, easy to read, and clear on costs, and cover injuries including brain, spinal, birth, and orthopaedic, as well as others.

Our liability reports are clear, concise, and easy to read, we ensure our experts are provided with training to understand the terminology and phraseology used in liability reporting. We offer liability reports in a range of areas including

general nursing, midwifery, mental health nursing, accident and emergency nursing, practice nursing, manual handling, tissue viability, and care provision including nursing and care homes.

We understand how important it is to build positive relationships with our clients and ensure a smooth process from the initial inquiry to the settlement of the case.

We have received repeat instructions over many years from both claimant and defendant legal representatives, which are a testament to the high regard in which we are held by our clients.

Our team of experts is carefully selected to provide the best combination of expertise, experience, and up-to-date knowledge in their field.

Please visit our website or call the office if you require any further information. Lucinda Lloyd, our Director of Operations, or Catherine Cooper, our Head of Clinical Negligence, would be delighted to discuss the expertise that we have in our team or any of our reports. Please see our contact details below. ■

Is an independent expert witness reporting company.

We have been providing an expert witness service for over 35 years.

We provide professional reports in the fields of clinical negligence & personal injury. We work with both claimant & defendant legal representatives.

Our quantum reports are succinct, robust, easy to read & clear on costs.

Please visit our website or call our office if you require further information.

Somek and Associates’

We have over 25 years’ experience of providing care/occupational therapy, physiotherapy, speech and language therapy, orthotics, prosthetics and dietitics reports for adult and paediatric brain and spinal injury clients.

Our brain and spinal injury experts can:

z Demonstrate advanced knowledge/skills and clinical reasoning within varied disability presentations.

z Provide comprehensive clinical and functional assessments and present recommendations, tailored to the individual client’s condition and consider family lifestyle, educational potential and adult living scenarios.

z Critically appraise evidence within the context of their own assessment findings and clinical experience, and provide robust opinions in relation to quantification of past and future heads of claim.

Our experts are able to provide reports for birth injury, wrongful birth, traumatic brain injury, cognitive dysfunction

and brain and spinal cord injury. All our Somek and Associates experts undergo medico-legal training to ensure they understand CPR and the legal process. We provide continuous professional development; recent judgements are integral to our training to ensure our reports provide an appropriate approach and costs for complex claims. To ensure that our experts continue to have a balanced portfolio we actively seek instructions from claimant and defendant solicitors. n

Clinicians play a key role acting as expert witnesses in personal litigation and clinical negligence. We require experienced healthcare professionals specialising in all clinical areas, especially those working in the fields of spinal cord injuries, amputation and elderly care/dementia.

Requirements:

z Self-motivated clinicians with 8 years’ post qualification experience and practicing clinically in a senior role, either within the NHS or private sector

z Registered with HCPC

We offer you:

z Excellent remuneration on a self-employed basis

z Opportunity to subscribe to our Annual Training and Resource Package

z Support and training from experienced expert witnesses

Your expert’s report was very in depth and informative and went into great detail in her breakdowns and nothing was left unturned... “

TB4 SeatingQUESTION TIME!

Introducing the all-new TRU-Balance® 4 Power Positioning Systems comes with anterior tilt. Offering a choice of 10, 20, or 30 degrees of power anterior tilt. This provides optimal access and consumers may find it easier to perform activities of daily living, such as accessing sinks, grooming, reaching items in cupboards, doing the housework and so much more.

So what it is all about? Here we have shared some of the most frequently asked questions about the new product!

WHAT IS ANTERIOR TILT?

Anterior tilt is a power seating function that changes the angle of the wheelchair seat in the sagittal plane where the rear of the seat is higher than the front. This facilitates an anterior pelvic position and places the person in a partial weightbearing stance. This position may benefit the user medically/physiologically, psychologically, and/or functionally.

HOW CAN ANTERIOR TILT BENEFIT AN INDIVIDUAL MEDICALLY/ PHYSIOLOGICALLY?

Anterior tilt of the pelvis can elongate the spine, open the rib cage and may have a positive impact on respiratory capacity/health.

Anterior tilt may aid in effective chewing, swallowing, digestion, and bowel function, as it can minimise compression of the internal.

Increasing the anterior tilt angle allows greater weight bearing on the long bones of the legs (tibia and femur), which may help slow bone loss.

HOW CAN ANTERIOR TILT BENEFIT AN INDIVIDUAL PSYCHOLOGICALLY?

A neutral to anterior pelvic tilt position facilitates spinal alignment, allowing the head to sit naturally on the cervical spine and minimising the amount of energy expended to maintain a horizontal eye gaze, to promote social interaction.

An upright seated posture can maintain selfesteem, promote a positive mood, and help build resilience to stress.

Alternating between sitting and standing positions increases the release of hormones like serotonin, which is a mood booster.

HOW CAN ANTERIOR TILT BENEFIT AN INDIVIDUAL’S FUNCTIONALITY?

Anterior tilt shifts the individual to the front edge of the wheelchair base, which may allow them to get closer to the tasks they need to carry out.

- Anterior tilt may facilitate safer and/or more independent sit-to-stand and sit/squat-pivot transfers due to the biomechanical position of the individual with the shoulders over the knees over the feet position.

WHAT ARE THE CRITERIA FOR AN INDIVIDUAL TO BE CONSIDERED A CANDIDATE FOR ANTERIOR TILT USE?

The person would benefit from assistance due to impaired trunk control to complete additional. The person has the necessary range of motion in their lower extremities to utilise anterior tilt safely and properly.

The person can tolerate the more upright body posture of the anterior tilt.

The person can tolerate the partial weight bearing the position will place them in. ■

For more information about the TB4 seating and Quantum get in touch:

Quantum Rehab UK

Contact: 01869 324600

Email: sales@quantumrehab.co.uk

Web: www.quantumrehab.co.uk

01869 324600

quantumrehab.co.uk

Vehicle adaptations ENABLING INDEPENDENCE

We’re here for wherever you want to go, with a range of accessible driving aids and vehicle adaptations that will give you the independence you desire.

There’s one purpose at the core of everything we do. And that’s to change lives by improving mobility. We believe everyone should enjoy the freedom which comes from making car travel easy and accessible to all. Which is why we specialise in remarkable innovations for everyday life.

A NEW COMPANY WITH A LONG HISTORY

Mobility in Motion was created to expand the range of driving aids and vehicle adaptations available for people with a disability, no matter how complex their needs. To meet these needs, we are now able to offer a marketleading range of products.

Although a relatively new company, we’re part of a long-established group which has been designing and manufacturing vehicle adaptations for over 40 years. So, when it comes to meeting the needs of disabled drivers, you can be sure you’re in the safest hands.

Independence is at the heart of our company’s story. Both Autochair and Brig-Ayd were created out of the desire to help people lead independent lives – without relying on other people to get around.

Independence is at the heart of our company’s story

TO THE ENDS OF THE EARTH. OR JUST TO THE SHOPS

Access to a vehicle is so important – keeping your life open and full of possibilities. But when you struggle with mobility, it can be hard to maintain an active lifestyle outside the home.

Our wheelchair stowage solutions make easy work of loading and unloading a wheelchair, mobility scooter or powerchair into your vehicle – all at the touch of a button.

We offer a full suite of driving aids including hand controls, pedal adaptations, remote control devices, steering aids and much more, allowing you to regain and retain your independence behind the driver’s wheel.

Drivers and passengers with reduced mobility can be seated with ease from a wheelchair or scooter by making use of our person lift, transfer plate and swivel seat adaptations.

With a network of nationwide installers, we come to you and fit the products in your vehicle quickly and securely – and if you need any support after installation, we’re always here to help. ■

We offer a full suite of driving aids including hand controls, pedal adaptations, remote control devices, steering aids and much more, allowing you to regain and retain your independence behind the driver’s wheel.

Brotherwood KLASTAR WAV CONVERSION

When Steven was searching for a new Wheelchair Accessible Vehicle with the style to match its’ practicality, one model proved to be a clear favourite – the Brotherwood Klastar WAV conversion for the Mercedes-Benz V-Class.

With its’ flat, level lowered floor conversion, seamlessly blended with the high-quality interior of the MercedesBenz V-Class, the Klastar conversion provides effortless access, whilst maintaining the stunning interior and exterior appearance and kerb appeal that drew Steven to the V-Class model initially.

STYLISH & PRACTICAL

Steven writes: “I’ve always been a fan of Mercedes-Benz and this particular model, it’s a very smart looking wheelchair van. I especially like the electric boot, ramp and winch system, making like a lot easier for me and whoever’s taking me out in it. I like to get out and about when I can, going to the football, pub, or cinema. I found Brotherwood online, and have to say from day one they have been extremely helpful and professional, constantly giving me updates on vehicle progress up to it being delivered.

I would highly recommend them as a company and the Mercedes-Benz V-Class if you’re looking for a smart, stylish accessible vehicle.”

The new Mercedes-Benz V-Class is packed with features that make every journey better for Steven – from the panoramic double-panel glass roof that floods the interior with light, to the refrigerated centre console with temperature-controlled cup holders, and the Smartphone Integration pack which connects Steven’s phone to the incredible 15-speaker Burmester Surround Sound system.

Externally, the AMG-Line package with 19”AMG alloy wheels ensures Steven’s WAV is as stylish as it is practical – and means no compromise has to be made on quality when providing the accessibility and comfort that Steven needs.

ENGINEERED TO ENABLE

The Brotherwood lowered floor conversion ensures that Steven can travel centrally, for an inclusive journey with friends and family – with a better view out of the windows and windscreen, and a lower centre of gravity providing a more comfortable ride – especially important for wheelchair users with spinal injury.

Brotherwood are one of the UK’s leading Wheelchair Accessible Vehicle (WAV) conversion specialists.

Established in 1985, Brotherwood WAVs are renowned for their comfort, inclusion, safety, and ease of use for wheelchair users and carers alike. Every Brotherwood conversion features a flat, level lowered floor, which provides several ergonomic and social benefits for the wheelchair user.

Brotherwood serve clients across the UK, carrying out free home demonstrations nationwide and working alongside Occupational Therapists and Case Managers to deliver successful outcomes for wheelchair users looking for comfortable, inclusive and safe transport that fits their needs and lifestyle. ■

For more information and to arrange a free, noobligation home demonstration, contact Brotherwood today on: 0330 1747 549 Web: www.brotherwood.com

I would highly recommend them as a company and the Mercedes-Benz V-Class if you’re looking for a smart, stylish accessible vehicle

Advancements in Power Add-on TECHNOLOGY FOR WHEELCHAIRS

Numerous studies associate increased engagement in the community with improved quality of life. Increased time spent outdoors also has also been shown to positively impact overall health and wellbeing.

Motorised wheels such as the WheelDrives or the E-Motion Duo replace a standard drive wheel. The quick release wheels provide powered assistance with each push, guided by sensors embedded under the push rim. They each offer a version of cruise control whereby the occupant can be propelled a great distance without ever needing to complete a full circular push. With battery ranges starting from 10 miles users can be confident that pushing fatigue isn’t going to limit them.

For people with reduced hand dexterity, Rehasense’s Power Assisted Wheelchair System (PAWS) handbike and Blumill handbike automatically connect to the wheelbase with the push of a button. Another alternative might be a joystick-controlled option like the Benoit Light Drive or E-Fix.

For those with mobility issues, accessing these benefits often comes with added difficulty. For manual wheelchair users, uneven terrain can be difficult to navigate. Using a powered wheelchair does give heightened outdoor performance but they might not suit an individual lifestyle - wheelbases are heavier and may be unsuitable for transport in an unmodified vehicle.

In an effort to bridge this accessibility gap, powered add-on technology is one of the fastest developing areas of mobility equipment. Powered add-ons allow individuals to reap the benefits of their manual wheelchair’s lightweight, compact footprint with the flexibility to recruit the benefits of a powered chair when needed. Typically, a device is affixed to the front or back of a wheelbase or within the drive wheels themselves.

Accessing public spaces with gravel paths or grassy areas can be troublesome in a manual wheelchair as the small caster wheels are likely to get stuck. Front mounted powered add-ons raise the caster wheels off of the ground and make use of a larger, motorised front wheel. The larger front wheel doesn’t sink into soft ground or get caught in rough surfaces so easily and the motors assist in navigating steep inclines or rough ground.

Amongst the wheelchair community, it is not uncommon for individuals to experience Musculoskeletal difficulties. In particular, manual wheelchair users are at significantly higher risk of rotator cuff and wrist injuries which can leave individuals feeling as though they have no choice but to limit their daily activities to preserve energy or prevent injury.

A study from 2020 found that users of powered add on devices increased their daily activity and engagement with family and friends.

A study from 2020 found that users of powered add on devices increased their daily activity and engagement with family and friends. It was also reported that individuals were more likely to take up hobbies due to their increased confidence of their own and the chairs performance whilst using powered add-ons.

Advances in add on technology are increasing independence and quality of life for many who previously fell into the accessibility gap. ■

Jordan Davies (BSc, IPEM), Rehabilitation Engineer at Wheelfreedom.

PRESCRIPTIVE

PRESCRIPTIVE

PRESCRIPTIVE MOBILITY SPECIALISTS

specialists, Wheelfreedom, have supplying prescriptive equipment for years. Products include:

Wheelfreedom, have prescriptive equipment for Products include:

Mobility specialists, Wheelfreedom, have been supplying prescriptive equipment for over 15 years. Products include:

Wheelchairs

Powerchairs

Powerchairs

Paediatrics

Specialist seating

seating add-ons

Specialist seating

Power add-ons

One-to-one assessments are held at their leading showroom in London to tailored solutions. Services include mapping, custom-made seating

assessments are held at their showroom in London to solutions. Services include custom-made seating controls.

One-to-one assessments are held at their industry leading showroom in London to provide tailored solutions. Services include pressure mapping, custom-made seating and special controls.

Wheelfreedom are CPD accredited to support health professionals and Occupational Therapists. Gain 3 CPD points as you learn about the latest innovations in Wheeled Mobility at their showroom in London.

Wheeled

Wheelfreedom are CPD accredited to support health professionals and Occupational Therapists. Gain 3 CPD points as you learn about the latest innovations in Wheeled Mobility at their showroom in London.

012 1126

Wheelfreedom are CPD accredited to support health professionals and Occupational Therapists. Gain 3 CPD points as you learn about the latest innovations in Wheeled Mobility at their showroom in London.

FUNCTIONAL ELECTRICAL STIMULATION (FES) for correction of dropped foot

FES is increasingly being seen as a first line intervention to improve the mobility of people with neurological disability. Paul Taylor has pioneered its use within the NHS.

Dropped foot is the inability to lift the foot as the leg swings forward when walking. It is caused by weakness in the muscles that lift the foot and/or excessive activity (spasticity) in the antagonist muscles. Dropped foot increases the risk of falls, reduces mobility and participation in activities of daily living.

WHAT IS FES AND HOW DOES IT WORK?

Functional Electrical Stimulation (FES) is the production of functional movement in paralysed or weak muscles by the application of small pulses of electrical current to the nerves that supply them. The Odstock Dropped Foot Stimulator (ODFS®) Pace was developed at Salisbury District Hospital. It stimulates the common peroneal nerve at its most superficial point where it passes the head of fibula, using self-adhesive skin electrodes. Stimulation is timed to the walking cycle by using a pressure switch placed in the shoe under the heel. Stimulation begins when the heel is lifted from the ground and ends just after heel strike. Stimulation causes the foot to lift and stabilises the ankle when it is returned to the ground. Stimulation feels like pins and needles and most people quickly become used to the sensation.

to stroke, spinal cord injury, Parkinson’s and some people with MS. It can also be used in early gait re-education to help facilitate a normal gait pattern, including the retraining of knee and hip control. Because FES can reduce spasticity though activation of reciprocal inhibition, it is often a more effective mobility intervention than passive orthotics and can enable greater range of movement.

THE MAIN EFFECTS OF THE ODFS® PACE (FES DEVICE) ARE:

Increased safety due to reduced tripping and increased stability in stance, reducing falls by 72 % Increased walking speed, functional ambulation category and distance range Reduced effort of walking Greater confidence, independence and quality of life

The ODFS® Pace is a practical device with adherence to treatment at one year of 86%. FES can be used to assist walking in any neurological condition resultant from an upper motor-neuron lesion (lesion within the brain or spinal cord above T12). This includes stroke, MS, spinal cord injury, traumatic brain injury, cerebral palsy, hereditary spastic paraplegia and Parkinson’s disease.

FES for correction of dropped foot is a recommended treatment in NICE guidelines IPG278 and ACPIN Clinical Practice Guidelines.

OML provide training courses for clinicians wishing to use FES in their clinical practice. Please visit our website for further details ■

The ODFS® Pace is primarily used as a long-term assistive device. However, therapeutic training benefit has been demonstrated in people who have a dropped foot due

I have been using a single channel stimulator for foot drop, due to MS, for 5 years. I wear it every day and it has allowed me to carry on working full-time. It is the single most helpful thing in this journey as a patient, and has allowed me to remain as active as possible.

Paul Taylor

Looking to become more independent and confident by reducing falls and trips and making walking less of an effort while living with the effects of brain or spinal cord injury?

91% of FES users report a reduction in the incidence of falls after using FES.

Functional Electrical Stimulation (FES) restores and improves movement to assist with walking, grasping, shoulder or bowel function leading to improvements in daily living activities, quality of life and reduced pain.

FES is a treatment which involves applying small electrical pulses to the nerve, activating the muscle which has become weakened due to a neurological condition.

Odstock Medical Ltd (OML) is the leading provider of FES treatment and equipment to the NHS.

What our FES patients say...

I do wear it (FES device) quite a lot and it’s the difference for me of just shuffling to the shops and back versus regaining my life and going for walks and having really fulfilling family holidays. I like being outside a lot and it helps me to do that as well

11-005-0026

For more information:

Web: www.odstockmedical.com

Email: enquiries@odstockmedical.com

Call: 01722 439540

WHY MANAGE POSTURE?

A wheelchair users very independence can hinge on effective postural management within the wheelchair. Postural management can and does influence:-

Systemic

function (i.e the effect of posture

on all the bodily systems including the cardiovascular system, respiratory system and digestive system).

Ease of propulsion in a manual wheelchair. Ease of access to driving controls in a powered wheelchair. Management of the interface between the wheelchair and other equipment of daily living.

Access to and completion of all activities of daily living inclusive of personal care, work/ education and leisure activities.

Access to communication and other assistive technology devices such as environmental controls.

Lucy Weech is the Clinical Director leading the Wheel of Health team based throughout the UK and Ireland. The team consists of 17 Clinical Associates who all have extensive post graduate experience in the postural management of complex clients. Presentations range from physical disability following trauma to those with profound and multiple learning difficulties. These clients frequently present either during the litigation process or post settlement. All Clinical Associates manage a highly complex caseload of children and adults. Within this role, clincians complete 24hour postural management assessments (including medico-legal reports); assessment, prescription and provision of specialist equipment; assessment for provision of wheelchair accessible vehicles; personal care and manual handling assessments.

WHY IS POSTURAL MANAGEMENT SO CRITICAL FOR WHEELCHAIR USERS?

Posture is often seen as static, with the posture presented at assessment identified as being the clients permanent posture, likely to stay that way. But consider how our own posture changes as we age, and our lifestyle changes. How much more so, then, will the postural requirements of wheelchair users change under the influence of rehabilitation, variable and changeable muscle tone, spasticity patterns, behavioural changes and so forth.

HOW DOES A POSTURAL MANAGEMENT SPECIALIST/EXPERT EVALUATE A CLIENT’S NEEDS WHEN ASSESSING?

The first step in an assessment process is to carefully evaluate the client’s physical presentation taking account of deformity, altered muscle tone, spasticity patterns, impaired sensation, effects of trauma and so forth. These findings should be clinically recorded to give a baseline to subsequent problem solving. It is important to evaluate how much correction is achievable for that which is obviously seen. For example, where there is a pelvic asymmetry that is correctable, then any seating solution should seek to correct it. If it is not correctable, then a posture management solution should seek to accommodate it, to reduce the risk of the deformity becoming worse.

HOW DO THE FINDINGS OF THAT EVALUATION INFLUENCE THE SELECTION OF THE MOST APPROPRIATE EQUIPMENT?

Having completed postural analysis and recorded clinical findings in detail, the professional clinician’s responsibility lies in the selection of equipment that is clinically appropriate and addresses issues identified during the assessment process. Features of wheelchairs and posture management equipment informs this process. The professional is therefore responsible for ensuring that they have a good grasp of the features of the equipment and how they affect posture. It is rare to find a single product that will effectively manage

client’s postural needs but rather a range of products used together to reach an effective clinical solution. We consider it of the utmost importance to actively work in direct collaboration with the client, their carers and stakeholders and take a multidisciplinary and holistic approach.

WHICH COMES FIRST; THE WHEELCHAIR OR THE VEHICLE, AND WHY?

It is of paramount importance to “work from the inside, out”. That is to say, that during the process, it is imperative to start with the client and their presenting postural needs, then work “outwards” in the selection of clinically appropriate products. Therefore, posture management products interface into wheelchairs which then interface into vehicles. We are then able to select a suitable vehicle to fit the wheelchair, rather than trying, usually unsuccessfully, to find a clinically appropriate wheelchair to fit the already purchased vehicle. Retrospective adaptations to previously purchased wheelchair accessible vehicles can cost tens of thousands of pounds.

HOW CAN YOU ENSURE THAT EQUIPMENT SELECTED MEETS BOTH THE NEEDS OF THE PRESENT AS WELL AS BEING ABLE TO FUTUREPROOF ONGOING CLINICAL NEEDS?

Competent clinicians need to work with equally competent technical teams and mutual collaboration

Wheel of Health

is of the utmost importance. Equipment suppliers have variable strengths and for wheelchair users who have a full-time dependency on all their equipment require both clinical and technical input that can address those complex needs. Additionally, it is true to say that the clinician needs to be able to crystal ball gaze as much as is possible with regard to the presenting condition (be that positive rehabilitative progress or degenerative progression). Our ethos is to work in direct collaboration with competent equipment suppliers who can provide, maintain and assist in the adjustment of equipment to meet the ongoing clinical changes of our clients. ■

Do you have a client in mind, (or are you the client) that would benefit from a postural management assessment?

Please contact myself or Wheel of Health HQ to discuss further:

Email: info@wheelofhealth.co.uk

Tel: +44 (0) 23 8076 8583

Mob: +44 (0) 78300 72700

Web: www.wheelofhealth.co.uk

» Specialist wheechair, seating and 24hr posture management clinical practice.

» Specialist provider of wheelchair, posture management and allied equipment solutions for adults and children with complex needs.

» Highly specialist and skilled professionals with specialist postgraduate training and expertise.

CONTACT US

Office: +44 (0) 23 8076 8583

Mobile: 078300 72700

Email: info@wheelofhealth.co.uk

Web: www.wheelofhealth.co.uk

Specialists in Wheelchair, Seating & 24hr Posture Management Solutions...

“Opening doors to maximise independence...”

Accessible and Inclusive Environments

Accessible and Inclusive Environments

Removing barriers by design

Removing barriers by design

BUILDING SURVEYING

BUILDING SURVEYING

ARCHITECTURE & DESIGN

ARCHITECTURE & DESIGN

CONTRACT ADMINISTRATION

CONTRACT ADMINISTRATION

PRINCIPAL DESIGNER / CDM

PRINCIPAL DESIGNER / CDM

COST CONSULTANTS

COST CONSULTANTS

EXPERT WITNESS

EXPERT WITNESS

PROPERTY FINDING

PROPERTY FINDING

SUITABILITY REPORTS

SUITABILITY REPORTS

William Martin’s specialist personal injury division comprises senior, experienced accommodation experts who lead a team of architects and designers to provide a service to those requiring a home intended to promote their independence, mobility and rehabilitation.

We have undertaken many successful new build and adaptation schemes including adaptations to temporary accommodation. We are accustomed to working closely with the injured party often in conjunction with their Case Manager, Occupational Therapists and legal team. We are able to offer innovative and bespoke solutions to meet the needs of each client.

Julian Rendall: jrendall@william-martin.co.uk

James Nocker: jpn@william-martin.co.uk

London: 0207 378 5800

Manchester: 0161 457 0336

32 Threadneedle Street, London, EC2R 8AY

3 Hardman Square, Spinningfields

Manchester M3 3EB

www.william-martin.co.uk

Life after traumatic injury can be challenging

Blesma is here for all serving and ex-Service men and women who have experienced loss of limb, use of limbs, hearing, sight or speech, either during or after Service

Get in touch to find out how we can support you and your family info@blesma.org www.blesma.org

Get in touch to find out how we can support you and your family info@blesma.org www.blesma.org

How we help seriously INJURED PEOPLE

Helping individuals at what is often the worst time of their lives and the lives of their family, is something I do not take for granted. I have dedicated my life to working for those whose lives have been forever changed from sustaining a neurological injury.

I see, through my work, the devastating effects of a road traffic collision or an accident at work. This impact is felt not only by the person who has been injured but their loved ones. The consequences of such life changing events are financial, physical, and emotional.

It is important that specialist solicitors, like myself, obtain interim funding at the earliest possible stage to fund in place a package of specialist rehabilitation. This will relieve financial distress, maximise rehabilitation potential, and to enable, as far as is possible, an injured person returning to the lives they enjoyed before they sustained their injury.

accommodation and he was relying on his family to meet his complex health and care needs. It was heart-wrenching meeting this young man and his family for the first time. He had so much potential, but he hadn’t been introduced to therapy, care, or legal experts to facilitate that, which is incredibly important. Fortunately, we worked with a team of specialists to turn around this young man’s life. He has now moved into his own adapted property, with a team of healthcare assistants and a specialist multidisciplinary team. An 8-figure settlement was secured for this young man, which will provide him with lifelong financial security.

I have had the privilege of working with individuals who have sustained severe injuries. For example, in 2023, the team and I settled a legal claim for a young man who sustained a very serious brain injury. At the time, he had a solicitor who did not specialise in acting on behalf of individuals who sustained serious injuries; in fact, his family had previously instructed the solicitor to deal with an immigration issue. The young man had no specialist input, had significant health concerns that were avoidable and easily managed, had no specialist equipment in place, was languishing in inappropriate

Working with experts in their fields is essential as it enables us to fight hard for our clients to deliver for their needs following lifechanging events. This includes working alongside my colleague Fiona Flynn, Rehabilitation Co-Ordinator at Slater and Gordon. When an investigation is needed into circumstances of a collision or accident at work and there is a delay in the insurer releasing funds, Fiona undertakes assessments to identify and seek to meet immediate needs arising from an individual sustaining a serious injury. This includes securing funds for care, equipment, and discharge from hospital. Fiona’s work is integral to my work in ensuring individuals are supported from the day of their injury onwards. ■ Contact:

Working with experts in their fields is essential as it enables us to fight hard for our clients to deliver for their needs following lifechanging events.

Traumatic brain injuries cause around 160,000 people to be admitted into hospital and around 2500 people sustain a spinal cord injury every year in the UK.

Kate Nicklin

STATUTORY WILLS

hen someone no longer has the capacity to sign their own Will it is possible to apply to the Court of Protection for an order authorising someone to sign a Will on their behalf; we call this a Statutory Will application. This article outlines a case which highlights the importance of having a Statutory Will in place.

BACKGROUND OF THE CASE:

When Oscar was born, he sustained a brain injury that left him with severe cerebral palsy. A clinical negligence claim was brought on his behalf and a large compensation award was made. Wrigleys already act as professional deputy for Oscar and look after his finances.

Oscar is about to turn 18 and has limited life expectancy. We spoke to his mum about the possibility of making a Statutory Will application to the Court of Protection. Oscar’s parents were never married and when Oscar was 3 months old his dad moved away, there has only been very limited contact over the years. Oscar’s mum gave up work to look after him and the deputy used part of Oscar’s award to purchase a property and adapted it for his needs. Oscar and his mum are very happy living there together.

WIf Oscar died without a Will then the rules of intestacy dictate that his estate should pass equally between his parents. If Oscar’s mum died before him then on Oscar’s death all of his estate would pass to his dad. We didn’t think this was in Oscar’s best interests. Also, there was a risk that the family home would have to be sold leaving his mum homeless. As Oscar’s mum had not been working, she was worried that she may not be able to secure employment in the future and felt financially insecure.

CONCLUSION:

A Statutory Will application was made. In Oscar’s new Will he gifts the family home to his mum outright, giving her peace of mind that she can stay living there for as long as she wants. Oscar’s other assets are divided so that 5% is gifted to his dad but the remaining 95% goes to his mum. We successfully argued this was in Oscar’s best interests for him to provide his mum financial security on his death. It was felt he was ‘doing the right thing’ by gifting his estate to the parent who had cared for him all of his life. The Will also dictates what happens if Oscar’s mum dies before him, other close family and friends can benefit and not just his dad.

This case study has highlighted why putting a Statutory Will in place is so important. ■

To find out more contact Jane Netting, Partner at: jane.netting@wrigleys.c:o.uk Tel: 0114 267 5621

A Statutory Will can ensure that the person’s wishes are honoured and that a Will is put in place for them that is in their ‘best interests’.

Oscar’s mum gave up work to look after him and the deputy used part of Oscar’s award to purchase a property and adapted it for his needs. Oscar and his mum are very happy living there together

Jane Netting

Court of Protection Specialist Solicitors Court of Protection Specialist Solicitors

We have extensive experience of working with injured or disabled people with matters concerning the Court of Protection.

We are uniquely placed to assist you in this specialist area as we are not part of a litigation firm and are independent.

Why Wrigleys?

• We are well known and respected nationally in this area of expertise and work with you to achieve the best outcomes for you.

• We have experience in driving negotiations with the CICA meaning we are often able to redraft clauses of the trust deed with your interests in mind.

Our team of specialists deal with various matters that arise following catastrophic injury, such as:

• Court of Protection applications

• professional deputyship

• professional trustee

• property purchases and adaptations

• issues concerning community care

• statutory wills and liaison with the CICA

• direct employment

• We have one of the largest trust and Court of Protection administration teams of any national law firm; this team includes tax specialists, trust specialists and legal experts

• We believe a strong, long-standing professional working relationship is key and we pride ourselves in that we care. We build relationships that last a lifetime.

Dual diagnosis of brain injury and a MENTAL HEALTH CONDITION

It is nonetheless an incredibly important one from both treatment and litigation perspectives. A person with a mental health condition and a brain injury has what is called a dual diagnosis, and the relationship between the two is complicated for many reasons.

BRAIN INJURY STATISTICS

According to statistics from the brain injury charity Headway, 356,699 people in the UK were admitted to hospital with an acquired brain injury (ABI) in 2019-2020 alone.

One in four people in the UK experience mental health problems every year. However, the figures surrounding brain injuries and mental health are even starker. Eighty percent of those who sustain a traumatic brain injury (TBI) will have mental health issues following their injury, and roughly 50% will experience significant depressive symptoms within the first year. Even 40% of people who sustain a mild TBI will experience ongoing mental health issues.

The evidence indicates that severe TBI survivors are more likely to have longer-term, higher levels of mental health issues than those with a mild TBI. However, the picture is complex. Mild TBI survivors can have a greater awareness and insight into their condition. They can also be more acutely aware of what they can and cannot do, which can impact their mental health.

For several reasons, 60% of TBI survivors will have insomnia throughout their recovery. Everyone can appreciate the negative impact of poor sleep and how

it can affect resilience, motivation and engagement. However, for a TBI survivor, particularly in the context of rehabilitation, the effects are magnified and can result in having a heightened pre-disposition to mental health issues.

IMPACT

Due to the nature of a brain injury, the injured person’s life can suddenly change in sometimes quite profound ways. Often, they experience deficits in executive and cognitive skills, including memory, concentration, attention, planning and organising. One day they are independent and managing their own life, and the next they find themselves unable to do many things they once could. For the TBI survivor, that realisation and comparison to their pre-accident self can be difficult to process and can, understandably, impact their mental health. It is easy to see how trying to come to terms with their injury can manifest itself in presentations of, for example, low mood or high levels of anxiety.

This means TBIs can trigger pre-existing mental health issues, produce symptoms that may, to some extent, appear similar to mental health conditions or cause entirely new mental health issues.

TREATMENT

This is written from a lawyer’s perspective, so cannot be viewed as medical advice. However, it can be difficult to differentiate between the symptoms of a brain injury and underlying mental health issues, making the treatment pathway difficult to navigate. Further, TBI survivors (particularly those outside litigation) are regularly treated by mental health services simply because there aren’t any specialist brain injury services in their area.

At its core, treating mental health issues in the context of a TBI is about equipping the injured person with the tools they need to adapt and compensate for their changed sense of

After the coronavirus pandemic and resultant lockdowns, mental health and wellbeing have been at the forefront of everyone’s minds. However, the interplay between mental health and brain injuries is a topic not discussed as much as it deserves

Ben Townsend

One in four people in the UK experience mental health problems every year. However, the figures surrounding brain injuries and mental health are even starker.

self. Focusing on the positive steps that can be taken, rather than the deficits the injured person is experiencing, is central to effectively treating underlying mental health issues.

It is paramount to know what intervention is needed and when and how it should be implemented within the wider rehabilitation programme. As ever in serious injury claims, the importance of an effective case manager cannot be understated, particularly in identifying the red flags that are often precursors to developing mental health issues. Family members also play a key role here. They are sometimes best placed to feed back to the treating team how the injured person is presenting post-accident compared to before, particularly where the injured person has pre-existing mental health issues.

The effectiveness of neurorehabilitation is significantly diminished if, due to underlying mental health issues, the injured person is unable or is not motivated to engage positively with the rehabilitation programme.

The evidence appears to indicate that mental health issues should be addressed before beginning neurorehabilitation. This is vital to maximise the effect of rehabilitation and ensure that any claim can be accurately quantified. A range of treatments are available to address mental health issues, including neuropsychological, cognitive behavioural therapy, neuropharmacological and clinical or neuro-psychiatric.

Mental health issues have a propensity to resurface, particularly during times of stress, such as significant junctures in legal proceedings. As such, the treating and legal teams need to remain alive to the issue of mental health throughout the rehabilitation programme.

LITIGATION PERSPECTIVE

The degree of crossover between brain injury symptoms and mental health issues can also pose difficulties from a litigation perspective, especially when the injured person suffered from mental health issues pre-accident. Defendants will often try to argue that the symptoms displayed by an injured person are pre-existing psychological issues rather than a result of the brain injury, and their symptoms are basically

the same as pre-injury. As solicitors, we should expect this argument to be made and be prepared to rebut it.

To deal with this issue, the rehabilitation team working with the brain injury survivor must ensure that potential psychological symptoms are addressed as part of the rehabilitation package. As mentioned above, several therapies are available to treat mental health issues. Hopefully, mental health issues will be amenable to treatment, which is the desired outcome. However, if problems persist at a level in excess of the pre-injury situation, it will be more difficult for the defendant to portray them as pre-existing psychological problems.

Proactively obtaining GP, hospital, and the Department for Work and Pensions records rather than waiting for defendants to raise their argument is a good starting point for the solicitor. Taking time to examine the documentary evidence carefully will help identify pre-existing problems, which can be compared with the injured person’s current presentation. Gathering information from family and friends is another useful avenue to explore and can quickly identify if or how the brain injury has exacerbated their symptoms. As people who knew the injured person before their injury and are likely to spend the most time with the injured person post-accident, their observations can be incredibly helpful in setting out changes to an injured person’s presentation.

Many might perceive mental health conditions as being a minor part of a brain injury claim. However, as I have outlined in this article, they can be fundamental to it. Failing to identify the cause of a brain injury survivor’s symptoms can significantly impact their recovery and any legal case they are pursuing. The professionals, friends and family involved with the brain injury survivor can all help in this regard. ■

Contributor credit: James Philpott

Morr & Co is a Surrey, Hampshire and London based law firm.

Our Personal Injury and Clinical Negligence department work exclusively for Claimants who have suffered catastrophic and life changing injuries, including brain injury, spinal injury, amputations and degloving and complex muscular skeletal injuries.

The department is led by a Charlotte Rees-Knowlden, a Partner who has over 20 years’ experience specialising in accessing rehabilitation for those who have suffered a major trauma / life changing injury. Charlotte is a Trustee for Headway South West London.

The Personal Injury and Clinical Negligence team at Morr & Co understand how traumatic and debilitating a life changing injury can be for an injured client and their family.

We pride ourselves on taking a rehabilitation focused approach, meaning we pro-actively work within and encourage agreement of The Rehabilitation Code 2015. This protocol encourages parties to a claim to use the Code to identify the needs of any injured client and address the cost of providing for their needs on a private basis.

Our approach ensures that our clients make the best and quickest recovery. Acting in the best interests of our clients goes beyond securing reasonable financial compensation.

& Co

We work with our clients, their families and independent experts, to improve their present and / or long-term health, well-being and lifestyle by facilitating the provision of privately funded treatment and equipment.

We have a strong network of experts who we work alongside to explore and provide bespoke rehabilitation plans such as medical experts, case managers, pain management experts, prosthetic experts and home adaption and technology experts.

Our approach is to deal with cases compassionately and robustly, working to achieve the best all round results for our clients. We work hard to maximise compensation settlements for our clients and are confident in our ability to understand the impact that the injuries have on them personally. This allows us to ensure that we work collaboratively with our clients and support them to get their lives back on track ■

Focused on LIFE after life-changing events

Focused on LIFE

life-changing events

Frenkel Topping Group is a long-established family of businesses who are tried, tested and trusted. With such a wide range of services available from our expert teams across the Group, we’re confident that we can support you with anything you may need throughout the litigation journey.

Frenkel Topping Group is a long-established family of With such a wide range of services available from our expert confident that we can support you with anything you may

From professional services and independent financial advisers to investment management and Client support services, we’re able to o er a full concierge-style service that supports you and your Clients’ needs at every stage of settlement and beyond.

From professional services and independent financial advisers Client support services, we’re able to o er a full concierge-style Clients’ needs at every stage of settlement and beyond.

Service across the Group include:

Service across the Group include:

Expert witness reports

Expert witness reports

Expert fund management

Welfare benefits advice

Welfare benefits advice

Personal injury trusts advice

Legal costs

Accountancy Advice

Personal injury trusts advice

Legal costs

Holistic financial planning

Care & case management

Talent planning

Holistic financial planning

Free training with the Knowledge Hub

Free training with the Knowledge Hub

Expert training for expert practitioners. The Knowledge Hub, Frenkel Topping Group’s training academy, delivers free virtual and face-to-face training to our professional clients. Helping you stay up to speed and informed, all our courses are APIL accredited and count towards CPD hours.

Expert training for expert practitioners. The training academy, delivers free virtual and clients. Helping you stay up to speed and accredited and count towards CPD hours.

We provide the support you need

We provide the support you need

Our expert team of Business Development specialists are your first point of contact and will work closely with you to ensure you’re getting the most out of the Group and its many products and services. The team will listen attentively to your requirements and develop strategies and solutions that make your work more streamlined and e cient.

Our expert team of Business Development specialists closely with you to ensure you’re getting the most out services. The team will listen attentively to your requirements that make your work more streamlined and e cient.

Enquiries:

Enquiries:

0161 886 8000 enquiries@frenkeltoppinggroup.co.uk

Web: frenkeltoppinggroup.co.uk

0161 886 8000 enquiries@frenkeltoppinggroup.co.uk

Part of the Frenkel Topping Group

Web: frenkeltoppinggroup.co.uk

Part of the Frenkel Topping Group

2023 - a year of change in the Personal Injury and Clinical Negligence Sector BUT NEUTRALITY AND EXPERTISE REMAIN KEY

For our clients, knowledge is reassurance, especially so during high-profile events that can be positioned as alarming in the media. To that end, we provide regular commentary analysing recent economic news, assessing the current and likely impact on funds and summarising how we are applying caution and prudence where necessary in the economic cycle.

THE PERSONAL INJURY DISCOUNT RATE AND A NEW RATE IN 2024

It’s been an eventful few months for the investment markets. The collapse of Silicon Valley Bank (SVB), the failure of Credit Suisse, as well as the latest Bank of England interest rate rise and monetary tightening measures from the Federal Reserve, have combined to create significant turbulence.

For clients after injury who hold investments, fluctuating markets can be concerning. For the investment experts at Ascencia, Frenkel Topping Group’s in-house discretionary fund manager, the current market volatility, while significant, is a blip in market behaviours similar to so many periods of volatility throughout history. It is the potential impact of events of this nature that are factored into the creation of Ascencia’s portfolios, with a focus on protecting the downside and taking an agile and pro-active approach to capitalise on the upside when it comes.

The anticipation of the Personal Injury Discount Rate that will be set in 2024 has highlighted Frenkel Topping Group’s experience and expertise in this area and caused many industry figures to look to us as a source of thought leadership.

WHe served an initial Schedule of Loss claiming circa £3.7million – the highest ever claim advanced for a case of NFCI – although this was reduced to £2.9m when it was admitted that Muyepa’s wife had fabricated the level of care her husband required.

As Frenkel Topping Group acts for both claimants and defendants, we approach the discount rate from a position of neutrality. Ultimately, it is our duty as experts not to maximise damages but rather to advise the courts on what we believe is the right outcome.

The Ministry of Justice has asked for submissions of evidence to support a dual or multiple rate and Frenkel Topping has contributed its expert commentary on the benefits and drawbacks of the various options and on the conflict that can be created around life expectancy and the grey areas the rate can open up in litigation processes.

Ascencia’s investment managers, as always, have taken a pro-active approach to recent market developments, enacting the necessary decisions to best protect funds including a constant review of asset allocation and implementing a more defensive stance, reassuring clients that their investments are being managed in the most appropriate way to maximise protection while this period of turbulence passes.

As the industry continues to navigate through an extended unprecedented period in history, and the backdrop against which the rate is set grows increasingly complex, we can expect the rationale for the 2024 discount rate to be under particular scrutiny.

Ultimately the most important consideration is the reallife impact of the discount rate on those claimants who are awarded settlements after life-changing injuries.

Will the discount rate move favourably for the defendant? Will the poor investment returns since the rate was last set and increasing inflation result in a more negative

2023 is proving to be a key year for the future of the Personal Injury and Clinical Negligence sector, highlighting the need for established experts who understand the complex journey of life after injury.

rate? Is a dual or variable rate a likely outcome and what would that mean for claimant and defendant?

The most pertinent question perhaps is: what does this mean for those cases that are due to settle beyond the announcement of the new rate? How will those valuations be impacted?

The implications of the Personal Injury Discount Rate are complex and wide reaching and we are ready to help the industry understand its impact when the time arrives next year.

THE IMPORTANCE OF CLAIMANT AND DEFENDANT

Muyepa v MOD – A ’watershed’ case and a salient reminder of the importance of calling reliable, knowledgeable and, crucially, truly independent witnesses.

A legal judgment in 2022 highlighted the importance of objective and unbiased opinions and of an expert witness’s overriding duty to the court according to our CPR Part35 duties to the court.

The recent case of a Royal Artillery soldier who had his £2.9m claim against the MOD for damages dismissed at court has highlighted the importance of reliable expert witnesses in medical damages claims, not only for the claimant but also the defendant.

The case revolved around exercises Brian Muyepa took part in in 2016 and 2017 in the course of his job. The first saw the soldier sent to Wales in March 2016, where he was required to spend time in a tunnel filled with cold water. Muyepa then spent a further five-and-a-half hours in his wet boots.

He was later diagnosed with non-freezing cold injury (NFCI), a debilitating condition colloquially known as ‘trench foot’, which causes discomfort in the body’s extremities and oversensitivity to cold.

Following the diagnosis Muyepa was told to avoid cold conditions, but in early 2017 he was sent to Salisbury Plain, where he spent much of his time outside working on vehicles. The condition subsequently worsened and he was medically discharged from the army in January 2018.

Muyepa claimed the injuries left him requiring a stick to walk, suffering constant pain in his hands and feet, unable to undertake basic personal or domestic tasks, unable to get in and out of his car unaided, unable to assist with the care of his disabled daughter, and incapable of employment.

He served an initial Schedule of Loss claiming circa £3.7million – the highest ever claim advanced for a case of NFCI – although this was reduced to £2.9m when it was admitted that Muyepa’s wife had fabricated the level of care her husband required.

It was the Defendant’s case that the Claimant “created, or consciously and significantly exaggerated, NFCI symptoms to such an extent that he has been fundamentally dishonest.”

The defence team produced a significant amount of video evidence culled from both social media and covert surveillance to support their claim, including footage of the Claimant dancing at a barbeque, walking unaided, getting in and out of his car and driving it unaided, and shopping.

Mr Justice Cotter concluded that the evidence showed

Muyepa had “hugely exaggerated his symptoms,” however it was the Claimant’s expert witnesses that came in for particular scrutiny, with suggestions of partisanship in the final verdict.

While the issues related to expert partisanship are serious at the best of times, in this instance Justice Cotter found that they were compounded as the experts had only ever been claimant-instructed. The same would apply to experts who are only ever defendant-instructed, and the importance of genuine neutrality in expert witness testimony cannot be emphasised strongly enough.

The Defendant’s care and employment witnesses came in for particular criticism, although it should be noted that the Judgment criticises all of the claimant’s experts for being partisan, at times, and neglectful of their CPR Part 35 duties to the Court.

In the case of the care and employment testimony, both experts were heavily criticised for acting as advocate for the Claimant, being partisan and neglecting their duties as an independent expert.

Cotter J concluded that both witnesses had “acted at times as advocate for the Claimant and both at times presented partisan views to the court and…in so doing neglected their duties as independent experts.”

In contrast, Cotter J highlighted the fair and balanced approach of the MOD’s five experts.

Ultimately, Muyepa’s case was duly assessed to be worth just £97,595 – a “conservative” figure on the basis of his fundamental dishonesty.

The dishonesty caused a very significant difference between the pled value of the claim and the value assessed by Cotter J, which was just 3% of the claim.

In such a situation a claim can be dismissed as long as the court finds this would not result in substantial injustice. The claim was dismissed with no substantial injustice found.

There could barely be a more salient reminder of the importance of calling reliable, knowledgeable and, crucially, truly independent witnesses. With four decades of experience, providing expert witness reports and services to claimants and defendants alike, Frenkel Topping Group can proudly claim to offer precisely that.

A key factor in Frenkel Topping Group’s strong position in the marketplace is its work in both claimant and defendant markets. Our position of neutrality and our expertise across both areas is a reason that we are the firm of choice. ■

Release the cash tied up IN YOUR ONGOING CASES

Legal Clinical Negligence caseloads present challenges for law firms. Expensive disbursements, lengthy settlement times, salaries and overheads present challenges even for the best funded Law firms.

Cash flow is the life blood of any firm and VFS have been the trusted partner of many Clinical Negligence firms for the past 10 years. By proving simple competitive cashflow solutions we increase your financial muscle.

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There is a lot of uncertainty and unknowns in running complex brain injury cases. By removing the financial

unknowns and worries it allows lawyers to do a great job for their clients.

Disbursement Funding Facility (DCF)

Can be used to fund disbursements and issue fees on an individual file basis including releasing cash tied up in disbursements already incurred releasing up 100% of the external disbursements incurred on each case. We can release cash on dibs already purchased

Costs Advance Funding (CAF)

This is our most popular product and comparable to invoice discounting and can be used when a law firm has won a case and the bill of costs has been served. VFS will advance funds against the settlement of the expected costs. This enables the firm to negotiate the right settlement and not accept a lower offer just to get the case settled.

High Costs Case Funding (HCF)

For higher-value cases where there is an admission of liability, VFS can release part of the WIP and disbursements to date. This aids cashflow and is repaid upon the natural conclusion of the case. VFS takes care of the funding and cash flow enabling the law firm to do what it does best and focus on the case and achieving the right outcome. ■

To find out more about how we can assist pleasecontact Stuart Taylor, Sales Director via stuart@vfslegal.com or 07974640951 www.vfslegal.com

Cash flow solutions from the UKs leading legal Funder, including; disbursement funding, cost advance, high-cost case funding.

The uncertainty that surrounds the funding required for such complex cases often leaves firms in a difficult position when forecasting cash required to run a case or how they compensate for the cases that lose.

Release the cash tied up in your high value clinical negligence cases

Disbursement Funding

ALL third party costs incurred in running the case as covered by your ATE.

High Cost Case Funding

When the case reaches a stage where liability has been admitted but there is still much more work to do to finalise, VFS can release the WIP incurred to that point.

Cost Advance

You have won the case and the draft bill issued, VFS can release the cash tied up in the bill.

To find out more visit www.vfslegal.com or for an informal chat telephone 020 3747 9333 or email enquiries@vfslegal.com

READING BETWEEN THE SPINES

In a claim for a child who suffered a TBI in a RTA causing severely impaired executive function and behavioural problems, a lump sum settlement of £9.2 million was achieved.

Members work nationally and internationally with leading provincial and London solicitors and national defendant insurer firms, often in cases of the utmostcomplexity or value and involving issues around capacity, provisional damages and statutory funding.

As a team of barristers and clerks, we pride ourselves on being accessible and responsive, working closely with those who instruct us to provide a proactive and strategic approach in order to secure outstanding results. Members are noted for their empathy and approachability; our approach is first and foremost to view each claimant as an individual, rather than litigant. We strive to secure not only excellent financial settlements but also optimal provision of care, support and equipment, to maximise quality of life.

BRAIN INJURIES

Whether arising from accidents at work, RTAs or medical negligence, our barristers have experience in all types of brain injury, from significant structural brain damage to more subtle brain injuries and postconcussional syndrome, cases of hypoxic brain injury, brain haemorrage and delay in diagnosis of brain tumours.

Recent case examples include: Securing the capitalised equivalent of over £12 million for a child with cerebral palsy. The settlement included a lump sum of £4.8million plus periodical payments varying with age up to £288,000 p.a. in adulthood.

Settlement of £2.55 million with periodical payments of £185,000 for 2 years, then £163,000 thereafter for an adult in a case involving experts across 14 disciplines and where statutory funding and reverse indemnity expertise was required.

SPINAL INJURIES

Our barristers regularly assist in claims concerning complete or partial spinal cord injuries arising from trauma, as well as clinical mismanagement, including cauda equina, spinal and epidural anesthesia and surgical error.

Recent case examples include: A claim on behalf of a schizophrenic man whose spinal cord compression was not recognised when he was a psychiatric inpatient, leaving him paraplegic and wheelchair bound. There were substantial disputes over the appropriateness of a private care package but settlement was secured for a lump sum of £1.5million and periodical payments of £347,000, with unspent sums to be setoff against the periodical payment the following year. ■

The Serious Injury Team at No5 Barristers’ Chambers offers strength in depth, with expert counsel at all levels offering an exceptional understanding of complex clinical, causation and quantum issues.

We provide a nationwide service for all our clients with a first-class service at all levels of advocacy and advisory work.

Leading EXPERTS

Specialists acting for a multitude of clients in all forms of personal injury.

Aspecialist set with 79 members, including 19 Queen’s Counsel, Old Square Chambers provides advocacy, advice and drafting of the highest quality, at trial and appellate level. Our exceptional clerking team are also recognised and provide friendly and professional support.

Old Square Chambers has proven expertise, at all levels of seniority, encompassing the full spectrum of personal injury matters. Our members are particularly recognised for their experience in high value and complex claims, frequently acting for both claimants and defendants in cases involving catastrophic and fatal accidents, and traumatic brain, spinal and life-altering injuries. We service a wide range of work across the UK to get the compensation our clients and families need to help rebuild their lives and cope with these life-changing

Recognised for their experience in high value and complex claims

injuries with expert rehabilitation, medical care and support. Our team’s experience in other associated areas, such as clinical negligence, costs work, product liability and professional regulatory disputes, allow us to provide a fully comprehensive service. We put our clients at the heart of all we do. We will fight tirelessly for your interests and to achieve the best interests. ■

For more information, please call one of our clerks on 0207 269 0300 or email clerks@oldsquare.co.uk

Specialised Neurological and Respiratory Care Services

Hawthorns Care Centre provides care and rehabilitation services for those who require Specialist and Complex Neurological and Respiratory Care. At the heart of the Hawthorns team is a shared passion to provide the best care possible for each individual.

We enable individuals to regain control and independence where possible and ensure that not only the individual, but their families and friends, are supported through challenging times. Our approach to care is to provide a safe, homely environment in which our clients can achieve their maximum potential. We facilitate this through open and honest communications

with the client, their families and all healthcare professionals involved. Regular MDT meetings in which goals are set and reviewed enable us to ensure we are meeting the individual needs of our clients, using a holistic approach to their rehabilitation journey.

Hawthorns Care Centre

O’Neill Drive, Peterlee, SR8 5UP 0191 587 1251

barchester.com/Hawthorns

Award-winning

With

LEGAL FUNDING RELEASING

VFS

Norman Kenvyn Founder & CEO

VFS can provide immediate funding against your issued bill of costs or when you have a case with admitted liability.

+44 (0) 20 3747 9333

+44 (0) 7748 963 965 enquiries@vfslegal.com vfslegal.com

Expert clinical rehabilitation case managers specialising in catastrophic injury nationwide.

We are a team of Community Physiotherapists. Led by Susan Pattison, we specialise in Acquired Brain Injury, Spinal Cord Injury and other Complex Injuries in local regions such as Greater Manchester / Lancashire, Cheshire, and South and West Yorkshire

+44 (0) 161 764 3799 info@sptherapyservices.co.uk

@SPTherapySvcs www.sptherapyservices.co.uk

Kate Nicklin

Serious injury specialist, particularly recognised for work with brain and spinal injury clients.

Rehabilitation and case management solutions nationwide.

T: 020 8649 5759 E: info@hcml.co.uk W: hcml.co.uk

MCS Case Management Ireland

Siobhan McSweeney RGN, RM. Case Manager Nursing Consultant

We have established team and an excellent reputation for successfully helping our clients with acquired brain injuries, cerebral palsy and spinal injuries.

T: +353 1 493 6948

M: +353 86 166 4318

E: info@mcscasemanagement.ie

W: www.mcscasemanagement.ie

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T: 020 8649 5759 E: info@hcml.co.uk W: hcml.co.uk

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Brain & Spinal Injury CONTACT INFORMATION

Support groups, charities and other useful contacts and organisations across the UK.

Vocational Rehabilitation Association UK

The VRA represents all those involved in delivering vocational rehabilitation services. A number of professional fgroups are involved from both health (NHS and private) and other government agencies e.g. the Department for Work and Pensions. www.vrassociationuk.com

Brain Injury Rehabilitation Trust (BIRT)

BIRT is a division of The Disabilities Trust, a leading charity that provides services to people with physical and learning disabilities, autism and brain injury. The Brain Injury Rehabilitation Trust (BIRT) aims to provide the best quality neurobehavioural rehabilitation for people with complex and challenging needs after brain injury. www.thedtgroup.org/braininjury

Brain Injury Hub

Online support centre for the families of children affected by acquired brain injury created by The Children’s Trust. www.braininjuryhub.co.uk

Brain & Spine Foundation

Provides support and quality information to people affected by brain and spine conditions, in order to reduce anxiety and help inform their choices. A free helpline is staffed by neuroscience nurses to answer questions about all neurological conditions and offer information and support on any medical and emotional issues. Helpline Number 0808 808 1000 www.brainandspine.org.uk

Carers UK

An excellent source of information, advice and support, this charity is at the forefront of campaigning for carers. www.carersuk.org

Brain & Spinal Injury

The Children’s Trust

A national charity, The Children’s Trust provides care, education, therapy and rehabilitation to children with acquired brain injury, multiple disabilities and complex health needs. It runs the UK’s largest paediatric brain injury rehabilitation centre at Tadworth (Surrey), and services include nationwide support in the community for children and young people with acquired brain injury.

www.thechildrenstrust.org.uk

Child Brain Injury Trust (CBIT)

A leading charity providing non-medical services and support, including a telephone helpline, for families. CBIT also provides training for health and social care professionals working with families. Helpline Number 0303 303 2248. www.childbraininjurytrust.org.uk

Headway

A national brain injury charity that promotes understanding of all aspects of brain injury and provides information, support and services to brain injured people, their families and carers. Headway also operates a regional network of branches and support groups. www.headway.org.uk

The United Kingdom Acquired Brain Injury Forum (UKABIF)

The United Kingdom Acquired Brain Injury Forum (UKABIF) is a membership organisation and charity which aims to promote the understanding of all aspects of acquired brain injury. There are also regional groups throughout the UK, and UKABIF works with these groups to set common aims, encourage sharing of information and practice and co-ordinate group work.

www.ukabif.org.uk

Spinal Injuries Association (SIA)

Spinal Injuries Association (SIA) are a charity that provides information and support to spinal cord injured people, their families and health care professionals. www.spinal.co.uk

The Backup Trust

The Backup Trust provides support services for people of all ages with spinal cord injury. Services include wheelchair skills training, activity courses, mentoring and support to get back to work or school after an injury.

www.backuptrust.org.uk

Aspire

Aspire works with people with a spinal cord injury to create opportunity, choice and independence. They aim to support people to lead a fulfilled and independent life from the moment of their injury throughout their life. They are also committed to research in the field of technology to find cost effective solutions to improve the quality of disabled people’s lives.

www.aspire.org.uk

Association of Personal Injury Lawyers (APIL) Association of Personal Injury Lawyers (APIL) is an independent, not for profit organisation providing accreditation to lawyers specialising in the area of personal injury law. Website includes a directory of accredited solicitors. www.apil.org.uk

British

(BABICM)

Association of Brain Injury Case Managers

British Association of Brain Injury Case Managers (BABICM) is a professional association that was established in 1996 to promote the development of case management in the field of acquired brain injury. www.babicm.org

Law Society

Law Society is the professional association that represents and governs solicitors for the jurisdiction of England and Wales. It provides services and support to practising and training solicitors, as well as serving as a sounding board for law reform.

www.lawsociety.org.uk

The Case Management Society UK (CMSUK)

The Case Management Society UK (CMSUK) is a non-profit association of Case Managers, committed to the delivery of quality case management through standards of best practice while promoting the individual and collective development of case management throughout the United Kingdom.

www.cmsuk.org

The Neurological Alliance

The Neurological Alliance is a wide range of neurological charities which have come together to make life better for people in the UK with a neurological condition. Their aim is to raise awareness of neurological conditions and their impact; inform and influence policy makers about the needs of people with neurological conditions; secure the highest standards of service and improved care for people with neurological conditions; promote research and the dissemination of information about neurological conditions.

www.neural.org.uk

A VERY SPECIAL THANK-’YOU’ to all our contributors

Most children and young people make a full recovery after a head injury, however, some experience longer term complications or difficulties.

That’s where our website can help.

Bumps Happen is an online resource for parents and carers of children and young people. We share the signs to look out for, and steps to take, in case your child has had a concussion.

If your child has had a head injury, or you’d just like to know more, visit Bumps Happen for help and guidance.

Disclaimer: Brain & Spinal Injury Handbook is published annually (once per annum) by Seven Star Media Ltd. No part of Brain & Spinal Injury Handbook may be reproduced, stored in a retrieval system or transmitted to any form without permission. Views expressed in the publication are not necessarily those of Seven Star Media Ltd, and are included to provide advice only. No content is a substitute for professional medical advice. During printing, images may be subject to a 15% variation. © Copyright of content belongs to individual contributors with the publication copyright belonging to Seven Star Media Ltd. All rights reserved. Please either keep this magazine for future reference, pass it on for somebody else to read, or recycle it.

Focused on LIFE after life-changing events

Focused on LIFE

life-changing events

Frenkel Topping Group is a long-established family of businesses who are tried, tested and trusted. With such a wide range of services available from our expert teams across the Group, we’re confident that we can support you with anything you may need throughout the litigation journey.

Frenkel Topping Group is a long-established family of With such a wide range of services available from our expert confident that we can support you with anything you may

From professional services and independent financial advisers to investment management and Client support services, we’re able to o er a full concierge-style service that supports you and your Clients’ needs at every stage of settlement and beyond.

From professional services and independent financial advisers Client support services, we’re able to o er a full concierge-style Clients’ needs at every stage of settlement and beyond.

Service across the Group include:

Service across the Group include:

Expert witness reports

Expert witness reports

Expert fund management

Welfare benefits advice

Welfare benefits advice

Personal injury trusts advice

Legal costs

Accountancy Advice

Personal injury trusts advice

Legal costs

Holistic financial planning

Care & case management

Talent planning

Holistic financial planning

Free training with the Knowledge Hub

Free training with the Knowledge Hub

Expert training for expert practitioners. The Knowledge Hub, Frenkel Topping Group’s training academy, delivers free virtual and face-to-face training to our professional clients. Helping you stay up to speed and informed, all our courses are APIL accredited and count towards CPD hours.

Expert training for expert practitioners. The training academy, delivers free virtual and clients. Helping you stay up to speed and accredited and count towards CPD hours.

We provide the support you need

We provide the support you need

Our expert team of Business Development specialists are your first point of contact and will work closely with you to ensure you’re getting the most out of the Group and its many products and services. The team will listen attentively to your requirements and develop strategies and solutions that make your work more streamlined and e cient.

Our expert team of Business Development specialists closely with you to ensure you’re getting the most out services. The team will listen attentively to your requirements that make your work more streamlined and e cient.

Enquiries:

Enquiries:

0161 886 8000 enquiries@frenkeltoppinggroup.co.uk

Web: frenkeltoppinggroup.co.uk

0161 886 8000 enquiries@frenkeltoppinggroup.co.uk

Part of the Frenkel Topping Group

Web: frenkeltoppinggroup.co.uk

Part of the Frenkel Topping Group

Release the cash tied up in your high value clinical negligence cases

Disbursement Funding

ALL third party costs incurred in running the case as covered by your ATE.

High Cost Case Funding

When the case reaches a stage where liability has been admitted but there is still much more work to do to finalise, VFS can release the WIP incurred to that point.

Cost Advance

You have won the case and the draft bill issued, VFS can release the cash tied up in the bill.

To find out more visit www.vfslegal.com or for an informal chat telephone 020 3747 9333 or email enquiries@vfslegal.com