As Chroma partners with a North Devon school to deliver a full arts therapies service, Lucy Collings Pettit, a Neurologic Music Therapist with Chroma, discusses the power of such therapy in children
In September 2020, building upon successful existing music therapy provision, Pathfield School in North Devon introduced a full arts therapies service within their school, in partnership with Chroma.
The Chroma team consists of a neurologic music therapist, an art therapist and a drama therapist.
This is the first partnership where Chroma has been fully commissioned to provide a full arts therapies program within a single school.
Pathfield is a special school for children aged between three and 19 years of age with a range of complex needs. This includes pupils with autism spectrum conditions, learning disabilities, social, emotional and mental health needs, as well as neurological conditions including brain tumours, epilepsy, cerebral palsy and Hypoxic Ischemic Encephalopathy (HIE), whereby children were starved of oxygen at birth.
This year has seen the introduction of neurologic music therapy techniques (NMT) within the school. NMT is concerned with neuroplasticity, therefore the specific techniques used within the school setting are used to maintain or improve skills for those pupils with a neurologic condition – typically speech and language, motor and cognitive skills.
The focus of NMT is to help these pupils acquire functional skills, usually for the first time. For pupils who suffered lack of oxygen at birth, they may have never known life any differently but, coming to terms with their condition is an important part of their rehabilitation.
Rehab in this setting has a developmental focus – there are many barriers to learning to overcome and interventions are based on what will achieve the most functional and relevant educational outcomes.
There is huge potential for all three Chroma arts therapists to improve functional outcomes to those pupils who have neurological conditions and suffered a brain injury.
Within this pupil population, the arts therapies as a whole are concerned with helping children come to terms with their condition.
They may have difficulty communicating verbally or articulating their thoughts and feelings effectively, and arts therapists can help them to gain better insight into their conditions and express, explore and better manage their emotions – allowing them valuable opportunities to communicate and process their feelings and experiences.
Arts therapies can provide children with a voice.
The fundamental role of the arts therapies in the school setting is to support pupils in achieving positive outcomes, including functional changes that ultimately enables children to overcome their significant challenges and barriers to learning.
Mobility after stroke – what options exist?
There are more than 100,000 new incidences of strokes in the UK each year – that is around one stroke every five minutes.
1.2 million people in the UK live with the after effects of stroke every day, making stroke one of the most resource-intensive indications faced by the NHS today, and a huge challenge for many years to come.
The NHS and social care costs of stroke are around £1.7 billion a year in England. Therefore, stroke inevitably demands medical and therapy solutions founded on sound scientific principles, such as those provided by Ottobock.
The National Institute for Health and Care Excellence (NICE) released the Stroke Rehabilitation in Adults [CG162] guidelines, in June 2013.
The guidelines advise the consideration of ankle–foot orthoses (AFOs) for people who have difficulty with swing-phase foot clearance after stroke (for example, tripping and falling) and/or stance-phase control (for example, knee and ankle collapse or knee hyper-extensions) that affects walking.
The treating orthotist will assess the ability of the person with stroke to put on the AFO or ensure they have the support needed to do so and the effectiveness of the AFO for the person with stroke, in terms of comfort, speed and ease of walking.
For those recovering from a stroke, the right rehabilitation aids – be that orthosis or electrostimulation – depend on the nature of their impairments, as well as their daily activities. The solutions selected will be tailored to their changing requirements over the course of their rehabilitation.
Hemiplegia – the loss of sensory and motor function on one side of the body – is often the greatest challenge faced by patients following their stroke. This occurs as a result of damage to the central nervous system. Stroke is a leading cause of disability in the UK – almost two thirds of stroke survivors leave hospital with a disability.
Mobility aids that are tailored to each stage of rehabilitation can substantially ease activities of daily living and promote mobility. Limb weakness is common after stroke and it is reported that over three quarters of stroke survivors report arm weakness, which can make it difficult for people to carry out daily living activities.
Functional Electrical Stimulation
Functional Electrical Stimulation (FES) reactivates the nerves that are no longer controlled by the central nervous system. Bioness have developed the L300 Go and L100 Go lower leg FES devices. Unlike FES devices commonly supplied within the NHS which require a control box/pulse generator via long wires, or a heel switch, the L300 Go and L100 Go utilise wireless technology. The H200 wireless is also available as a upper limb solution.
The simple design makes it easy for users to don/doff, with the potential for single-handed application. The self-contained electric pulse generator (EPG) uses accelerometers and gyroscopes to provide 3D motion detection in all 3 kinematic planes and enables users to walk without the need for a heel switch, opening up freedom of choice for footwear and allowing the user to walk barefoot. The 3D motion detection and learning algorithm provides consistent stimulation, deployed in 0.01seconds and adapts to the users gait dynamics.
Custom Made Orthoses
Our custom manufacturing unit at Ottobock Minworth specialise in hand crafted orthotics made to specification. The orthotist will design the orthosis depending on specific patient needs. Our experienced and award winning technicians ensure that each orthosis made is to the highest level of fit and comfort for your patient.
Ottobock Minworth blend cutting edge manufacturing techniques with traditional manufacturing skills to ensure the best possible outcomes for your orthotic device. A full range of AFOs, DAFOs, GRAFOs, and Stance control, Cosmetic and Convention KAFOs are available, complimented by Ottobock’s full range of world leading bars and joints.
Braces and Supports – Upper Extremity
Limb weakness is common after stroke and it is reported that over three quarters of stroke survivors report arm weakness, which can make it difficult for people to carry out daily living activities.
The Omo Neurexa plus is a shoulder support that prevents or reduce subluxation, resists pathological movement patterns, has a forearm support to further offload the shoulder joint. The Clima Cool material also aids with sensory feedback.
The Omo Neurexa plus can also be used in conjunction with the Manu Neurexa plus, or the Manu Immobil Long – a wrist hand orthosis that stabilises and supports the wrist where the wrist or hand is paralysed. Together, these products make up the complete upper limb solution.
Braces and Supports – Lower Extremity
Stock lower limb braces are designed to improve posture, mobility, walking speed and balance, as well as providing the end user with a greater sense of safety.
The WalkOn Range are dynamic lower leg orthoses, suitable for indoor and outdoor use. The primary feature of the WalkOn orthoses is that they are dynamic – a particular benefit for patients with permanent dorsiflexor weakness. The range is made of glass fibre (Flex) and carbon fibre prepreg materials (Trimable, Reaction and ReactionPlus) which provide easy energy storage and return during the gait cycle. The ergonomic design of the WalkOn orthoses means they are discreet and inconspicuous to wear.
Ottobock also offers a range of other lower limb braces for mild dorsiflexor weakness.
Stance Control Orthoses (SCO)
Stance Control Orthoses, usually available through NHS funding, are for patients with partial paralysis or absent knee extensor power. In general they allow for free swing phase and stable stance phase.
Askham enables families’ voices to be heard
Families are being enabled to regain their voice in the care and rehabilitation of their loved ones through the creation of a new forum at a specialist Cambridgeshire community.
An ‘Ask the Therapist’ forum has been introduced by Askham Rehab, part of Askham Village Community, to help bridge the gap created by lockdown between relatives and therapists.
Through monthly video calls, families of Askham residents with complex brain injuries can receive support and advice from the community’s multidisciplinary team, alongside updates on their loved one’s treatment and pathway.
The sessions rotate between therapists specialising in the neurological fields of psychology, physiotherapy, occupational therapy, and speech and language.
The aim is to allow the relatives to spend time with all four therapist teams to build rapports and reassurance, and gain the knowledge needed in preparation for their loved ones’ discharge.
Askham say the sessions were created to help support the mental health of residents during times when they cannot interact with their loved ones and their therapy team as usual.
“When the pandemic came, we soon realised we had lost the voice of our relatives. While they were still calling in or contacting us via email, we lost the daily 1-on-1 conversations they had with our therapists,” says Priscilla Masvipurwa, Chair of the Askham Rehab Quality Improvement Board.
“We decided we needed a forum where relatives could be part of an informal setting and seek advice on brain injuries with our therapists. By having a group, the relatives had the chance to meet with others who were going through very similar journeys.
“It created a confidential space where they could learn from and support each other.”
While rehabilitation support continues to be provided to residents as usual, Priscilla says the team were mindful of the need to extend emotional support to relatives during such difficult circumstances.
“The initial idea was to actually offer teaching sessions, but we quickly realised that would just close people off from expressing their concerns and struggles,” she says.
“Ask the Therapist has created a place where people experiencing the same circumstances can advise each other on how they are coping. It has turned into a productive space where educational and emotional support is given.
“Relatives just want someone to talk to. Sometimes they aren’t even on the radar of therapists and we didn’t want that happening at Askham.
“Ask the Therapist allows us to reach out to the relatives and if any of them need more support we can assess that in the informal meetings and signpost or initiate some kind of therapy outside of the sessions.”
The success of the lockdown-inspired initiative has led to wider discussions to potentially have people who have received treatment at Askham to take part in future sessions to impart their experience to others going through the same journey.
“The positive feedback has been overwhelming, and has led to possible plans to open the session up to the wider community in the near future,” adds Priscilla.
“We’re grateful to be able to offer this service to our users and I’d like to encourage others to explore wellbeing schemes that allow people to seek out help and support, especially during these mentally challenging times.”
Aliyyah-Begum Nasser, Director at Askham, concludes: “As a family business with for over 30 years’ experience, we truly understand the value and power of family relationships and are keen to ensure that our patients can channel the strength and support of their families into helping them fulfil their rehab potential.”
Music therapy enables rehab to transcend boundaries
People living with brain injuries across the UK and Ireland are being brought together by a music therapy programme, which has delivered proven results in rehabilitation.
From its base in London, Connect Music Therapy has traditionally held its sessions in-person in people’s homes, but more recently launched an online offering which is enabling its reach to be significantly extended.
Founder Janina Brady, who also travels to her native Ireland to hold sessions, had adapted her business to enable her to reach greater numbers simultaneously, as well as allowing her to hold one-to-one sessions beyond Connect’s usual geographical reach in the UK.
Janina, who began teaching music in 2010, set up Connect in 2018 and supports people with a range of disabilities and additional needs.
She works widely with people with brain injuries and neurological conditions in enabling them to access the physical, cognitive, emotional and communication benefits music therapy can deliver.
“Music can deliver benefits in so many different ways and can be so important in day to day life,” says Janina, who holds a Masters in music therapy.
“We work with people for the long-term and can see the positive impact it has on them over a developing period of time. I’m continually blown away by the responses we get and how people respond to it.
“When you look at a scan of how a brain responds when music is played, it lights up like a Christmas tree, there is nothing else that stimulates like that. And by stimulating parts of the brain that have not been damaged by their injury or condition, we are helping to create new pathways.
“And when you see the effect that has on the person, the joy it beings out and the progress they are making, it makes this the most wonderful, rewarding work.”
Although sessions had been in-person since Connect was established, the COVID-19 pandemic meant that was no longer possible. But realising the importance of the continuity and positive impact on her clients, Janina took her sessions online from the beginning of lockdown.
“As we work with our clients over a long period of time, music becomes part of their lives, so I realised the need for that to continue. Clients have responded so well to the sessions moving online, and one very nice aspect of that is that so many family members or carers have become more involved in their sessions,” says Janina.
“It has been great in enabling us to bring people together much more widely that we’d ever have done prior to the pandemic. By creating a group which involves people from London and elsewhere in the country alongside people from Ireland, we are developing a community.
“Music is such a bridge for people, it connects everyone in some way.”
Music therapy can take different forms for people, depending on their unique circumstances and needs.
“We can adapt that we do to whatever their capability is, whether that’s communicating through blinking or nodding, or whether that is by banging a drum with their foot,” says Janina.
“We use a variety of approaches depending on the needs of the person. As one example, we often use musical markers throughout the day, through the use of special songs to associate with a morning routine, waiting for the bus, whatever it might be. By effectively creating a musical timetable, we are helping to create structure for people’s days.
“But while everyone’s needs are different, we are working across the board to promote wellbeing and to focus on what our clients can do, rather than what they can’t. We focus on the positives and on seeing our clients at their best.”
While remote sessions may not have been something considered pre-pandemic, they have proven their worth over the past few months, adds Janina.
“In many ways, sitting in front of a screen has similarities to me being there. I can still be in front of my clients, and hold things up for them to choose from and I can see their reaction of blinking or nodding, so it has been able to work,” she says.
“Online sessions have shown to be a good alternative. For example, in situations going forward where I have a client on immune suppressants and I can’t visit, we could look to do a session online. And when I went to Ireland at Christmas I had to isolate for 14 days, I could do my sessions remotely as usual, irrespective of where I was.
“And since the first lockdown, we have adapted even more in terms of adding more microphones and equipment, so we’re all set up for going forward. I can’t wait to get back to seeing clients face to face, but remote sessions will have their place alongside that.”
Brain injury4 weeks ago
‘I’m sorry for handling the steering wheel with buttered fingers’
Case management4 weeks ago
New case management business continues to grow
Brain injury4 weeks ago
Sleep problems ‘can be worse with mild TBI’
Neuropsychology3 weeks ago
Mental health issues ‘may stem from childhood cognitive problems’
Stroke2 weeks ago
Stroke Association launches long-term stroke/COVID study
Community rehab4 weeks ago
Finding a voice for Richie
Stroke2 weeks ago
Surviving stroke: the transition from hospital to home
Brain injury3 weeks ago
Impact of COVID-19 on brain to be investigated