From being a London-based community group, LEGS has now taken that sense of community onto a national scale by moving its neurophysio exercise sessions online. NR Times finds out about its expansion.
Having gone into the pandemic as a small community exercise group for people with neurological conditions, LEGS has now become an online rehab resource for people throughout the UK.
Initially holding sessions in a studio in Westminster, enabling people from the surrounding area to access its specialist physio-led supported exercise and social opportunities, its rapid transition to taking sessions online has seen the LEGS operation having to grow in tandem.
From two sessions a week pre-pandemic, LEGS has now ramped up its offering to ten online classes.
Participants come from as far afield as Northern Ireland, with the original community of people from Westminster and Kensington and Chelsea now becoming a truly national community, whose relationship continues to be built via interactive Zoom rehab sessions and a thriving WhatsApp social group.
And by thinking creatively, the charity has managed to access a number of funding opportunities, which has enabled the purchase of tablets for those who would otherwise be without the technology to allow them to join sessions.
A grant from the National Lottery allowed LEGS to increase its numbers of online sessions, while also enabling the creation of a London-based supported walking group.
“We’re a really small team but the demand we have seen since taking our classes online has meant we’ve had to work very creatively,” says Sarah Sparkes, lead physiotherapist at LEGS.
“In a matter of days, our online programme was created. Our research revealed Zoom was the best platform for people with cognitive difficulties, so very shortly afterwards, our online classes were born.
“But having previously held two a week in-person, the demand was very shortly there for that to increase to ten.
“The response has been amazing – we have participants from Northern Ireland and Lincolnshire, which has given a whole new definition to the community we’ve always worked so hard to help create. And through being able to provide the technology to those who would otherwise not be able to access our sessions, we’ve been able to include them too. We know that has made a massive difference.
“Our Twitter followers have also increased from around 80 pre-pandemic to well over 600 now, so we’re building a new community on there, too.”
And the community LEGS has helped to create is thriving, with participants seeing positive outcomes of their sessions.
“We do a physical assessment whenever someone joins and that is repeated at 12 weeks. We are seeing some great progress, the quality of engagement we’ve seen through doing sessions online has been great,” says Sarah, who combines her role at LEGS with working at St George’s Hospital in London.
“We were a bit concerned at first when we went online, as our sessions are £5 each, and there is so much free content out there. But we have realised that so many people realise the benefit of a professional doing their class, who tailors the sessions to their needs.
“We got some great reaction to our sessions, and we’ve found that most people like to have their sessions on gallery view – I think there’s a nice sense of support but also allows people to challenge themselves. If they see someone else doing something, it often spurs them on to be able to do it too.
“The relationships that have already been built are great. Sometimes I’ll come out of a shift at St George’s and there will be a huge amount of messages on the WhatsApp group to get through – it’s very vibrant and people are so keen to share the progress they’ve made, like they’ve managed a flight of stairs today. It’s very nice to be part of that.”
Going forward, while LEGS has not traditionally operated an online model, an online element will certainly continue, says Sarah.
“We’ll be adopting a blended approach, as we’ve seen how well it can work, I’m not sure I thought physio over Zoom could work so well but it has done,” says Sarah.
“From not really knowing how it would go, we have held Christmas and summer parties over Zoom, in addition to our classes, which continue to be so well received.
“We will definitely keep going with the online work, although will hopefully be able to return to face to face. There are so many people who have joined in with, and benefited from, our sessions during the past few months and we’ll continue to support them however we can.”
Community neurorehab gym continues to expand
A community therapy centre which enables neuro patients access to the physio-led exercise which can support their recovery continues to expand in response to demand for its services.
West Berkshire Therapy Centre was opened in 2014 to bridge the gap in existing community resources, and initially opened for 20 hours a week with ten items of equipment.
Since that time, the Thatcham centre has expanded into premises twice the size of its initial home, and now has 17 items of equipment which clients can access 35 hours each week.
While the centre has been forced to close during lockdown periods, the investment in its offering has continued, with a further £17,500 being spent to upgrade equipment.
In addition to its regular clientele of around 260 people, around 200 more will be referred to the centre from the Berkshire Long COVID Integrated Service, led by Dr Deepak Ravindran, who has worked closely with the centre for several years.
As well as the anecdotal evidence from clients who attest the positive effect West Berkshire Therapy Centre has, the centre’s work has been proven to improve client mobility by an average of ten per cent, psychological outlook by 15 per cent and weight loss by three per cent.
All clients are assessed by the centre’s physio before being prescribed an individual exercise programme. The centre prides itself on its client-centred approach and some of the equipment in the gym has been designed and built specifically in response to what clients said were important to them.
West Berkshire Therapy Centre was created by the West Berkshire Neurological Alliance, a group of 23 local neuro charities, which recognised the need for greater specialist provision for people living with neurological conditions in the area.
John Holt was instrumental to the creation of both the Alliance and the Centre. Having supported his wife in living with MS for over 40 years, he took the lead on ensuring greater provision and support was there for those who needed it.
“I’m not from a medical background, I’m a food technologist, and while I was chair of a trade association during my career, I was used to working with competitors and business enemies, that was just what happened for the greater good of us all,” he says.
“So I was rather shocked when I got involved with the local voluntary sector and found that wasn’t the case. I was very proactive in all of our charities working together as I know the importance of working as one alliance.
“People who were living with neurological conditions were often having to fend for themselves when it came to community rehab, and that’s why we wanted to create the West Berkshire Therapy Centre.”
Having been established on the back of £145,000 in fundraising, five years later the demand for its services was such it had to expand into larger premises and invest in more equipment.
The centre – which is funded by voluntary contributions for sessions and through fundraising – now has eight part-time staff and a core of volunteers to support clients with whatever rehabilitation issues they have.
While most clients have neurological conditions – including stroke, Parkinson’s, MS and Post-Polio Syndrome – the centre has broadened its reach to include large numbers of people with arthritis, heart and lung conditions, sight impairments as well as amputees.
“We’re completely pan-disability and will support anyone who needs us. Our clients talk to us and we listen and adapt,” says John.
“I think many clients come to us because we are a safe place for them and they’re among people who understand the challenges they face.
“It is very important that we talk about things openly. For example, we talk about how hard it is when you can’t get to the bathroom in time and you wet yourself.
“When you face issues like that, it can be the start of a spiral downhill, you might then stop going to work or stop leaving the house, but we share these kinds of things.
“By having this interaction, it becomes a place people aren’t afraid to open up.”
With the centre having been closed for much of the past year, John and the team are ready to welcome back regular and new clients, including the many who are recovering from Long COVID.
“Many of our clients won’t have exercised for several months, but we hear very often that people have waited 20 years for a centre like this, so a few months hasn’t been long in comparison,” says John.
“But we are very much looking forward to re-opening and supporting our clients in regaining any progress and fitness they may have lost. Hopefully we are on the right track now after three lockdowns and clients can come back to us regularly.
“Long COVID is a new condition for us, as it has only come into being in the past few months, but we are ready to support people with their symptoms and in them using exercise as part of their recovery.”
New at-home tech aids virtual rehab
Neurophysio patients are receiving personalised virtual rehabilitation through the adoption of new technology.
Hobbs Rehabilitation is supporting chronic stroke patients by enabling them to use the EvolvRehab platform for at-home therapy, with exergames playing a central role in the rehab approach.
The use of EvolvRehab will be subject to a year-long study – funded by the Seedcorn funding program of the NIHR Brain Injury MedTech Co-operative (MIC) based in Cambridge, with researchers from the University of Winchester – to measure the level of effectiveness, as well as acceptance by patients.
Initial feedback from the first two stroke survivors to begin using the newly-launched Evolv RehabKit has been described as “extremely positive” with three-month programmes involving the use of prescribed exergames designed around their individual needs.
The integration of Microsoft Teams into the EvolvRehab platform means that patients can maintain direct contact with their therapists with periodic video meetings.
Hobbs are also using Teams to provide the patients with their weekly questionnaire that will be used in the study.
Hannah Woods-Hier, the therapist supervising the project for Hobbs, is overseeing the personalisation of the exergames for each of the patients, as well as following their adherence to treatment and performance results.
“We are enabling an engaging programme of exercises for patients that can be tailored by their therapist to their needs to be completed at home,” says Hannah.
“I find that patients are more compliant with the programme as they are having fun while doing it and perhaps completing more exercise than they think, as they are engaged in the games as opposed to the number of repetitions they are completing as in traditional home exercise programmes.
“Patients are able to see how they are moving through the avatar on screen, which provides prompts to them to monitor the quality of their movement rather than just achieving it, which is always a difficult monitor through a traditional home exercise programme.
“This gives the patients greater awareness of their own movement patterns.”
And while patients are engaged in the games, therapists are monitoring their progress remotely, says Hannah.
“This lets me know how the patient is adhering to the programme, as well as the length of time each session takes and how many repetitions they are completing,” continues Hannah.
“This lets me personalise their programme further to ensure they are working at the correct level and intensity, progressing them as needed.”
The use of the RehabKit in patients’ homes is part of the developing relationship between the tech business and Hobbs Rehabilitation.
“We’ve been using the EvolvRehab solution at Hobbs for years now, and we’ve worked closely with the Evolv team to provide them with clinical feedback on their products,” says Nicky Ellis, co-founder of Hobbs Rehabilitation.
“The NIHR Seedcorn project gave both of us an excellent opportunity to test their new RehabKit directly in patients’ homes.
“The project start was delayed because of the COVID lockdown here in the UK, and the pandemic has greatly reduced the possibility of patients to receive one-on-one or group therapy in clinics, which makes this telerehabilitation project even more relevant.
“Now that we have EvolvRehab up and running with patients, we’re looking forward to seeing the results.”
David Fried, CEO of Evolv, says of the project with Hobbs: “This collaboration with Hobbs marks an important milestone in terms of promoting telerehabilitation for stroke patients in the UK. This NIHR Brain MIC funded-project demonstrates the clear interest in seeking ways of providing greater access to specialised rehabilitation directly in the home.
“Judging by the early response from patients, they’re also very keen to do more rehabilitation in their own time with the aim of improving their quality of life. People are really enjoying using our RehabKits with EvolvRehab personalised exergames as a way of increasing intensity and dose of therapeutic activity, which is so important in helping improve outcomes for stroke survivors.”
Global therapist community established to share best practice
A global community of therapists has been created to share best practice and knowledge, while enabling new and creative ways of thinking, working and support for clients to be developed using research, insight and experience from around the world.
Remote Rehab was established during the COVID-19 lockdown, during the unexpected and widespread introduction of telerehab when many in-person visits to clients were no longer possible.
The online group was set up as a forum for therapists, experts and researchers around the world to connect, creating an opportunity to share information and knowledge, as well as providing much-needed support to fellow professionals.
So far, the community has around 200 national and international members.
The creators of Remote Rehab describe it as a “knowledge hub”, with an array of online resources, support groups, masterclasses and courses all designed to enable therapists to give the best possible rehabilitation to clients.
“We believe that telehealth isn’t just something to use during a pandemic, it’s something that can play a vital and important role going forward,” says Leanna Luxton, co-founder of Remote Rehab.
“We have members from Europe, Canada, Australia, Taiwan, India and America, they all use telehealth so much more than we ever have done here, they’re way ahead in the game. They have such insight to share with our community, which I know has been very valuable to so many of our members.
“We know from the hundreds of conversations we have had with therapists that many have felt ill equipped to use telehealth effectively. Remote Rehab was created as a forum for us to talk about telehealth and rehab in general to get ideas and insight about what else we can be doing to support our clients.”
While telerehab has been in widespread use during the pandemic, for many out of necessity rather than choice, Leanna is a passionate advocate that it should continue.
“Of course there are some things that should be done in person, and they should continue to be done in person, but the use of telehealth can be so beneficial,” says Leanna, a neurophysiotherapist and owner of Northampton-based Blue Arc Health.
“There is a lot that can be done remotely, which can create opportunities around increased capacity for your service, with less cost and greater ease for the patient.
“As therapists, we are our patients’ biggest cheerleader and guide, but you need to be able to empower them to do things themselves. If you give them exercises to do at home, they need to be able to do them without you being there.
“I want my patients to be able to say ‘I’ve done this’, which is how it should work. You want your patients to feel confident to do this on their own, knowing you’re there whenever they need you, and using telehealth gives a great opportunity to do that.”
Through the creation of an online community in Remote Rehab, Leanna hopes it will be a forum for therapists who are keen users of telerehab, as well as those who are more sceptical.
“I think we should be open to having conversations about the pros and cons of telehealth” says Leanna.
“I think we should look for the opportunity and understand the challenges. This is not about one thing that needs to suit everybody, there are so many different ways of using telehealth within your service model.
“For me it’s about a blended approach using the tools, techniques and practices that work best for our patients.
“We have so many members of Remote Rehab from around the world who aren’t following the normal pattern, they think a bit differently, and there is so much we can learn from each other.
“I think we should all be looking to add to what we do and look for additional ways we can support our patients, and by learning what others are doing and sharing inspiration and best practice, we are doing that as a community.”
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