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21st Century technology: A care provider’s guide

The team at the Elysium Neurocare facility at Badby Park, Daventry, share how they are exploring the use of technology for the benefit of patients.

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Robot pets

We have robot pet dogs and cats, and even a monkey and a horse. They respond to touch/voice commands, carry out movements and vocalise. They are primarily used to promote engagement by the patient, encourage pleasant feelings which helps set them in a good mood to participate in therapy, promote positive bonds with staff, and as a source of distraction should the patient start engaging in disruptive behaviours. For selected patients who have favourite smells, we can spray specific odours on the pets, so that all of the sensory modalities are engaged for a pleasant experience.

Voice-activated intelligent agents
We’re using Google Assistant with a patient who had quadriplegia following a gunshot injury. It enables him to control his television and lights, retrieve his schedule for the day, play his favourite music and sports clips, and make both voice and video calls to family and friends. Measures of wellbeing, behaviour and mood are monitored to see if they change as a result of this intervention.

Exergames
We’ve built up an exergame resource using the Nintendo Wii. This includes both hardware and a range of software games. In collaboration with colleagues in physiotherapy and speech and language therapy, and a er carefully documenting the past habits and leisure activities of a patient, games are selected to help promote engagement in these therapies, and generally give the patient a sense of both enjoyment and achievement.

Neuro-rehab apps
We’re using neuro-rehab apps to help with the needs of specific patients. Thus, we are using a scanning app, Visual Attention produced by Tactus Therapy, to help improve scanning in patients who show visual neglect following a condition such as stroke.

Intelligent clock displays
We are trialling clock displays which, in addition to day, date & time, have reminder features to help patients remember items such as scheduled activities, and via wifi can also be linked remotely to family and friends so that messages or pictures can be sent directly to the patient. We are also trialling a clock display which gives audio output of display information to touch, so as to benefit the visually impaired who may not be able to read the clock display.

Virtual reality apps
We have a Google Cardboard-based virtual reality app, WayBack, which features a video from the coronation in 1952, and which enables the patient to immerse themselves in scenes from the video. We will be introducing other VR apps, including geography-based ones. As with the aforementioned robot pets intervention, their primary purpose is to encourage pleasant feelings which help to set the patient in a goodmood, as a form of reminiscence therapy, and as a source of distraction should the patient start engaging in disruptive behaviours.

Odours, music, images and light for relaxation classes
Relaxation classes have generally been unimodal, with either verbal instructions or music. We are trying to use multiple modalities, ideally in synchrony, to enhance feelings of wellbeing in relaxation classes.

Using the latest technologies, we configure the setting where relaxation classes take place, so that selected room lighting can be generated, relaxing music or sounds are played, a pleasant odour is released and relaxing images such as sunset on a beach are displayed.

Regular feedback from patients, families and sta is obtained during implementation of all the interventions mentioned. And, as far as possible, practical outcome measures are included to evaluate the effectiveness of the interventions. The 21st Century has given us new technologies which can potentially broaden the independence and wellbeing horizons of neurological patients. As healthcare professionals, we need to respond to the challenges associated with their implementation, and this requires both commitment and creativity.

This article was co-written by Elysium’s Narinder Kapur, Callum Watson, Heena Parmar and Amy Watts.

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More retired rugby players report concussion than any other injury

Concussion is the most common injury among retired rugby athletes, according to new research.

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Researchers from Durham University and Auckland University of Technology compared the injuries of retired rugby athletes with retired non-contact athletes.

They found that retired elite rugby athletes reported up to seven times the number of injuries than those who played amateur rugby and non-contact sports, and concussion was the most commonly reported injury, and had the most common recurrence, for both groups of rugby players compared to non-contact athletes.

Among retired rugby athletes, 81 per cent of elite and 76 per cent of amateur players reported at least one concussion, and concussion injury had the highest recurrence.

The rugby athletes, who were all code athletes, which means they played rugby union or rugby league, were also up to 10 times more likely to report experiencing a lasting impact of previous concussion, among other injuries, including back and joint pain.

The researchers concluded that past participation in rugby union and rugby league, particularly at elite level, is linked to a higher risk of cumulative injuries and a continued impact of previous injuries after retiring from the game.

Retired elite rugby code players reported that previous concussions had a negative impact on their current health, the researchers found.

They urge that there should be more efforts to reduce injuries in rugby codes at all levels, given such a high number of concussions.

“The monitoring of injuries at the player level rather than at club level could be one approach to improving the management of injury for individualised player welfare,” the paper, published today in the journal Sports Medicine, states.

“This could include a system by which the individual player’s injury history can be followed as they move across professional club contracts, and specific strength and conditioning and sports therapy strategies prescribed to help prevent recurrence of injury.”

This is the first study to examine total injuries across entire careers of contact sport athletes, according to the researchers, and the reported effects on physical wellbeing post-retirement.

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Half of brain injury survivors lost access to rehab

More than half of brain injury survivors have lost access to rehab due to lockdown measures, and fear for their futures, according to research by Headway.

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Fifty-seven per cent of people surveyed, who had all sustained their injuries in the last two years, say their access to specialist treatment has been negatively impacted from lockdown measures.

Among those living with the long-term effects of brain injury, two thirds reported that their mental health has deteriorated due to government measures to control the spread of Covid-19, and the same number fear for their futures.

These findings highlight the importance of ensuring those affected by brain injury are provided with appropriate physical, psychological and social rehabilitation, says Headway.

Peter McCabe, the charity’s chief executive of Headway, says the findings are ‘deeply concerning’.

“The first two years following a brain injury are very important in terms of a patient’s long-term prognosis and any delay to receiving specialist rehabilitation can impact their ability to lead an independent life in the future,” he says. 

“Of equal concern is the short-term impact of the lockdown on survivors and their families.

“The effects of brain injury, such as problems with memory, a lack of insight or difficulties controlling behaviour and emotions, can mean that survivors face significant challenges in understanding and coping with the necessary safeguards put in place to deal with the pandemic.

“This can lead to conflict with other members of public as a result of not remembering the rules around social distancing, or excess pressure and emotional toil being placed on carers and family members.

“With local authorities under increasing financial pressure, local charities are facing an uphill battle to survive, exacerbating survivors’ fears for the future.

“Unless the government provides local authorities with adequate funding for community-based rehabilitation services, thousands of brain injury survivors and carers will either be left without support or be forced to rely on more costly state-funded care.”

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Delays in neurological treatment for seven in 10 patients

More than seven in 10 people with neurological conditions report delays to medical appointments due to Covid-19, according to new research.

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This means people with long-term neurological conditions could be missing out on vital tests and treatment, according to the Neurological Alliance.

More than 70 per cent of those who replied to the Neurological Alliance’s survey between 9 and 20 June said their NHS appointments had been delayed, and four in 10 did not know when their appointment would be rescheduled.

Due to the risk of infection and many staff being redeployed, most face-to-face neurology appointments have been delayed or cancelled.

“For some people with a neurological condition,” the Neurological Alliance states, “missing out on the right treatment at the right time can have life-changing consequences.

“For example, advanced drug therapies for Parkinson’s only have a short window during which they can be effective, so some people could already have lost their opportunity to have a life-changing therapy.

“Certain disease modifying treatments for multiple sclerosis, which reduce relapses and slow the progression of the condition, have also been delayed or cancelled in some NHS clinics.”

Without improved capacity across neurological services, the charity warns that people with neurological conditions risk facing further, potentially life-changing, delays.

Many people with neurological conditions were advised to ‘shield’ during the pandemic, due to being high-risk. The government relaxed guidelines around shielding on 5 July, and plan to pause of from 1 August. The report, however, found that people with neurological conditions who were shielding are concerned about the risks of going out more.

Half of respondents reported finding the government’s advice on shielding to be unclear, almost a third had difficulty accessing their normal food supplies and almost a quarter had experienced difficulties getting their regular medication.

Almost one in four respondents reported feeling lonely, and one in 10 felt hopeless.

The Neurological Alliance is urging NHS England to set out plans to ensure an immediate restart of services as soon as it’s safe to do so. The charity is also calling for:

  • Specialist neurology staff redeployed to COVID-19 wards to restore staffing in neurology departments to pre-Covid-19 levels
  • Adequate support within NHS mental health services to deal with the immediate mental health needs of people with neurological conditions who have been shielding or self-isolating
  • Patients discharged prematurely due to COVID-19 to be regularly reviewed to ensure their mobility and motor skills are not deteriorating

Georgina Carr, chief executive of the Neurological Alliance, says: “While health and care professionals have done all they can to retain some contact with people with neurological conditions during this crisis, our survey clearly shows that people with suspected and confirmed neurological conditions are being left in complete limbo while frontline services have been diverted to treat COVID-19 patients.

“This just isn’t acceptable and means thousands of people are not getting the life-changing treatment and support they so desperately need. People with neurological conditions must not be left in the dark any longer.”

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