Neuro Rehab Times issue 29

NR TIMES NEURO REHAB TIMES

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Did you make the shortlist?

See the contenders for this year's awards inside

Celebrating 20 Years of Sleep Unlimited As one of the pillars of health, good sleep is vital for both successful rehabilitation and compliance with other therapies.

Sleep Unlimited specialise in assessment of those with complex conditions using Actigraphy – and advice using Cognitive Behavioural Therapy for Insomnia (the NICE recommended guidelines for treating an insomnia disorder).

Please email denise@sleepunlimited.co.uk for an information pack and free sleep screening questionnaire.

We also run training for healthcare professionals – our highly acclaimed REST® Training Programme includes: a two day training course; option to sign up for a license to use the REST® resources; and group supervision sessions.

Please email training@sleepunlimited.co.uk for a course flyer and booking form, or see our website www.sleepunlimited.co.uk

Sleep Unlimited Ltd PO 570, Gateshead NE8 9GF 0191 580 0008 for our website

www.sleepunlimited.co.uk

WELCOME

Editor's note For our interactive digital edition visit

nrtimes.co.uk

Celebrating achievement When we launched our first-ever NR Times Awards, we did so with the ambition of shining a light on the inspirational and often life-changing work being done throughout the field of neuro-rehab.

We hoped we would hear from some of those whose dedication, commitment and innovation is helping to changing the future for patients both now and in years to come.

And, truthfully, we have been overwhelmed by the entries we have received. The numbers, and quality of submissions, have been beyond all expectations.

Send your stories and opinions to Deborah Johnson, Editor deborah@aspectpublishing.co.uk For advertising enquiries contact Gary Wilding, Head of Sales gary@aspectpublishing.co.uk Also on the NR Times team: Andrew Mernin, Founder / MD andrew@aspectpublishing.co.uk Sorina Mihaila, Designer Andrew Nealen, Contributor

The ambitions we had for the inaugural NR Times Awards have certainly become reality, and thanks to all those who have made that possible. From our sponsors - particularly headline sponsor Elysium Healthcare - through to those who have made nominations, we are so grateful for your support.

Today, we are delighted to unveil the shortlists in all 12 categories. Eleven will now be judged by our panel of judges and category sponsors, with one - Rehab Leader of the Year - now open to a public vote.

Judging such fantastic shortlists will be a hard task indeed; and while only one can win each category, we look forward to celebrating the achievements of many more, whose contributions are making such a positive difference.

This issue has many other stories of achievement, in a number of ways. We have the fantastic stories of Lawrence and Aidan, both of whom have overcome such adversity and so many challenges to now enjoy life and look to a positive future.

We also have the progress of major names in neuro-rehab, and we are delighted to celebrate their ongoing growth and development. From Circle Case Management’s sector-leading franchising opportunities, through to Slater and Gordon’s new office opening and the pioneering project into dementia care planning by St Andrew’s, the continuing innovation from those working in this sector is fantastic to see.

We hope you enjoy this issue, and will join us in congratulating everyone who has made the shortlist of the NR Times Awards.

As ever, if we can support your organisation in celebrating your own success, please do get in touch with any of the team. We’re always delighted to hear from you.

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

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

company/nrtimes @editorNRTimes 3

CONTENTS

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06 C O V E R S T O R Y Are you part of the NR Times Awards shortlist?

12 MUSIC IN REHAB Post-op physio support for children with Cerebral Palsy 14 NEED FOR A NEWTORK How Aidan was supported in his rehab journey 2 0 O U T P AT I E N T R E H A B How rehab is a process, not a place 2 2 F I X E D -T E R M C O N T R A C T S What employers need to know 24 GAIT SUPPORT How NexStride can help with FOG 26 SUPPORTING RESILIENCE How therapists are supported in their work 28 CARE PLANNING Pioneering new project unites dementia and co-production capacity 4

Contents 33 TECH-LED CARE Using computer-assisted tools in brain injury rehab after ABI 34 THER APIES IN ACTION The importance of multi-disciplinary working 3 8 B E I N G YO U R OW N B O S S New sector-leading case management franchise initiative 40 EMPOWERING SUCCESS Case management making a difference

42 GLOBAL GROWTH Fourier Intelligence’s latest step in its ongoing expansion

44 MAXIMISING CAREER POTENTIAL Escaping disillusionment as an occupational therapist 4 6 O N T H E M OV E Slater and Gordon’s expansion into its latest location 50 GATHERING EXPERTISE Elysium Neurological’s Clinical Advisory Panel 54 COGNITIVE REHAB Reviewing the new INCOG 2.0 guideline 5 8 R E D E F I N I N G F N D P AT H WAY New service to revolutionise traditional care and outcomes

CONTENTS

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6 2 R E VO L U T I O N I S I N G R E C OV E RY Stroke and robot-assisted therapies 64 HARNESSING SUCCESS A para carriage driving journey 6 6 2 0 T H A N N I V E R S A RY PhysioFunction celebrates its milestone

6 8 C O M P L E X C A R E A N D PA R E N T S Options around care and support 70 SURVIVING AND THRIVING How Lawrence rebuild his life after brain injury

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C O V E R S T O RY

Here, we unveil the shortlists of the inaugural NR Times Awards.

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fter receiving entries from individuals, businesses and organisations around the world, we can now reveal who has made the final few in each category.

The amount of submissions received exceeded all expectations, and the quality of entries has meant that the numbers on each shortlist varies greatly - in many categories, it was too difficult to discount many of the outstanding entries at the shortlisting stage.

The NR Times Awards, sponsored by Elysium Healthcare, were launched this year for the first time to recognise and celebrate the outstanding practice, innovation and dedication from those working across the field of neuro-rehab in changing the lives of patients, both now and into the future.

Across 12 categories, the Awards will highlight the inspirational work being done by teams and individuals in

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supporting patients and families, and often helping to transform the practice area they work in and the wider neurorehab sector.

Judging will now take place over the coming weeks, with the awards ceremony being held online on October 26, when the winners will be revealed.

Categories will be judged by a representative of each sponsor, and by our independent panel of judges: - John Davis, renowned neurotrauma specialist and consultant principal lawyer at Slater and Gordon - Vicki Gilman, chair of BABICM and founder of Social Return Luke Griggs, chief executive of Headway - Chloe Hayward, chief executive of UKABIF Judges will be exempt from judging any category in which there is a conflict of interest.

Deborah Johnson, editor of NR Times, says: “We have been absolutely thrilled and taken aback with the response to our first awards, and from the support we have had from our entrants, judges and sponsors. Thank you to everyone, on behalf of the whole team, in making this such a success so far.

“The quality and breadth of entries has been of the highest calibre, and putting the shortlists together was no easy task. Some of the shortlists have many more names on there than we initially intended - but we genuinely felt we could not discount such excellent entries at this stage, so will pass to our judging panel for their insight ahead of them choosing a winner.

“We are very excited to reveal the winners next month, but for now, congratulations to everyone who has made the shortlist. Please be very proud of your achievements and for the amazing work you are doing.”

C O V E R S T O RY

CATEGORIES

Beyond-expectation rehab outcome of the year – sponsored by Elysium Healthcare Breakthrough Case Management Calvert Reconnections Chroma Circle Case Management East Coast Community JRCMS Neural Pathways Neurokinex Reach St Andrew’s Healthcare St George’s (Wolfston)

Above and beyond award – sponsored

by BIS Services Calvert Reconnections Circle Case Management Cygnet Corporé Eagles Wings Consultancy NeuroHope Pink Concussions Emily Shaw, CHD Rehab Carol Burdis, Spinal Injuries Association Dr Keith Jenkins, St Andrew’s Healthcare

Brain/spinal injury law firm of the year – sponsored by Chroma Irwin Mitchell Lavelle Partners Nash & Co RWK Goodman Slater & Gordon Stewarts

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SPONSORED

Neuro-rehab innovation of the year – sponsored by Iris Care Group.

BES Healthcare BIS Services BPM Rehab Children's Trust Genrobotics Lusio Rehab Neural Pathways Richardson Care VIM Health

Inspirational contribution award – sponsored by Tru Rehab.

Professor Nick Alderman, Elysium Healthcare Darran, St Andrew’s Healthcare Dr Vincent Harding, St Andrew’s Healthcare Ian Pearce, NeuroProactive Jennifer Rudd, JRCMS Social Return TBI OneLove

Charity of the year – sponsored by Reach.

Child Brain Injury Trust Headway Derby Headway Salford Headway Worcester Huntington’s Disease Association LEGS Natalie Kate Moss Trust Pink Concussions Spinal Injuries Association St Andrew’s Healthcare

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SPONSORED

Remote rehab initiative of the year – sponsored by Think Therapy 1st.

Children's Trust Enable I-maginery LEGS Lusio Rehab Reach

Case management firm of the year – sponsored by Morrello Clinic.

Breakthrough Case Management Circle Case Management Corporé Emma Way Enable HCML Maia Rehabilitation West Country Case Management

Research initiative of the year – sponsored by Askham Rehab.

Dr Alyson Norman, Plymouth University Dr Adrian Parry-Jones, Manchester University St Andrew’s Healthcare Tisch MS Centre, New York

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SPONSORED

People’s choice: rehab leader of the year – sponsored by Breakthrough Case Management Professor Nick Alderman Sir Chris Bryant Dr Judith Gates Vicki Gilman Martin Hibbert Zen Koh Annabelle Lofthouse Natalie Mackenzie Professor David Menon Dr Chris Nowinski Jules Shiel-Boulger Harvey Sihota Daniel Thomas

CLICK HERE to register your vote for the People's Choice award now

Therapy provider of the year – sponsored by Irwin Mitchell Ariya Neurocare BIS Services Chroma CHD Rehab Clarity Psychology Cognivate Enable East Coast Community Morrello Clinics QEF PsychWorks Associates Reach Remedy Think Therapy 1st

Charity of the year – sponsored by Reach BIS Services Cygnet Elysium Healthcare Kibblesworth Centre Iris Care Group Richardson Care South West Yorkshire Partnership NHS Foundation Trust

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N R news

Music therapy expedites ankle foot orthotics rehab Children with Cerebral Palsy who are receiving post-operative physiotherapy support at the Portland Hospital for Women and Children, London, having undergone Spinal Dorsal Rhizotomy (SDR), are benefiting from Chroma’s music therapy sessions as they experience elevated rehabilitation sessions.

Children, aged between 2-7 years, seen in joint sessions with Dorset Orthopaedic, one of the UK’s leading providers of private prosthetic and orthotic rehabilitation, typically struggle to sit still to allow measurements to be taken. While they are being measured for prosthetics and orthotics, Chroma’s music therapist, alongside the physio team, engages with the children to ensure their treatment meets their needs.

SDR is a specialised neurosurgery that treats lower limb muscle stiffness (spasticity) in children with cerebral palsy by dividing sensory nerve rootlets in the spinal cord. Intensive physiotherapy is crucial following SDR to practice movement patterns in the absence of spasticity and build up muscle strength; the use of music therapy expedites their rehab.

Typically, ankle foot orthotics target the ankle and shin strengthening and supporting the ankle in its position and promoting the position of the knee – essentially helping support the children with their standing. This makes a huge difference to their walking, Children undergo an intensive three-week therapy programme following surgery, not only to ease rehabilitation from the surgery but more importantly, to support the new pathways that have been developed following the surgery, facilitating the way the children move.

Integrating music therapy within physiotherapy sessions further supports the children in re-learning how to move, how to shift their weight, balance, movement, and walk – it really is working from the ground up and starting again because their legs feel very different.

Additionally, for younger children, music therapy helps to normalise the child’s experience, offering new and changing ways of motivating and engaging them in rehabilitation and building relationships. It also builds confidence in movement and to be confident in their bodies.

And of course, music primes movement. It’s intuitive without necessarily using words. For each child’s journey, music helps increase their stamina enabling them to be in a position longer than they would do outside of therapy.

Jon Fever, a music therapist at Chroma, said: “Music therapy is a completely different medium to work with and 12

something that doesn’t require words to explain what you want the child to do.

“Music therapists create a musical atmosphere – a song, a story, or could be using the music through pattern sensory enhancement (PSE) as a directive for the children to go up or down depending on the intensity of the music – it becomes intuitive. The music tells them how to move which is a fun alternative to quite often monotonous, painful (but necessary) exercises.”

“Working as part of the multi-disciplinary team - Chroma, Dorset Orthopaedic and the physiotherapists at The Portland Hospital - help reduce anxiety in children by creating fun and engaging stories. For example. we’re all members of the child’s band, which shifts any sense of power or hierarchy between child and therapist. This will often impact and support the child’s engagement and confidence.”

“Using music therapy as an engaging medium within a gruelling rehabilitation journey is essential to support better rehab outcomes and ensure orthotics are optimal for each child - supporting the very best outcomes for these amazing children.”

To find out more, please visit wearechroma.com.

N R news SPONSORED

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SPONSORED

Building a network of support Breakthrough Case Management traces the story of Aidan’s rehab journey As a case manager with extensive experience in brain and spinal injury, when Catrin May was first approached

by Asha Beswetherick of Enable law, to interview as a potential case manager for Aidan, (at the time, an 11-year-old child), she was naturally happy to be asked for her input. However, as in most complex injury cases, she was under no illusion that the road ahead would be a smooth one.

Aidan had been born at 33 weeks gestation with the umbilical cord around his neck, resulting in an hypoxic brain injury and a subsequent diagnosis of cerebral palsy.

Cerebral Palsy is a neurological condition caused by brain damage either before or during birth. Potential issues a child might face include movement and walking disabilities; speech difficulties; learning disabilities; cognitive impairments; hearing or vision loss; epilepsy; emotional and behavioural challenges; spinal deformities; joint problems and more.

“For years,” Catrin explains, “Aidan’s mother had felt that she was in some way responsible for her child’s injury and was frightened that if she made a claim, it would be proved to be her fault. Aidan’s father however, felt sure that it had been negligence and reassured Aidan’s mother, ultimately convincing her that litigation was the right thing to do for Aidan.”

Even once the family had made the decision to pursue the claim, Aidan’s

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mother had reservations about engaging a case manager to assist them through the process, concerned that she may lose control and not have a say in her son’s rehabilitation.

With a background as a Registered General Nurse, co-founder and director of Breakthrough Case Management, Catrin, has over 15 years of case management experience and understands the impact traumatic injury has on the whole family. She is known for her compassionate, common-sense approach and a focus on the importance of collaborative work with clients, their families and clinical professionals.

“I would be being dishonest if I said I wasn’t concerned by the fact that Aidan and his family had had so little support outside of his family throughout his formative years” says Catrin.

“Ideally, in cerebral palsy cases, as with any complex brain injury, we would be looking to get a rehab programme in place as soon as possible after the index event. However, Aidan was 11 years old at the time I met him and his family. He was attending mainstream school and input from statutory

"With the correct equipment, Aidan's posture, breathing and speech improved dramatically"

services had been minimal, to say the least.”

“When I first met Aidan, he was able to walk a few steps but needed to be supported by either a walker or another person. His mobility was very poor. He wasn’t able to sit up in a chair.

He had a wheelchair, but it was too small for him,” explains Catrin.

At the time, Aidan and his family; mum, stepdad and sister, were living in a house with an adapted downstairs bathroom, but his bedroom was upstairs. “Aidan’s accommodation really wasn’t suitable for his needs; there was no hoist, despite Aidan being tall, his parents were carrying him, up and downstairs themselves, morning and night” says Catrin. “Aidan has such a lovely family, (he also has a good relationship with his father) and their love and care for him was evident the moment we met. However, the situation was just not sustainable.”

When Catrin met Aidan, he was unable to drink out of a glass. He would use a straw but would make a mess when drinking and his choking risk was high.

When eating food, Aiden would gag, and his mother would always have a bag at the ready.

“You can imagine that this made it incredibly difficult for the family to dine out, and so, often, they just didn’t,” says Catrin.

Although Aidan’s family were able to work out what he wanted, Catrin remembers being completely unable to understand his speech

when they first met.

“As obvious as the need was for physio and occupational therapy, I knew immediately that we also needed to involve a Speech and Language Therapist as soon as possible” says Catrin. It was important that it was someone who would give Aidan a sensory oromotor programme.

“At Breakthrough, we see our role as case managers as facilitators for partnership working, and this was certainly the case in this instance.

Here was this lovely boy with a wonderfully supportive family doing their very best in a difficult situation.

I was so eager to get the proper support in place for Aidan as soon as possible and start building the team that would come together to make a real difference to this boy and his family’s life.”

With many years of case management experience and wellestablished connections in the field of rehabilitation, Catrin was quickly able to put together a team of therapists and clinicians best suited

to Aidan’s needs.

Catrin got in touch with Sarah Chatterton, Speech and Language Therapist, who started a sensory oromotor programme with Aidan that included a comprehensive exercise plan, practised five days a week with additional exercises at weekends.

This quickly started to address his difficulties with eating and drinking independently. At the same time Sarah also worked on Aidan's speech using an 'oral placement' approach to develop more accurate lip and tongue positions for individual speech sounds, along with transitions between speech sounds in words, phrases. sentences and conversation.

“Aidan and Krissy have been a joy to work with,” says Sarah. “The success of the SLT programmes was wholly due to the practice that took place on a near-daily basis. Both Krissy and Aidan worked incredibly hard together to achieve the positive outcomes, both with eating and drinking and with Aidan's improved speech clarity.”

Alongside speech and language therapy, Catrin engaged an Occupational Therapist to review Aidan’s equipment. Having worked extensively with Gina Joslin in the past, she knew that the OT was well placed to make the necessary assessments and recommendations and ensure that Aidan had access to the very best assistive equipment.

“I knew Gina would be able to help improve Aidan’s posture and level of comfort and in turn, give him the greatest level of independence going forward.”

'Aidan and his mother were both encouraged to be actively involved with my assessment and decision making process so that they fully understood the goals the therapy team were aiming for” explains Gina. “With the correct equipment - manual wheelchair, powered wheelchair, walker and a supportive easy chair, Aidan's posture, breathing and speech improved dramatically.”

It was also clear to Catrin that Aidan needed a comprehensive

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SPONSORED

physiotherapy programme. “I’ve worked a lot with Alison Fedeli in the past and I knew she would be a great physiotherapist for Aidan” explains Catrin, “Being a case manager is so often about matching clients with the most appropriate or effective therapist for the client’s situation”.

Alison says she found Aidan ‘delightful’ to work with, noting “He

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is always willing to carry out his physiotherapy exercises and tries his best. Asha and Catrin helped him to set up a home therapy room and he has worked hard to strengthen his back, shoulders and legs. Aidan has gradually improved his posture, balance, walking and stamina.”

Aidan was very engaged in all of his therapy programmes from the

outset and thanks to his efforts and the encouragement and support of his family, a lot has changed for the family in eight years.

Aidan and his family now live in a fully adapted home, featuring wide corridors for his wheelchair, a lift (Disney themed, which as Catrin notes, was ‘very important’), hoists, specialist bath and shower. Aidan can move independently within

SPONSORED

the home and access all areas without the assistance of his family.

Today, Aidan cycles at home daily and goes to the gym twice a week and also exercises in water. His physiotherapist Alison explains that he is “encouraged to continue to work hard to keep the great gains he has made,” noting that it is “great to see how much he loves attending college and work experience. With improved mobility he can join in with fun activities and chat with his friends.”

Aidan is able to walk independently for short distances and sits up straight without support. Now able to eat without gagging and to drink from a glass, the family regularly go out to eat together. In fact, they recently took a family holiday to Disney World in Florida. Aidan loves rugby and is a big Exeter Chiefs fan.

“When I speak with Aidan today, he can tell me his news and I understand everything he says” says Catrin, with a smile. “He has a lot to say! He’s a happy, funny, positive person. Working with him and his family has been an absolute joy.

“Aidan was late getting the full rehabilitation programme he needed, it is always beneficial to start rehab as soon as possible, however Aidan proves that big improvements can be achieved later on if you have the right rehab team in place.”

Asha Beswetherick, of Enable Law agrees: "The transformation I have seen in Aidan since acting as his Deputy alongside Catrin as case manager has been phenomenal.

From being able to access equipment and therapies, having the right wheelchair to, what has probably been the most significant change, moving into his newly adapted home where Aidan has the space and facilities to support all his needs. As Deputy, I know Aidan's needs will change as he

Aidan is now able to walk independently for short distances and sits up straight without support

continues through his adult years but with the support of his family and an excellent case manager, he has a supportive team around him that certainly makes all the difference in making decisions on his behalf".

“Catrin is amazing. She gets me everything I need and want. I love talking to her.” says Aidan, who is well known at Breakthrough Case Management, for his positive outlook and his incredible smile.

“We love to receive photos from Aidan; whether it’s a family holiday photo, an outing to the rugby, a Christmas snap with his dog, or an update on his new garden ‘bar’ - it always features that smile,” says Catrin.

Krissy, Aidan’s mum is delighted with the impact Catrin’s input has made on her son’s and her family’s life.

When asked what she would say to another family in the same situation being offered a case manager, Krissy explains, “When he was eleven, I said I did not need a case manager. Now,” she says, “I say I couldn’t be without one.”

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F

ounded in 1986, Brain Injury Australia is the nation’s peak advocacy organisation representing the over 700,000 Australians living with a brain injury. Its annual National Brain Injury Conference has become one of the premier learning and development events on the international disability calendar – driving improvements in services and supports for people living with a brain injury, their families and carers.

Consistently ranked as one of the top ten most liveable cities in the world, Adelaide is perfectly positioned between the Adelaide Hills in the east and its beaches to the west and is surrounded by more than two thousand acres of parklands. With plenty of award-winning restaurants and bars serving the best

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of Australian food and wine combined with a teeming arts, events and festivals calendar, there is plenty for the Conference delegate to see, do and taste.

The Conference’s Organising Committee invites people with lived experience of brain injury, family members and carers, researchers, clinicians, allied health professionals, service providers and policymakers to submit proposals for presentations on everything brain injury.

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SPONSORED

Rehabilitation is not a place: It is a process How GripAble can support outpatient stroke rehabilitation

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ecently there has been a shift from inpatient to outpatient rehabilitation for stroke patients.

Through more active and engaged patients, cost effective practices, and improved outcomes, outpatient therapy has the ability to provide opportunity and comfort for patients, providers, family members and caregivers alike.

Why outpatient rehabilitation?

There are several reasons why individuals are opting for earlier discharge and outpatient therapy: Community integration: Outpatient therapy allows for earlier discharge of stroke rehabilitation patients into the community.

Evidence suggests that supporting community integration will keep patients more active and engaged throughout their rehabilitation journey. In addition, the influence

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of family or caregiver support during intensive therapy can result in improved functional outcomes compared to conventional therapy alone.

Maintain gains: Stroke rehabilitation outpatient therapy has been shown to help to maintain gains made in inpatient stroke rehabilitation and ultimately improve patient outcomes.

Individuals are able to put into practice the skills they developed during inpatient therapy and repeat them in real life scenarios with the support of family and caregivers.

Fnancially friendly: Patients are often kept in expensive inpatient stroke rehabilitation beds longer than is necessary due to a lack of outpatient options, which causes backlogs and issues with flow. Outpatient stroke rehabilitation

is relatively inexpensive when compared to the resources required for patients to stay in an inpatient facility. Shifting stroke recovery to an outpatient setting can help refocus resources, reducing the burden on overstretched care professionals.

Additionally, research validates that patients are more likely to benefit from therapy in their homes versus an inpatient setting. Bernhardt et al. found that “on a stroke unit during a therapeutic day, stroke patients were shown to spend their time largely inactive. More than 50% of patients’ time was spent in bed, 28% was spent sitting out of bed and only 13% of time was spent in therapeutic activities.

Patients were alone for 60% of the time which is contrary to the evidence that increased activity and environmental stimulation is important to neurological recovery.”

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How GripAble can support outpatient rehabilitation When promoting outpatient rehabilitation options, some challenges can occur. Patient adherence and realistic, yet impactful therapy activities are crucial to consider.

This raises several questions: > What activities provide the intensity required for neuroplastic changes? > How do we keep patients engaged? > How can we ensure quality of movement?

With these questions in mind, GripAble offers a clear solution.

GripAble is a gamified rehabilitation platform, offering both assessment and training of the upper limb. It delivers gamified therapy activities, digital assessment, and data-driven insights into a patient’s function. The handheld GripAble sensor connects

to an app on a tablet, where the user can be assessed and play a range of engaging games and activities that focus on training the different aspects of grip, hand and wrist movement. Through these fun and engaging activities, GripAble helps individuals to stay motivated with their rehabilitation.

A prime candidate to receive GripAble’s unique rehabilitation

Research validates that patients are more likely to benefit from therapy in their homes versus an inpatient setting includes individuals with arm weakness after a stroke who are

able and motivated to follow regimes independently or with the support of a caregiver. Therapists can set daily goals and assess an individual’s activity against these goals. Users get real-time feedback on their performance and can save and send their activity reports to their therapist.

GripAble was designed with outpatient remote rehabilitation at its heart by enabling ongoing hand and arm therapy at home, proving that rehabilitation is not a place — it is a process.

GripAble is available for direct purchase in the United Kingdom, and is distributed by Medline in the United States.

For more information on how GripAble can be used in your therapy practice please contact hello@gripable.co

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Fixed-term contracts what you need to know

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The use of fixedterm contracts can give clarity and certainty to employers and employees alike - but for employers, they must ensure they are meeting their legal requirements towards those working for fixed-term periods.

Cecily Lalloo, managing director of Embrace HR, independent HR specialists in private care sector support, discusses the key points of which employers must be aware.

The use of fixed-term contracts can give clarity and certainty to employers and employees alike - but for employers, they must ensure they are meeting their legal requirements towards those working for fixed-term periods.

Cecily Lalloo, managing director of Embrace HR, independent HR specialists in private care sector support, discusses the key points of which employers must be aware.

Fixed-term contracts can be a useful way for employers to cover positions for a defined period of time, giving assurance that there is enough resource for particularly busy periods or certain projects, while also

affording flexibility. For employees too, being contracted to work for a fixed period can give clarity around the nature and duration of their role, and what is expected of them during that time.

In such a fast-changing sector as healthcare, where resources may suddenly be particularly under pressure, the option of a fixed-term contract can be an effective tool to bring in people for a defined period.

For example, to cover an absence on maternity leave or a long-term sickness absence.

There are four main types of fixedterm contract: *Pure fixed-term contracts – these expire automatically, at the end of the term, without the need for notice.

These are quite inflexible as there is no option to terminate the contract early *Contracts with a notice clause providing for early termination – if notice is not given, the contract will expire automatically at the end of the term * Contracts stated to be for an initial term, during which notice may not be served – the contract terminates on notice after the initial fixed term has expired * Evergreen contracts – these renew automatically for another fixed term, unless one of the parties gives notice of termination.

Fixed-term employees are protected by legislation through the FixedTerm Employees (Prevention of Less Favourable Treatment) Regulations 2002.

This states that employees on fixed-term contracts are treated no less favourably than permanent employees - so in terms of aspects like pensions or defined benefits, they are comparable.

During their period of employment, employers should review the contractual terms and benefits offered to fixed-term employees and look for any differences from those offered to permanent staff.

Longevity also counts in an employee’s favour, particularly at the point at which a contract expires, which is regarded as a dismissal. Throughout their period of employment, they are entitled to be informed of any permanent roles.

Fixed-term workers will have unfair dismissal rights after being employed for two years, and for those who have been continuously employed for four years or more on a series of successive fixed-term contracts, they will legally - and unless there is justification for the use of consecutive temporary contracts be treated as a permanent employee.

But in the case of unfair dismissal, fixed-term employees are awarded greater protection, and there are circumstances in which they will be deemed to have been automatically unfairly dismissed.

There is no requirement to have two years of service to bring this claim.

For a dismissal to be fair, it must be for one of the potentially fair reasons set out in legislation, which are: • Capability • Conduct • Redundancy • Contravention of a statutory obligation • Some other substantial reason.

In this situation, employers will need to establish which reason they seek to rely on, and follow a fair procedure. Each case will be based on the circumstances at the time.

The use of fixed-term contracts can be beneficial for both sides - but employers must ensure they are adhering to the legal rights afforded to fixed-term employees, and the fact these may increase after two and four years.

For advice or guidance in this area, please contact Embrace HR at www. embracehr.co.uk

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What is Freezing of Gait and can NexStride help?

Freezing of gait (FOG) is a common motor disorder in Parkinson’s disease (PD).

It is characterised by sudden, unanticipated interruptions in gait, lasting from seconds to minutes, in which people feel that their feet are stuck to the floor and unable to move forward despite trying hard.

FOG episodes can occur in other neurological diseases too. The phenomenon is particularly debilitating and often requires physical support from another person to get unstuck and start walking again.

Treatment strategies developed for managing gait disorders and freezing include medications, deep brain stimulation (DBS), physical therapy interventions and external visual cues.

The classic presentation of gait freezing is sudden and dramatic stops and starts while walking, but

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some patients describe that they feel like their feet are glued to the floor with an inability to take the next step. These episodes often occur when crossing doorways, turning around, or approaching an obstacle. The severity is very variable from person to person with some experiencing only occasional episodes and rarely, some individuals will experience almost continuous FOG preventing useful ambulation.

Freezing of Gait obviously impairs mobility but also increases the risk of, and causes, falls and significantly reduces quality of life.

Gait disorders, including freezing, affect 60–80% of PD patients, often presenting in the later stages of the disease.

Several factors can cause or worsen the freezing of gait, including fatigue, distraction, anxiety, stress, visual clutter, transitions from

one walking surface to another, and narrow spaces. Patients who have freezing of gait also tend to experience more severe postural instability and other motor symptoms of the disease.

Studies have shown that more advanced PD patients who show primarily a freezing of gait phenotype tend to have less benefit from dopaminergic medication and have more potential side effects, including motor fluctuations.

Thus, there is a growing clinical focus on novel therapeutic interventions, not only for FOG but working on the significant nondopaminergic pathology that exists in the primary progressive freezing gait syndrome. Physical therapy, particularly a program that involves balance and gait training, is an essential non- pharmacological intervention to improve gait freezing and associated motor symptoms.

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Standardised gait questionnaires and structured physical activity programmes have been used to assess patients' motor and cognitive function, providing a baseline to evaluate this and guide clinical intervention.

Visual cues are known to be an effective method for improving freezing episodes. The presence of sensory feedback may be useful for overcoming a "motor block" and promoting movement.

Various external visual cues, such as laser lines, stripes on the floor, or footstep rhythms, can be an effective way to overcome freezing, providing the patient with a predictable sequence to follow.

Additionally, tasks such as mental imaging and rhythmic audio cues can also effectively trigger gait initiation in PD patients.

Anatomical Concepts offers a neat product called NexStride that uses

cueing technology to help overcome

the freezing of gait.

The NexStride product combines

both visual and rhythmic audio cues,

and makes them adjustable and ad aptable to different types of walking

aids.

NexStride combines

The device can be attached

discreetly to any walking cane or visual and rhythmic

frame with a laser line adjusted to audio cues and makes

a distance that suits the individual

user. A metronome can also provide them adjustable and

an audio cue with the volume control adaptable

at your fingertips. Fundamentally

by using the visual and/or auditory

cueing you are able to bypass the

blocked neural pathway that is

causing the freezing of gait.

The NexStride can effectively trigger

gait initiation in many persons who

have difficulty with FOG.

You can find out more or purchase

the NexStride at https://www.ana tomicalconcepts.com/nexstride or

contact them for more information.

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SPONSORED

Chroma, supporting therapists’ resilience

By Rachel Smith, music therapist, Chroma

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SPONSORED

"No one is left to struggle"

C

hroma is leading the way in ensuring creative arts therapists receive the tools they need to develop resilience in the work they are carrying out each day.

Therapists work with a variety of clients, all of whom have their unique issues, of which Chroma therapists provide unwavering support to help them overcome these and move forward positively.

But as is the case with talking therapies, it can take its toll on the mental health of the therapists. And, Chroma, established by practicing arts therapists, understand all too well the mental burnout and fatigue that can occur as a result of the job. This is why they have ensured their therapists receive the very best support, in-house, that can help prevent stress and promote self-care.

All HCPC registered creative arts therapists need to access their clinical supervision, but the clinical team at Chroma offer additional management supervision. This support can occur weekly if the case is particularly difficult or stressful, but typically every eight weeks. If the case the therapist is working

on is particularly challenging, support can even be provided daily – so therapists never feel alone and always feel heard and supported in their role.

During these sessions, the clinical management team will find out how the therapists’ case is going and what needs further exploration – supporting therapists to think about their goal setting.

Chroma also provides an on-going monthly CPD programme offering training on all aspects such as report writing, working with families, short-term work, dealing with funding, autism etc.

This helps therapists, especially new therapists, hone in their thinking about the work they are doing and understand the importance behind what they are doing, whilst receiving guidance on the support they are providing clients – they’re not alone to fend for themselves – Chroma is always on hand to help.

No one is left to struggle, and with that level of support therapists build their resilience towards the work they do every day and to better support their wellbeing at work and, outside of it.

To find out more, visit wearechroma.com.

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SPONSORED

Dementia care planning and co-production Dr Inga Stewart, consultant clinical psychologist and head of co-production

Through a pioneering new research project, people with dementia and their loved ones will play a greater role in their care than ever before - and care professionals will be supported to make this happen.

NR Times finds out more from project lead Dr Inga Stewart, who discusses her ambitions for a person-centred approach to become commonplace in healthcare “We want to get to a point where you just couldn't imagine writing a care plan without involving the person it's about, and the people who are supporting them in their care” That commitment to the highest standard of person-centred dementia care lies at the heart of pioneering new research, which aims to create a new approach to care planning which could change the current face of healthcare.

Led by Dr Inga Stewart, consultant clinical psychologist, clinical research fellow and head of co-production at St Andrew’s Healthcare, the project will shine a light on the need to put the patient and their partners in care at the heart of care planning - a process in which they all too often feel sidelined.

With the support of the Alzheimer’s Society, the research will inform the

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development of a toolkit to help care teams actively involve those directly affected by dementia, working in equal partnership to create a care plan that takes in all perspectives on care and is as person-centred as it is possible to be.

The research project - The coproduction of the care planning process with people with dementia - brings together experts in dementia through their academic, clinical or lived experience, creating a steering group with a comprehensive, 360-degree knowledge of dementia and current practices to help inform how effective change can be made.

The main issue challenged through the project - the sidelining of people

"There will be some practice where care plans are written about people, and they're not involved at all"

with dementia in their own care - is something that is sadly quite commonplace in care settings, says Dr Stewart.

But with care planning covering every aspect of their life - from what support they need with particular tasks, through to which shampoo they prefer - it is essential it is tackled.

“We can see some really good practice, where the person with dementia is involved in their care plan, as are their families or care partners. But then there will be some practice where care plans are written about people, and they’re not involved at all,” says Dr Stewart.

“And I think, sadly, the latter is probably more the norm. I don’t think it necessarily comes from a bad place; I think it’s more often a lack of understanding about co-production, how you engage and involve people to really work together to create a care plan.

“Often, people think you just can’t do that with somebody with dementia.

“It might be that a person doesn't

really know where they are, they don’t know what a care plan is. But that doesn’t mean you can’t coproduce their care - they will know what they like and what they don’t like, they will know what their hopes and wishes are.

“And you can adapt your way of working and communicating with somebody to ensure that coproduction can happen.”

Co-production is a term at the heart of everything Dr Stewart and St Andrew’s are seeking to do, ensuring the person is the focal point throughout their care.

And for Dr Stewart, this lies at the heart of the research, and is key to changing the future for dementia patients.

“Co-production really is a set of values, it’s about respect and genuinely listening to and taking on board what somebody else thinks,” says Dr Stewart.

“Often people think it has to be about agreement, but actually it’s about everybody having a voice. When you create these coproduction opportunities, everybody comes with their own experience.

“So you might have people who come with their experience from their professional background, whose learning will have been done academically; but their experience will be different to the lived experience of those who have

dementia, or are living alongside people with the condition.

“For me, I have worked with lots of people with dementia, I've worked with lots of care partners and family and friends, but I have not lived with dementia, and I have not lived alongside somebody with dementia.

So I don't know what those experiences are really like.

“If we all bring all of that to the table, and we genuinely take on board all of these experiences, knowledge and ideas, then what we can co-create is really exciting. And it's so much more than any of us could do individually.

“We’ve got to think of it in terms of levels, and what often happens is that people are co-producing but they don't even know they're doing it.

“So it might be that whilst you're supporting somebody with their personal care, perhaps they're having a shower, and you're chatting

"Often people think it has to be about agreement, but actually it's about everybody having a voice. When you create these co-production opportunities, everybody comes with their own experience"

away to them about the things that they like.

“You could be talking about their family and you find out that they have a gorgeous garden back at home, and they love to potter in the garden and they know about flowers. So then you end up speaking to the rest of the team and saying, ‘I found out something new about this person’. And that comes out in the care plan.

“So it can be happening in many forms already, but what we want is for everybody to have the opportunity to co-produce to the fullest extent they can.”

By bringing together a steering group with wide-ranging experience of dementia and living with dementia - nurse and social worker Julie Hayden; ex-football referee Peter Jones and ambassador for the Alzheimer’s Society; independent pharmacist and local Alzheimer’s Society ambassador Emma Wood; Niccola Hutchinson-Pascal, head of the co-production collective at UCL; and Professor Jacqueline Parkes, specialist in applied mental health at University of Northampton - all approaches to dementia can be analysed.

The project has created a number of practice standard statements to help guide the focus on the patient in the creation of care plans:

SPONSORED

Practice standard statements > I am an equal partner in planning my care > I am at the heart of decision making > I have had a conversation about care planning and I feel ready to start > The language and approach is understandable to me > People significant to me could be invited to be involved in planning my care where appropriate and acceptable to me > I am the expert in my own experience.

My knowledge and my care partners’ knowledge is respected and included > The steps that we are going to take together to attain my aims are clear and achievable. > We can review my care plan together at any time

“There is always room for improvement in dementia care, and through this research project, we want to bridge the gap. We want people to realise what they’re doing that is really good, but also how they can overcome some of the barriers,” says Dr Stewart.

“The practice standard statements are really fundamental, they are the basis of all of the work that we've done.

“We drew on what was already out there in terms of literature, and we drew on people's lived experience, and also their professional experience, to think about what are the foundations of co-produced care planning?

“By creating this toolkit, we want to support the staff tasked with writing care plans to co-produce them with the person and their care partners. That is our focus.

“The actual toolkit itself is dementia-friendly, and could be used by care partners as well. There are hints and tips in there to help. It also has a checklist, which can be used as a self-assessment or audit tool on a broader level, to look at people’s care plans across the service.

A pilot of the toolkit is currently underway at St Andrew’s, building further on the care provider’s existing commitment to co-production.

“There is already a lot of working going on in co-production, and we’re currently working on our co-production framework, which is really exciting,” says Dr Stewart.

“I think this toolkit fits very nicely into

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our dementia services, and this will be one of our outcome measures - we’ll be able to show just how co-produced our care plans are by using the checklist as an audit tool.

“I feel really confident about the toolkit.

A lot of work has gone into it, and I hope it will help to make the cultural change we all want to achieve.”

Beyond the St Andrew’s pilot, interest is building from care settings around the country, which is informing the next stage of research.

“Right from the beginning, we have had a huge amount of interest externally, from care homes and hospital settings,” says Dr Stewart.

“We hope they will be involved in the second stage of the research, which is the multi-site research. I hope this can be an opportunity to influence practice and to influence and challenge thinking and assumptions that are out there.

“While people working in care may be innocently assuming that you cannot co-produce care planning with people with dementia, we want to show them that is wrong and how you can do things differently and better.

“By supporting them in this, and showing them and guiding them through the process, we can make change, and that is what we really hope to do.”

To get involved in the consultation, contact Dr Stewart and the team at research@stah.org.uk

"While people working in care may be innocently assuming that you cannot co-produce care planning with people with dementia, we want to show them that is wrong"

SPONSORED

Rebuilding lives and creating futures QEF’s Care and Rehabilitation Centre provides expert neuro rehabilitation and 24/7 nursing care; supporting people to rebuild core skills after an acquired brain injury, stroke, incomplete spinal injury or neurological illness.

We provide person-centred, holistic therapy and care and work closely with the NHS, case managers, families and everyone involved with an individual’s neuro rehabilitation.

Contact us to find out more Tel: 01372 84 1111 Email: neurorehab@qef.org.uk Web: www.qef.org.uk/CRC_professionals

Watch our virtual tour and meet the team at qef.org.uk/CRC_virtualtour

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SPONSORED

32

SPONSORED

Using computer-assisted technology in brain injury rehab

R

ichardson Care is one of the first organisations in the UK to use RehaCom® cognitive therapy to improve outcomes for people with acquired brain injury. After introducing RehaCom in 2020, alongside other therapies such as Cognitive Behavioural Therapy, Dialectical Behaviour Therapy, relaxation and psychoeducation, service users at Richardson Care have experienced a range of benefits. These include: -improved short-term memory -recalling previously-lost childhood memories -better attention skills and ability to divide attention -increased concentration -improved cognitive skills -improved reaction times -improved higher executive functions The RehaCom® technology assists in the rehabilitation of cognitive difficulties that affect specific aspects of attention, concentration, memory, perception and activities of daily living. This means that difficulties can be targeted and specifically trained. The system is auto adaptive, meaning the activity will get harder or easier depending on the performance of the person. This ensures steady progression, increasing motivation and reducing frustration for the client. RehaCom® also offers a number of screening modules to detect impairments and recommend corresponding cognitive training modules. Regular screening can also help show progression and provide detailed reporting.

Check out our video to see RehaCom® in use here.

Case study Lynda suffered a hypoxic brain injury in 2010 and was in a coma for three months. She was admitted to Richardson Care in December 2014. She needed frequent prompting and encouragement with all aspects of daily living, such as personal care. She was also wheelchair-bound and had been told that it was unlikely she would be able to walk again.

Lynda started using RehaCom® in 2021 and since then has recalled previously-lost childhood memories

Lynda started using RehaCom® in 2021

as well as improving her short-term memory. Her attention, concentration and other cognitive skills, including mental maths, have also made significant improvements. She reports improvement in her selfesteem.

The holistic approach by the whole multi-disciplinary team has enabled Lynda to transform her life. She is physically independent and can walk well unaided.

She enjoys swimming, going to bingo, going shopping and out to cafes. She has a part-time admin job assisting the Admissions Team at Richardson Care, where she arrives on time and completes her duties with enthusiasm. She has learnt to manage her emotions, develop confidence and resilience.

Read Lynda’s case study in full here.

Richardson Care has six specialist residential services in Northampton: three for adults with acquired brain injury and three for adults with learning disabilities and complex needs. All service users are supported by a multi-disciplinary team of therapists and dedicated care staff who provide person-centred care.

For more information call 01604 792166 or visit www.richardsoncares.co.uk

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SPONSORED

Therapies in action the importance of multi-disciplinary working NR Times learns more about the role of speech and language therapy and physiotherapy combining to support patients at Nottingham Brain Injury Rehabilitation Centre to exceed expectations, regain independence and rebuild their lives

In supporting a person to rebuild their life after brain injury, or in the event of neurological illness, the input from the multi-disciplinary team and their specialism across a breadth of aspects of neurorehabilitation is vital.

Two of those disciplines, physiotherapy and speech and language therapy (SLT), can work particularly closely, supporting each other to restore some of the independence in communication and movement which can make such a huge difference to a person’s life.

At Nottingham Brain Injury Rehabilitation Centre, SLT and physio work together on a daily basis with clients across its residential, slow stream rehab and high dependency units, supporting them from the very earliest stages of recovery to secure outcomes often beyond all expectations.

The impact of the individual disciplines can be powerfully felt within the wider rehab picture - both as inpatients within the centre, and as outpatients, with the re-launch of its specialist outpatient service - enabling clients to establish the

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channels of communication and movement which will allow them to move forward.

“We work with a very complex client group and are dealing with cognitive impairment. It’s essential that from the start we establish communication in whatever way we can,” says Eden Akiatan, a senior neurophysiotherapist at the 59-bed centre, owned by Active Care Group.

“For this reason, we work hand in hand together with SLT. Once we have that communication, then we can engage with them.”

“It’s building that relationship and building the trust,” says speech and language therapist Nicholas Sobieraj.

“The more we can work together as an MDT, the more we can support them in their recovery.

“Often our patients come to us and they can tolerate five minutes of something, sometimes not even that. So by working on different aspects of therapy you can build the tolerance. Over time, you suddenly realise they can now do something for half an hour, even an hour. And it’s about giving the support for them to get to that point.”

Eden adds: “We want our patients to live their lives, that’s what we want to help them achieve. I always tell them ‘Let go and just live’. Live your life and do what you love.

“That’s our aim, to help them to get there, and working together we can help them to do that.”

‘We never give up, however long it takes’ Sarah* arrived at the centre in a minimally conscious state after a left-side stroke which left medics fearing for her future. After discharge from hospital, Sarah, who is in her 50s, was unable to communicate and had severely limited movement on her right side. She also had a tracheostomy in place.

Progress was slow, with no major improvement for over a year. But while Sarah’s rehab potential may have been questioned by some, for Eden, Nicholas and the Nottingham team, they resolved to continue rehab and wait as long as it may take to support Sarah in achieving the long-awaited breakthrough.

“Even during the time we were seeing no progress, we continued to work,” says Eden.

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“We did a lot of bed exercises. We supported the rehab assistants in working on a passive range of movement, we worked with the occupational therapists to do hand work and upper limb work.

“Even if you can’t see them responding, we keep believing that the bits we are doing will add up to something.”

And the persistence of the MDT paid off, with significant improvement coming suddenly, after more than a year of Sarah being at the centre and in a minimally conscious state.

“It was sudden, but then we had the momentum. And from there, she was able to do more of the things that we're asking for,” says Eden.

“We were no longer doing the passive work for her. She was doing more and more herself. The momentum in therapy really picks up.

“Everything we do is based on the individual person’s tolerance and endurance, working within their capability and levels of fatigue.

Fatigue can be very difficult, but by working at a pace that is right for them, we can make great progress.”

Sarah’s tracheostomy has also been removed and she is managing well with her consumption.

“We worked with her as an MDT

“Everything we do is based on the individual person’s tolerance and endurance" and looked at deflating the cuff, we considered very carefully when was the right point in her rehab journey to do this. We trialled removing the cuff and monitoring her saturation levels so they didn’t decrease too much,” says Nicholas.

“This went well so we started to look at eating and drinking again, starting really slow with teaspoons of water then building up from there, really

working on the swallow - the more you’re able to practice it, the more it will improve.

“We cautiously monitored everything over the weeks and months, and she is now on a pureed diet. The goal is to improve as far as we can go. We have reached a point where things have been constant for a while, but that is not to say things will not improve further.”

Physically, Sarah is also making great improvements in her right side strength.

“She still uses the hoist but she has made good progress with the upper and lower limb. Initially when she came to us she had no movement on the right side, but now she can fully use her right lower limb and can pick up with her right hand,” says Eden.

“When sitting, her balance is brilliant. She can sit independently on the edge of the bed for 30 minutes and she can also do sit to stand with us.”

The motivation seen in Sarah, alongside the support of her family

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SPONSORED

"One way of getting the most from our people is engaging them in something they really enjoy"

Nicholas Sobieraj, speech and language therapist

have been key factors in her strong progress.

“She can now have conversations with her family and has a much better quality of life now than when she first came to us,” says Nicholas.

“She is very motivated and wants to progress, which does make a difference, alongside the fact she has a very supportive family.

They give us a lot of feedback and we have very open channels of communication with them - if there is ever anything they want to raise, they know they can discuss it with us.

“If they aren’t visiting, they’re video calling every day, which really helps

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with the cognitive side of the recovery as well. The stimulation from the family and the familiarity are very important.”

While two years ago when Sarah came to Nottingham, the outlook was very uncertain, now the topic of discharge is being considered.

“We will always work with the family in achieving this, and the family in this case will be ready to give the support that is needed,” says Eden.

“But when we look at discharge back home, we will do a home visit to look at whether the home is appropriate for this person’s needs. We need to make sure we are discharging with

the appropriate support there. We can make referrals to community teams if there are needs that need to be met.

“But with our outpatient service, we can always be there with further rehab, if a person maybe still needs some physio or OT input. That way they can be independent, but with the support when they need it.”

Committed to person-centred therapy Working across the three units at the centre - Millwood, which specialises in slow stream rehab; high dependency service Fernwood;

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and Hazelwood, the residential care service - the needs of clients in therapy can differ greatly.

But from the very earliest point, the approach to person-centred care and rehab is the same, whatever a person’s level of injury or need.

“We will always do what we can for the client and their needs and interests,” says Eden.

“We recently bought a boxing bag because one of our clients used to go to the gym before the injury. He was a bit apprehensive when he came to us, there was a lot of anxiety around him engaging.

“So one way of getting the most of our people is engaging them in something they really enjoy. We bought the boxing bag for him and he is loving it.

“It’s great for him because it’s working on the upper limb, working on the standing tolerance, working on the core, while at the same time working on the cognitive performance and cognition. You’re able to look at the entirety of the person, which is

the approach we like to take.

“For this client, just as one very recent example, this approach has worked very well.”

Nottingham has a range of support mechanisms available to help clients, from assistive technology and eye gaze devices, through to cutting-edge sensory equipment to give feedback on posture and movement. This is in addition to the expertise of its inhouse therapists, nurses and rehab assistants.

“The needs of people in Millwood

"Cognition, orientation, movement, communication, everything is assessed"

can be very different to those in Fernwood, there can be a very different level of communication difficulties, but all of our sessions

are designed on getting to know the patient and support them as best we can. It’s very bespoke,” says Nicholas.

“This starts from the very first point, when we will do an assessment from head to toe,” says Eden.

“Cognition, orientation, movement, communication, everything is assessed. We work very closely with SLT and OT to establish the impairment, usually mostly cognitive impairment, and work out how we go forward from there.

“We will consider every way in which we can progress. It might not be quick, but we’ll look at the techniques and equipment we can use to support that. We want our clients to engage with us and communicate with us in whatever way they can and from that relationship comes progress.”

For more information about Nottingham Brain Injury Rehabilitation Centre and other services at Active Care Group, visit www.activecaregroup.co.uk

Eden Akiatan, senior neurophysiotherapist

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SPONSORED

Franchising - an exciting new initiative in case management Richard Thorp, managing director of Circle Case Management, discusses how they are offering others a sector-leading route into starting their own business Along with my partners, Pippa Bird and Yvonne Spijkerman, two of the most highly respected case managers within the industry, we have owned and managed a case management company for nearly ten years. Managing a mixture of employed case managers and freelance associates, alongside our expert witness and Mental Capacity Assessment services.

Case managers often enter the industry without any experience.

With most case managers transferring from clinical settings, Circle Case Management provide training and high levels of admin, clinical and supervisory support, whilst working to create manageable significant caseloads.

We pride ourselves on our case manager retention, with many case managers developing their skills and moving into supervisory and service lead positions.

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We understand that as clinicians grow, they may want the opportunity to start their own business, as we did, making their own mark within the industry.

Case management is a personal service; case managers develop a close working relationship with a client (P) and their family, we understand that reallocating a case to a different case manager may not be the best option for P. Disruption to P can have an impact on their recovery and wellbeing and with this in mind, we have created a new route for case managers that would overcome this issue and still give them the pathway to becoming a business owner.

The progression from clinician to

"Circle Case Management enables ambitious case managers to buy a territory within the UK"

business owner can seem like a scary jump to make, especially if the case manager has no business experience. The management of all aspects of case management, business procedures and clinical policies can be a lot for many to manage efficiently, especially with the advent of CQC registration and the growing requirements of instructing solicitors and Insurance companies making sole practice increasingly more demanding.

Knowing what decisions to make in the best interests of your business can be difficult when starting a new company. Without experience and a deep understanding of the case management and the medio legal industries, costly mistakes can happen with processes which effects the level of service delivered to P. As an established business, we are able to reflect on case managers that have previously left our team to create their own businesses and ask “How can we assist case managers to reach their goals whilst retaining assets within the team that we have invested in?”

SPONSORED

Richard Thorp, managing director at Circle Case Management

As a supportive management team, we wanted to provide another option for case managers to flourish with their own business, whilst also protecting the training, supervision, guidance and support we have invested into the case managers’ progression.

The Circle Case Management Franchise opportunity was the perfect solution - an innovative option that is not available with any other case management service provider across the UK. Using our many years of business and industry experience alongside our outstanding reputation from our multi-award-winning teams of professionals, Circle Case Management enables ambitious case managers to buy a territory within the UK under the recognised Circle Case Management brand and create their own successful case management business.

We have created a unique launch assist program that will guide case managers into managing their own successful Circle franchise. The program is a full support system for your launch, including business

registration, how to market and promote your business, and the clinical procedures and processes to ensure your franchise is a success.

We are launching our first three franchises into the world of small business ownership this autumn, with the support continuing throughout your Circle franchise journey.

Our franchise opportunity will empower case managers to be able to take the leap into business ownership, paired with our experience, they can drive their company forward

business, mentoring owners to achieve CGC registered manager status to offer instructors confidence in your company; and helping these ambitious individuals through the maze of taking on their own clerical, clinical teams and associates with the full support of our highly experienced HR team.

Our franchise opportunity will empower case managers to be able to take the leap into business ownership, paired with our experience, they can drive their company forward to the heights of award-winning case management services.

There could be a franchise popping up in your area - watch this space!

To find out more, please visit www. circlecasemanagement.com.

Following launch, we will be holding regular business master classes to bring your company to the next level, meetings with our award-winning marketing manager to propel your

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SPONSORED

Introducing Empowering U Case Management (EUCM) T

he Jakhu family have owned and operated several care providers in England and Wales for the past 30 years.

After continued success in the sector, Empowering U Complex Care was launched in 2014 to provide complex care to individuals who require support at home and in the community. The organisation has gone from strength to strength across the Midlands.

Empowering U Case Management (EUCM) was born out of a requirement to build a case

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management firm that delivers a client-first, collaborative approach to case management. By sitting under the wider Empowering U umbrella, EUCM have access to a vast amount of expertise and experience gained in the health and social care sector and use this to deliver a unique service, putting the client first in everything they do.

EUCM is led by Barry Lehane, Head of Case Management and Rehabilitation and Jenny Mitchell, Head of Business Operations.

Together they hold over 24 years experience within in the field of Case Management.

EUCM have a team of 10 Case Managers, which include Physiotherapists, Registered General Nurses, Registered Mental Health Nurse and Occupational Therapists, who are geographically distributed over the country to enable us to cover each county.

They ensure their case managers have the appropriate skill set as well as the experience of working within a multi-disciplinary team and the ability to advocate for the client. To underpin all this, they follow EUCM person-centred approach. Through their comprehensive induction and ongoing support and governance,

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they ensure their case managers are best placed to help their clients optimise their recovery.

When seeking a compassionate, provider of comprehensive case management, one name to consider is EUCM. Their approach to case management infuses the client's journey to recovery with a sense of empowerment, ensuring they are directly involved in every aspect of their care, thus aligning with their values "Equality, Unity, Compassion, Maximise Independence.”

A unique approach – equality, unity, compassion, maximise independence The heart of EUCM's unique approach lies in its commitment to inculcating an enriching environment for their clients. They provide an uplifting and supportive service that empathetically respects and upholds the rights, goals, and individual characteristics of each client. EUCM believes in the power of collaboration - working together with clients, their families, and healthcare professionals to form a robust team with a shared goal. But key to their approach is motivation; helping clients harness their inner strength and optimism, fuelling progress even in the face of challenging health conditions.

informed decisions about their care and making their voices heard.

They strive to equip clients and their families with the confidence to actively participate in their care.

Their blend of care coordination, detailed knowledge of the healthcare landscape, and an absolute focus on empowering individuals with complex needs offers a life-changing service to clients and their families.

Through their remarkable work, EUCM continually pushes the boundaries of what is possible in case management, contributing significantly to better outcomes for clients and their families in the UK. While the journey to recovery or adjustment can often seem daunting, providers like EUCM underscore the fact that with the right support, collaboration, and unyielding motivation, the path ahead can be navigated with dignity, respect, and empowerment.

Governance EUCM are committed to continuously improving the quality of our services and safe-guarding the high standards of case management which they offer. They ensure that the stakeholders are in good hands and that the team are functioning at their highest potential.

All of their case managers are registered with their individual professional bodies, which is checked on a regular basis during audits. On top of their professional body, they are registered with BABICM and/or CMSUK. They all work to the codes of conduct released by BABICM and CMSUK. EUCM are up to date with the status of the IRCM. EUCM provide a robust and indepth induction to all their case managers, even if they have been in case management for several years.

Regular clinical supervisions, training and team days are held to ensure that EUCM uphold their high standard of clinical governance.

Comprehensive services EUCM offers a broad range of services designed to cater to the diverse needs of their clients.

Their services encompass case management for adults and children with complex needs and long-term conditions, providing the support they need when they need it, in a respectful and dignified way. They hold firm to the belief that each client deserves individualised care that comprehensively addresses their unique needs and circumstances.

Empowerment at the core One of the defining features of EUCM is an unwavering commitment to empower clients and their families on their journey to recovery or improved quality of life. Their person-centred approach helps clients navigate complex healthcare systems, making

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Fourier Intelligence opens landmark centre 42

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G

lobal rehabtech leader Fourier Intelligence has marked the latest step in its expansion with the launch of its Malaysia Corporate Office in Malaysia.

Backed by Saudi Aramco’s Prosperity7 Venture, Fourier Intelligence has grown significantly since its inception in 2015 and successfully raised $62million in funding.

With over 2,000 installations and a market presence in 56 countries globally, the company focuses on rehabilitation technology that aims to empower patients and therapists using robotics and artificial intelligence.

With a diverse portfolio of more than 30 products and 200 turnkey solutions, Fourier Intelligence specialises in developing advanced robotic exoskeletons and virtual reality-based therapy platforms to address needs for upper, lower, balance and movement impairments.

Coupled with gamified therapy,

these innovations enable healthcare providers to deliver personalised and effective rehabilitation programs, improving the patient’s overall recovery outcomes and quality of life.

With an existing prominent presence in Malaysia through multiple largescale projects with Sunway Medical Centre, Pertubuhan Keselamatan Sosial (PERKESO) and WQ Park, Fourier Intelligence aims to serve as a direct waypoint for the domestic medical industry to obtain the latest advancements in rehabilitation technology.

The new centre will also act as a strategic hub to support Fourier Intelligence's business operations and further strengthen its commitment to providing cuttingedge rehabilitation and assistive technology solutions to the South East Asian market.

“We are thrilled to launch our new Malaysia Corporate Office here, as it allows us to serve our regional stakeholders better,” says

Zen Koh, co-founder and Global CEO of Fourier Intelligence.

“In general, the rehabilitation tech industry in Asia is still in the early adoption phase, and we hope to elevate this through our offerings in this region. This aligns with our mission to empower therapists and patients through advanced robotics and AI solutions.

“We look forward to driving the Malaysian and overall South East Asian markets forward and anticipate facilitating stronger collaborations with local partners, healthcare professionals, and research institutions to drive innovation and enhance patient care.”

“Fourier Intelligence is driven by knowledge sharing and believes that collaboration is key to advancing the rehabilitation industry, as it enables industry partners to forge closer ties and share knowledge for the betterment of the sector.

“We hope that with our new Malaysia Corporate Office in place, we can see a huge growth in rehabilitation technology and wider adoption of intelligent rehabilitation.

Fourier Intelligence also actively participates in industry events and conferences to facilitate advancements in the rehabilitation industry, such as the upcoming RehabWeek 2023, which will be held in Asia for the first time, and furthers their commitment to driving innovation and progress in the rehabilitation industry.

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Occupational therapists the move from disillusion to empowerment

Think Therapy 1st discuss fulfilling the full scope of practice through working as an occupational therapist As a career, occupational therapists (OTs) typically signed up for the holistic approach of empowering individuals to participate in meaningful activities despite injuries and health conditions.

Nonetheless, a growing number of OTs grapple with disillusionment arising from the phrase “not within your scope of practice,” created by a health system that attempts to 44

compartmentalise treatment and therapy into separate departments with separate practitioners from separate organisations.

Imagine a system turned on its head, where the occupational therapists are able to treat clients as they were trained, moving through the rehab model of restoring function, then adapting and finally compensating for loss of function when it can't be overcome.

While also coordinating with the client across the multi-disciplinary team (MDT) to ensure the best treatments at the right time, rather than the restricted occupational therapy treatments offered by limited-scope roles.

Instead, the occupational therapists get to use their specialist knowledge, their ability and wellplaced opportunity to coordinate the wider MDT to manage the client's full recovery across all disciplines and areas of their lives.

Can you imagine the outcomes?

We don’t have to; we are seeing them.

Ten years into the unique model of Specialist Rehabilitation Occupational Therapy that is offered exclusively by Think Therapy 1st, where OTs not only gain job satisfaction and career fulfilment , they’re also alongside their clients while they make such remarkable gains.

SPONSORED

The latest audits of clients who completed their full therapy achieved the following: > 91 per cent of their personal goals – remaining goals were either discontinued or had contingency plans in place to complete after therapy input > 97 per cent of their therapy goals focused on enabling clients to return to activities they want and need to do > 90 per cent improvement in selfcare activities, such as washing, dressing, eating, and sleeping > 84 per cent improvement in productivity activities, including school, work, household tasks and using transport > 97 per cent improvement in participating in leisure activities, including hobbies, sports, and socialising.

Even clients who only completed part of their therapy, for instance, less than half of what was recommended, made significant gains: > 67 per cent achieved of their personal goals > 68 per cent achieved of therapy goals > 66 per cent improvement in selfcare abilities > 47 per cent improvement in productivity activities > 41 per cent improvement in leisure activities.

Hear directly from one of our associates below: “After working in statutory services for many years the idea of stepping into independent practice felt quite daunting, but the team at TT1st are so supportive and knowledgeable it made the process much easier.

“The TT1st model appealed to me straight away with a clear focus on activity and empowering the client to reach their full potential. I found it really refreshing that the goals are so individual to the client, this makes the role really varied and also so rewarding.

“The company is forward thinking and the operational processes are really efficient which means

high standards are maintained and clinical time is productive and focussed which in my experience promotes greater job satisfaction.”

Rachel Stott, Associate Specialist Rehabilitation Occupational Therapist And hear from our clients: “Life is fantastic…I think I'm near enough back to normal…If it wasn’t for you, I think I would still be shut up indoors. You saved my life, and I'm really thankful I had you” “20 months after my accident, I went on to do my sponsored walk. I walked three miles and raised over £4,000 for the Essex

Air Ambulance. I understood that this was therapy and was getting me better in other ways not just physically” If you are an OT brimming with potential and want to explore fulfilling your full scope of practice, think about joining us we’re nationwide.

TT1st providing a platform for OTs to amplify their impact and reignite their passion for the profession.

Visit our website for more information and to be part of this community of practice join our Facebook group: TT1st National OT Network for Functional Rehab.

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SPONSORED

Ben Gent, specialist medical negligence lawyer

Slater and Gordon on the move into Newcastle Through a series of new office openings, law firm Slater and Gordon is investing in widening access to its expertise for people across the country.

NR Times visits its latest opening, having relocated its office in Newcastle, and speaks to the team about its commitment to the region, building its existing reputation further, and how its wide-ranging capability can prove crucial for clients in accessing the support they need As a well-known and trusted name nationally, Slater and Gordon’s expansion into growing numbers of localities across the country is bringing the expertise of its lawyers even closer to those who need their support. The firm has always had

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a presence in Newcastle but has recently relocated to the new and improved premises.

Regarded as a leader in its field in serious injury work - particularly in life-changing brain and spinal cord injury claims - and in supporting clients through distressing cases of clinical negligence, Slater and Gordon’s expansion is seeing it become even more accessible on a local level.

With an ethos of client-centred service, and a commitment to building the strongest possible relationships with both clients and fellow professionals, the growth

of its office network gives greater opportunities for in-person contact with its team of experts.

Alongside this, clients are able to tap into the expertise of lawyers based elsewhere in the Slater and Gordon network, many of whom are national leaders in their field.

The latest relocation in Newcastle, builds on a long track record of success for Slater and Gordon in the city and wider North East. With years of trust amassed from its work in industrial disease,enabling countless clients from across the once heavily industrialised region to access life-changing support, the

new office concentrates on industrial disease, serious injury and clinical negligence work.

Responding to the growing demand for its services from across the region, its team - which continues to recruit is building on its existing client base and relationships with professionals and support organisations, to offer the best possible service from its new home in central Newcastle.

Key names in the team include John Davis, a well-known figure nationally who this year marks 40 years in law, who is hailed in independent legal publication Chambers and Partners as “probably the leading lawyer in the North East on neurological trauma”; ‘rising star’ neurotrauma lawyer Kate Nickin; and Ben Gent, a specialist medical negligence lawyer top-rated

by Legal 500 and Chambers and Partners.

And through its new presence on the ground in Newcastle, Slater and Gordon is keen to build its footprint in the North East even further.

“We already have a strong reputation in this region, and we have always had work from the North East, but I think being local and present in the area is very important for everyone,” says John Lowther, a clinical negligence lawyer with over 10 years’ experience of working in the North East.

“We have a strong network, which we are keen to grow even further, and have built relationships with some really key organisations which can be of benefit to our clients. Charities like Heel and Toe, organisations like Healthwatch - I am chair of Healthwatch South Tyneside - are great local resources, and add to the relationships we have nationally too.”

“There is such a deep vein of expertise running through the firm, both locally and nationally, which is so important for our clients,” says John Davis, one of only a handful of lawyers nationally to be accredited in both brain and spinal injury work.

“Our opening in Newcastle shows our commitment to this region, and the fact we are there for our clients. But importantly, we can offer access to exceptional people within the Slater and Gordon network for advice, in addition to the expertise of our team locally.”

Kate Nickin, neurotrauma lawyer

“It’s important when acting for clients in a particular area that you know the local experts, so which therapists you’d go to, where to signpost people, where is best to find the support they need,” says Josephine Hall, who previously worked in Slater and Gordon’s London office before returning to her native North East.

“It’s also easier to see clients, which we know they really value, and to see the circumstances they face. You can disguise a certain amount on video calls, but when you see them in their own surroundings, you get a much better idea of their situation. There are things they may not tell you, but when you see it with your own eyes, you better understand how you can help them and get a fuller picture of their needs.

Through its new presence on the ground in Newcastle, Slater and Gordon is keen to build its footprint in the North East “Our priority is to do absolutely everything we can to support our clients, and to find every way we can to make their lives better after a

distressing event.”

While locally the networks may be different, the commitment to supporting clients is consistent throughout the Slater and Gordon group. With a reputation for fighting hard for its clients, in cases that can routinely take many years, its North East team share the determination of their colleagues around the country in delivering the best possible outcomes.

“There is a genuine commitment to putting the client at the centre of everything, which is something you hear a lot, but Slater and Gordon really do,” says John Davis.

“Our ethos is absolutely uncompromising on this and we’ll do everything we can to get the best outcome for our client and their particular circumstances, however long that takes.”

With a track record of securing significant settlements for claimants in both serious injury and clinical negligence work - and, crucially, in enabling people to rebuild their lives through accessing bespoke support and securing justice - the team’s expertise can be a key factor in determining the end result.

"It's absolutely vital that you go to a lawyer who is a specialist in their

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John Davis, specialist neurotrauma lawyer

their respective field, you’ve got to be really careful about that,” says John Lowther.

“There was one case which came to me, where previously it was being looked at in the region of £5,000, but the previous lawyer wasn’t a clinical negligence specialist. With proper investigation and after establishing the full circumstances, we actually settled for over £1million.

“We will leave no stone unturned in investigating a claim, to ensure our clients get the support and the justice they deserve. We will unpick everything and give them the answers they need and so they can access what they are entitled to.

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“For many clients, it is very important to them that they are making a claim to make sure positive change happens, that procedures are changed as a result of what has happened to them. That is something we are very pleased to support with - mistakes do happen, and that is very unfortunate, but it is important that lessons are learned and preventative measures are taken that could stop the same thing happening to someone else.”

“The fact we are part of a national network adds so much more, too, and enables us to offer a holistic service,” says Josephine.

“We have a specialist midwifery and nursing team, who are such a

valuable resource. We also have specialists who offer advice on welfare benefits, which is a service not everyone offers but which can be a lifeline for many clients.

“For those who unfortunately may not have claims, our in-house expertise means we can signpost them to the right places, we’ll always do everything we can.”

To find out more, please visit www.slatergordon.co.uk.

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Occupational Therapists and Case Managers play a key role acting as expert witnesses in clinical negligence and personal litigation.

We require experienced Occupational Therapists and Case Managers specialising in all clinical areas, especially those working in the fields of neurology, stroke, brain injury, spinal injury and cauda equina syndrome, who are confident, have excellent communication skills (verbal and written), enjoy a challenge, are intrigued by the forensic nature of this work, and above all are keen to learn new skills.

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SPONSORED

Elysium Neurological holds its first clinical advisory panel

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Elysium Neurological has held its first Clinical Advisory Panel (CAP), to assist clinical teams in the provision of care for individuals with complex and challenging needs. The panel is comprised of leading experts within neurological rehabilitation and treatment and will provide advice and recommendations for three cases per meeting, following presentations made by the teams involved in the individual’s daily care.

Convened to support teams at service level, the panel will draw on the wealth of specialist knowledge and experience that is present across the five different neurological pathways within Elysium, but is not always accessible to regional teams on a day-to-day basis. Paul Mooney, Clinical Director for Service Development & Improvement, Elysium Neurological Services, was instrumental in the development of the CAP and explains the reasons behind its launch.

Paul says: “We recognised that, collectively as a division, we have a huge amount of expertise across our five clinical pathways, and we wanted to ensure that there was a mechanism to be able to use this effectively to enhance patient care. The various clinicians within our services can now benefit from the ability to draw on each other’s knowledge and experience through the CAP, which is a formal panel that sits externally to a given service and that can be approached for advice around particularly challenging cases.

“On the balance of probability, every in-patient service will deal with complex and challenging individuals, and that can be a difficult and sometimes lonely place for clinicians.

Sometimes we can feel that we have tried everything that we can

think of to support a person, so it’s helpful then to get a fresh pair of eyes, to link in with peers from other professions, from other services, even other pathways, to think about different ways of doing things.

“By drawing on the most skilled clinicians available across our services, we can ensure best practice that helps the individuals who use our services to get the best level of care possible.”

Elysium Neurological operates five neurological pathways across 10 services throughout England.

The pathways (Neuroprogressive Conditions, Complex Physical Conditions, Complex Dementias, Neurorehabilitation, Neurobehavioural Rehabilitation) provide specialist neurological treatment, care and rehabilitation for individuals with a variety of different complex needs. For Paul Mooney, the CAP was a natural step in formalising how clinicians already support each other.

Paul says: “There are similarities in how services operate in neurological care but within each of those pathways, clinicians may approach people and problems in a different way. So, if there is a particular case where one approach is not yielding the best outcomes, it is good practice to reach out to others to reflect on a possible solution. Therefore, the development of CAP was actually a very logical move, it felt like an evolution of our overarching teambased philosophy of care.”

Louise Smith is Registered Manager and Executive Hospital Director at Badby Park Care Centre, and although she is a panel member for CAP, she joined the first meeting along with members of her team, to present and discuss a complex case.

Here, Louise shares her motivation for participating in CAP and why she felt the process was beneficial not only to the resident, but also to herself.

Louise says: “I'm a mental health nurse, but I've always worked in neurological services since I qualified

"The various clinicians within our services can now benefit from the ability to draw on each other’s knowledge and experience through the CAP panel"

25 years ago. So, I've developed quite a lot of knowledge and skills over that period of time with regards to challenging cases and individuals with complex needs. However, when you're faced with a challenging situation each day, all of the time, sometimes you can’t find the answer, you don’t necessarily think outside of the box.

“Whereas a clinician with a more objective view, who is a step back from the everyday care, can offer advice and suggestions from a new perspective. Drawing on expertise from multiple clinicians is a continuation of what we do at service level, but CAP is about broadening that access and extending it across all our services, to bring in that additional knowledge and experience.

“I asked my clinical team, who work with this particular resident on a day-to-day basis to come and present her case, receive feedback and then implement recommendations.

They felt very positive about the experience and really took the feedback onboard. They’ve started

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" CAP benefits everyone who takes part. When we listen to the experience of others and the problems that they are solving it makes us reflect on our professional experience" to implement some of the things that were advised, for example, they’ve been speaking to the dietitian and asking new questions. We’ve also been liaising with our visiting consultant, in regards to making some medication changes and he is now reviewing those.”

Louise and her team have already started thinking ahead to the next CAP and considering ways to develop

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them further.

Louise continues: “My team found it really beneficial, they enjoyed it and they're already starting to think about other cases that they can potentially use CAP for. If possible I would like to involve the resident’s family more. Unfortunately for the case we reviewed most recently, we were not able to engage with the family prior to the meeting. We do

have families who are very actively involved and present at the site on a regular basis, and I would definitely encourage them to participate if this was in regards to their family member. They are part of the team that's providing care and support and their input is invaluable to that resident every day. They know them best, they know their history, what's been tried before and what hasn't. Understanding that history is really important when working with challenging needs.”

Shona Anderson, Regional Director of Nursing for Elysium Neurological Services, believes that CAP plays a vital role in ensuring quality of life for individuals with complex needs, and is an important learning opportunity for everyone who takes part.

Shona says: “For me there are two main reasons why CAP is so important. The first is continuing to ensure the utmost quality of life possible for the people that we support. We know that everyone who attends CAP wants the absolute best for those they care for, and that’s why they are asking for advice from the panel. Participating in CAP is a proactive way of ensuring that the individuals that use our services receive the most personalised and effective care and support that can be provided as a team.

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“The second reason is that we often look to external companies for training and for individuals to come in and teach us, but actually we've got all these skills, experience and champions within our services. And because the care that we provide across our five pathways is so diverse, and often complex, then this expertise could be in mental health, or tissue viability, diabetes or end of life care for example. We have the whole range, but we often overlook those individuals and we don't perhaps champion them enough.

“CAP benefits everyone who takes part. When we listen to the experience of others and the problems that they are solving it makes us reflect on our professional experience and we realise that we have also overlooked some of our skills and knowledge. CAP is a great learning opportunity for us all.”

Margrid Jeffries is Head of Clinical Services and the Deputy Service Director at Jacobs and Gardens, a neurological centre in Hertfordshire that provides specialist services for men and women who have complex neurological conditions. Margrid

"We know that everyone who attends CAP wants the absolute best for those they care for" joined the first CAP as a panel member and echoes the sentiments offered by Shona Anderson, and feels that even if your particular service is not presenting a case during CAP, it is still beneficial because the knowledge and suggestions can be brought back and shared amongst the wider team.

Margrid explains: “There’s a sort of inverse benefit to CAP that I didn’t really expect. For example, you might

be sitting there as the ‘expert’, but because the discussion is detailed and covers a lot of ground, with input from multiple clinicians, you can learn new things and take the feedback to your service. There’s continuous learning and the quality improvement opportunity is always there.”

Get the latest insights, blogs and news from Elysium Neurological over on their EveryExpert thought leadership hub: elysiumhealthcare.co.uk/ neurological/every-expert/

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Navigating cognitive rehabilitation: a review of the updated INCOG 2.0 guidelines

By Natalie Mackenzie, director and cognitive rehabilitation therapist at BIS Services

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B

IS Services have provided specialist cognitive rehabilitation assistants for nearly 17 years, to provide support and rehabilitation to individuals living with brain injury and neurological conditions. As a cognitive rehabilitation therapist, I am often asked what my role is, and how it sits apart from other therapist or clinicians.

A cognitive rehabilitation therapist plays a crucial role in helping individuals who have experienced cognitive impairment due to injury, illness, or chronic conditions.

We implement targeted therapeutic strategies designed to improve or restore cognitive functions such as memory, attention, language, and problem-solving. We conduct comprehensive cognitive assessments, create personalised rehabilitation plans, and facilitate cognitive exercises.

Our role is to track progress, adjust therapeutic interventions as necessary, and work closely with other healthcare professionals to ensure comprehensive input. The role also involves providing education and support to clients and their families, helping them understand the nature of cognitive impairments and strategies for managing them in day-to-day life.

Cognitive Rehabilitation Therapy (CRT) follows a step-by-step process, tailored specifically to each client’s unique needs and goals. The primary steps in the process typically include: 1. Evaluation: The first step of CRT involves a thorough evaluation of the client’s cognitive abilities and deficits.

This assessment may include formal neuropsychological testing, medical evaluations, and interviews with the client and their family.

2. Goal setting: Once the evaluation is complete, therapy goals are identified in collaboration with the client and their family, and the wider MDT, if there is one. These goals are often functional in nature, relating to activities of daily living that have been impacted by the cognitive impairment.

3. Therapy: The therapy phase involves targeted activities and

exercises designed to improve cognitive functions. This can involve retraining intact cognitive skills, teaching compensatory strategies for impaired abilities, and cognitive exercises to challenge and strengthen cognitive abilities. We focus on the key cognitive domains, often commencing with attentional processes.

4. Re-evaluation and adjustment: Progress towards therapy goals is regularly monitored, and the rehabilitation plan is adjusted as necessary based on the client’s progress and evolving needs.

5. Transition and maintenance: As the client meets their therapy goals, they may transition from intensive therapy to maintenance therapy, with a focus on continuing to use and reinforce learned strategies and skills in their daily life.

The intervention incorporates four core strategies, forming an integrated approach to rehabilitate individuals with cognitive impairments.

1. Education: This approach enlightens clients and their families about the nature and effects of cognitive impairments. It involves learning about the brain, understanding how the injury has affected cognitive functioning, and what to expect throughout the rehabilitation process. I create

bespoke education packages for each client, utilising medical reports and family feedback.

Education is ongoing around specific areas of cognition, with fatigue management playing a large role.

2. Functional training: This focuses on specific skills that a person needs in their daily life. It is highly personalised and can include skills such as managing finances, cooking, or using public transportation to more complex processes related to vocational goals.

3. Process training: This strategy aims to improve the cognitive processes underlying these daily life skills.

Exercises might be undertaken to enhance memory, attention, perception or problem-solving skills, with the aim of improving overall cognitive functionality. These are informed by initial assessments and other neuropsychological assessments that have been undertaken.

4. Strategy training: This teaching method involves implementing compensatory strategies to help clients manage their cognitive difficulties. For instance, techniques for memory enhancement—such as the use of reminders— might be taught, or organisation strategies might be shared to help manage time more effectively. The list is often endless and the strategy toolbox

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full to the brim when it comes to new strategies.

There is a considerable body of research in cognitive rehabilitation that underpins the development and application of various therapeutic strategies. This was not always the case. CRT was not; for a long time recognised as a valid intervention.

Often it was included in the work of neuropsychologists or specialised occupational therapists.

The guidelines refined their stance on the role of various therapeutic modalities, such as cognitive stimulation, cognitive training, and cognitive rehabilitation therapy.

These are now considered as complementary parts of a holistic therapy plan, rather than standalone treatments.

Research evidence overwhelmingly supports the efficacy of cognitive rehabilitation in brain injury cases. Numerous studies have demonstrated significant improvement in clients who undergo

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cognitive rehabilitation therapy, particularly in the areas of memory, attention, and executive functioning.

This is further bolstered by metaanalyses that have highlighted the positive impact of cognitive rehabilitation on overall cognitive function and quality of life The INCOG 2.0 guidelines, published in early 2023 in The Journal of Head Trauma Rehabilitation, underscore the significance of addressing executive functioning in cognitive rehabilitation.

The INCOG 2.0 guidelines provide a framework that allows for individualisation, understanding that each client’s journey is unique

They advocate for the use of interventions that enhance problem-solving skills, strategic thinking, and self-regulation. This includes practical strategies such as goal management training and metacognitive strategy instruction, which aim to help clients manage daily tasks more effectively.

Additionally, the guidelines recommend the implementation of personalised task practice, emphasising real-world application and meaningful engagement. The use of computerised cognitive training programs is also encouraged, given their potential to target specific executive functions.

Since their initial release in 2014, the INCOG guidelines have undergone significant revisions in their 2.0 version, reflecting the evolving landscape of cognitive rehabilitation following traumatic brain injury.

These changes reflect INCOG's commitment to staying abreast of the latest research and clinical practices in cognitive rehabilitation following traumatic brain injury.

They showcase the evolution of the guidelines from their 2014 version to the present, highlighting both the refinements made and the avenues yet to be explored in this vital field of therapy.

One notable change is the enhanced focus on personalised, client-centred rehabilitation plans. This adjustment emphasises the importance of tailoring treatments to individual needs, taking into account the client’s unique circumstances and recovery goals.

The INCOG 2.0 guidelines understand the necessity of personalised plans. They provide a framework that allows for individualisation, understanding that each client’s journey is unique.

The guidelines also emphasise the importance of ongoing reassessment and adjustment of treatment plans, promoting an approach that optimises client outcomes.

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The new reviews of the INCOG 2.0 guidelines provide fresh insights, further enriching their utility. They highlight the inclusion of both client and caregiver perspectives as central to effective treatment plans.

This human-centric approach individualises therapies, and this shift aims to foster an improved therapeutic alliance, enhancing the efficacy of cognitive rehabilitation strategies. This empowers the clients in their rehabilitation journeys, allowing for increased motivation, as well as improved outcomes.

Another key change in the INCOG 2.0 guidelines is the endorsement of a multi-modal approach to treatment. The guidelines suggest the potential benefits of combining cognitive rehabilitation with other interventions, such as physical exercise and medication, depending on the client’s specific circumstances and needs.

This multi-pronged approach is a substantial departure from the 2014 guidelines, which focused primarily on cognitive rehabilitation alone.

The guidelines also provide clinicians with detailed information on how to assess a person's cognitive needs and the strategies that should be put in place in order to maximise their recovery potential. In addition, it provides details on when and how to refer clients for more specialist interventions if required.

By providing clear direction on how to assess clients and tailor interventions, it allows practitioners to focus their efforts effectively and ensure the best possible outcomes for those affected by neurological conditions. Additionally, it provides an important starting point for designing new programmes which can benefit from evidence-based approaches.

In order to ensure that cognitive rehabilitation efforts are successful, clinicians must be sure to familiarise themselves with the INCOG 2.0 guidelines and use them as a reference when creating

A human-centric approach individualises therapies. This shift aims to foster an improved therapeutic alliance

new programmes.

Despite the significant updates and improvements in the INCOG 2.0 guidelines, the current state of their implementation presents both progress and challenges. On one hand, there's a growing adoption of these guidelines, particularly in rehabilitation units where they recognise the importance of personalised and multi-modal treatments.

However, several challenges persist.

The most common of these include variance in resource allocation, lack of standardised training for healthcare professionals, and the absence of robust monitoring and evaluating systems to measure guideline adherence and effectiveness. Translating to community settings continues to be of great challenge.

While the guidelines highlight the need for an individualised approach, translating this into practice can be complex and time-consuming, particularly given the nuanced nature of traumatic brain injury.

One potential area for improvement in future updates could be increased attention to the role of technology in cognitive rehabilitation. With the rapid advancements in digital health technologies, there are ever more tools available that could potentially be incorporated into treatment plans.

Additionally, despite the endorsement of a multi-modal approach, there is a need for further research to understand the optimal combination of treatments for

different client profiles.

Ultimately, while the INCOG 2.0 guidelines represent a significant step forward, their effective implementation remains an ongoing challenge that necessitates further research, resources, and concerted efforts from all stakeholders involved.

In summary, the INCOG 2.0 Cognitive Rehabilitation Guidelines are useful resource that equips healthcare professionals with the knowledge and tools to effectively manage cognitive impairments, with specific domain specific recommendation.

By implementing the strategies and interventions outlined in these guidelines, healthcare professionals can make significant strides in improving patient outcomes and enhancing overall quality of life in individuals living with brain injury neurological conditions.

For further information regarding how our services can support your clients, or for CRT training information contact us at www. thebiss.co.uk or call 01622 584456.

Natalie Mackenzie, director and cognitive rehabilitation therapist at BIS Services

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Launch of FND Service to redefine traditional pathway A new approach to diagnosing and treating Functional Neurological Disorder (FND), and related conditions such as somatic symptom disorder and chronic pain, is set to transform patient care and outcomes, with a pioneering partnership leading the charge to redefine traditional pathways.

Proclaim Care have collaborated with Brain & Mind to devise a new approach to, and a specialist rehabilitation pathway for, FND, with extensive clinical expertise and experience of supporting people with the condition combining to create the Functional Neurological Disorder Service (FND Service).

The service is set to revolutionise FND treatment and support from the earliest opportunity, replacing the traditional Immediate Needs Assessment with a joint diagnostic and rehabilitation assessment from Proclaim Care and Brain & Mind’s expert teams, with reports completed within 42 days. A fixed fee service is offered for the initial review and assessment.

The FND Service - for patients aged 16 and over - has been created in response to the growing need for new approaches to supporting people with the condition, with the condition becoming more widely acknowledged

and understood, but NHS resources are becoming increasingly pressured in response to the demand and referrals often being made to the incorrect service.

Evidence suggests that with timely, effective treatment, two thirds of people with FND and related complex neuropsychiatric conditions will make significant improvement - but NHS waiting lists are currently around 12 months for the initial specialist assessment, with a similar waiting time expected again before specialist treatment can be accessed.

Clients of the service - which has been created in consultation with insurers, claimant and defendant solicitors - benefit from the significant clinical expertise of case manager Flora McMullon, who also has 25 years’ experience of neurological nursing, consultant neuropsychiatrist Dr Michael Dilley and consultant neurologist Professor Mark Edwards, founders of Brain & Mind.

"FND is something that has existed since the dawn of time, it’s probably not that much more common now than it ever was, but people are now labelling it in a more unified way"

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As an established name in case management and rehabilitation management, Proclaim Care has supported clients with FND for many years, and its belief that something needed to change in this area was echoed by Brain & Mind - a unique service which brings together neurology, neuropsychiatry and specialist neurological and psychological therapies into holistic, client-focused care.

“It’s one of our passions to really drive forward the way in which we deliver case management services, and through this partnership with Brain & Mind we can really change the way in which we’re working across the industry,” says Neil Irwin, commercial director of Proclaim Group.

“The pathway we have created is a new and different way to achieve better outcomes for our clients. Case management hasn’t changed in a long time, and we are always trying to find ways to do things differently and to improve the industry through education - and we believe, working with Brain & Mind, this is going to be a really important addition for people with FND.” The challenges in provision and recognition While FND is not a new condition, the profile it now has is more of a

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"I've seen people becoming more and more disabled because their condition is not being acknowledged"

recent occurrence. Through greater understanding of FND, driven by the work of Professor Jon Stone, Professor Alan Carson and Professor Mark Edwards amongst others, more is known about the condition and its impact.

“FND is something that has existed since the dawn of time, it’s probably not that much more common now than it ever was, but people are now labelling it in a more unified way,” explains Prof Edwards.

“It certainly used to be the case among neurologists that this became a diagnosis where they basically said ‘It’s not neurological, so you’ll have to go and see someone else’. But actually, this is someone presenting with neurological symptoms, so it’s our role as neurologists to do something about this.

“That led to work demonstrating how disabling this is, and how you see a similar level of impairment and quality of life as in Parkinson’s disease or MS. You generally see quite poor outcomes without treatment.

“But with that has come the need to understand the underlying problem of what is actually going on in the brains of people with FND and to understand how you integrate that with psychological and social understanding, looking at it in terms of brain health in general.”

But with this greater awareness has come the risk that FND is now regarded as a ‘catch all’ term for a number of conditions.

This can lead to patients being referred from service to service, trying to find the best match for the symptoms they experience, leading

to what can be significant decline.

Often, they can be directed down a brain injury pathway, which can have a detrimental effect.

“We have often seen people who have actually been made worse through conventional neurorehabilitation, because it has been conducted with the belief that their symptoms are all due to a traumatic brain injury,” says Dr Dilley.

“They will have had 18 months to two years of rehabilitation, either in a community setting or in an outpatient NHS neuropsychological rehabilitation setting, where the idea of brain injury has been perpetuated, that this is the root cause of things.

“This approach carries an important message to the patient, that this is irreversible structural damage; whereas FND is a change in the way your brain is working, it's not about damage or degeneration.”

And for those referred between services, and particularly against the background of a legal claim, this too exacerbates their problems.

“This group of patients are frequently rejected by services, and may have a background in any case of difficult relationships and attachments. This can result in a very challenging and conflictual relationship with health and social care services,” says Dr Dilley.

“We often see cyclical patterns of

healthcare contact, where people move between services and then go back to A&E, which leaves them feeling alienated and very unhappy.

“In the context of a claim, you have the accident in the background, which might be the cause of this problem, or may have made it worse. You're being bounced around, and you can see why some of these symptoms become intractable. And the longer they continue, the harder they are to manage.

“The accepted dogma within the medico-legal profession that you can't treat people once they're engaged in a claim, actually, that's not true for the majority - I’d suggest the sooner you get to sort them out, the sooner you’ll get to sort out the claim.”

From Flora’s background in nursing, as well more recently in her role as a case manager, she sees first-hand the disillusionment of patients who live with FND. “From working in acute hospitals and looking after people who have not been given a diagnosis or else have had a really poorly explained diagnosis, I have seen them becoming more and more disabled because their condition is not being acknowledged, explained and managed properly,” she says.

“It’s a similar story in the community for people who have never really been given a diagnosis, who often develop

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progressively worsening disability and quality of life.

“Coming into rehab management, I’m passionate about getting an early diagnosis for people - if they’re going through lots and lots of services where they get poor outcomes, they become very distrustful of healthcare professionals because they feel they’re not acknowledged, or they have been brushed aside or dismissed as there problems being ‘all in the mind’.

“But there is the opportunity for some really positive gains. And that is what my role as a case manager is about, having a relationship with someone so they know you understand them and you believe them.”

While NHS waiting lists are hugely challenging - with expected waiting times of 12 months for an initial assessment, and then another 12 months to access treatment, and in worst case scenarios waiting times can be up to four years - efforts are being made to improve NHS services and clinical pathways to make them more appropriate for patients, in light of new research and understanding.

Both Prof Edwards and Dr Dilley have been involved in creating specialist services at UCLH, St George’s Hospital and King’s College Hospital, and have been involved in creating a National Optimal Care Pathway for FND in the NHS, which has been through national patient and

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healthcare professional consultation.

However, while undoubtedly positive in theory, in practice, there is a long way to go.

“A lot of the efforts to develop more effective services have been held back by fragmentation…we see that particularly between physical and mental health, and also between specialised and community-based treatment,” says Prof Edwards.

“And the NHS Optimal Care Pathway pathway is not funded - so it’s a fantasy pathway. But hopefully over time, we can get commissioners to give it the funding it needs.”

The need for another way - the FND Service Against a background of patients feeling unheard and not receiving appropriate treatment - and routinely waiting months, if not years, to even receive the first assessment - the urgency for greater support for people with FND is clear.

The need for a more defined pathway, and with it diagnosis of all the problems present and moving as quickly as possible to appropriate intervention, is the driving force between the creation of the FND Service which, through case management and rehabilitation, seeks to achieve significantly better outcomes for patients with FND and related conditions.

The four-stage pathway gives greater

clarity than ever before, and with it transparency on timescale and costs. It also maps out a clear service model, showing the process that will be followed from the point of referral.

Referral into the service - at the earliest possible time - can be critical to the outcome.

“I think most people working in the medico-legal world have a good sense of when something just isn’t right with a client or a case, but the key is pinning down exactly what diagnoses are driving that sense,” says Dr Dilley.

“With FND, there are some specific features of patients who are more likely to have these in their presentation. So in their past history, they may have multiple previous medical and psychiatric problems.

They may have an unusually large number of symptoms, maybe they’re on multiple medications.

“There can be a mismatch between the severity of an event and then the severity of symptoms, we can see a change from minimal symptoms to very high severity very quickly.

“There are also the interactions - the number of phone calls, the number of contacts, the intensity of those contacts. This can give you a sense that the case is different and one common possibility is an underlying diagnosis of FND.” After the referral is made to Proclaim Care comes rapid screening of medical information, where the ‘red flags’ of FND and related conditions can be identified from a person’s history and consideration is given to whether the FND Service pathway is the correct route for them.

The information is compiled and initially reviewed by Proclaim Care, then passed to Brain & Mind for further review, and a brief bullet point report is compiled based on the joint review of medical information.

For patients where FND or related conditions seem likely on the basis of this rapid notes review, the next stage in the pathway is a combined case management and medical assessment.

This encompasses many of the aspects traditionally covered in an Immediate Needs Assessment combined with a specialist

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"The longer people go without receiving treatment, the worse their final outcome" neuropsychiatric and neurological clinical assessment.

Building on the commitment of the FND Service to simplify and streamline the pathway as much as possible, these assessments are combined into a comprehensive report that covers all diagnoses present, current symptoms and a rehabilitation recommendation, with a target for delivering this 42 days from referral.

“We are looking to simplify the process,” says Prof Edwards.

“Effectively what we want to do is get in early, do the clinical assessment, and we can make the diagnosis.

The whole idea is that if you can get people early, give them the right diagnosis and explain that to them, then suggest what kinds of treatments would be most effective, then it’s going to end better for the claimant.

“There are often multiple diagnoses - someone may have FND but also chronic migraine, depressive disorder, PTSD, a pre-existing personality disorder - but if we are looking at it from both neurology and psychiatry, and we have a very good picture of the current symptoms, current level of function and the current challenges, then we can determine the best pathway.

“To do this from an expert reporting point of view would be very time consuming, and also very costly, because you’d be consulting three to four different experts. And it would take maybe a year and a half.”

After the initial review and assessment, before a person progresses down the treatment pathway, it is important that their readiness for rehabilitation is

established, to ensure they are able to achieve the optimum outcome at the given time.

“We have a range of specialist FND rehabilitation treatment programmes spanning community, day-patient and in-patient settings, but as well as selecting the right kind of treatment, the person needs to be ready. Rehab readiness is a bit of a ‘Goldilocks moment’, where you’re ready to be a collaborator in rehabilitation,” says Dr Dilley.

“That is an important component of this pathway: we need to assess people’s readiness to actually engage before you fund it. You want to be sure this individual can use the time well, and not three months later, when you’ve already spent the money, realise this isn’t working. That is of no benefit to anybody.”

Establishing readiness can be an important component in building trust with the client, who may have already been rejected by several different services.

“They need to trust us, they need to know they are believed,” says Flora.

“While they could be a candidate for this pathway, it could be that there are other factors in their life that mean this can’t happen right now, be it family, housing, finances, whatever it might be.

“If they are given the opportunity for

the best type of rehab, you want them to be in the best place for that to be successful and for them to make meaningful change.”

With the FND Service now open for referrals, as well as delivering potentially life-changing outcomes for people who have previously struggled to secure the support they need, it also hopes to demonstrate the importance of earlier intervention.

It also hopes to deliver on Proclaim Care’s ambition to lead change and education within case management, showing how things can be done differently to the traditional, longstanding approaches to rehab.

“There is good evidence that the longer people go without receiving treatment, the worse their final outcome. The evidence suggests around two thirds of people will see significant improvement with treatment,” says Prof Edwards.

“Through this pathway we plan to gather evidence to see what progress can be made, what expectations can we have, and what improvements can we make to how we work. We hope that can help to inform future approaches to FND.” For more information, please visit www.proclaim-group.co.uk.

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Revolutionising stroke recovery: Vim Health robotic-assisted therapies According to the National Library of Medicine, Stroke is one of the leading causes of long-term disability today.

Stroke, characterised by the sudden interruption of blood flow to the brain, can have profound and often life-altering effects on individuals.

Stroke survivors often face challenges in regaining their motor skills and independence. However, the landscape of stroke rehabilitation has been transformed by integrating robotics into treatment plans. In this article, Vim Health looks at how technology is helping stroke survivors as they embark on their journey towards recovery.

At the core of robotic-assisted therapy lies neuroplasticity, the brain's

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remarkable ability to rewire itself in response to injury or learning.

Stroke can damage neural pathways, leading to impaired motor functions.

However, consistent, and targeted therapy stimulates the brain to forge new connections, allowing patients to regain lost skills. Rehab technology capitalises on this principle by

providing intensive, repetitive, and precise movements essential for enhancing neuroplasticity.

No two stroke survivors are alike, and their rehabilitation needs can vary widely. This is where innovative technology truly shines. For example, Gait training devices, such as the Lyra from THERAtrainer and the LiteGait,

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can be tailored to an individual's needs, adjusting factors such as range of motion, resistance, and intensity. This personalised approach ensures that every individual receives the therapy that will be most effective for their unique circumstances, enhancing the chances of a successful recovery.

Traditional rehabilitation often faces challenges in providing the required intensity and consistency of therapy due to time, resources, and human endurance limitations. However, the treatment offered at Vim Health differs. With the use of robotics, Vim Health are able to give highly repetitive and consistent movements, which are crucial for retraining the brain. The ability to engage in a higher number of repetitions within a single session accelerates progress and improves motor skills, leading to faster recovery.

Rehabilitation is a journey that requires dedication and persistence. Equipment such as the Balo from THERAtrainer and the Tyrostation from Tyromotion incorporate real-time feedback mechanisms that guide patients through correct movement patterns.

This instant feedback helps individuals adjust, improving their technique and overall progress.

Furthermore, the interactive and engaging devices at Vim Health boost patient motivation, make rehabilitation sessions more enjoyable, and increase compliance with therapy plans.

Integrating sensors and data collection capabilities in robotic-assisted therapy empowers therapists with valuable insights. Objective measurements of patients' range of motion, strength, and coordination allow evidence-based decisionmaking. Therapists can monitor progress and make necessary adjustments to treatment plans, ensuring patients are continually challenged "No two stroke appropriately. survivors are Rehabilitation professionals play a pivotal role in guiding stroke survivors through their recovery. alike" However, traditional manual therapy can be physically demanding for therapists, potentially limiting the quality and duration of sessions.

Allowing therapists to focus on guiding patients' progress - traditional hands-on therapy and robotics work in synergy to maximise impact in therapy sessions.

Early mobilisation prevents complications such as muscle atrophy, joint contractures, and pressure sores in stroke survivors. Rehab robotics enables early engagement in therapy, enhancing the likelihood of a full recovery. As patients regain mobility sooner, they have a greater chance of regaining their independence and overall quality of life.

Robotic-assisted therapy is redefining the landscape of stroke recovery, offering a promising path toward regaining abilities. The personalised treatment, intensity, real-time feedback, and objective measurement provided by these devices contribute to more efficient and effective rehabilitation. While traditional therapies remain invaluable, integrating robotics creates a comprehensive approach that harnesses the power of technology to unlock the potential of the human brain's remarkable adaptability. Vim Health is a neurorehabilitation centre offering roboticassisted therapy, including the latest innovative technology.

For more informatin, visit www.vimhealth.co.uk.

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Naomi working out with her Bodypoint Stayflex support set-up

Harnessing success: one person’s inspiring para carriage driving journey This is a story about Naomi Sutton and her journey into Para Carriage Driving.

The story begins in October 2019, and has been driven by Naomi’s passion for equestrian sports. Her path has not been without obstacles. Naomi had been diagnosed with Hypermobility Spectrum Disorder from a young age, and later developed Functional Neurological Disorder (FND). Her FND was diagnosed in April 2019, and it prevented her from continuing to participate in horse riding. Undeterred by these challenges, Naomi sought ways to enhance her performance and support her physical needs in the sport she had grown to love. Determined to pursue her passion for equestrian sport, Naomi transitioned into Para Driving.

Functional neurologic disorder (FND), also known as conversion disorder and functional neurologic symptom

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disorder, refers to a group of common neurological movement disorders caused by an abnormality in how the brain functions. FND is not caused by another disorder and there is no significant structural damage in the brain.

The most common symptoms include motor dysfunction: Functional limb weakness/paralysis; Functional movement disorders including tremor, spasms (dystonia), jerky movements (myoclonus), and problems walking (gait disorder); Functional speech symptoms including whispering speech (dysphonia), slurred or stuttering speech.

It is estimated that between 50,000 and 100,000 adults and up to 20,000 children under the age of 16 live with FND in the UK. In addition, there are an estimated 10,000 new cases per year.

The Stayflex is a chest harness which Bodypoint designed with both support and safety in mind. Though looking a bit like a butterfly harness, it has added materials that allow dynamic movement across the shoulders, and along the lower fastening straps, but not in the central padding, thereby avoiding the problems often arising from elasticated butterfly harnesses which often ride up the body giving risk of strangulation.

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"I wouldn’t have been able to do this without my Bodypoint Stayflex set-up"

Naomi Sutton with her Bodypoint Stayflex set-up on the field

Carriage Driving is a sport that received a lot of publicity as being one of the late Duke of Edinburgh’s favourites.

Carriage Driving is a friendly and inclusive sport where there are many opportunities to become involved.

There are many different types of Carriage Driving available, whether it's simply for pleasure or for competitions (which are known as horse driving trials). Drivers control a carriage that's hitched to one, two (positioned in tandem or as a pair), or four, horses or ponies.

Para Driving consists of drivers sitting on a vehicle drawn by a single horse or pony while facing three trials – dressage, marathon, and obstacle driving. Since 2006 Para Driving has fully joined the ranks of the other 7 FEI (International Federation for Equestrian Sports) disciplines with national and international competitions in Driving for individuals with a disability. A Para Driver is classified into one of two grades according to his or her functional ability, to ensure a level playing field.

Naomi Sutton with BES Healthcare’s ATS Virginia Saavedra, and camera-shy dog!

In Para Driving there is an attendant ('groom') who stands behind the driver and can give support and verbal direction to the driver. Steps on the carriage behind the driver are called the backstep and the grooms are also called ‘backsteppers’. Grooms are required for safety reasons because the driver must stay on the carriage at all times, holding the reins, and controlling the horses. They have an important role to fulfil ensuring the safe release of the driver should the carriage overturn.

Naomi did not explore any supportive aids since she did not anticipate competing at a high sporting level.

However, she soon excelled in Para Driving, and began searching for solutions to accommodate her conditions and provide improved stability. Initially Naomi tried using a lap belt, which is a standard accessory, and which she placed around her chest. Although of some help, this did not provide the necessary support, and the backstepper had to hold the strap in place manually. To ensure adherence to the regulations of the sport (which prohibit fixing any equipment without a quick-release system for safety reasons), Naomi continued to seek a more suitable option.

Naomi's journey took a significant positive turn when she met her mentor Julie, the Chef d'équipe for Para Driving, and Pandora's Diplomat, Julie’s pony. Recognising the need for a more effective support system, they connected with BES Healthcare.

Virginia Saavedra, one of BES Healthcare’s Assistive Technology Specialists (ATS), visited the yard to assess the situation and collaborate on finding a FEI legal, safe, and functional solution.

The team worked together to incorporate rings into the mounting system, providing the necessary support for a Bodypoint Stayflex harness. Naomi became the first person to be set up this way, and the results were remarkable!

Armed with her improved set-up, Naomi took on the competition arena, showcasing her new-found confidence and physical ability. Her exceptional performance led her to become the reserve champion in her class, marking a significant achievement in her carriage driving journey. Word quickly spread, and other athletes expressed their interest in adopting the same set-up for themselves, recognising its potential to enhance their performance.

Reflecting on her experience, Naomi said: “In the second phase of the competition – the cones – I got the best score out of all of the competitors, including the able-bodied entrants, and I wouldn’t have been able to do this without my Bodypoint Stayflex set-up.”

Naomi's testimonial stands as a testament to the power of determination and the impact that proper postural support can have on an athlete's performance. Through the collaboration between BES Healthcare, her coach Robert, Julie, and Pandora's Diplomat, alongside the implementation of the Bodypoint Stayflex set-up, Naomi overcame significant physical challenges and continues to excel in the world of Para Driving. Her story serves as an inspiration to others facing similar hurdles, offering hope, and a reminder that, with the right tools and support, anyone has a chance to achieve their dreams.

To find out more, visit beshealthcare.net.

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20 years of PhysioFunction

The 27th of August 2023 marked an enormous milestone for PhysioFunction, our 20th birthday!

From humble beginnings, offering a domiciliary service to clients in Northamptonshire and the surrounding area, emphasising hands-on therapy (Bobath, N.E.T.) and exercise to continue with rehabilitation after NHS discharge, PhysioFunction has grown into a leader in neurological rehabilitation provision with our flagship clinic based in Spratton housing a vast array of world leading rehabilitation technology and our expert team.

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Throughout PhysioFunction’s evolution, clinical provision has remained at the forefront of our service and in 2006 our Clinical Director, Jon Graham coined the term – Rehabilitation Triad - to describe the combination of handson therapy, technology and exercise.

The key to physical rehabilitation is refining the prescription and delivery of these components at various phases during recovery. To support this PhysioFunction began expanding its services to incorporate technologies, beginning with the Saeboflex and Odstock Footdrop FES,

and expanding to incorporate a wide range of rehabilitation and functional technologies to support both physical recovery and day to day function.

Over the years PhysioFunction has also expanded its geographical coverage beyond the bounds of the Midlands to Bedford, Oxford and London through an associate network and to Sheffield, Harrogate and York with a franchise network, before refinement and focus of the service around a commitment to exoskeleton technology, beginning with the REX and ReWalk in 2016 and being enhanced by the addition

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of the FREEWalk in 2019, led to a move to a centre of excellence at the Chris Moody Centre at Moulton College in 2017. With this centre of excellence came to opportunity to add larger, less portable rehabilitation technologies to the service including an AlterG antigravity treadmill, Tyromotion Pablo Station, FES bike and cross trainer, LiteGait and MediTouch BalanceTutor. As well as a gym area and consulting rooms, we had access to a hydrotherapy pool, a warm-water exercise pool, and a 25 metre swimming pool. Our clients were delighted with the new facility, and for those who couldn’t travel we continued to provide home-visits.

The clinical team was able to closely collaborate on a daily basis. Our admin team could meet clients and see their progress over their visits.

In August 2019, we were advised that Moulton College could no longer accommodate us as the facility was to be repurposed by the local council as a community leisure centre. We wanted to remain in a rural setting and did not want to relocate to a commercial building on an industrial estate. We were lucky to take vacant possession of two neighbouring converted farm buildings with spectacular views over the rolling Northamptonshire countryside, a factor not always instantly considered important in a rehabilitation facility but is the first thing mentioned by almost every first-time visitor to our clinic. After full internal refurbishment during the winter of 2019 – 2020 lead to an “open day” we were ready move and open our brand-new facility just as the first lockdown was announced! Thankfully, due to our embracement of rehabilitation technologies, we are able to continue to deliver high quality remote rehabilitation, including using home-based technologies such as the MindMotion GO. Once restrictions were eased and we were able to welcome patients back to our clinic with appropriate PPE and enhanced infection control procedures, we began to grow the new facility in

earnest. Alongside diversification to provide local essential workers or concerned members of the public with access to PCR and fitness-tofly testing, helping 100s of people travel out of the UK for business or leisure, PhysioFunction has continued to grow and expand its range of technologies to welcome the Desmotec D-Line and V-Line, and GMove suit, as well as expand our clinical team. To provide further support for our current and prospective clients, we have established PFit to provide personal training, sports therapy, massage and nutritional coaching services to maximise health and fitness.

PhysioFunction is a hugely dynamic and responsive rehabilitation provider with the mission of helping individuals achieve the best physical and emotional recovery from serious illness or catastrophic injury, and providing career opportunities for those who share this vision, so whether you are a prospective client, a case manager looking for the right place for your client’s rehabilitation, or a healthcare professional looking to work as part of a team dedicated to promoting recovery and optimising wellbeing in all of our clients, and accessing so world leading rehabilitation technology whilst doing so, look no further than Physiofunction.

Cheers to the next 20 years.

To find out more, visit www.physiofunction.co.uk.

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Supporting parents of children with complex care needs For parents of children with disabilities and complex care needs, life can be extremely challenging. Here, Michelle Marshall, case manager at ILS Case Management, discusses options around care and support, including home care and hospice respite

In a previous role, I worked for over ten years at my local children’s hospice as a children’s palliative care nurse.

A large proportion of my work was organising, delivering, and managing the short break care which happened either at the hospice or in the community depending on the family and their preference.

Respite for parents whose children have complex care needs can mean many different things. For some it allows parents to go back to work, and others use the time to complete household chores, catch up on sleep or spend time with their other kids doing activities that they would not normally be able to do as a whole family.

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Deciding to have respite care for a complex need’s child is a decision not often taken easily by parents. I have met many families who have put off having respite care for many years for a variety of reasons they may feeling that they are failing in their parental role and feel that they should be the person that their child relies on, they may not trust others to look after their child or be concerned that their child will not know the care givers.

So, what can help parents to make this tricky decision? Sometimes it can be hearing about the experience of other parents whose children have complex care needs and have care in place already. Speaking to someone who is going through the process and can tell a parent how they find it, can be extremely powerful and influential. Fast forward through those years without respite to the time when they begin having respite and parents will often reflect and think ‘why didn’t we do this earlier?’.

Having the flexibility and choice of where to have the respite is usually the next big decision to be made by the family. All families have diverse needs, preferences and circumstances which will influence their decision and sometimes the reality of that decision can be quite different compared to initial thoughts, once the care is in place.

I’ll use an example of a family I have previously worked with. The mother was due to have a care package introduced at home to enable her to have a break from her caring role and she was excited about this starting. A few months after the care package started, we discussed how this was going, and although there were no problems or concerns with the running

of the package and the care being delivered to her son, the mother was struggling. Having carers in her own home for long period of time meant that she was finding it difficult to relax and distance herself from her son and the carers. In addition, her son’s bedroom was small meaning that a lot of the care was being delivered in the main family living area. She felt she could not relax on her own home and was continuously making sure that the house was always tidy. She found that she was always doing things such as getting meals and medicines ready, even though she was not asked to by the carers or obliged too. These factors meant that she could not switch off and was not benefitting from the service. This home care package was reviewed and amended to provide a mixture of community care and care away from the home which met this family’s needs.

Community care does suit many families. One family I have worked with decided that they wanted home care based on a number of reasons. The first and main one being the reduction in risk of their son picking up an infection. Secondly for convenience, his morning routine of medicines, feeds and physiotherapy would have meant it would have been a rush to get everything done and travel to the hospice. Add to this the very time-consuming activities of packing clothes, medicines, and equipment for their child to access respite outside the family home, especially for short respite, having someone come to the home was more practical for them and less time consuming.

Travel distance that some families is also a factor to consider, a long journey to pick up and drop off can significantly

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reduce the ability of parents to make the best use of the time their child is receiving care outside of the family.

This issues of exactly who would be delivering the care can also be a factor to consider. When delivering home care, as a hospice we would generally send out the same members of staff. Some parents preferred this, as they felt that these members of staff knew their child so well, whereas in the hospice the staff could change each time. By having the same staff in the home parents felt more at ease leaving their child and also those members of staff alone in their house.

As well as observing and providing successful respite care in the child’s home, I have also been part of providing short break care at the hospice. The first time a parent would bring their child for either day care or overnight stay, many would also stay with them as well but take more of a back seat to the hands on care of their child, giving staff the opportunity to learn about their child whilst having the parent nearby in case they are needed.

Some may only do this the first time while others would do this every time.

It is very much an option that t given to all families to accommodate everyone’s needs. Although still in the building it means parents can still have time away to rest but are also close by so that if they wished they could come down to the main care area to see their child- for some parents this can help with their anxiety of having care from others rather than themselves.

One child I specifically remember came into the hospice on a weekend

night every few months and his parents would also come. The mother had high anxiety of leaving her son with others however felt reassured that she could stay as well and was happy for us to take charge and lead his care, as she knew that we would come and get either her or the child’s father at any time during the stay if we had any questions and concerns. They had their own separate bedroom with an adjoining bathroom which led into their son’s bedroom. The parents still liked to be part of the bedtime routine but were then able to step back and have dinner and the evening by themselves.

Due to the complex needs of the children and young people we looked after parents generally aren’t able to leave their child with a family member or friend. Many families also chose to have care in the hospice as it prepared them and their child for the future of possibly needing to use the hospice for end of life and after life care. It enables them to all become familiar with the staff and the hospice surroundings, especially for those with siblings.

For many parents having care away from the home means getting what they would call ‘a full break’. To leave their child and walk away for maybe even six hours can be hard, for many it can be a huge sigh of relief handing over the care and responsibility to someone else.

As well as benefitting the parents there are also many benefits for the children and young people of having care away from home. Socialising with friends can be exceedingly difficult for children with brain injuries and

complex needs, and as their parents are main care givers they would have to come with their child on any social outing. Like any child or young person children with additional needs don’t always want to have their parents around all the time, especially when being with their friends. This is where the hospice could step in to help meet the children social needs as well medical needs. Many of the children who came to the hospice became friends either because they go to the same school together or through meeting at the family events which the hospice organises. Parents wanted to allow their children to have the same social experiences and opportunities as children of the same age who have no medical needs. Following discussions with the families we would often plan for friends to have overnight stays together. For example, we would hold pamper evenings, movie nights and gaming evenings for friends and then they would both sleep over. Seeing the happiness in their faces when with their friends and giving them these social opportunities was one of the many highlights of my role.

Another key memory of mine was the celebration of a young person’s 18th birthday. He had wanted to go clubbing for some time and was eagerly awaiting his 18th birthday to do this, but again with his parents being main carers he did not want to do this with them. He did have contact with another boy of the same age through the hospice. We were able to pre-plan with the two boys for a night out into town where they visited clubs and bars and then went back to the hospice for an overnight stay, all of which was supervised by hospice staff. For a lot of the children and young people these are key events and memories in their life.

From my experience proving both community and hospice care, and from working closely with the families, there really is no right or wrong decision. All families will have varying needs and circumstances which will affect the decision they make on whether they have home care or care in a respite setting. What I feel is most important is giving families that opportunity to have a choice and consider their individual options.

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How I got my cockiness back After being left with a serious brain injury in a car collision in 2019, Lawrence - then a member of the SAS Reserves - has made huge strides in rebuilding his life.

Here, he shares his story of recovery and how his ability to communicate has been transformational in rediscovering the confidence and cockiness which are so important to his life as a ‘normal’ 23-year-old As a 21-year-old man achieving his life’s ambition of joining the Armed Forces - winning a place in the prestigious SAS Reserves and progressing through his training -

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Lawrence had much to look forward to in his future.

But in a devastating car crash in October 2019, he sustained a brain injury and catalogue of serious physical injuries.

His life as he knew it was over, and despite a good physical recovery, Lawrence became insular, with the struggle to participate in conversations or determine his friends’ sarcasm making him withdraw from society. His confidence all but disappeared.

However, through the power of therapy - and particularly speech and language therapy and its project based online communication groups - Lawrence has

achieved his ambition of being able to rediscover a social life.

He is able to confidently participate in the conversations he would once shy away from, he has a girlfriend - something he feared may never happen in the earlier stages of his recovery, when he could only see an isolated life ahead - and is set to begin a plumbing diploma.

“There have been a lot of bad times, but I’m now in a good place. I’m happy,” Lawrence tells NR Times.

“I used to want to be on my own, but not anymore. Through the groups, I have got my confidence back. They have probably been the most important part of my rehab and I wouldn’t be able to do anything like I’m doing today without them.”

Surviving and regaining independence After being left fighting for life after the car accident in 2019, Lawrence was faced initially with a battle for survival, followed by a long road to physical recovery and ongoing implications of his brain injury.

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Having been taken to the RVI Major Trauma Centre in Newcastle, Lawrence spent three-and-a-half weeks in a coma in intensive care.

“I don’t remember the crash at all. I just remember waking up in hospital and wondering why I was there. I was in intensive care for weeks and I have no memory at all of that time,” he recalls.

“I would talk to my brothers when they came to visit but they said I was saying stupid stuff, really random things that just didn’t make sense. I remember just lying in bed, looking out of the window.

“There were times that I didn’t even know who any of my family were when they came to visit me, and I wasn’t even sure who I was. I was introducing myself as being someone completely different.”

After Lawrence thankfully won his battle for survival and began his recovery, he was transferred from the RVI to a hospital nearer his Northumberland home.

“I saw more of my friends, and also I now had the chance to leave the hospital, people could come in and push me around in a wheelchair,” he says.

“But while I had a bit more freedom, being in hospital with such short visiting times felt like I was in prison.

“I was lying in bed all day and I wasn’t having any of the therapy I went on to get, like speech and language therapy or occupational therapy, and had just a bit of physio.”

After a private rehab package was secured, Lawrence was able to go home - and with support of a law firm and his case manager at A Chance for Life, he was able to really step up his recovery.

“It was so much better to be back home. At first, I couldn’t do much, but my mam and dad would push me in the wheelchair while they walked the dogs, or I’d push myself,” he says.

“Once I got a case manager and a rehab team, things did start to improve massively. I made big progress with my physio, I did struggle with the pain when I was walking and had to keep going back to the wheelchair, but I could walk for a bit and then stop.

“I built up what I could do and I felt

"I wasn’t even sure who I was. I was introducing myself as being someone completely different"

like I was making progress, just the fact I could see some progress made me feel better.”

Continuing to advance thanks to his therapy, Lawrence also spent three months in specialist rehabilitation centre STEPS in Sheffield, equipping him to live independently.

By unfortunate coincidence, Lawrence’s parents had sold the family home to downsize to a smaller property - with Lawrence and his two older brothers living their own lives, and another brother still living at home, his parents had moved into a two-bedroom house - meaning his quest for independence was even more important to him.

“My mam and dad used to sleep in the living room at first so I could have my own room. But I wanted my own space and I wanted to live independently,” he says.

“I was really happy with how things went at STEPS. I had my own apartment for the last five weeks to get me used to living on my own.

It was really good for me, I enjoyed my time there and made some good friends too.

“When I left STEPS, I had a trial of living independently and it went well.

I can cook for myself and live on my own. I live fully independently, but my mam and dad are close by, which is nice.”

The life-changing impact of brain injury While Lawrence achieved his ambition of regaining his independence, he began to realise the extent to which brain injury had affected his life, particularly through his social interaction.

From enjoying an active social life with a strong group of friends before the

life-changing crash, Lawrence now felt excluded and unable to participate.

Fatigue was also an ongoing issue.

“When I was in a group, I couldn’t keep up with the conversation,” recalls Lawrence.

“I didn’t know who was saying what and I wasn’t taking it all in. If someone was talking to me, I might not hear it all because of the noise of other people speaking, so I might say something completely wrong.

“I felt better if I didn’t join in. I wouldn’t talk at all if there was more than one person in the group.”

Sarcasm was also something Lawrence really struggled with.

“My brothers can be quite jokey, but I thought they were being serious.

They’d say something and then say ‘We’re being sarcastic, Lawrence,’ but to me it didn’t seem like they were joking,” he says.

“I would tell them I didn’t understand but they would still do it. I guess they found it hard to change the way they had always communicated with me.

“But I did get frustrated at times when I was talking to my brothers because I couldn’t tell when they were joking with me and when they were being serious.”

Lawrence’s fear of becoming involved in conversations meant he became withdrawn.

“I got to the point where going out would only make things worse for me emotionally. It made me so much less confident. If I was at home by myself, then I had no reason to talk and no need to interact with anyone,” he says.

For what was once a young man with a budding elite military career, Lawrence’s life felt like it had changed “beyond anything I had imagined” and his confidence hit rock bottom.

The cockiness enjoyed by Lawrence, and by so many other young people in the prime of their lives, had gone.

“I was never the most cocky person, but I do think it’s a good thing to have to some extent. It’s part of your confidence and helps with your ability to deal with things,” says Lawrence.

“But then I didn’t have it anymore.

I struggled to read emotions and struggled to find the things to say and I couldn’t handle situations.

“I needed to get some of that

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"I am happy. I wake up happy. I know I have the confidence to deal with what lies ahead" cockiness back to feel a little bit closer to who I used to be.”

Becoming an effective communicator and rediscovering the cockiness The loss of the confidence to speak in conversations, even with family and friends, affected Lawrence significantly.

“I just wanted to be normal but I knew I wasn’t anymore. I didn’t know what to do at this point, to be honest,” recalls Lawrence.

Lawrence identified his goal of wanting to regain some of his cockiness to his speech and language therapist, Matthew Nakonesky of Speech Therapy North East.

Group therapy was identified as a course of action for Lawrence - and

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one which would turn out to be transformative.

Lawrence took part in a number of online communication groups, where he was joined on video calls by a number of other people who also lived with brain injury, and had similar stories of struggling to communicate.

“I didn’t know anyone in the groups at first, but we were all the same. We all struggled, but we all helped each other to get better,” he recalls.

“Everyone was the same, we all had suffered a brain injury and we were trying to rebuild our lives, so I felt less pressure speaking in front of them because they understood.”

Within a short space of time, Lawrence began taking a lead role in the

sessions, his confidence returning in abundance with the progress he was making.

“Because you can speak and have a conversation in this situation, it helps your confidence in going out there and doing it. You know you can do it, so then you can go out into the street and into the world and do it,” says Lawrence.

“It was such a massive boost to my confidence and it has helped me deal with the pressure I felt. If I hadn’t have been part of the groups, there is no way I would be like I am today.”

Happily, Lawrence is also pleased with the level of cockiness he has regained, rating it at around 6/10, which he believes is enough.

“I think I have the right level of cockiness,” he smiles.

“I am happy. I wake up happy. I know I have the confidence to deal with what lies ahead.

“But I know that if I didn’t have my speech and language therapy, I might be physically fit, but I wouldn’t be able to sit here and have a conversation. I can do that now, and that has changed my life.”

Matthew, who has specialised in speech and language therapy for almost 24 years, says: “It has been fantastic to see the progress Lawrence has made, and to know that the communication groups have been such a central part of this.”

“The whole reason we have the groups is for people to build their skills and boost their confidence in a safe environment, which they can then take into the real world outside.”

“When we first met, Lawrence really lacked confidence and would say very little in meetings, if anything at all.

Now, he takes a leading role. I’m so proud of the progress he has made and continues to make in his life.

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A bright future From the devastation of what happened in 2019, Lawrence is now in a positive place and is looking ahead with optimism.

He is in a happy relationship and has just returned from his second holiday with his girlfriend, and has big plans for the future.

“When I was little, I had two dreams - either to be in the Army or be filthy rich. I can’t be in the Army anymore, so it’ll have to be filthy rich,” he smiles.

Having volunteered at a rock climbing centre, something which has become a passion for him and has been crucial in regaining physical fitness, he is now volunteering with a plumbing business to gain the vital skills for his future career.

He will embark on his Level 2 plumbing diploma in September.

“I still have a lot of problems with fatigue, so I can’t just go and get a job, but I want to work and do some graft,” he says.

“I’ll be going to college two nights a week from September, and then I’ll be working one day, which I am confident I will be able to manage. I want to do it.

“I think eventually I’d love to set up my own property development company, so I’m learning some of the skills I’ll need to do that. I hope that will make a great career path for me.”

While Lawrence can now look ahead with confidence, and continues to access speech and language therapy intermittently when he feels he needs it, he is keen to support others who may be in his position with reassurance.

“I feel like a normal person again, but it has taken a lot of work,” he says.

“You can’t flick a switch, it’s hard, really hard sometimes. But don’t quit. Don’t give up.”

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