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Community rehab

A week in the life of a rehabilitation assistant

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Katie Pinn, Senior Cognitive Rehab Assistant at BIS Services.

My week really starts on a Sunday as this is when I plan my upcoming week, I check to see if any clients have appointments during the week, what goals we are working on, where we are in each and make sure there’s lots of variety within sessions.

My first client on a Monday I must check in on their well being, ascertain level of productivity over the weekend and schedule the new week. This particular client I’ve had to provide with much support due to shielding during both the 1st and the second lockdown.

During the first lockdown many clients’ support went virtual, however due to vulnerability support had to be given face to face. One major barrier to delivering virtual support was teaching the client how to use new technology, this can be difficult for anyone, however the extra challenges caused by brain injury exacerbated the difficulties. When teaching someone with a brain injury something new repetition is key, I model how to use WhatsApp video and Zoom practice with the client regularly and created simple and clear visual instructions.

This particular week I am meeting a new client in preparation so spend a long time reading the referral form and speaking to management. During meet and greets it’s really important to try and build rapport with client and family ascertain the client’s interests, consider how these could be linked into support and try to open their mind to the idea of working with you. It’s quite a skill and I think I’ve become quite adept at building rapport quickly. It really is key to future engagement and can make or break starting a new package.

Tuesdays I’m working with a different client and again it’s important to plan and structure our week, with this particular client I also support budgeting skills. After a brain injury many clients can also be financially vulnerable and are patients of the Court of Protection and under Deputyship and are provided with a weekly budget. It is important to make sure this is spent sensibly. Enough money has to be left for food, for themselves and any pets, transport fees and bills if this is something the client is able to manage.

It’s important to encourage clients to save, and this allows exploration of executive functioning skills. One of these client’s goals focus is around decorating their home. We want to encourage clients to maintain goals independently if possible in order for clients to engage and have a sense of autonomy and also achievement. Practical support is needed in this case as my client had impaired sight as well as coordination difficulties, which makes tasks like painting very difficult. However, I didn’t want to complete this task for them so I focus my help with small fiddly bits encourage them to paint the large areas.

Our work is not about completing tasks for them, far from it; it involves teaching, encouraging, motivating and so on. If we need to actually get our hands dirty and pull our sleeves up to do that, that’s what we do! After sessions it’s important to complete our sessional reports ASAP and update multidisciplinary team on any important information.

This is particularly important with clients struggling with their mental health, which has been pertinent this last year more than ever. Communication has always been of upmost importance, and now more than ever. At BIS Services our supervisors and managers are available for us to contact all the time if we need some advice or are concerned.

Wednesday I’m back in Ramsgate. In the early stages of rehab, clients often lack insight into their brain injury and consequences, which creates hurdles for support. It is challenging to teach clients strategies to compensate for brain injuries if there’s a lack of understanding why it’s needed. I do a lot of work around insight, particularly with one of my clients where I provide education and as difficulties arise I highlight and then help problem solve in the moment.

Immediate feedback is really important and it must be approached in a sensitive and cautious manner. Insight changes can also trigger a shift in mood,  which is inevitable after any injury and emotional support and empathy is required. I liaise frequently with Neuro Psychologists as most clients also receive psychological support, but not all the time. In those cases our input is even more challenging as we can often be the only person clients have to talk to, and this again has increased through the pandemic.

My second client has better awareness of his brain injury and is able to engage in cognitive and audio visual exercises. This is great for stimulating neural pathways strengthening connections and ultimately improving function. We practice functional transfer and tasks to practice new skills and cement more familiar ones.

Late afternoon I plan activities for my last few clients for the week. With another client we focus on functional skills and their hobbies. These sessions are always fairly fun, often involving baking, crafts, or photography.

in the evening I may I have an MDT meeting online. Again, this is a chance to speak to the professionals in the team, incorporate any advice and get feedback.

Thursday mornings I’m doing a few shops with the client. Lots of planning is involved before going out. Meal planning, simple recipes, cupboard checking when ingredients are needed and so on.  Plans and lists are written down for the client and support is given around journey planning as well as problem solving in the shops, if an item is out of stock and substitute needs to be found, which is often difficult for my client.

Many clients can also find the hustle and bustle of the supermarket stressful or anxiety inducing, so it is important to help clients, especially those who have difficulty emotionally. I assist with encouraging and regulating breathing techniques and calming in the moment.

In the afternoon I had a supervision with the educational psychologist for a new client, to teach me about assistive technology and how to incorporative in sessions and manage fatigue. My Fridays are quite hard and they’re not the ideal end to the week but i try to incorporate fun activities and manageable tasks as clients could be quite fatigued by the end of the week.

My first client I actually do their food shop on their behalf as they’re not able to access the communities themselves due to lockdown. I still have to pre-plan their shop and cash handling needs to be looked at. My next client we actually do quite a lot of work around relaxation.

In the first lockdown BIS Services set up a virtual timetable and we’ve kept a library of resources so I sometimes accesses the hypnotherapy recorded sessions and use this so that my client is in the right frame of mind for their psychology session in the afternoon. This is their opportunity to talk through the week. I prompt them to think about any stressors and we set mindset for the weekend. A lot of work is done around building resilience and perspective with this client.

My final client then sees me in another county (we get around a lot!) The first thing we focus on is  community access for this younger client. What may be as simple as buying a coffee for you and I becomes a challenge someone with brain injury. I motivated and supported the client to order and pay for their own items. Functional practice of independent living tasks, activities of daily living and hobbies and interests are all considered. On Friday I get home about 7:30 just in time to travel to  my stable, feed the animals and hope the Gin and Tonic fairy has left me something for when I return home!

Community rehab

Music group launched to support BAME community

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Leicester Musical Memory Box is launching its online music project Geet Sangeet

A music group established to support people living with dementia, memory loss and brain injury has received funding to launch an online project for the South Asian and BAME community.

Leicester Musical Memory Box (LMMBox) was founded in July 2018, and since that time has grown from one group in the city to six, providing interactive music sessions for people of all ages and backgrounds, including a group specific to the South Asian community.

The group – which has two staff members who are fluent in Gujarati, Hindi, Punjabi and Urdu – aims to provide the local community with a supportive network and a safe space to explore the unique challenges that a brain injury may bring to individuals, as well as their families and carers.

The new online music project is named ‘Geet Sangeet’ – translated as ‘Songs Sung Together’ – and will incorporate music and cultural references specific to the South Asian community, led by group leader Beena Masand from LMMBox.

Each session will begin with gentle exercises to warm up the body and brain, followed by singing and discussion about various music, songs, and media.

Attendees will also receive their own ‘musical memory box’ in a bag to help increase the interactivity of the sessions.

The project has received funding from the new Local Connections Fund, and is in collaboration with Headway Leicester.

Music has proven benefits for people with memory problems or a brain injury, including enabling people to connect with past experience and enabling freedom of expression, confidence and independence.

Attendance at the groups also helps to improve mood and reduce feelings of social isolation.

“We know we are providing a vital service to our members and receive enquiries regularly,” says Kyle Newman, group leader and co-director of LMMBox.

“In spite of the lockdown, we are thrilled to be able to once again provide a culturally specific group for the South Asian community.

“We also know that the group leader needs to come from that community and have the music and cultural knowledge to be able to engage participants effectively.”

“We are delighted to collaborate with LMMBox and reach out to more people across Leicester who have been affected by brain injury,” adds Mary Goulty, service manager at Headway Leicester.

“There is a clear need for a support service within the BAME community and that’s why we launched our BAME group last year, which is providing a vital lifeline to brain injury survivors we support and their families.”

To contact LMMBox, visit www.leicestermusicalmemorybox.co.uk

For support with brain injury in the Leicester community, visit www.headwayleicester.org.uk.

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Community rehab

‘Huge positive progress – but change still needs to happen’

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Susan Pattison - founder of SP Therapy Services

Having set up in private practice 22 years ago, SP Therapy Services has watched a burgeoning sector grow around it. Here, founder Susan Pattison shares her views on its progress, and why community rehab has an ever-increasing role to play.

“We’re no longer a child who is complaining without a strong voice – we’ve grown up into the teenager who can articulate themselves.”

Susan Pattison’s analogy of the specialist neuro sector is an interesting one.

From setting up in business in the very early days of development for private practice 22 years ago, she has watched a thriving industry grow up around her.

“When I first set up in business, it was said many times I was like gold dust,” she recalls.

“Setting up on your own wasn’t common at all, particularly as a neurophysiotherapist. At that time, physio was about sprained ankles, not complex brain injury cases.

“When I was in my previous job, I was discharging people home to nothing, which is why I wanted to set up in business. I never set out to be a business woman, I just wanted to do right by my patients.

“I still remember my husband and family shaking their heads and saying I had six months to make a go of it, it was not widely done at all. It was a risk.”

As a trailblazer for private practitioners, Susan has gone on to build a thriving neurological physiotherapy and occupational therapy business, SP Therapy Services.

From its base in Bury, its nine-strong team covers Cheshire, Lancashire, Greater Manchester, South and West Yorkshire, supporting patients in both clinical and home settings.

“Now, it feels like my business is just a little goldfish in a huge pond, it’s a long way from the early days but these are actually really exciting times,” says Susan.

“We have grown up as a community and are making a lot of noise in the right ways. We have UKABIF banging on Parliament’s doors, helping to make neurorehab a hot topic, we’ve got BABICM setting standards for brain injury case managers, we’ve got Headway with their list of solicitors – and everyone is working together to move forward.

“I think the private sector has now come up and is a beacon of light for the NHS, we respond to the need and are there in support.

“A huge amount has changed over the past 22 years, and it is still changing. We have to continue to change, to work hard and progress together.”

And that need for ongoing change is something Susan feels passionately about – particularly the need for investment in community rehab, to support the work of the NHS post-discharge.

“If we are going to invest in saving a life, then we need to ensure a quality of life for that person. These people need rehab to have that,” she says.

“We can’t keep front-ending and need to invest in the longer-term care once they are discharged into the community. Rehabilitation has to happen in people’s communities as that’s where they live their lives.

“But investment in community rehab can’t be seen as a luxury, or something that is nice to have. It’s absolutely critical to people and families being allowed to rebuild their lives.

“With the impact of the pandemic, hospital waiting lists are going through the roof, and that is going to be pushed out into the community.

“But with such a strong private sector now, which has grown from the child into the teenager, as I put it, the support is there, it’s in place. And we’ll keep being that beacon for community rehab, continuing to call for the investment is needs.”

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Community rehab

Visual impairment ‘may affect 1 in 30 children’

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Every class of 30 children will have at least one who suffers from a brain-related visual impairment

A brain-related visual impairment may affect one in every 30 children, new research has revealed.

In a study of Cerebral Visual Impairment (CVI), which was thought to be rare, University of Bristol researchers have found it is more commonplace than previously accepted.

The study, funded by the National Institute for Health Research (NIHR), investigated how many school-aged children may have undiagnosed brain-related vision problems.

Information was collected about 2,298 children aged five to 11 across 12 schools using teacher and parent questionnaires. They invited over ten per cent of the children (262 pupils) for a detailed assessment using validated tests to identify children with brain-related visual problems suggestive of CVI.

The team, from the University’s Medical School, found that based on their results, on average, every class of 30 children, would have one or two children with at least one brain-related vision problem.

They found no single problem was most common and the difficulties observed included problems with eye movements, visual field, recognition of objects and seeing things in clutter.

The team also found that children who were struggling with their learning and were already being given extra help at school, were more likely to have brain-related vision problems – four in every ten children with support for special educational needs had one or more brain-related vision problems, whilst for all children it was only about three in 100.

Researchers said they hope the study helps to raise awareness of CVI among parents and teachers, and can help them identify signs of the condition earlier.

“While this does not prove that these kind of vision problems are the cause of the difficulties with learning for any particular child, it does suggest that attending to children’s visual needs, such as making things bigger or less cluttered, might be a good place to start,” says Dr Cathy Williams, the study’s lead author and Associate Professor in Paediatric Ophthalmology at Bristol Medical School.

“While this does not prove that these kind of vision problems are the cause of the difficulties with learning for any particular child, it does suggest that attending to children’s visual needs, such as making things bigger or less cluttered, might be a good place to start.

“If interventions can work to reduce the impact of these problems on children’s learning, it might improve both educational and wellbeing outcomes for children.”

Brain-related vision problems include difficulties with moving the eyes, seeing things in their visual field, and recognising objects accurately and quickly.

While eye chart tests check how well a person can see the details of a letter or symbol from a specific distance, these visual acuity diagnostic assessments miss many children with CVI, whose acuity is normal or near-normal.

The findings of the study have been published in Developmental Medicine Neurology.

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