Having been left with serious injuries in a cycling accident, Ian recovered from the physical impact but continued to suffer chronic pain. Here, he discusses how he has learnt to deal with it and get his life back on track.
“About two years ago, I was involved in quite a serious accident while I was out on my bike. I flew over handlebars and hit my head on the ground, leaving me unconscious.
I was left with an array of injuries, including decompression of two of the disks in my spine, which needed an operation to resolve. But from being in the ambulance after my accident – the earliest point I can remember after coming off my bike – I was in enormous pain.
While over time I have managed to recover my body functions, having struggled in the aftermath of the accident, I continued to experience pain. Most days were pretty tough. I was on a lot of medication, which contributed to my fatigue.
I was sleeping a lot, spending a lot of time in bed, I was very tired all of the time and in a lot of discomfort.
I’d always been very, very active, and enjoyed cycling, motorcycling, tennis, walks with friends and family, I was a very outdoors person – but that all came to a halt. The most I could manage was a short walk, and even then I was very fatigued.
I didn’t understand what was happening to me or why, it was just continuous, unrelenting pain.
By this point I had returned to work and the demands of my job. I was just about managing to keep on top of my commitments, but only just.
With a wife and two young daughters, my life had typically been very busy and very active, but now I was unable to do as much together, or spend as much time as I’d like with them.
This went on for over a year, and was, without doubt, the toughest time of my life.
My case manager helped me to find a solution which has enabled me to rediscover my life, through a programme called RESTORE, pioneered by RTW Plus.
Through RESTORE, an online learning programme which supports you to understand and manage pain, and take back control of your body and life – which enables access to a consultant and support from health coaches 24/7 – I have been educated in what I can do to help myself.
All of a sudden, from not knowing what had happened to me and feeling helpless, I was supported in understanding what was going on.
Prior to that, what had happened wasn’t described to me that well, and I had so much medication that everything was often quite blurry. The concept of chronic pain wasn’t something that was addressed once my physical injuries had healed.
Through this programme, I was educated as to what had happened to me. As a keen cyclist, I’d had many accidents in the past, but all were short-term tissue damage, which were very painful at the time, but that pain went away. I now was able to understand why this time was different, and to be realistic in my expectations.
I’ve never been good at pacing myself, but now I was able to stop and think what it was I was trying to do, what I wanted to do, and how to manage and achieve that.
Crucially, by understanding my pain, I became less frustrated and less dependent on medication, meaning my life would not always have to be a cloudy blur. I became more confident as a result.
From believing this was how my life was going to be, not very pleasant and full of pain, now I had hope and confidence it was going to get better. There was light at the end of the tunnel.
Understanding more about pain got me really engaged, and I started reading about it and looking for examples. After work, I’d be picking up books and learning more. Having the knowledge about what is happening to you, and how to help yourself, is so powerful.
Having been able to come to terms with my pain during the 16-week course – it’s usually eight weeks, but was tailored around my busy work schedule – I could then get my life back on track, backed by the confidence I had rediscovered.
I’m now cycling every other day, which I haven’t done since my accident, and am getting my life back to what it used to be. I’m doing things that matter and spending time with my family, which is what it’s all about.
I realise I am on an ongoing journey with my pain, and that hasn’t finished and will continue for some time to come, but I’m in a good place now – a place I could never have imagined being a few months ago.”
Neurotechnology – life-transforming or an expensive white elephant?
Rachel Charles discusses the power and potential of technology in neurorehabilitation
We are at an exciting time in neurorehabilitation, where we are discovering more and more about our brain and nervous system and how we can adapt to life-changing injuries by harnessing the potential of technology to push the boundaries of what is currently possible.
Our previously unseen electrical and brain activity can be enhanced to enable us to visualise our emotions, communicate when we can’t speak, lift limbs that we have difficulty moving. We can be transported to far off, fantastical lands from the comfort our armchairs by putting on a VR headset, and exercise on a treadmill without being able to walk.
This is not just the stuff of Hollywood movies and fantasy novels, but real life that can be seen, touched and used in rehabilitation centres across the world right now.
So, how do we ensure that this technology is accessible, appropriate and enables the people using it to achieve their goals and aspirations? How we do prevent exoskeletons from gathering dust in cupboards or the corners of therapy rooms? How do we justify and prove that these technologies make a difference and are worth the investment?
Firstly, we need to keep in mind who the technology is for. We are adaptable, complex systems that require varied, intensive, targeted opportunities to refine and improve our abilities. We know about “practice makes perfect” – practice needs to be the right amount, in the right place, at the right time – for a purpose and have meaning, not necessarily helping us achieve perfection. One size definitely does not fit all.
Secondly, we need to coproduce, collaborate, and cooperate to share knowledge and skills – it is essential the end user is part of the team. It is totally possible to repurpose and adapt current technologies that are already in use such as robots and VR games for the rehabilitation market. What works in one setting does not necessarily work in others. It is a great opportunity to design and manufacture technology that is fit for purpose, which can be updated and upgraded and recycled.
Thirdly, we will still need therapists and case managers. (You probably think that this is because I am one…”so you would say this wouldn’t you”). Technology is not a magic bullet and will not replace therapists or therapy or the need for case management. It will enable more people to participate in high dose, high quality rehabilitation that is commissioned by case managers and structured by therapists as part of their individual rehabilitation programme.
Therapists need to be open-minded and given access to systems and training that enable them to use their clinical reasoning to consider technology as a viable option as part of their treatment plan. Case managers need to keep up to date with innovations and technologies by networking and sharing information so that our clients have the possibility of being able to access neurotechnology now and in the future when this is appropriate.
Lastly, technology has the potential to transform the rehabilitation experience of people affected by life changing injuries and our understanding of the brain and nervous system. By trialling available technologies with people who may benefit from them and being able to demonstrate tangible changes in function – enabling people to thrive, not just survive – we have the potential to create a very different future for all of us.
- Rachel Charles is a case manager at Social Return Case Management.
BABICM – rising to the post-pandemic challenges and opportunities
Vicki Gilman, chair of BABICM, shares her priorities for the organisation as case management looks to a new future
Vicki Gilman has taken up the post of chair of the British Association of Brain Injury & Complex Case Management (BABICM) at a hugely important time as case management moves into a new post-pandemic chapter, following an unprecedented period where case managers rose to the diverse challenges presented by COVID-19 and helped to create a new future.
A future where technology and virtual communication will feature like never before; where the need to work in collaboration has never been greater; and where the creation of the Institute of Registered Case Managers (IRCM) will enable registration of case managers for the first time.
While undoubtedly an exciting time with huge potential for case management, the challenges – and opportunities – for BABICM, as it too builds for the future on the foundations of its 25 years of expertise, are plenty.
“Becoming chair was something that was first suggested to me about three years ago, and at that time I had no idea, as no-one did, that we would all see such huge change in our lives,” Vicki tells NR Times.
“There were several things in the back of my mind then that I thought might be key themes – some of them remain the same despite what has happened since, although by no means all of them. I think a lot has been learned over the past 18 months that I don’t think we will go back from. So, in many ways, this marks a fresh start.
“I’m immensely proud of how the whole case management sector responded, how we stepped up to the challenges and with such speed. Case managers are used to looking at complex scenarios in unique circumstances and working to find ways forward within the context of each case.
“The pandemic served up additional challenges which prompted a lot of innovation and different and new thinking, with plenty of opportunities.
“As ever in case management we have taken the learning from everything we do, but this time case managers – along with everyone else – were juggling the unique changes in their own lives such as homeschooling children and supporting friends, neighbours and family members whilst continuing with their highly complex and confidential work to support each individual case by case.”
Vicki, managing director of Social Return Case Management, takes over the BABICM chair from Angela Kerr, who is now chair of the IRCM. BABICM will continue to play a central role in the ongoing development of the body, as a founding member, which hopes to secure accreditation from the Professional Standards Authority (PSA) in the near future.
An experienced case manager, health entrepreneur and clinical specialist neurophysiotherapist, Vicki spent six years on the BABICM Council, returning last year for a preparatory period before taking the chair.
Building on her experience of specialist rehabilitation, expert witness work and case management and being part of BABICM, while taking inspiration from the events of the past 18 months and impending future changes, Vicki has identified a number of priorities to address during her time at the helm.
- Equity and belonging
“I have starting educating myself to a greater degree and have had a lot of conversations with people who know a lot more than me about equality, diversity and inclusion,” says Vicki.
“This is actually quite challenging and I don’t personally know enough yet. I do know that both the organisation and I need to do more. As I go on my journey, it is my aim to find allies and to bring other people into learning more with me. Together we can make BABICM better place.”
“It follows that our increasing membership means we have greater diversity, and it is not enough to say ‘We don’t discriminate’.”
Vicki says equity and belonging must be sentiments which underpin BABICM. “It is a really important to ensure a greater understanding is threaded through the work of BABICM,” she says.
“For me, equity means more than equality, and we want to help people feel they belong here. It’s not enough just to say these words.”
“We need to strengthen links we already have and collaborate with other organisations who are important to our members through the work they do,” says Vicki.
“Angela has done an amazing job to strengthen and move the organisation forward, of identifying organisations and allies we should be working in collaboration with and creating links with people at the right level – organisations such as the CQC, Court of Protection, UKABIF, some education establishments, to name but a few.
“There are lots of ways we can deepen and develop on that, and as we come out of the pandemic there will be more opportunities. Zoom calls are really time-saving and effective, but hopefully we will also have the option to do things in person again going forward.”
- The future as a profession with registration
One of the most significant changes in case management, the creation of the IRCM, is set to professionalise and regulate case managers in a sector-changing move.
“We will continue to support the goals and development of the IRCM, it is by no means done and we need to continue the work here,” says Vicki.
“We are fully supportive of the direction of travel and fully endorse registration for case managers. This is a way for the public to be protected specifically in the realm of case management and for case managers to be able to demonstrate that.”
- Training and learning
“I want to continue the development of the high-quality learning and training opportunities available to our membership, but also to those outside,” she says.
“We aim to keep it very relevant to current clinical and professional needs, keeping ahead of the curve and making sure that what we are offering is of the highest quality. As professionals working with complex cases, I can only see that need developing further.
“In the last few years BABICM has really showed its strength as the leading provider of education and training for case managers working with complex cases. The feedback we’ve received for our courses has been tremendous and that has continued even during the pandemic. Training will remain key and grow in importance.”
“I’m very keen to increase the involvement of BABICM and its membership in research around case management related issues. I want us to lead the way in with research into evidence-based practice for people with complex needs,” says Vicki.
BABICM has recently been involved in a number of research projects, working alongside the University of Plymouth. In yet to be published findings, the team has studied how case managers and clients alike have adapted to the pandemic.
“There is research out there which supports the work of case management, but we are taking greater responsibility to add to that evidence base and that is something I foresee will increase and needs our members to be involved in,” she says.
“This will of course add even further to our library of resources to support the work of case managers.”
- Providing useful resources to members
“I see us to stepping up in provision of information to assist across our membership within legal, clinical and professional aspects of their work,” says Vicki.
“Those involved in the case management of complexity and those working with case managers need resources that are tailored to their needs.
“We already do this in many ways via our website with recorded webinar content, upcoming training and development events, publishing our standards and competencies and signposting and links to other sources of support regular bulletins. Our website is proving a very useful resource library which is seeing growing traffic, as it assists our members and others.
“As our members apply for registration with the IRCM there will be an even greater requirement to demonstrate what case managers are doing and whether they are meeting the standards, so we need to continue to build relevant resources to support this need.”
ILS Case Management – working in partnership with clients and their support network
Read the latest in our case management focus features.
In the latest of our case management focus features, we meet ILS Case Management and learn more about its growth and development over a quarter of a century and how it continues to innovate to deliver the very best service to clients
Why was ILS Case Management established and what was the ambition at the outset?
ILS Case Management was established, over 25 years ago, by two occupational therapists to provide both case management and expert witness services for catastrophically injured adults and children. However, they quickly recognised the potential conflict of interest in providing both services and decided to focus solely on high quality case management services.
The ambition from the outset was to develop a team of highly experienced therapists, who had existing expertise in brain and spinal cord injury and to provide bespoke, person-centred case management. The clients have always been at the heart of our business and our case managers work closely with each individual to support them in achieving their unique goals.
How has ILS Case Management developed over time?
We now have a team of over 50 case managers providing tailored support to over 200 clients nationwide and manage more than 375 support workers. Each of our case managers are experienced health and social care professionals, who bring with them an amazing wealth of knowledge, experience and expertise.
Recognising the importance of peer review and clinical standards we now have a unique team of professional mentors who support our case managers with their clinical reasoning and reflective practice. They all have extensive experience as case managers, but no longer hold a case load of their own. Working closely with the case managers, they are able to provide continuity of case management for our clients when their case manager is on leave. This continuity is crucial for our clients, and their legal teams, due to the complex nature of the work that we do and has been invaluable during the pandemic.
As a business we also contribute to the standards and development of case management in the UK by having clinical staff on the boards of both BABICM and CMSUK.
In addition, ILS case managers are supported by a dedicated integrated team of client HR and payroll professionals. The client HR team provides support to the case managers with recruitment and management of support workers, while the client payroll team ensure client payrolls are effectively managed including calculating support worker sick pay and annual leave allowance together with pensions administration.
How did you adapt to the many challenges presented by COVID-19?
We were quick to react to government advice, taking the information given to inform our practice and safeguard our staff and clients. We used our clinical experience and well-developed risk assessment skills to provide COVID safe client visits where necessary whilst making the most of virtual platforms to deliver our service.
Understandably, working with a vulnerable client group, our approach was cautious; when visits were essential we made them as safe as we could through the use of PPE and lateral flow testing, as well as taking measures to maximise ventilation at the location. Person-centred practice remained at the centre of our work. Clients and those close to them were an intrinsic part of our risk assessment ensuring they were all consulted and supported throughout the restrictions.
Recognising each client and their circumstances are unique, we were able to adapt our practice to ensure we could continue to meet their needs. We were pleasantly surprised with the ease in which practice could adapt to a virtual environment. Some clients relished the opportunity to embrace new ways of communicating, while, understandably, others preferred a face-to-face (or mask to mask!) visit.
We will certainly continue to a make the most of the technology that we have become adept at using. We see the huge benefits in online professional and multi-disciplinary team meetings. By reducing the travel and associated costs, shorter meetings can be held more often which in turn has facilitated better communication and has resulted in improved cohesion and better outcomes for our clients.
What are your priorities going forward?
Our priorities remain the same; we are committed to providing excellent person-centred case management and how we deliver that has adapted to the environment that we find ourselves in. We continue to enable our clients to meet with case managers before they commit to engaging and to help facilitate this, we have adapted our online CVs to include a short introductory video presented by the case manager, which provides an insight into their experience and character as individuals.
We will continue to use MS Teams, Zoom, WhatsApp and FaceTime to deliver virtual meet and greet sessions. These have been widely applauded, taking the pressure off the client to make their environment ‘visitor ready’ for each occasion. We have reverted to face-to-face INA’s wherever practicable, while an assessment can take place virtually, this stage, for us, is the beginning of the formation of the essential client/case manager rapport that will carry through the rest of their working relationship.
For the assessment, we feel the immersive experience of a client’s environment leads to a richer understanding of their needs, views, and aspirations.
What does the long-term future look like for ILS Case Management?
Our mission remains true to the principles of the founders: to provide person-centred case management for children, young people and adults who have experienced catastrophic injury. We will work in partnership with them, their families, their support network, and our referrers to achieve outstanding client focussed outcomes. And, as our team continues to grow, we will be able to provide our unique, comprehensive service to more of the people who need us.
Our vision is to promote positive change to support everyone who has experienced a catastrophic injury. We will provide person-centred case management recognising that families are key players; contribute to the brain injury professional knowledge and research base; and actively promote inclusion and diversity.
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