These are transformative times for neuro-rehab, even without the fallout of COVID-19.
The pandemic, of course, is the great change-maker currently, amid social distancing and a revolution in remote working and service delivery. Indeed, smarter use of digital platforms by health and social care teams might be a lasting legacy of the virus.
But other changes are afoot too.
New therapies, backed by rapidly strengthening evidence bases, continue to come to the fore. Technology pioneers are stepping up their focus on brain and spinal conditions. New roles on the rehab pathway are emerging and cross-discipline collaboration is on the up.
Also, public awareness of NR-relevant conditions is rising, and the case for more investment in rehabilitation grows ever stronger.
Working against this backdrop of change, are the many professionals united by patient goals who continue to adapt and develop their skills and methods.
Our new video series aims to take stock of these changeable times, sharing new insights, ideas and approaches from leaders in the field.
We’ve enlisted case manager Vicki Gilman to uncover new, exciting and, perhaps, under-reported, developments in neuro-rehab through a series of in-depth interviews with fellow professionals.
In our first video, Vicki, who runs Social Return Case Management, interviews Dr Melanie Lee, a clinical psychologist whose work around pain management is particularly innovative.
As well as sharing these strategies, she also talks about interdisciplinary working in pain, the value of nurturing and focusing on compassion and bravery in the rehab team among a range of other topics.
You can view the first video below:
Keep an eye out for the next in the series right here on nrtimes.co.uk.
If you’d like to suggest a future interview for Vicki email firstname.lastname@example.org.
‘It’s a privilege to be able to help others’
A case manager inspired into the profession after her father’s brain injury has set up her own business.
Amy Crosby has created Evolve Case Management to deliver specialist support to people with brain and spinal injuries, building on her career in nursing and case management, as well as her personal experience of life-changing injury.
After her father sustained a TBI in 2015 after falling down some stairs, resulting in a frontal lobe craniotomy and a five-month stay in hospital, Amy saw first-hand how vital and badly-needed support is post-discharge, for individuals and their families alike.
“I realised then how little I knew about brain injury. As a nurse, you’re used to being able to fix things, but brain injury is very different. My dad couldn’t fit into the world he used to live in, which he thought he could go back to, and there was no support or education for us as a family,” she recalls.
“Now, having been through that myself, I can identify with other families and help them with some of the barriers they will face – I can forewarn them of some of the challenges that will lie ahead, educate them and empower them. Fear is such a powerful emotion, but once you understand things better, you aren’t as scared. It’s about adjustment and acceptance.
“I’ve been through the wringer too, so understand what they’re going through, but by working in case management and essentially being a ‘project manager’, I can help to get the right support they need.”
Having established Evolve earlier this year, following a stint back on the NHS frontline to support COVID-19 efforts, Amy is now able to deliver that support across the North East and North Yorkshire.
After her father was discharged home from hospital and realising the scarcity of NHS community provision, she saw the need to “upskill” and find out what more she could do to make his life better.
Amy appointed a private occupational therapist and saw the difference that could make, and also discovered the support from her local branch of Headway, in Darlington.
“I’d heard the term ‘case manager’ banded about and one of the volunteers at the Headway group was a case manager, and I thought that sounded like a bit of me, I’m very methodical and like solving problems,” says Amy, who is now chair of Headway Darlington & District.
“Being brought up in a very working-class family in one of the most deprived areas in England, running my own case management company was never something I aspired to doing. However, I have had the pleasure of meeting many clinicians and therapists within my role as case manager who have done just that and seen the autonomy and creativity working for their own companies offered them. The pandemic gave me the kick up the butt to do it, and I thought ‘What are you waiting for?’
“With Evolve, our ethos is all about client-centred care and making a really strong stand for people, we offer support that is unique to their needs and wishes. Having that personal experience, I realise what a joy it would have been to have a case manager in our situation and it’s a privilege to be able to help others. As a new business, we’re constantly evolving and learning in ways of doing that.”
As as well as through her work in case management, Amy is also committed to making a difference to people’s lives through her role with Headway Darlington & District.
“When I first started going there were probably 40 people there who were all so different in their presentation, they all had a brain injury but had such different needs and support requirements,” says Amy.
“We are pushing for change and to create a much more established better pathway for these people and their families after their discharge from the acute setting. We want to change the status quo instead of putting a plaster over it. The pandemic will delay a lot of progress for a lot of people and will have set them back, so it’s more important than ever to make change.
“Sometimes I look back on the journey I have been on over the last six years and the times I thought ‘How do I move on from this’ but now it feels like it all had a purpose, I’m a firm believer that everything happens for a reason.
“I’ve seen through my personal and professional experience how early support and intervention following injury can transform individuals predicted outcomes, enabling them to have a much-improved quality of life. It’s also often much more cost-effective long term and is something that I am passionate and committed to promoting for all brain injury survivors and families.”
Supporting professionals to understand suicidal risk
Understanding suicidal risk and supporting professionals to deal with such a hugely difficult topic is to be tackled in an event being held next week.
Life-changing brain, spinal cord and complex injuries can be significant factors in increasing this risk, as a result of the huge spectrum of difficult emotions a person faces in dealing with their new reality.
And for the professionals dealing with clients going through such trauma, suicidal thoughts and acts can cause great distress to them and it can be difficult to know how to react and what action to take.
Through the ‘Understanding Suicidal Risk – A Guide for Professionals’ event, held by Sphere Memory and Rehabilitation Team, advice and guidance will be offered to empower those working in complex injury to deal with such situations.
The webinar, held on Thursday, July 1 from 10.30am to 11.30am, will be delivered by consultant psychologist Dr Clare West, and is raising money for SameYou – the charity founded by Game of Thrones actor Emilia Clarke after surviving two brain haemorrhages, to give a voice to fellow brain injury survivors and to deliver better holistic rehabilitation care.
Dr Katherine Dawson, director and consultant clinical neuropsychologist at Sphere, says that while the issue of suicidal risk has gained more prominence during the pandemic, for professionals working with brain and spinal cord injury patients and those individuals who have experienced trauma, the issue is ever-present.
“It is a timeless issue, which can cause anxiety for those around the individuals regarding management and intervention. Furthermore, often individuals really struggle to even voice how they feel and the enormity of suicidality can often silence individuals which then worsens hopelessness,” says Dr Dawson.
“If someone does share their suicidal thoughts and feelings, in response people often don’t know how to move forward with that.
“During the pandemic, the loneliness and isolation has increased, and very early into lockdown quite a lot of my clients went into crisis as their support network, which provides a lot containment, wasn’t there anymore – while Zoom serves a purpose, it’s not the same as in real life.
“People hear ‘suicide’ and can panic. There is understandable fear associated with it, and often those around the individual may inadvertently respond in quite a reactive way, wanting to try and fix the issue. We recognise that this can cause significant distress and anxiety and it can be hard to know what to do in the face of suicidal risk.
“Hopelessness is the most immediate risk factor for suicide so instilling hope is essential. The assessments we will consider in the webinar outline how to assess the different levels of risk including looking out for red flags, primary drivers and secondary drivers.
“We focus on how to complete a suicide interview collaboratively, leading to a clear plan of risk escalation and services to involve at specific times.
“Through putting the spotlight on a suicide intervention management plan, we can look at this in a thoughtful and containing way, reducing the risk of reactivity and decreasing anxiety.
“We’ve heard directly from a lot of case managers that risk and managing risk is something they are concerned about, so we hope this event will help them with what is a very difficult topic.”
Sphere are asking for a suggested £20 donation to SameYou to attend the event. To register, visit here
New chair of BABICM appointed
A new chair has been appointed by the British Association of Brain Injury and Complex Case Management (BABICM).
Vicki Gilman has taken over at the helm of BABICM, which is the representative body for continued professional advancement of case management and promotes best practice in supporting people with brain injury and complex conditions.
She takes over from Angela Kerr, who steps down after five years in the role at the helm, in what is BABICM’s 25th anniversary year.
“I’m delighted to be BABICM’s new chair in our 25th anniversary year. The organisation has a well-established, powerful and influential voice and we will continue to ensure that the needs of people with brain injury and complex medical conditions are recognised and met,” says Vicki.
An experienced case manager, health entrepreneur and clinical specialist neurophysiotherapist, Vicki is currently managing director of Social Return Case Management, a company she established over six years ago.
She qualified in physiotherapy at King’s College, London and completed a Master of Science degree in neurorehabilitation at Brunel University.
For several years, Vicki worked in a specialised military neurorehabilitation unit, treating adults with brain injury, spinal cord injury, and other complex conditions.
Vicki coordinated and worked clinically in NHS and independent sector multidisciplinary community teams treating people with neurological conditions, and she was an expert witness in brain and spinal cord injury for over 20 years.
Her work in a multidisciplinary team steered her into case management, and for six years Vicki was on the BABICM Council and chaired its training events group, returning last year to BABICM Council for a preparatory year before stepping into the role as chair.
“These are challenging and changing times for everyone in healthcare and beyond,” continues Vicki.
“As case managers we need to be flexible but quick to respond to new developments and ways of working, ensuring the best possible outcomes for our clients.
“As an organisation, BABICM has to be responsive to the needs of our members; we must ensure that they receive the training and support required to maintain our high professional standards and to deliver best-practice services.”
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