Neuro patients are suffering “avoidable, unnecessary disabilities” through a lack of access to specialist rehabilitation during the COVID-19 pandemic, new findings have revealed.
With the country plunged into lockdown in March, therapists were redeployed into critical support roles across the NHS and tens of thousands of patients across the country saw the cancellation of sessions and appointments crucial to their ongoing recovery, with reports that many regressed due to the lapse in support.
Recent research from the Stroke Association revealed that through the lack of access to therapy resources during the lockdown period, “many could lose out on the opportunity to make their best possible recovery”, which neuro professionals have confirmed extends beyond stroke patients and affects their whole clientele.
Lack of rehabilitation, especially physiotherapy, could increase demand for care for several years, adding huge pressure to already stretched resources, confirmed the research.
Juliet Bouverie, the charity’s chief executive, said: “Despite the tireless efforts of frontline clinicians who have gone to herculean efforts to maintain services under extremely difficult conditions, some treatments still became unavailable and most stroke aftercare ground to a halt. This means more stroke survivors are now living with avoidable, unnecessary disability.”
Neurophysiotherapists have echoed these findings, with the restrictions on their ability to continue their usual support to clients having a potentially long-term impact.
“There was only so much we could all do during that time as NHS services were reprioritised to save lives. Access to therapy resources for many of my clients was massively impacted upon and we are now having to deal with the results of that,” says Deborah Harrison, group clinical lead and specialist neurophysiotherapist at Neural Pathways
“One of my clients, as well as having a brain injury, was due to have a new specialist neuro-orthotic fitted. This has been going on since last November.
“He has had appointments cancelled, we can’t progress his rehab as he isn’t yet able to get up and walk, so he can’t progress his life.
“People can’t progress until the equipment or resources they need become available, and that’s increasingly difficult to achieve as many NHS services are still on hold pending a potential second wave of COVID-19.
“For this client’s situation to have gone on for almost a year would have been unthinkable last November, but these are the circumstances we have to deal with, and that’s just one example.”
To enable a person’s recovery to at least be maintained, neurophysiotherapists are having to turn to a host of alternative measures, reports Deborah.
“I have one client who I do spasticity work with, and with that inevitably comes pain. He used to access a hydrotherapy pool three times a week, but that has been closed for the past six months so we’ve had to look at other ways to manage it, including neuro acupuncture,” she says.
“We have also delivered a huge amount of clinical oversight remotely and will continue to take a ‘remote first’ approach. However, as we have moved further into the pandemic, it is clear that clients are becoming physically worse and harm is occurring without hands-on therapy.
“With a very big gap in being able to see people face to face and usual therapy services still on hold, there is the risk that if people continue to not get the therapy they need, secondary complications can occur.
“This includes things like people getting pressure ulcers and contractures in joints from not being moved enough.
“Without a carefully planned 24-hour posture and positioning plan and other personalised rehab they will probably deteriorate, and that is very difficult to see happen when you are used to being able to help clients on their road to recovery.”
Due to the lack of availability of NHS resources, some patients have resorted to finding private rehabilitation, meaning that people with stroke and other neurological problems are using their own funds to top up their rehabilitation where NHS services are still on hold.
“One particular client has chosen to pay for more private therapy, which is the only way of ensuring they can continue to make progress without their usual NHS rehabilitation” says Deborah.
With COVID-19 cases rising again across the country, and local lockdowns being implemented around the country – with mounting speculation of another full national lockdown being enforced – neuro professionals are having to do all they can to prepare for such a scenario.
“In my team, we prepared quickly but very well for the first lockdown, and developed a comprehensive COVID risk assessment protocol before the restrictions were imposed.
“As we are classed as essential workers and had rapid access to PPE, we were still able to maintain our duty of care to our most clinically vulnerable clients – these were the clients who would have ended up in ITU if we couldn’t carry on seeing them,” she adds.
“Compared to the beginning of the pandemic, rehabilitation teams are far more prepared and can now safely see more clients face to face, with a fully reasoned risk assessment and correct PPE in place.
“We are hopeful that, alongside remote support, we will see the volume of safe face to face therapy resume nationally, allowing people who have missed months’ worth of essential treatment to be get back on with their recovery and back on with life once again.”
Meet Britain’s youngest care manager
A carer with a specialist brain injury rehabilitation provider has become the youngest care manager in the country aged only 23.
Chloe Gregory, a service manager who was inspired to go into specialist care aged 16 when she became the personal assistant to her cousin who has learning difficulties, has now secured accreditation from the Care Quality Commission (CQC) only seven years later.
She recently passed the Fit Person Interview, an assessment by the CQC which confirms knowledge of compliance and legislation in a care environment, and is now believed to be the youngest accredited care manager anywhere in England.
“For me, working in social care is so heart-warming. You’re able to give someone’s life so much more meaning and a much better quality of life and knowing there are so many things you can help them improve on,” says Chloe, who works at the Burton Road Care Home in Derby, owned by Voyage Care. The centre is a specialist facility for men with challenging behaviour.
“One of our guys used to demonstrate challenging behaviour, whereas now he doesn’t as much. We have got him in such a good routine. He goes to college multiple times a week. Seeing him progress with his education and his behaviours reducing from three or four time a day to once or twice a week, that is what I’m proud of. It’s so hart warming to know that we supported him to do that.”
Chloe began her career in care aged 17, when she took up a role as a support worker with Voyage. The group offers specialist brain injury rehabilitation in its 18 rehabilitation services across the UK, as well as in transitional and step down properties and in the community. It also supports people with disorders including Huntington’s Disease and autism.
Although Chloe had experience of supporting her cousin, she had no formal qualifications in care or specialist care, so was enabled to secure the training she needed in her new role, which required her to do her full-time job while also studying for qualifications.
“I was given so much support during that time and ever since, I’ve been given everything I need to ensure I succeed in my role,” says Chloe.
“I’ve worked hard to achieve my level two qualification and then my level three in management of adult residential services. I’m now working towards my level five.”
Of a career in care, which continues to be an area with significant levels of vacancies, she says: “I’d say to anyone thinking of a career in care, take the chance. Even if you have no background in care.
“People have a lot of misconceptions about what working in care is like but it’s such a fulfilling career to know that I’m helping someone to live their best life.”
Tonia Marston, Chloe’s operations manager at Voyage Care, adds: “It appears that Chloe is the youngest Registered Care Manager in the country, and definitely in Voyage Care. This is largely down to her focus and the time and effort she has invested to really understand how to provide the highest standards of quality care.
“At Voyage Care, we encourage people to challenge themselves and be the best that they can. Chloe is a shining example of what you achieve with commitment and hard work.”
Boost for project that uses music to support mental health
Blue Light Symphony Orchestra (BLSO), the UK’s only orchestra for all emergency services personnel, has been awarded £10,000 funding from the Coronavirus Community Support Fund, distributed by The National Lottery Community Fund.
Covid-19 has given rise to an increase in mental health problems, not only in the general public, but also emergency service workers who are experiencing exceptionally increased levels of stress and anxiety.
First responders need access to timely and relevant intervention but for many, finding words to express and process their emotions is difficult and the funding will be used to provide music therapy to overcome mental health issues.
A feasibility pilot project, in partnership with Surrey Police and Sussex Police, Surrey Fire and Rescue Service and East Sussex Fire and Rescue will be delivered by Chroma, the UK’s leading national provider of arts therapies services.
Research shows that music can significantly improve psychological health and wellbeing as it engages the neurochemical systems responsible for reward, motivation, pleasure, and stress. However, music therapy is not routinely offered to emergency workers as part of the support that enables them to deal with the traumatic events and situations they deal with each day.
Seb Valentine, a Detective Sergeant in the Surrey Police Safeguarding Investigation Unit based in Guildford and founder of the Blue Light Symphony Orchestra, said: “This funding is vital and will enable us to deliver ground breaking music therapy sessions initially in Surrey and Sussex.
This project will provide 12 weeks of group music therapy, delivered by Chroma music therapists, to 24 police officers, firefighters and staff suffering from symptoms of PTSD, stress or anxiety.”
“This is the first step in developing the world’s first programme of music therapy designed specifically to reduce these symptoms in emergency workers.”
Daniel Thomas, joint managing director of Chroma said “We are delighted to be a part of this project, which could be the stepping-stone to providing consistent, effective therapy for all frontline staff. The work they do on a day-to-day basis is invaluable to society and in running this pilot scheme, we can begin to support them, long-term, as and when they require.”
In the summer, Blue Light Symphony Orchestra held a 999Run raising over £1,000 to further their aim of improving mental wellbeing in the emergency services through music.
There’s a ‘dire’ need for more VR rehab studies, researchers argue
Researchers analysed twelve studies that looked at VR-enhanced rehab, and concluded it can offer long-term positive outcomes for patients with traumatic brain injuries (TBI), especially those with motor skills and cognitive deficits, and those experiencing difficulties with their balance.
One of the benefits of VR rehab is that it can provide a safe environment for people to practice skills with minimal risk of harming. Some VR platforms, the paper states, can model almost any type of environment that may be useful for rehabilitating motor skills including walking, balancing and moving on different types of terrain.
The researchers, from the College of Public Health at the University of Kentucky, US, looked at six studies that examined gait and balance. All six of the studies showed that VR-enhanced rehab made moderate improvements to TBI patients’ gait and balance.
The four studies researchers looked at that around VR’s effect on upper limb functioning was more limited, and drew mixed conclusions. The use of VR to enhance cognitive rehab had the least amount of supporting evidence. The six studies the researchers looked at measuring VR and cognitive rehab found limited evidence.
The researchers state that their review not only provides helpful data, but also shows the gaps in research. They concluded that their findings highlight a need for more research that can inform providers, policymakers and the public to draw conclusions about the effectiveness of VR-enhanced rehab, especially around newer, immersive VR-enhanced rehab.
“VR-enhanced rehabilitation has been utilized for almost two decades, yet data regarding its clinical effectiveness remain limited by multiple lower quality studies,” the paper states.
“This lack of data impacts the generalizability of findings and conclusions about such important factors as physical effectiveness, motivational improvement, and cost-effectiveness that healthcare providers, policymakers, and the affected public are able to draw.”
There needs to be more research in this area as newer VR tools become available in rehab, the researchers urge, to better understand how VR can help neuroplasticity, which is the brain’s ability to learn new things by making new neural connections.
“With the advent of newer generation VR tools utilising 3D visual and auditory stimuli such as mixed reality (MR) and immersive VR platforms, new hypotheses can be tested with the Hebbian theory of neural plasticity concepts at their core,” the study states.
Studies, the researchers say, now need to adapt to include more advanced and improved technology, which will allow new opportunities for clinical rehab.
“For example, in a healthy population, improvement potentials were found in balance and visuo-motor reaction time after MR action game play,” the study states.
There is a ‘dire need’ for future studies to improve the current understanding of the potential for VR-enhanced rehab, the researchers state. This is particularly the case in the US, whose healthcare system underperforms or ranks lowest across multiple health outcomes, including access and cost-efficiency, compared to other developed countries.
“Although we must be cognizant of the potential for initial higher costs associated with the purchase, maintenance, and staff training of some of these VR platforms to be incurred, many VR platforms could actually help provide more cost-effective care,” the paper states.
The researchers argue that more broadly available commercial VR systems could avoid altogether the need for more costly interventions.
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