Royal Rehab Private Hospital and MetroRehab Newsletter – Issue #3 – March 2021

ROYAL REHAB PRIVATE & METROREHAB NEWSLETTER » ISSUE 3 » MAR 2021 FI

Rehab Matters

R AL FO R E ST B L AU LA N AI E I AV TIM T

RS

at Royal Rehab Private

IA

Robotic Exoskeleton Fast-Tracks Mobility For Patients with Neurological Conditions Royal Rehab is proud to be the first provider in Australia to offer patients access to advanced exoskeleton technology. EksoNR, created by US-based robotics company Ekso Bionics, is set to excel rehabilitation for people with neurological conditions such as stroke, Parkinson’s disease, multiple sclerosis, Guillain Barre Syndrome, spinal cord injury, and acquired brain injury.

“Breakthroughs in technology are driving better and faster outcomes for people living with life-changing conditions and injury, however these have been unavailable in Australia until now,’’ said Royal Rehab CEO Matt Mackay. ‘’We are delighted to be changing the status quo with EksoNR and helping people with paralysis.’’

EksoNR has been specifically developed for use in rehabilitation settings. The device requires active participation from patients to function. This advances the progress of rehabilitation by strengthening muscles and

driving brain plasticity. EksoNR also offers real-time data which enables physiotherapists to measure progress and adjust programs to get faster results.

Clinical evidence suggests EksoNR gait training offers many benefits outside of the device including improvements in functional balance in people with motor incomplete spinal cord injury (SCI); improvements in walking distance for people with stroke and motor incomplete SCI at discharge compared to admission; and improvements in patient gait speed at discharge compared to admission.

EksoNR is available through Royal Rehab’s services including Royal Rehab Private Hospital and is coming soon to MetroRehab Hospital.

Call us on 02 9808 9222 or email us at ekso@royalrehab.com.au for any questions or referrals you may have.

More information on EksoNR can be found at royalrehab.com.au/eksonr

Empowering Independence

Contents Royal Rehab Private Hospital EksoNR Delivers Positive Results for Neurological Rehab Clients...............p2 RACGP CPD Education Events Coming Soon!............. p4

MetroRehab Hospital Understanding the Importance of Prognostication in Rehabilitation ............ p4 Specialist Stroke Rehab gets 90-year-old Teresa Home ............................p7 Spotlight on our Health Professionals.............. p8

Click here to go to our MetroRehab articles

A Message from our GM Welcome to the third issue of Rehab Matters — the combined newsletter of Royal Rehab Private and MetroRehab Hospitals designed to keep specialists and GPs up to date on the latest in rehabilitation medicine.

In this issue, we’re delighted to share news that Royal Rehab has acquired advanced robotic exoskeleton, EksoNR – an Australia-first. Designed to fasttrack rehabilitation for people with neurological conditions, EksoNR is already delivering clinical outcomes around standing and walking, as well as psychological benefits.

As Royal Rehab continues to grow, we are reorganising some positions. As I write, I am in the process of transferring to the position of general manager Disability Services at Royal Rehab.

I am pleased to welcome Selina Rowe into the role of general manager Royal Rehab – Ryde, which incorporates general management responsibility of Royal Rehab Private Hospital. Selina has over a decade of experience leading multidisciplinary community and inpatient-based services.

Wishing you and your patients all the very best.

Jessica Scanlan nee Taveira Outgoing General Manager, Royal Rehab Private Hospital

EksoNR Delivers Positive Results for Neurological Rehab Clients Since Royal Rehab’s launch of advanced robotic exoskeleton EksoNR, this game-changing device has helped numerous clients fasttrack their mobility.

Client Profile – Alex: The 18-year-old rising sports star severely damaged his spinal cord while training with the Under-17 NSW Rugby Sevens youth selection squad in 2018.

His parents were told that he may never walk again.

After acute care, Alex was transferred to Royal Rehab’s Spinal Injury Unit where he spent seven months working to regain function and movement in his limbs.

Alex and his family were quick to explore every possible opportunity to maximise his recovery, leading them to the EksoNR exoskeleton at Royal Rehab. The family embraced the opportunity to boost Alex’s rehabilitation.

After nine sessions of EksoNR therapy, Alex has: » improved his standing endurance, » doubled his walking time, » increased his steps per session by 133% and improved his step pattern and weight symmetry.

“I hadn’t been able to take my first step since the accident, but with the EksoNR, I can do it. There are so many benefits. It’s really great both physically and emotionally to be able to stand up again.” – Alex According to Alex’s mum Kylie, “Watching him take those first steps was wonderful and powerful. It once again regenerates the hope that technology and medical advancements will continue to provide new opportunities for Alex and others like him.”

Alex and his family are excited to track his progress as he continues to use EksoNR in future rehabilitation sessions.

EksoNR is available throughices Royal Rehab’s servehab including Royal Rl and Private Hospita to is coming soon MetroRehab Hospital.

Client Profile – Manooshak: When 77-year-old Manooshak suffered a stroke to the right side of her brain, known as a right thalamus and right internal capsule infarct, everything on the left side of her body was affected. She was able to walk short distances but required full assistance including a stick, foot splint, walk belt, and shoulder sling. Significantly, there was some movement in her left leg, however she was heavily compensating on her right leg to walk.

Royal Rehab physiotherapist, Stephanie, recommended incorporating EksoNR into Manooshak’s rehabilitation program as a tool to help her re-train the brain and muscles, correct and stabilise her walk and regain a normal walking pattern.

After four sessions, Stephanie says the benefits are already starting to show.

“When we first saw Manooshak walk, she would throw her leg forward and couldn’t lift her foot. This meant her good side is doing a lot of work. The EksoNR helps her use the strength she does have to correctly shift her weight, lift her leg and place her foot down in a normal way.” – Stephanie “Already, I can see Manooshak is walking better both with and without the device. She doesn’t tire as quickly because there is a bit of power in it, and because she can get more practice, she’s building strength. We know with stroke recovery, that the more practice the better,” she said.

Client Profile – Ken: The 71-year-old was one of the first clients to use EksoNR at Royal Rehab. Ken sustained a spinal cord injury in his early twenties and was paralysed from the chest down.

He began to suffer from severe back pain in late 2020 and was diagnosed with a slipped disc in the lumbar region of his spine.

As his condition worsened, Ken was admitted to Royal Rehab Private Hospital. It was there that he was introduced to EksoNR to help him walk again. After seven sessions of EksoNR therapy, Ken’s confidence and ability to walk improved significantly. Using a rollator frame and more recently, crutches—he is now able to walk up to 80 metres—a stark difference from the initial 20 metres he was able to do coming into rehab.

“I was really encouraged by seeing the data which detailed my progress and improvement. My team and I always had a mini celebration when I made any improvement.” – Ken In a matter of weeks, Ken has: » improved his mobility from fully assisted to supervised, » doubled his walking time, » increased his speed by 35 per cent, » improved his number of steps by 66 per cent.

Call us on 02 9808 9222 or email us at ekso@royalrehab.com.au for any questions or referrals you may have. More information on EksoNR can be found at royalrehab.com.au/eksonr

EksoNR can be considered for patients who have experienced: » Stroke » Multiple sclerosis

» Spinal cord injury » Acquired brain injury

» Parkinson’s disease » Guillain-Barré syndrome

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Rehab Matters at MetroRehab Hospital

Understanding the Importance of Prognostication in Rehabilitation Prognostication is one of the most important skills to have as a medical practitioner. In the context of neurorehabilitation, it refers to the ability to predict the impact of rehabilitation (and other) interventions on functional outcome, as opposed to, for example, predicting life expectancy.

There are predictive tools, however current algorithms lack the necessary data and evidence to be sufficiently accurate in predicting level of disability, so the art

Dr Darren Lee, Rehabilitation Medicine Physician

of prognostication remains largely dependent on clinical assessment.

The following cases highlight how outcomes of rehabilitation can vary significantly between and within individuals, surprising even the most experienced of clinicians.

I first met “Sandra” over 3 years ago when I was asked to assess her in the neurosurgical ward after being transferred from the Neuro-ICU. Thus begun a journey that continues to this day, illustrating the challenges and rewards of working in the specialty of rehabilitation medicine. I recall seeing two patients that day with aneurysmal subarachnoid haemorrhage. The other was “Leah”, a 69-year-old female transferred from another hospital with a Fisher grade 4, WFNS grade 5, SAH with a GCS of 3, due to a

ruptured aneurysm arising from the right middle cerebral artery bifurcation with associated intracerebral and intraventricular blood. She underwent clipping of the aneurysm, subsequently required a VP shunt for hydrocephalus, and intraarterial therapy for moderate cerebral vasospasm. Four weeks after admission, she was still drowsy, was only able to follow simple instructions, had weakness in her left leg more than the arm, demonstrated neglect of her left side, and still required full nursing care including a hoist to lift her out of bed.

At this point, I agreed she would benefit from inpatient rehabilitation to reduce her burden of care and improve her quality of life in the longer term but felt she had limited prospects to return to independent living.

RACGP CPD Education Events Coming Soon!

We are excited to share the great news that Royal Rehab has received accreditation from the RACGP to provide Continuing Professional Development (CPD) activities to general practitioners.

The RACGP CPD Program supports

Australian GPs to maintain and improve their professional knowledge and skills. We’re proud to play an important role supporting GPs to improve patient outcomes and the provision of high-quality primary healthcare.

Look out for information on Royal Rehab Private and MetroRehab Hospital’s first CPD event coming soon.

Excellence in medical rehabilitation

A Message from our GM I arranged admission to MetroRehab Hospital, with the expectation of at least 6 weeks as an inpatient.

Needless to say, she exceeded expectations and was home after only 3 weeks, independent with mobility and self-care, less than two months after her subarachnoid haemorrhage and subsequent lifesaving neurosurgical interventions.

And then Sandra, a 43-year-old female, found at home by her flatmate, with a ruptured anterior communicating artery aneurysm resulting in widespread subarachnoid and frontal intraparenchymal haemorrhage, with intraventricular extension, Fisher 4, WFNS 4, GCS 7 on admission. She had emergency surgery for clipping of the aneurysm and insertion of an external ventricular drain, developed moderately high-grade vasospasm in her anterior circulation bilaterally, treated with intraarterial therapy. The EVD was removed after two weeks when hydrocephalus resolved. I saw her the day she came out of ICU, three weeks after admission, and she was transferred to MetroRehab Hospital a few days later, on the same day as Leah.

Moving forward, after four months of intensive inpatient rehabilitation, five months after severe SAH, she was finally discharged from hospital.

At this stage, she remained largely non-verbal with a severe cognitive impairment, needed the assistance of two staff to transfer, and required assistance with all ADLs due to motor impairments in all limbs, particularly on the right, where

she had received botulinum toxin injections for muscle overactivity.

The National Disability Insurance Scheme (NDIS) had only just been rolled out in Sydney at this stage, and we were able to get her approved for this new scheme.

Despite this, it was agreed that she would be better served temporarily moving into an aged care facility providing high level care, with regular physiotherapy onsite, rather than one of the recently opened disability group homes funded by the NDIS. However, three months after discharge from MetroRehab, and eight months since her SAH, and despite intensive outpatient physiotherapy, she had developed a flexed right knee that was not able to be straightened, with an associated pressure ulcer in her popliteal fossa. Many would call this a fixed flexion contracture, a term I generally try to avoid due to the implications on reversibility. In the interim she had developed evidence of hydrocephalus on imaging. I referred her back to her neurosurgeon and eventually proceeded to VP shunt insertion. However, this was postponed by several months due to the development of an extensive DVT in her right leg, precipitated by the severe spasticity causing immobility in that leg.

In the meantime, I readmitted her to MetroRehab for intensive inpatient rehabilitation and further botulinum toxin injections, resulting in a significant improvement in the knee deformity from being flexed to 80° at the nursing home, to 20° by discharge.

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As Royal Rehab continues to grow and pioneer in our sector, we are reorganising some roles to strengthen our ability to continue to best serve our patients.

After 13 years as general manager at MetroRehab Hospital, I am transferring to the role of chief operating officer, Royal Rehab. It is an exciting time for the organisation and for MetroRehab as we work together to continue to achieve excellence in the provision of rehabilitation and disability services.

It has been my honour and great privilege to lead MetroRehab Hospital and I am delighted to welcome and introduce Nicholas Edwards into the role of general manager/director of clinical services at MetroRehab Hospital.

Nicholas has over 25 years’ senior management and executive experience within both the public and private healthcare sectors.

With his extensive experience, I am confident our patients and partners in care can expect the same high level of clinical expertise, care, and compassion.

It is an exciting time for rehab in Australia with Royal Rehab leading the way with the introduction of advanced robotic exoskeleton. You can learn more about the EksoNR in this issue of Rehab Matters, as well as doctor and client stories and much more.

Denise Thomas Outgoing General Manager, MetroRehab Hospital

As a result, her mobility significantly improved during this second shorter admission. She was now able to stand with assistance, and could mobilise short distances with a FASF, albeit toe walking with a flexed knee due to overactivity in her knee flexors and plantarflexors. On return to the aged care facility, a mechanical lifter continued to be used as the safest option for staff to transfer her.

In 2020, three years since her initial presentation, partly due to COVID-19, she has moved out of the nursing home into the care of her family. She continues to improve cognitively, is running up and down stairs, is considering moving into a group home for people with disabilities appropriate to her needs, and in the longer term is considering some form of employment, with the assistance of the Royal Rehab Brain Injury Community Rehabilitation Team. someone

It took us a further four rounds of Even if botulinum toxin injections into has been given an her calf and hamstrings, over The staff at MetroRehab the subsequent 12 months, unfavourable prognosis, and Royal Rehab are ideally coming in and out of various it is never too late to revisit placed to navigate the complex rehabilitation programs the question of whether interface between the health including multiple brief inpatient rehabilitation may be of benefit, and disability sectors. admissions and day program especially as options for attendances at MetroRehab, This need is highlighted when with the use of various splints pharmacological management patients, like Sandra, do not fit and casts on her leg, and and evidence for new neatly into an existing model outpatient physiotherapy at the technologies emerge. of care, necessitating the use of nursing home, for her to improve creative strategies to gain access to the point of being able to walk to the rehabilitation that they require independently, with only a slight limp. and deserve.

Over the same 12-24 month period, she continued to gradually improve cognitively Even if someone has been given an and functionally, and with further rehabilitation, unfavourable prognosis, it is never too late she was able to physically perform ADLS with the use to revisit the question of whether rehabilitation may of both arms and speak in full sentences with emergence of her be of benefit, especially as options for pharmacological infectious personality, albeit with ongoing memory impairment. management and evidence for new technologies emerge.

Without targeted spasticity management and intensive rehabilitation, she would undoubtedly now be bedbound with limb contractures and requiring full nursing care, having “plateaued” after six weeks of rehabilitation.

Dr Darren Lee BSc (Med), MBBS, FAFRM (RACP) is a rehabilitation medicine physician and a Visiting Medical Officer at Royal Rehab Private and MetroRehab Hospitals.

PD Warrior

®

Available at MetroRehab and Royal Rehab Private Hospitals We are licensed to offer PD Warrior®, the internationally recognised program designed to slow the symptoms of Parkinson’s disease.

For more information, call Royal Rehab Private Hospital on 02 9808 0522 or MetroRehab Hospital on 02 8585 4900.

Excellence in medical rehabilitation

Specialist Stroke Rehab gets 90-year-old Teresa Home In March 2020, Teresa found herself unable to get out of bed. Her daughter Susan called an ambulance which took her to acute care where she presented with dizziness, nausea and ataxia. The independent 90-year-old had experienced a right lateral medullary stroke.

Teresa was later referred to MetroRehab Hospital where she remained for three months as an inpatient receiving a personalised rehabilitation program. Teresa later continued her rehab in the MetroRehab day program.

MetroRehab Hospital provides expert neurological-specific rehabilitation, and the trained team of health professionals work under the direct supervision of leading rehabilitation specialists to assist patients in their recovery and rehabilitation journey.

The stroke has caused Teresa’s balance to be severely affected and she could no longer walk without assistance nor could she manage her daily activities. She also had trouble talking and swallowing and experienced constant dizziness. The MetroRehab team took their time with Teresa to understand her goals. For this energetic green-thumb and cooking connoisseur, that meant being back at home in her beloved garden and kitchen.

Teresa benefitted from multidisciplinary care at MetroRehab Hospital including occupational therapy,

physiotherapy, speech pathology, dietitics, clinical psychology, social work, and music therapy, whilst being under the care of Dr Darren Lee, Rehabilitation Medicine Physician, and supported by Lara Fernandez, Stroke and Neurological Programs Manager, throughout her inpatient and day program journey.

According to Lara, “We were thrilled with each improvement Teresa made—progressing from a 2-person transfer to being able to mobilise independently with a four-wheel walker. Teresa’s Berg Balance score, which measures static and dynamic balance abilities, also improved from 27/56 to 51/56 following the inpatient stay and day program.”

Teresa is now back living at home with her husband and daughter, and credits the entire team at MetroRehab for their carefulness with her care.

“Mum has been so determined to get her old strength back,’’ explained Susan, Teresa’s daughter, ‘’She’s now back doing all her usual activities around the house with barely any support. You definitely wouldn’t think she was 90 years old!”

For more information on MetroRehab’s stroke and neurological programs, call us on 02 8585 4900.

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Spotlight on our Health Professionals Natalie Di Donato PHYSIOTHERAPIST (BHLTHSC. MPHTY) Natalie graduated from the University of Sydney with a Bachelor of Health Sciences and went on to obtain a Masters of Physiotherapy with Distinction. Natalie has been working at Royal Rehab Private Hospital since 2015 and enjoys the diversity of working within a mixed rehabilitation population. She has a particular interest in neurological rehabilitation including stroke, traumatic and acquired brain injury, spinal cord injury, and Parkinson’s disease. Natalie is trained to provide PD Warrior®, a physiotherapy-specific program for people with Parkinson’s disease. She is excited to be undertaking training for robotic exoskeleton EksoNR for gait and mobility training. Natalie loves the collaborative nature of working closely with other health professionals and providing a holistic approach to patient care.

Madelaine Turner SOCIAL WORKER (BSOCWKSOCPG) Madelaine obtained a Bachelor of Social Work and Social Planning from Flinders University in Adelaide, graduating in 2016.

Having a deep interest in social work, Madelaine worked in Crisis Respite in Adelaide, a mental health program, and also in disability, mainly working with children with cerebral palsy. A sea change saw Madelaine move to Sydney and she currently works as a social worker at MetroRehab Hospital.

Madelaine is a valued member of the team as she supports patients, their families, and carers, during admission and in planning for discharge from MetroRehab Hospital.

Alessia Apostolopoulos PHYSIOTHERAPIST (BEXSC, MPHYS) Alessia graduated from the University of Technology Sydney in 2017 with a Bachelor of Sport and Exercise Science and went on to complete her Master of Physiotherapy. Alessia is passionate about working in rehabilitation within a hospital setting so it worked out perfectly when she completed her student placement at MetroRehab Hospital. In February 2020, and upon graduation, Alessia commenced full-time employment at MetroRehab Hospital as a physiotherapist and continues to enjoy assisting various patients through their rehabilitation journey. Alessia is particularly interested in working with various stroke and neurological conditions and is passionate about helping people reach their goals.

Patricia Barnes NURSING ASSISTANT (CERTIFICATE III IN AIN) Patricia graduated from Kingswood TAFE in 2017 with a Certificate III Assistant in Nursing.

During her studies, Patricia completed her student nursing placement at MetroRehab Hospital where she gained

invaluable experience, and before too long, started working at MetroRehab Hospital full time. Patricia prides herself on helping patients reach their personcentred recovery goals and draws on her empathy and compassion to lead her in her practice. She finds it especially rewarding to watch the evolution of a patient’s recovery journey.

Additionally, Patricia recognises the value in teamwork and very much enjoys the excellent teamwork and collaborative nature of MetroRehab Hospital.

Shiva Tootoonchi Tabrizi REGISTERED NURSE (BNURSE, ONC) CLINICAL CARE COORDINATOR Shiva completed a Postgraduate Certificate in Orthopaedic Nursing with Distinction in 2018 from the University of Tasmania and has since gained extensive experience working at Royal Rehab Private Hospital looking after a variety of patients with complex neurological and neurodegenerative disorders, the post-operative management of orthopaedic surgeries such as joint replacements and spinal decompressions, as well as spinal cord injuries. With a special interest in post-operative and chronic wound management, as well as implementing evidence-based practice, Shiva strongly believes in delivering individualised and holistic care.

She enjoys working collaboratively with other members of the multidisciplinary team at Royal Rehab Private Hospital in order to achieve the best possible outcome for patients.

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