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“Because rehab won’t wait”

Lake District charity launches UK’s first COVID-19 compliant brain injury rehabilitation programme based on outdoor activities and social distancing.

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A Lake District charity has developed the UK’s first COVID-19 compliant brain injury rehabilitation programme combining traditional interdisciplinary clinical therapies with physical activity in the outdoors.

Located on the outskirts of the bustling market town of Keswick in the Lake District, Calvert Reconnections, run by the Lake District Calvert Trust, is a brand new neuro-rehabilitation, residential centre providing ground-breaking rehabilitation programmes for those who have suffered an acquired brain injury.

The centre, based at Grade II listed Tithe Barn, ‘Old Windebrowe’, one-time home of Lakeland’s most famous of poets, William Wordsworth, is now taking referrals in advance of its September opening.

There is considerable support from medical research for the notion that outdoor activity is beneficial to brain injury rehabilitation.

With its focus on outdoor activities, Calvert Reconnections is uniquely placed to incorporate social distancing into its programme through activities such as rambling, fell walking, fishing, gardening, horse riding, orienteering, cycling, canoeing and sailing.

The centre’s residential and communal facilities are fully compliant with COVID-19 guidelines while newly developed services include post lockdown respite and post COVID-19 step down rehabilitation.

A highly experienced consultant neurologist and consultant in rehabilitation medicine, over the last 30 years Professor Mike Barnes has been dedicated to the development of neurological rehabilitation throughout the UK and internationally.​

He believes rehabilitation provision has been driven to crisis point by COVID-19 with services facing disruption and closure due to social distancing, shielding requirements, lack of specialist support and funding.

“This ground breaking new programme, combining traditional interdisciplinary clinical therapies with physical activity in the outdoors, will put the UK at the forefront of brain injury rehabilitation on a global scale – because rehab won’t wait,” said Professor Barnes, who acts as an expert advisor to Calvert Reconnections.

Commenting on the opening of Calvert Reconnections, Centre Director Sean Day said: “Our centre was already unique in that it was the UK’s first intensive acquired brain injury rehabilitation programme combining traditional interdisciplinary clinical therapies with physical activity in the outdoors.

“Since lockdown, we have further developed our programme to ensure it sets a global benchmark for brain injury rehabilitation, delivering a ground-breaking, world-class rehabilitation programme tailored to support individuals in their recovery.”

The team at Calvert Reconnections includes highly experienced and qualified activity instructors, neuro rehab coaches, an occupational therapist, neuro-physiotherapist and a consultant neuropsychologist.

Programmes will be developed with the individual based on clinical evidence and research guidance while a variety of physical activity, including outdoor adventure, will be available.  Every programme will include realistic personal goals, utilising evidence-based validated outcome measures to monitor progress.    The programme aims to not only improve physical and psychological well-being, but also increase self-confidence and independence.

The crisis facing rehabilitation services has come into sharp focus in recent months.

Last month, the Royal College of Occupational Therapists (RCOT) gathered support of MPs from across the UK’s political spectrum for its call for the Health Secretary to prioritise rehabilitation for those affected by COVID-19, with Chief Executive Julia Scott predicting “a tidal wave of need”.

An earlier pre COVID-19 report by Calvert Reconnections and barristers Exchange Chambers also revealed how the recovery prospects of brain injured patients in the UK are being jeopardised by a chronic lack of resources.

Calvert Reconnection services:

Acquired Brain Injury Neuro-Rehabilitation

Providing post-acute residential assessment and rehabilitation for adults with acquired brain injury, Calvert Reconnections provides unique individualised rehabilitation opportunities utilising the outdoors, to maximise recovery

and develop positive management strategies to create sustainable change.

To effectively enable participants to make sustainable physical and cognitive improvements and establish effective management strategies, it is recommended that participants will engage with the Calvert Reconnections Acquired Brain Injury Rehabilitation program for 3-6 months.

Referral criteria:

  • Individual has an acquired brain injury.
  • Desire to engage in an outdoor activity focused rehabilitation programme.
  • Medically stable.
  • 18 years +.
  • Consent to brain injury rehabilitation at a residential service.
  • Funding for a residential placement has been approved.
  • Onward plans in place prior to the commencement of the rehabilitation programme.

It is also imperative that participants are:

  • Confirmed COVID-19 negative at admission.
  • Able to follow and respect social distancing rules with minimal support, both indoors and outdoors.
  • Assessed needs are able to be supported with the skills and experience of the new Calvert Reconnections team.

Post COVID-19 Rehabilitation

Health professionals are observing a range of respiratory, musculoskeletal, neurological, and psychological deficits in individuals who have received hospital treatment for the COVID-19 and the number requiring rehabilitation is growing rapidly.

It is critical that these people have access to rehabilitation in order to have the best possible chance of maximising their recovery.

The full extent of the rehabilitation needs of people recovering from COVID-19 are not yet known, however, it is predicted that 4% of people will require rehabilitation in a residential setting.

Calvert Reconnections will liaise with the acute rehabilitation service provider as the assessment and transfer information they share will be crucial to a smooth transition and continued effective rehabilitation.

The team will then continue the interdisciplinary assessment and develop an individualised rehabilitation plan to support a person’s recovery and transition back to their own home.

It is anticipated that the period of Calvert Reconnections’ post COVID-19 rehabilitation will be between 2-8 weeks on average but this may be extended depending upon the complexity of rehabilitation needs.

Post Lockdown Recovery and Restoration

The COVID-19 outbreak and subsequent lockdown has had a significant impact on everyone’s daily lives.

During this time, many people have been bored, frustrated or lonely and may have affected their mental wellbeing by feeling low, worried, anxious, or concern about their own health or that of those close to them.

Calvert Reconnections will provide a shared respite period for carers and participants together – or they may prefer a period apart having spent much time together recently. Taking advantage of the stunning Lake District landscape, we will run a wide variety of supported activities.

This service will be a real benefit for people to have a positive mental and physical wellbeing experience for 2-3 weeks to recover from the recent worry and turmoil. We know that life may well continue to be difficult but addressing and maintaining good mental health will support longer term personal resilience.

https://www.calvertreconnections.org.uk/ opens in September 2020 and is now taking referrals – https://www.calvertreconnections.org.uk/referrals/

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Magnetic sensor could detect early signs of TBI

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Signs of traumatic brain injury, dementia and schizophrenia could be detected at an earlier stage as a result of the development of a new sensor which measures weak magnetic signals in the brain.

Through the development of the new Optically Pumped Magnetometer (OPM) sensor, scientists are hopeful of enabling a greater understanding of connectivity in the brain, which could have significant benefits in the chances of early diagnosis.

The device, developed by teams of scientists at the University of Birmingham, is currently in trail stage and clinicians at the Queen Elizabeth Hospital Birmingham are involved in its use in pinpointing the site of TBIs.

Its potential to increase diagnostics for neurological injury, neurological disorders such as dementia, and psychiatric disorders such as schizophrenia, has been widely recognised, and the team are now seeking commercial and research partnerships to help advance its development further.

The new sensor has enabled advances in detecting brain signals and distinguishing them from background magnetic noise, when compared to commercially available sensors. By using polarised light, the device can detect changes in the orientation of spin atoms when exposed to a magnetic field.

The team was also able to reduce the sensor size by removing the laser from the sensor head, and made further adjustments to decrease the number of electronic components, in a move that will reduce interference between sensors.

Benchmarking tests have taken place at the University’s Centre for Human Brain Health, and has reported “good” performance in environmental conditions where other sensors do not work.

Specifically, the researchers showed that the new sensor is able to detect brain signals against background magnetic noise, raising the possibility of magnetoencephalography (MEG) testing outside a specialised unit or in a hospital ward.

The research – published in the ‘Detection of human auditory evoked brain signals with a resilient non linear optically pumped magnetometer’ report, Kowalczyk et al (2020) – was led by physicist Dr Anna Kowalczyk.

“Existing MEG sensors need to be at a constant, cool temperature and this requires a bulky helium-cooling system, which means they have to be arranged in a rigid helmet that will not fit every head size and shape,” she says.

“They also require a zero-magnetic field environment to pick up the brain signals. The testing demonstrated that our stand-alone sensor does not require these conditions.

“Its performance surpasses existing sensors, and it can discriminate between background magnetic fields and brain activity.”

The researchers expect these more robust sensors will extend the use of MEG for diagnosis and treatment, and they are working with other institutes at the University to determine which therapeutic areas will benefit most from this new approach.

Neuroscientist Professor Ole Jensen, who is co-director of the Centre for Human Brain Health (CHBH), highlighted the potential of the sensor.

“We know that early diagnosis improves outcomes and this technology could provide the sensitivity to detect the earliest changes in brain activity in conditions like schizophrenia, dementia and ADHD,” he says.

“It also has immediate clinical relevance, and we are already working with clinicians at the Queen Elizabeth Hospital to investigate its use in pinpointing the site of traumatic brain injuries.”

The team at the CHBH has also recently been awarded Partnership Resource Funding from the UK Quantum Technology Hub Sensors and Timing to further develop new OPM sensors.

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Management during a pandemic: what we’ve learned

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As the country faces the second wave of the coronavirus pandemic, the management team at Richardson Care reflect on their experiences so far. Richardson Care has six specialist residential care homes – three for adults with acquired brain injury and three for adults with learning disabilities. Caring for up to 78 people, many of whom are vulnerable brings added responsibilities and pressures, as well as additional skills.

Our experience in supporting people who are rebuilding their lives after brain injury or living with learning disabilities means that we are problem solvers. We support people to overcome challenges every day. Never has this been more important and we’re proud of the way that our management team and staff have responded.

We asked our Homes Managers for their personal views and experiences of the pandemic – from their initial reactions to plans for the future. We discover what we’ve learnt, and how we can change things for the better.

Resilience
‘The capacity to recover quickly from difficulties; toughness’ has been demonstrated by our team throughout the pandemic. Jane Payne, Operational & Clinical Officer at Richardson Care, takes us back to the beginning of the year: “On February 18th 2020 we informed staff that there was a new virus, and preventative measures were put into place; including hourly touch point cleaning, increase in hand washing and an increase in awareness. Ahead of government guidance on March 12th 2020, we took the very tough, necessary decision to close our doors to family and friends to protect service users. We made sure that all staff worked only in one home, so in the event of an infection, it would not be transferred from one home to another by our staff.”

“The management team have become incredibly solid; working as one in supporting each other, as and when each has needed, as we live and work through the rollercoaster that is Covid-19. I am proud to lead; and be part of such a strong group of individuals displaying a sole purpose of ensuring the care, welfare, safety and security of our service users and staff. Richardson Care has shown we are more than resilient, we have become stronger through experience. Care: it’s in our DNA.”

Jacky Johnson, Registered Manager at our Boughton Green Road home for adults with acquired brain injury talks about the realities of dealing with something that no one had ever experienced before. She says: “We were dealing with real disease: a real virus, in real time with real people…The guidance received from various governing and public bodies changed before the ink could dry…The initial fear demonstrated by some staff left others having to broaden their shoulders… taking on extra activities within their daily routines…The expectation on myself as a Manager weighed heavily, it felt like I should know all the answers to the questions they asked… I was clear of my expectations from my team and them of me… Resilience: it’s not about how many times you fall… it’s about how many times you stand up and face another day.”

Teamwork
It was important to create a positive spirit as we knew our response would impact our service users. Central staff were redeployed so each home had enough admin and maintenance support in their team. This means they have been able to form closer relationships with the service users, some have been helping out with maintenance jobs – developing their skills and feeling valued while completing meaningful activities.

The teams within each home became closer, bonding more as they faced challenges together. No job was too big.

Weekly management meetings moved online in February. The Managers have worked more closely together while being socially distanced. Helen Petrie, Manager at The Richardson Mews adds: “No-one has ever been in this position before. We’re all learning together and supporting each other. We’re there to boost morale when it’s needed, sharing experiences and insight to keep our service users and staff happy and safe.”

Resourceful
We’ve found more efficient ways of operating – reducing risk while continuing to help our service users develop their daily living skills. For example, instead of going out to the shops several times a day, there’s just one trip per day. This means planning ahead, so service users have been helping to plan the menus, write shopping lists and prepare for their daily needs. These all require cognitive skills.

We have all become much more tech-savvy, using the internet, apps, photos and video calls as well as phone calls and letters to keep in touch with service users’ family and friends. We’ve also been checking in with each other more too.

Wendy Coleman, Registered Manager at our Duston Road home adds: “For service users, routine is a major part of their life. When their usual activities are no longer possible – no home visits, day services, community activities – staff have shown how well they have supported service users, reassuring them throughout all this. They have also been dealing with more challenging behaviours due to service users’ complex needs and lack of understanding of what is happening. We have created different routines and activities, promoting health and exercise.”

At The Richardson Mews (inspired by Joe Wicks) the day now starts with ‘Morning Motivation’ – exercising to music every day to improve fitness, flexibility and well-being. We’re also making more use of our in-house gym equipment. One service user who has a brain injury thrived during lockdown: he was in a wheelchair in February and now he can walk 70 lengths of the parallel bars.

Although the service users have missed going out, we have had plenty of scope and opportunity to develop in-house activities. Our large gardens and outdoor spaces have been used for gardening, ‘coffee shops’, sports and games, trampolining and treasure hunts. Our indoor communal spaces have hosted quizzes, craft activities, music and karaoke sessions. We’ve celebrated birthdays with gifts, parties and barbecues. We’ve maintained structure when needed, providing mental stimulation, social interaction and fun, while supporting well-being and skills development.

Appreciating each other
“The new normal is valuing and appreciating the simple things in life and each other, focusing on the positives,” adds Wendy Coleman. As we have gone through the months, we’ve noticed positive changes in service users – improved bonding with staff due to them having much more 1-1 time. Individual service user’s communication skills have also improved.

“Staff have done all this whilst dealing with the impact on their own lives. I feel through all this we all have changed our priorities, we have learnt different coping skills, adapted to change, and have gained new skills.

“It is important to show how we value, support and appreciate each other, talk more, respect and most importantly listen to each other. Learning that showing praise and valuing people is so important in these difficult times.”

Never has the responsibility of managing specialist care services been so great. As we prepare for the next phase of the Coronavirus pandemic, we know that we have the experience, skills and resilience to face the challenges ahead.

Richardson Care provides specialist residential care and rehabilitation for adults with acquired brain injury and learning disabilities. An independent family business with a 30-year track record, it has six residential care homes in Northampton. Find out more at www.richardsoncares.co.uk

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The danger of Z-drugs for dementia patients

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Strong sleeping pills known as ‘Z-drugs’ are linked with an increased risk of falls, fractures and stroke among people with dementia – according to research from the University of East Anglia.

Sleep disturbance is common among people with dementia and the impact for patients and their families is significant.

To date there are no proven effective treatments available, however people with dementia are often prescribed Z-drugs (zopiclone, zaleplon, and zolpidem).

But a new study published today reveals that stronger doses of these drugs are linked with an increased risk of adverse effects.

These adverse effects were found to be similar or greater than those for higher dose benzodiazepines or ‘benzos’ – which are also used to treat sleep disturbance, and are known to have several adverse effects.

The team say that patients already taking higher doses of Z-drugs should not stop taking their medication suddenly, however they should seek a review with their GP.

Prof Chris Fox, from UEA’s Norwich Medical School, said: “As many as 90 per cent of people with dementia suffer sleep disturbances and it has a big impact on their mental and physical health, as well as that of their carers.

“Z-drugs are commonly prescribed to help people sleep – however these medicines were never licensed for dementia and they have been associated with adverse events such as falls and fracture risks in older people.

“We wanted to find out how they affect people with dementia, who are frequently prescribed them to help with sleep disturbance.”

The team analysed data from 27,090 patients in England diagnosed with dementia between January 2000 and March 2016. The average age of the patients was 83 and 62 per cent were women.

They looked at the adverse events for 3,532 patients who had been prescribed Z-drugs and compared them to people suffering sleep disturbance who had not been prescribed sedatives, and patients who had been prescribed benzodiazepines.

They also looked to see whether Z-drug dosage played a part in adverse outcomes.

Prof Fox said: “We studied a range of adverse outcomes including fractures, falls, deep vein thrombosis, stroke and death – over two years. And we were particularly interested to see whether higher doses led to worse outcomes.”

Higher dose Z-drugs and benzodiazepines were defined as prescriptions equivalent to ≥7.5mg zopiclone or >5mg diazepam daily.

“For patients prescribed Z-drugs, 17 per cent were given higher doses. And we found that these patients on higher doses were more at risk of falls and fractures, particularly hip fractures, and stroke – compared with patients who were not taking any medication for sleep disturbance,” said Prof Fox.

Those on lower doses however (≤3.75mg zopiclone or equivalent) were not found to have an increased risk of adverse outcomes.

And there were no differences in adverse events for Z-drugs compared to benzodiazepines, except lower mortality rates with Z-drugs.

Prof Fox said: “This research shows us that higher dose Z-drugs should be avoided, if possible, in people living with dementia, and non-pharmacological alternatives preferentially considered.

“Patients already taking higher dose Z-drugs should not stop taking their medication, but we recommend that they should make an appointment to see their GP for a review,” he added.

Prof Clive Ballard, of the University of Exeter Medical School, who collaborated on the study, said: “Our findings serve an important caution regarding the harms of sleeping tablets in people with dementia.

“This research is a very timely and unfortunately necessary reminder that sedative medications are not a helpful way to manage social isolation during Covid-19.

“Our study also highlights the importance of research to develop non-drug approaches to help people with dementia to sleep – whether they are at home or in residential care.”

Dr Ian Maidment, Reader in Clinical Pharmacy at Aston University and lead pharmacist on the study, said: “Z-drugs are widely used to treat insomnia in people living with dementia, but are only recommended as a short-term treatment for the maximum of four weeks. Our work shows the importance of clinicians including GPs and pharmacists reviewing patients on long-term Z-drugs.”

The study was led by UEA, in collaboration with researchers from The Quadram Institute, Aston University, University College London, and the University of Exeter.

‘Adverse effects of Z-drugs for sleep disturbance in people living with dementia: a population-based cohort study’ is published in the journal BMC Medicine on November 24, 2020.

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