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Action among the daffodils

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William Wordsworth urged to the world to “come forth into light, let nature be your teacher”.

He was obsessed with the natural world’s power to help, heal and nourish.

Surely then, the lake poet would have approved of the owners of his old Cumbrian bolt hole.

For they are also channelling the power of nature, in the name of rehabilitation.

On the outskirts of Keswick, down the sort of road that only the Lake District can produce – dramatic skies, looming peaks and ancient trees stretching their arms over the narrowest strip of tarmac – stands Old Windebrowe.

The finishing touches are just being put on restoring the 500-year-old tithe barn and dairy cottage when NR Times arrives on a wintry morning.

Fortunately the heating is working and, over coffee in the barn’s vast communal space, Jill Beswick updates on the progress.

She recently moved here from Shetland to take up her role as clinical lead for Calvert Reconnections, an acquired brain injury (ABI) rehab centre harnessing the great outdoors to drive better patient outcomes.

Her experiences of running a community rehab service on the remote Scottish island could stand her in good stead for rolling out her new employer’s big plans.

“I’m used to remoteness, weather and small communities that really seem to look after each other. We moved up to Shetland for a two-year adventure and ended up staying for 16 years but when I saw this job it struck me as a brilliant opportunity and I’ve been on a rollercoaster ever since.”

 We’re sitting in an area where brain injuries survivors, support workers and therapists will gather in the morning, anticipating a day of outdoorsy adventure; and socialise in the evening, windswept and glowing from the best the Keswickian elements can throw at them.

“When I show the locals round they all remember the ceilidhs they used to come to here,” says Jill. But the real historical highlight of the building is its Romantic connections.

Wordsworth’s close pal growing up was one Raisley Calvert, and their friendship continued into adulthood.

By age 21, however, Raisley had developed tuberculosis and was dying. He saw great potential in his young writer friend and wanted to help him fulfil it.

He made sure that his family’s Old Windebrowe cottage was given rent-free to Wordsworth and his sister Dorothy and they lived there for several years.

He also left him £900 in his will to afford him the freedom to write, prompting William to pen the sonnet, To the Memory of Raisley Calvert declaring: Calvert! It must not be unheard by them / Who may respect my name that I to thee / Owed many years of early liberty.

It’s fitting that the room where Wordsworth lived, and which was a launchpad for his career, will be used for life-changing interventions once more; with Calvert Reconnections developing it into a classroom for residents and staff.

The organisation believes it has created the UK’s – and possibly the world’s – first intensive ABI rehab centre focused on outdoor activities.

Residents will typically stay for three to six months, with accommodation for up to ten adults with ABI at any one time.

The centre offers a “24-hour interdisciplinary approach”, with clinical and rehabilitation support combined with various outdoor activities to challenge individuals and deliver evidence-based outcomes.

Before its £1.4m redevelopment, the property had been largely unused, save for some activities like archery. Thanks to a fundraising drive by the Calvert Trust, the charity which provides outdoor adventure holidays for disabled people, it has undergone a dramatic transformation.

The Grade II-listed building now has accessible bedrooms, a self-contained flat to help support people in their independent living, alongside a living area with kitchen and laundry facilities to encourage residents to do as much for themselves as possible.

The centre also has links to Calvert Trust’s portfolio of other facilities, including outdoor activities centres and accommodation also in the Lake District.

The facility adds much-needed residential brain injury care capacity, helping to alleviate a problem continually highlighted by neuro-rehab professionals; the chronic lack of available resources, which can jeopardise patient outcomes.

Recent research carried out by Exchange Chambers barristers and Calvert Reconnections highlighted this further.

It shows that ninety-seven per cent of senior brain injury lawyers believe there are a lack of residential- based brain injury rehabilitation units in the UK.

Also, 71 per cent say the NHS is unable to provide effective support. (Clearly this research took place before the Covid-19 crisis, and time will tell what impact the pandemic has on NHS investment in the future.)

Calvert Reconnections is helping to plug this gap in residential ABI care, while also offering a novel approach – drawing on the benefits of outdoor activity.

“The fact that we really focus in on the outdoor activities and adventure as part of our therapeutic model makes us completely unique. There is nowhere else doing what we do,” says Jill.

“The outdoor activity approach is our therapeutic medium to reach the goals that people want to achieve around things like planning, time management, social interaction and managing impulsive behaviours.”

Outdoor activities can also enhance wellbeing and confidence, Jill explains.

“The goal might not be to climb a mountain, for example, but it’s the fact that what you are doing is a challenge that matters, and this alters how you feel about yourself and your own mental wellbeing.

“If I can do this, which I never thought I could do, then what else can I do? It starts opening up other horizons.”

The outdoor element is underpinned by an interdisciplinary programme which Jill and her team build around the needs of individual residents.

“With a neuropsychologist, neurophysiotherapist and junior occupational therapist employed on-site, alongside rehab coaches with a background in enabling support or activity instruction, the team has been put together to respond to bespoke needs.”

And daily routines do not follow the norm in neuro-rehab.

“We don’t have a clinical model here,” she says. “We don’t have say, physio at 10 o’clock and speech therapy at 11. We don’t have a set programme of that kind at all.

“We work in conjunction with our participants, get to know their aims and work together to achieve them. It depends on their interests as to how we match that and also decide what therapies are appropriate.

“Certainly, we don’t have a programme that everybody has to fit into. We speak to people, find out their interests, the difficulties they have, their aspirations and what they want their future to look like.

“We can then look at how we can build that into their own therapy programme.”

An array of activities is offered to residents, depending on their individual needs and preferences. Calvert Reconnections has an adjacent horse riding centre and is also only four miles from the Calvert Lakes Activity Centre.

“Taking the access we have to the stables as an example, it’s not just about horse riding, there is equine care, stable management, repairing fences and outdoor management. We are focusing very much on the activity challenge alongside the vocational one.

“We have two people carriers which will enable us to get out and about, and we do want to work with the community and with local businesses and groups.

“The response we have had so far has been fantastic and we hope there are many opportunities for us to work together.

“We’re not a secure unit, we’ve developed this as being a part of the community, and we want people to feel able to go out into the community. Doing this helps to open up further opportunities for life experience.”

After busy and active days, the Calvert Reconnections centre itself offers a homely environment, with ten individuals bedrooms on the ground floor and a first-floor living area including a snooker table to increase the opportunity for social interaction.

The centre is designed to be both relaxing and challenging.

“If you go to most rehab units, they are a bit like hotels in that every bathroom and bedroom looks the same. But that’s not what we’ve got here. Every room is different, which gives it character, but also provides a better opportunity from a rehab perspective because it can offer different challenges.

“Depending on what type of bathroom facilities they have at home, for example, we can try to replicate them to better prepare them for the future.

“Also, with a lot of newly-built rehab units which are very accessible, but very clinical, you find that when somebody is going home, they may not have had any experience of steps, slopes or other walking challenges that occur in real life areas.

“Whereas here, while some of it is a bit quirky because it’s a very old building, we have a real life setting and we want it to challenge our residents.

“If you make things too ideal, you’re setting people up for failure when they go out into the community. Can they go to the local shop if you’ve not been practicing on stairs or different surfaces?”

The approach is also designed to support residents’ mental wellbeing, helping them to better manage the cognitive challenges of daily life.

“Often, when people are going through their acute phase of rehab and to get them out of hospital, the focus is on whether you can walk, wash and dress yourself. But actually they may not be able to manage a daily routine.

“They look good because they’re walking fine, but planning their day and managing their activities within the day is a real struggle. So we feel that to be able to work on that cognitive rehabilitation, mental wellbeing is a massive aspect that we’ll also be addressing.”

As well as focusing on the needs of her residents, Jill also hopes to help to build up the hard evidence for Calvert Reconnections’ distinct approach.

“Previously this type of service has not existed, which is why we need these evidence-based outcomes.

“But everyone we have spoken to and consulted with, whether that’s potential clients, clinicians, case managers, physicians and personal injury lawyers, is really excited about the model and feels that this is absolutely the way forward.”

And once such evidence is collected demonstrating the value of Calvert Reconnections’ approach, Jill aims to share it as widely as possible.

“We are very excited about the work we are doing and the impact this will have on the people who come to us from across the country, and hopefully on many others too,” she says.

Since our visit, Calvert Reconnections has opened for referrals. Find details here: www.calvertreconnections.org.uk.

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Brain injury

Has UEFA done enough to protect player safety at Euro 2020?

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The collapse of Denmark’s Christian Eriksen due to a cardiac arrest during his team’s opening game at Euro 2020 shocked football fans worldwide and raised many questions about player safety. Here, sports disputes lawyer Barrington Atkins examines football authorities’ approach to the safety of players and asks whether UEFA has done enough to protect those competing at Euro 2020

 

Concussion safety was meant to be at the forefront of the Euro 2020 finals. 

All 24 teams committed to following the recommendations of the Union of European Football Associations (UEFA) Concussion Charter, which was a commitment to player welfare and player safety. 

All 24 teams agreed to implement the serious measures recommended by UEFA to provide care for players who experience concussions or have injuries on the pitch. The message of the Charter was clear: if a player is suspected of concussion, they must be removed from the field of play.

UEFA’s focus on concussion follows a growing awareness of the greater risk footballers’ face of neurodegenerative diseases from head injuries. Research commissioned by the Football Association and the Professional Footballers’ Association found that ex-professional footballers are three and a half times more likely to die from dementia than people of the same age range in the general population.

The concussion and fractured skull sustained by Wolves’ Raul Jimenez following a collision with Arsenal’s David Luiz in November 2020 was the final straw that led to the implementation of the concussion substitutes rule in the Premier League. This new rule states that if a player has clear symptoms of concussion or video provides clear evidence of concussion, his team will be permitted to replace him with an additional substitute.

On 21 February 2021, Rob Holding became the first Premier League player to be replaced under the rule. The protection the rule provided to player safety was instantly demonstrated as Holding was confirmed to have concussion the following day.

Despite the proven benefits, UEFA decided against approving the concussion substitutes rule for the Euro 2020 finals. The injuries football fans have witnessed during the European tournament have undoubtedly challenged UEFA’s decision and called into question whether the Concussion Charter is effective enough for player safety.

The first incident occurred when France’s Benjamin Pavard sustained a head injury following a collision with Germany’s Robin Gosens. Pavard received treatment for several minutes before being given the green light to continue playing. Pavard later revealed that he was knocked out for 10 to 15 seconds. Controversially, UEFA confirmed that the correct concussion protocols were followed.

Only six days later, Austria’s Christoph Baumgartner received a blow to the head, went back on the pitch and was then substituted. His coach later admitted that Baumgartner had been experiencing dizziness. 

Russia’s Danila was the third player in the tournament to collapse to the ground following a head injury. He was cleared to play on but was withdrawn at half time. These incidents demonstrate that football authorities need to do more to protect players’ health.

Cardiac conditions too are highly significant here, being the leading cause of death in professional footballers. Data has revealed a prevalence of sudden cardiac death of seven in 100,000 football players.

Quick application of a defibrillator can improve a patient’s survival by 75 per cent. However, when Cameroon’s Marc-Vivien Foé collapsed during the 2003 Confederations Cup in France, it took six minutes before attempts to restart his heart began. The lack of awareness of the need for speedy care contributed to Foé’s death, but the incident spurred football authorities to implement changes to reduce the risk of cardiac arrest on the field.

The English Football Association has now increased screening frequency so that players are tested between the ages of 14 and 25. For incidents where cardiac conditions slip through the net, sporting organisations have pitch-side defibrillators and medical staff trained in CPR to help resuscitate a player if they suffer a cardiac arrest.

Player safety was brought to the forefront on 12 June 2021 when Christian Eriksen experienced a cardiac arrest during Denmark’s game against Finland. Thankfully, football authorities’ understanding of the need for urgent medical attention in cardiac emergencies helped save Eriksen’s life.

The Euro 2020 finals have shown that football authorities need to take further urgent action to protect player welfare and player safety. However, as Christian Erikson’s recovery happily shows, player safety can be achieved when football authorities apply the correct protocols and have appropriate medical equipment in place.

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Insight

Life after lockdown – what comes next?

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As we prepare to emerge from lockdown in less than two weeks, attention is turning to what the ‘new normal’ will be like. Margreet Wittink at Renovo Care shares some reflections from the pandemic and thoughts on what may lie ahead

 

The 19th of July 2021. More than just any date.

We all have certain dates that are important to us, like birthdays and anniversary dates. However, this year we have been governed by dates set by the government trying to get back to a normal life post-COVID.

We seemed to be going in the right direction but then the Delta variant presented itself. The infection rates started to go up again and continue to rise but with far less hospital admissions. Opinion seems to be divided on whether we need to remain cautious and wait or return to normal life whatever it may bring.  The British Medical Association is calling for caution and is asking for ongoing use of face masks and new ventilation standards.

The 19th of July 2021 will mark the fourth and final stage of lifting lockdown in England. It makes me reflect on the period since March 23 2020 when the first lockdown started.

A birthday present my son didn’t want. Being an essential worker continuing to drive to Hollanden Park Hospital on an empty M25 and A21, seeing a banner thanking those who continued to work which I appreciated so much. Taking staff temperatures which was thought to be needed for just three months but lasted so much longer.

The absolute low of the period? Losing a much loved colleague and being unable to pay the traditional respects. But never losing sight of the most important aspect of our work; keeping our patients at Renovo Care safe.

Will life get back to normal? But what is normal? Hasn’t COVID shown us all that life can change dramatically in a short period of time?

That is something that is all too familiar to our patients who come to Renovo Care for their neurological rehabilitation following stroke, traumatic brain injury, Guillain Barre Syndrome to name a few of the diagnosis we treat.

We know how important family support is to our patients and how difficult it has been for them to be at our hospital without seeing their loved ones regularly in person. The use of Zoom and Microsoft Teams has given us a way to be in touch and being able to share therapy sessions, but it has been a poor substitute.

Recently we have been able to allow family members, who take on a carer role, in again nearer the discharge date to work together to prepare for a smooth transfer from Renovo Care to home. This has made such a difference to them to know what can be expected when their loved one comes home following a major event that changed their life.

Normality. What will it look like? No more face masks or social distancing? Are we ready for it?

I think that staff and patients alike will welcome staff not having to wear masks. When one of our patients left, he actually asked one of the therapists if she could remove her mask for a moment so he could see what she looked like.

Not wearing face masks will allow us all to see facial expressions again which is so important for communicating with each other. Hats off to our speech and language therapists who had to adapt their way of working around the COVID restrictions.

Will our visiting return to the way it used to be? Successful neurorehabilitation requires 24-hour support of all the parties involved which includes family. Being able to get hugs, to be held and to be seen face-to-face by your loved ones when you are working hard to regain your independence is so important to keep the focus on the goals they are trying to achieve.

It will require a transition from staff as we’ve had a dedicated visitors’ areas away from our patient rooms and rehab facilities for such a long time now, that it will be a novelty to have visitors back in these areas again.

The 19th of July 2021; the final stage of England’s COVID lockdown roadmap. The final review will happen on the 12th of July following analysis of the latest data. The Delta variant is on the rise but so are the vaccination numbers. Renovo Care has had a successful vaccination programme for staff and patients.

It looks like it is really happening and here at Renovo Care we will be ready for whatever comes and will make sure that our patient best interests are at the heart of what we do. 

  • Margreet Wittink is head of therapies/ lead occupational therapist, at Renovo Care Group’s Hollanden Park Hospital

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Insight

‘Like bees collaborating in a hive, achievements in rehab should be shared’

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Achievement in rehabilitation should be shared and celebrated with supporters to help sustain and encourage progress, says Lisa Beaumont, whose own ten-year recovery from stroke continues with the support of family, friends and therapists

 

Rehabilitation works best when it is not undertaken in isolation.

Over the past month, I have been thrilled by the progress that I have made towards my goal to walk without a stick, my posture has improved significantly during lockdown and I have enjoyed walking in the garden in June’s sunshine. 

My progress has reminded me of the saying, “it takes a village to raise a child”. I would like to adapt that expression to become: “it takes a village to deliver successful rehabilitation, many people have important roles to play”.

Just like bees cooperate in a productive hive, it is helpful for the patient to share their achievements with supporters, because their affirmation gives encouragement for renewed progress.

From the outset, I have been very fortunate that I’ve had the support from family, friends and therapists throughout my ten year recovery. 

An important feature of the rehabilitation platform Neuro ProActive is that it makes it easy to share a patient’s progress with  each of the key players in their recovery programme. For me, it looks like this:

My team is my neuro-physiotherapist, Jane Cast (neurorehabkent.com)

My representatives are my carers and sister. It is a bonus that I can keep everyone who is in my support bubble informed about my progress privately, by sharing photos and videos securely within the fully-encrypted platform.

Neuro ProActive is also a key player. Recently named as a Strategic Partner for UKABIF, we are now also part of the Criminal Justice Acquired Brain Injury Interest Group.

Prepared with assistance from Paige Gravenell (neurorehabkent.com)

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