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Building bridges is all in a day’s work for OTs

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Working as an OT, with individual’s who may have physical, sensory, cognitive, emotional and behavioural difficulties, can vary hugely from day to day. 

I liaise closely with other therapists within our centre, particularly in Physiotherapy and Speech and Language therapy on a daily basis. The team and I also have strong relationships with other community teams/resources and various local NHS hospital based therapy teams. This helps us here at The Bridge to be able to offer trulyholistic support to our patients, from preparing for their arrival to after they leave; and it means a lot of work goes on beyond the boundaries of the traditional core function of OTs.

Christine’s* story offers a prime example of this. Christine came to us having had a stroke in her early fifties which had had a serious impact on her function in multiple ways.

At the time Christine was living in a house which was wholly unsuitable to meet her complex needs moving forward.

Christine was around 18 months post-stroke when she arrived, so was unlikely to make many significant functional improvements. However, there was still much work to be done in enabling her to be as independent as possible.

Christine’s main goal was to go home. This was her sole focus and we kept that at the forefront of our work throughout her time here. A plan, to be delivered via a multidisciplinary approach, was put in place built around this goal, plotting the way ahead and mitigating the risks.

We also focused on providing an environment in which she could feel safe. One difficulty she faced was hemianopia, a common visual impairment post-stroke where the eyes are still technically working but there is a problem with the visual processing within the brain. When we first met Christine, she couldn’t see past the mid line of her visual field – the rest of the environment on her right hand side simply did not exist in her world. Now, she is blind to less than a quarter of the normal field of vision.

To help achieve this progress, we used scanning techniques with basic repetition during functional tasks like washing and dressing, or when moving in her wheelchair up and down the corridors on the unit. For example, I would put post-it notes along the corridor and she had to find them all, turning her head to compensate for her visual deficit. Similarly with washing and dressing, we would place the items she needed in different areas of the room. This strategy meant she had to move and turn her head to locate the objects, an important action in preparing for a more independent life.

As the goal we were working towards was allowing Christine to live in her own home, I worked very closely with her allocated social worker and housing provider to firstly assess her current property, which was deemed not suitable for her to return to. I then assessed a further property jointly with the local housing provider and identified that this new bungalow was better suited to Christine’s needs but required some adaptations to be fully meet Christine’s longer term needs.

After a Disabled Facilities Grant was made on my recommendation, we implemented adaptations to the bathroom and installed a ramp to allow wheelchair access. Kitchen counters were also lowered to make them more accessible, enabling Christine to make a cold drink. Hot drinks were not possible due to the risks involved, but being able to make cold drinks was another step towards independence.  

There was a lot of work between all parties to put the right equipment into the house and to devise and implement the strategies to best manage Christine’s cognitive and behavioural difficulties. Great effort was required in securing her a larger then standard package of care to support her needs on discharge home, but we achieved that and Christine was able to return to a much more suitable home environment with the appropriate level of care to support her needs.

Today she has support from her family and a package of care through which she is visited four times per day with additional carer input overnight which will be reviewed and hopefully reduced over time once Christine settles further into her new home environment.

This is a vast improvement on her situation compared to when Christine first came to us needing close monitoring by staff every few minutes and significant periods of one to one care to ensure her safety. If not for the aforementioned interventions, people like Christine all too often end up in nursing homes, with none of the independence she enjoys today. 

Crucial to this outcome, alongside the care and rehabilitation Christine received whilst at the Bridge, was the close collaboration we were able to foster between our team and the various community partners.

Pauline Matthews is an occupational therapist at The Bridge Neurological Centre in Middlesbrough, which is operated by Elysium Healthcare.

*Name changed for anonymity.

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Two major neuro events postponed due to COVID-19

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The Neuro Convention and The National Paediatric Brain Injury Conference have both been postponed

Two significant events in neuro practitioners’ calendars have been delayed until later in the year, as the effects of the COVID-19 pandemic continue to be felt.

The National Paediatric Brain Injury Conference, which was already revised from an in-person to online event, will now not go ahead as planned in February due to the continuing demands on frontline healthcare professionals as COVID-19 cases continue to rise and the country is plunged back into lockdown.

The event, organised by The Children’s Trust, is now earmarked for May 13, although that is subject to further developments in the pandemic.

The ‘Connections and Collaborations’ conference is set to attract an international audience and will hear from an array of speakers from around the world, many of whom are global leaders in the field of paediatric neuro care.

Explaining the postponement, Dalton Leong, chief executive of The Children’s Trust, says: “Over the years, a high number of attendees are from the NHS, including consultants, doctors, surgeons, nurses, and therapists.

“We know that many of these staff are being redeployed to support the Covid pandemic.

“To run a conference at this time, taking them away from delivering vital frontline services, does not seem a sensible option. We look forward to holding the conference later in the year when, hopefully, these pressures have reduced.”

As well as the conference, the Neuro Convention too has been postponed, moving from March until September to enable delegates to attend in person.

The event, held at the Birmingham NEC, typically attracts around 3,000 people from across the country, and organisers hope that by delaying the date, it will give the best chance of lockdown and social distancing measures being lifted to allow them to go ahead.

In addition to the event planned for September 15 and 16 – although that too may be subject to change – an additional digital version of Neuro Convention is set to go ahead in March, enabling neuro professionals to still receive the insight and analysis planned for the NEC event in an online format.

Neuro Convention is hailed as being Europe’s only specialist trade event for brain and spine experts, and boasts an array of internationally-respected speakers and leaders in their field.

“We have been in consultation with various Government departments and whilst the rollout of the vaccine has given the country much needed optimism, we have been advised that we will be unable to host the Neuro Convention event in the spring,” say event organisers Roar B2B.

“The safety of our visitors, customers, partners and staff is paramount. We are confident that moving the event to September will enable us to run the safe, successful event the industry demands.

“To support our exhibitors, partners and the wider industry we are delighted to announce an additional digital version of Neuro Convention. This will provide a digital meeting place, world-class speaking sessions and access to the latest products and services.”

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Arm and hand function could be regained following spinal cord injury through new pioneering research

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Treatment could be developed for arm and hand dysfunction in people living with spinal cord injury through a pioneering new research project.

A pilot study of new therapy for improving upper extremity function is now underway, following funding from BrainQ Technologies – an Israel-based startup which is working widely in precision medicine to reduce disability following neurodisorders – to the Kessler Foundation.

The study is titled ‘The safety and effectiveness of the use of a brain-computer interface-based electromagnetic field treatment in the management of patients with chronic spinal cord injury: A pilot study’ and is seen as a potentially significant breakthrough in researching possible treatment.

It will be led by Dr Ghaith Androwis, a research scientist in the Centre for Mobility and Rehabilitation Engineering Research at Kessler Foundation, and Dr Steven Kirshblum, senior medical officer and director of the Spinal Cord Injury Program for Kessler Institute for Rehabilitation, who received the grant to further their work in the field.

Thousands of new traumatic spinal cord injuries occur each year, with statistics showing around 17,500 of those are from the United States alone, and more than half of those people experience loss of motor function of the upper extremities which limits their independence and adversely affects their quality of life.

“To achieve the best outcomes after spinal cord injury, restoring arm and hand function must be a priority in rehabilitative care,” says Dr Kirshblum.

“This study is an important first step towards increasing the ability of individuals to function more independently at home, in their communities, and the workplace.”

During the study – which will be conducted in the US and Israel – researchers will test the safety and efficacy of noninvasive low frequency electromagnetic field stimulation delivered via the BQ System.

Individuals with spinal cord injury (duration 18-30 months) will participate in the 34-week study. Functional status will be measured at baseline and compared with status following the experimental treatment.

By quantifying gains in motor function, motor control and activities of daily living, this pilot study will provide preliminary information on the potential application of BrainQ’s therapy in rehabilitation programs for individuals with disability.

“We are very interested in testing the effectiveness of this novel and non-invasive approach in persons with spinal cord injury,” adds Dr. Androwis.

“Such interventions may improve participants’ performance of activities of daily living leading to gains in their overall quality of life. This particularly is important when an intervention can be provided simultaneously with conventional therapy.”

This multi-site study is being conducted at Kessler Foundation, The Miami Project to Cure Paralysis, Miami, and Sheba Medical Center, Israel.

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‘My brain is slipping into my spine’

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Karl Johnston suffers from a rare condition called Chiari Malformation Type 1

After years spent in pain and struggling for a diagnosis, Karl Johnston felt relief when he was confirmed as having a little-known condition where the brain effectively slips into the spine. Here, he shares his story.

“Some dads get to put their children on their shoulders, but I’ve never got to do that.”

That is just one of the day-to-day realities facing Karl Johnston, whose condition, Chiari Malformation Type 1, means his brain is effectively slipping into his spine.

For eight years, Karl had experienced a catalogue of symptoms, including intense and debilitating neck pain, light-headedness, fatigue and numbness in his arms, but without securing a diagnosis of his condition.

But now, the 35-year-old admits he feels some relief at the knowledge he has Chiari Malformation Type 1, as devastating as the diagnosis was to receive.

“A lot of people felt sorry for me when I finally got a diagnosis, but it was a relief because I’d been telling people that I was suffering for years and they hadn’t believed me,” says Karl, from Wallasey, on Merseyside.

“You start to question yourself about things. Just knowing takes a lot of the weight off you.

“Some days the pain is so much that it’s difficult to move around and all I want to do is lie down.”

The biggest difficulty emotionally, says Karl, is the impact it has on his ability to play with his daughter Seren.

“It’s devastating when she wants to play and I’m not up to it,” he says.

“Some dads get to put their children on their shoulders, but I’ve never got to do that.”

While Chiari Malformation Type 1 is most commonly diagnosed in adults, it is believed to often be present from birth.

Many people with the condition are asymptomatic, meaning it is only found if they have an MRI scan.

Karl had symptoms from when he was a teenager, but getting a diagnosis was difficult due to the lack of awareness around the condition.

He is now determined to help raise awareness of Chiari Malformation Type 1, in the hope that others may be able to secure a diagnosis quicker than his.

“There needs to be a way to make doctors and people in general more aware of these rarer conditions because otherwise people just fall through the cracks,” says Karl.

The dad-of-one has been supported by The Brain Charity, a national charity based in Liverpool that supports people with all forms of neurological conditions. Statistics show that 1 in 6 people in the UK is currently living with such a condition.

The charity recently told NR Times that demand for its services had soared by over 70 per cent since the start of lockdown in March, with predictions that the numbers of people needing support with issues including mental health, Long Covid and employment rights would grow further still.

Having turned to the charity last year, Karl is now getting the practical and emotional support he needs to get on with his life.

“The Brain Charity helped me get a better understanding of what was going on with my condition,” he says.

“It has felt like so many people haven’t taken me seriously but The Brain Charity has.

“They didn’t pity me but tried to understand what I was going through.”

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