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Leading the remote resistance

Andrew Mernin reports on an emerging technology aiming to revolutionise how rehab professionals work together on patient goals.



COVID-19 could spark a cultural renaissance, according to some in the art world.

Artists thrive on isolation, BBC arts chief Jonty Claypole points out, and therefore an explosion of new work could emerge from current conditions.

The spirit of renaissance – meaning ‘rebirth’ in French – might also course through our workplaces.

Kitchen tables, spare bedrooms and garden sheds are among the many residential quarters to have been commandeered by home workers recently.

And while it hasn’t been easy for many to adjust, the change has exposed some of the inefficiencies and excesses of traditional ways of working.

In the neuro-rehab field this could lead to an irreversible shift in how things are done, says Dr Penny Trayner, a paediatric clinical neuropsychologist. “COVID-19 could change the way we work forever.

We are already seeing organisations doing a ‘factory reset’ on how they do things, founded on using new skills and technology.

“It’s pretty difficult to justify not doing things in the most efficient way possible. Once the restrictions from the pandemic are lifted, we will no doubt find that going back to the old ways of working is much less efficient than the video conferencing, apps and technology that we have been using in the meantime.”

Penny and her colleagues at Clinical Neuropsychology Services have long been working remotely to deliver assessments and interventions for young people across the UK.

But they also have a stake in the ensuing race towards new ways of working.

For they are the pioneers behind Goal Manager, a cloud-based software platform for rehabilitation goal setting for multidisciplinary teams (MDTs) in remote locations.

It acts as a data manager and enables MDT assessment, goal planning, review, communication and evaluation, with all necessary gold-standard processes supported, and all accessible remotely from anywhere.

“Goal Manager was developed directly from clinical practice experiences, ‘by clinicians for clinicians’, and so it has an evidence base behind all of the components built into the software, which cover all of the key practices in team goal setting.

“The idea developed from my experiences of working remotely while running a community-based neuropsychology service for the past 11 years. This style of working is something we’re very familiar with and, in fact, in neurorehabilitation generally, many are used to working in this manner due to the scarcity of services in the UK.”

Although borne out of brain injury services, the platform incorporates the World Health Organisation’s International classification of functioning (ICF) – a global framework that addresses any physical condition.

It can therefore be used in any health service context where goal-setting is relevant, for example in stroke, spinal injury and cardiac services.

Penny says: “Remote working is a wave that’s been coming towards all healthcare services for a long time, but there have been barriers to people implementing it, in terms of time and infrastructure amongst other things.

“Those barriers are now being overcome, because everyone is invested in finding ways to work together remotely. We’ve already addressed a lot of these barriers in creating Goal Manager and it’s ready to go for any rehab teams that need it.”

Penny’s day job, delivering neuropsychology services to children and young people in the community nationwide, requires being plugged into MDTs all over the country.

Goal Manager emerged from this necessity.

“Most neuro-rehab services in the community involve people working remotely. This is generally the lay of the land for independent services across the UK.

“The software was developed from within our service to ensure that we could consistently provide best practice, as well as reduce time and costs associated with goal setting, by automating the processes involved.

“As more of my colleagues took an interest and want to use it for their own services, it took on a life of its own and we launched it for commercial use in 2019.”

In designing the app, Penny recognised that goal setting was a vital, but often extremely time-consuming, element of rehab.

For example, tracking the activity of teams, they found that one service user, over six months, required an MDT of four people a total of 70.5 hours to complete goal setting activities.

This excluded the time taken to share progress between meetings, and time taken to travel to different locations to meet.

“Spending these hours on goal setting takes away valuable time that could be better spent on clinical work,” Penny says.

Goal setting is crucial in acquired brain injury (ABI) rehabilitation for collaboration within MDTs, motivating service users and tracking progress.

But, despite the extensive evidence base, effective goal setting across services is still inconsistent.

Goal Manager team members Dr Penny Trayner (left) and Merryn Dowson.

Goal Manager aims to address this challenge. It compiles relevant data from assessments which then form the foundations for goals.

Goals are then set using of Goal Attainment Scaling (GAS), a tool which is widely used in rehabilitation, but can be complicated to use in practice.

SMART objectives towards completing each goal can then be set, so that the contribution of each member of the team toward meeting these goals is clearly laid out.

The platform was initially tested in an independent practice focused on brain injury in young people. It led to a 43 per cent reduction in time spent on goal setting.

These findings were shared at the conference for the neuro- rehab special interest group at a World Federation for Neurorehabilitation event last year, catalysing demand for the system in large in and outpatient services.

In the UK, Goal Manager also has potential to support the aims of the Rehabilitation Prescription, which sets out the services that an individual should be receiving following a brain injury.

This was acknowledged by the UK Acquired Brain Injury Forum (UKABIF) at the end of last year, when Goal Manager was awarded their inaugural Mike Barnes Award for Innovation.

Penny says: “Cutting time spent on goal setting reduces costs and gives more time to spend on actually achieving the goals.

“Currently, services record their goals in different formats using different documents, maybe on spreadsheets, or maybe on paper, and shared over email, or at physical meetings.

“There is no consistency and it can be challenging for clinicians to pull all of this together and make sense of the data, as well as service users.

“We’ve put everything onto one platform, streamlining the processes involved and enabling progress and output reports to be produced that consolidate all the goal setting data on one document.

“Up until recent weeks, a lot of teams have been dependent on having physical meetings to discuss and coordinate their activity.

“Goal Manager provides the infrastructure to support a virtual version of what they’ve already been doing. All of its components are tools that clinicians are familiar with and using – and which are linked to best patient outcomes.

“But we’re also aware that time and other pressures can limit professionals’ capabilities in making best use of these tools.

“So we’ve simplified activities, providing a one- stop-shop for best practice in goal management that allows teams to get on with what they’re doing without having to worry about administrative demands.”

Beyond the UK, the platform is being rolled out in the US as part of community rehab services and professional training for physiotherapy students.

Impending developments include a patient-portal, which will support service users in taking ownership of their goals.

“Patients can already log into Goal Manager, but we want to create a more bespoke portal for them, to make their goals more meaningful and accessible and to give them more input into the narrative of their goals.

“Just the other day I had a 11-year-old patient, who accesses their data through the existing platform, telling his team ‘it’s my life and it is important to me that I can use the app and see my own data’. And he’s absolutely right.”

A research dashboard that enables researchers to easily analyse the vast bank of anonymous data generated by its users is also in development.

By making the platform free to use for educators and researchers, it is hoped that it proves an impetus for a much-needed surge in research into outcomes in complex neurological conditions.

Meanwhile, Penny and her team aim to provide technological guidance to rehab professionals struggling to adapt to the remote working renaissance.

“Many healthcare professionals, and people in general, perhaps don’t feel confident using technology and have just not had to use it that much in their work in the past.

“We are running a series of webinars and training events about goal setting and making the best use of technology in rehab.

“The current changes we’re all going through are something we are well prepared for; we’ve got all the infrastructure in place to support teams to carry on doing their work. So we want people to know that we’re here to help.”

For more on Goal Manager visit



Gauggel, S & Hoop, M. (2004). Goal-setting as a motivational technique for neurorehabilitation. Handbook of Motivational Counselling, 439.

Plant, S. E., Tyson, S. F., Kirk, S., & Parsons, J. (2016). What are the barriers and facilitators to goalsetting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis. Clinical rehabilitation, 30(9), 921-930.

Tucker, P. (2015). Goal setting and goal attainment scaling in child neuropsychological rehabilitation. In Reed, J., Byard, K., & Fine, H. (Eds.), Neuropsychological rehabilitation of childhood brain injury (pp. 151–170). London: Palgrave Macmillan.


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Video: everyday vs specialist tech

Assistive technology Expert Andy Fell joins Irwin Mitchell law firm for an in-depth exploration of the very latest independence-boosting devices and platforms.



Technology plays a day to day role in our lives and mobile phones, tablets, Alexa and Siri are common place.

Imagine the impact on your life if you were no longer able to interact with a touch screen or keyboard or give voice commands….

In this virtual event, Assistive Technology expert Andy Fell gives practical demonstrations of how everyday technology and specialist technology can be used to help give independence to those who need it most and why specialist technology may be needed.

During the event hosted by Lauren Haas, personal injury solicitor at Irwin Mitchell LLP, Andy goes into detail about what apps and gadgets are on the market, how everyday technology can be optimised such as the Amazon Alexa, and answered a number of questions ranging from touch screen sensitivity to smart watch reminders.

Case managers, ancillary medical professionals, as well as interested members in healthcare, social care, parents and clients may find this recording useful, as well as anyone caring for, working or living with people such as dementia sufferers or sufferers of other conditions which restrict their mobility.

Andy Fell is an independent disability and assistive technology (AT) consultant with almost twenty years’ experience working with all disabilities and age groups.

He is a qualified Rehabilitation Officer for the Visually Impaired and, since qualification, has lectured on the use of assistive technology and role of AT in the life of disabled people.

He has worked with a wide range of charitable organisations including British Dyslexia Association, was head of assistive technology for Guide Dogs for the Blind and National Disability Advisor for the Royal Yacht Association.

He has also worked for blue chip companies, the emergency services and various government departments including Department for Work and Pensions.

Andy is a fellow of the Royal Society of Arts, chairman and founding trustee of the Wetwheels Foundation and sat on the British Dyslexia Association – Workplace Assessors Professional Review Panel.

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The relationship between music and running

By Daniel Thomas, joint managing director of Chroma Therapies.



By Daniel Thomas, joint managing director of Chroma Therapies

With its ability to produce new neural pathways, Neurologic Music Therapy is able to encourage movement, co-ordination, improve speech and language, and improve the ability to read/feel emotions, reactions and more, in people living with catastrophic injuries.

This is because music automatically connects to the brain. And this automaticity is what makes music so powerful.

Music also has to ability to push your training capabilities farther and faster especially in running.

This is why a running playlist is the ideal accompaniment to any runner.

Each songs tempo stimulates the brain, evoking a running response of either a faster pace or a steady rhythm depending on what you want to achieve.

For a faster pace, a good running playlist should contain songs with 150-180bpm.

Unfortunately, with not many songs out there using that speed (unless you enjoy rock, metal or speed garage for running) than the other option is to choose songs with 75-90bpm, as this tempo is perfect for a steady rhythm and maximising efficiency.

Do you recall an earlier blog where we discussed cadence and stride length using NMT for preventing falls in the elderly?

We suggested music with a high bpm count promotes movement, good cadence and walking speed, so songs like Nancy Sinatra’s ‘These Boots are Made for Walkin’, which has 85 bpm, is ideal.

BPM strongly correlates to step cadence.

Rhythmic Auditory Stimulation (RAS) is an important aspect of NMT.

Predictable rhythmic structure allows the sensori-motor system to move in sync with the beat.

This is, in essence, why music is important to runners, as it has the ability to communicate with the brain in order to help maintain a steady pace or increase speed depending on the bpm.

When it comes to mental wellbeing, we will always discuss music’s ability to improve mental wellbeing, and its effect can also be attributed to runners.

Music’s ability to improve stride, cadence and style, to produce better and better runs, and enable runners to achieve personal goals also have a positive effect upon mental wellbeing.

A sense of accomplishment. And with the right playlist, runners can end each run on a high.

We also like to discuss how NMT is more effective when it is personalised to that individual.

The same can be said in the case of a runner. A playlist that includes, not only songs with the ideal tempo for them, but also have some personal meaning, have the greatest positive effect upon runners.

The more enjoyable the run, the less fatigue is experienced. This may be due to the fact that music is able to interfere with the parts of the brain that communicate fatigue, essentially causing a distraction, so less fatigue is experienced.

For runners, the relationship between music and running can be seen to be just as effective and important as the relationship between music and recovering from a brain injury.

Its ability to improve running capability, speed, motivation, and promote mental wellbeing is what makes the difference between a run just being a run and reaching ‘Flow State’ – the mental state where the runner is in the moment of running – no distractions, and the run becomes…euphoric.

Read more: Running in the name of mental health

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Concussion could lead to depression, ADHD, dementia and Parkinson’s – study



A new study has revealed a link between concussion and the risk of being diagnosed with attention-deficit hyperactivity disorder, mood and anxiety disorders, dementia and Parkinson’s disease later in life.

Despite ‘clinical recovery’ from concussion typically lasting one week, a team of researchers from the University of Manitoba suspected there may be longer term effects. They used 25 years of population-based health data between 1990 and 2015, involving almost 50,000 cases of concussion from people living in Manitoba, Canada.

They found that concussion was associated with an increased risk of being diagnosed with attention-deficit hyperactivity disorder (ADHD), mood and anxiety disorders (MADs), dementia and Parkinson’s disease.

After analysing the population data, they found that concussion was linked to an increased risk of diagnosis of ADHD, dementia and Parkinson’s.

Women who had a concussion were at greater risk of developing ADHD and MADs, but there were no differences between men and women for the risk of developing dementia or Parkinson’s.

Multiple concussions didn’t affect the risk of later being diagnosed with ADHD, but a second concussion increased the risk of dementia, while exposure to more than three concussions increased the risk of being diagnosed with MADs.

While previous studies have found links between concussion and ADHD, dementia, Parkinson’s and MADs, most have relied on patients self-reporting their symptoms, the researchers write.

However, this study can only show an association, not cause and effect.

The mechanism behind this increased risk is unknown, but the researchers state it’s possible that the pathways of some biomarkers that are dysregulated in ADHD, Mads, dementia and Parkinson’s, namely, cortisol, are also affected after a concussion.

The paper, published in the BMJ journal, states that future research is needed to explore the relationships between concussion and ADHD, MADs, dementia and Parkinson’s in other populations.

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