Game changing neuro-rehab opportunities are emerging as a result of the coronavirus crisis, argues health and social care investment expert Boda Gallon.
The Impact of the Covid-19 pandemic has been multi layered. Yes, we’re faced with a fragmented health and social care system, continued uncertainty, and a gloomy economic outlook. There are, however, positive opportunities for investment and service redesign within NR and the wider specialist healthcare marketplace.
Increased investment interest for this most resilient of sectors, combined with a clearly identified need for positive change, should drive the creativity needed to embrace opportunities and deliver the much needed integration, improved productivity and efficiency of services across health and social care.
This positive outlook, however, still comes with a need to understand changes in our behaviour, to embrace change, to break down cultural barriers and focus on opportunity planning.
All of which is much easier said than done. A key lesson that has been brought home to us during the Covid-19 pandemic is that heroes are people. Ordinary, but extraordinary, people.
Once we get past fighting fires and lockdown fever most experts agree that things will never be the same. The key reason for this can be found in our primal brain and how we act and continue to live under a state of fear.
The neuroscientific term for this is “a somatic marker,” as coined by Antonio Damasio. I believe that Covid-19 is a negative somatic marker that we’ve
all had installed in our brains over the past several months and is likely to have a powerful, lasting impact on how we behave, but also a positive impact on the aspects of the cultural changes required for the health and social care marketplace to develop.
Change needs to go deeper, and Covid-19, as our generation’s negative somatic marker, is probably the best reason to change we will ever witness.
Covid-19 could also finally be the catalyst for the political will required to drive the full integration and parity between health and social care. It is no real surprise to find the recent disclosure of Camilla Cavendish’s plans that social care could be brought under the control of the NHS to honour Boris Johnson’s pledge to “fix the crisis in social care”.
This will also present opportunities and require new ways of working for people, but this will ultimately drive better and more seamless service experiences for all our patients, clients, residents, customers and consumers.
We are going to find ourselves in an entirely new online environment, with an entire generation of consumers and service commissioners expecting to interact via screens and having the aspiration and confidence of services being delivered in a ‘Covid-19 free’ environment.
This new virtual hybrid world will need to be delivered with empathy to help everyone overcome the negative Covid-19 somatic marker and still meet the basic human needs for relationships, touch and social interaction.
The perceived threat of Covid-19 does not mean that new services cannot be launched or repositioned. The opportunity is to develop more flexible services able to meet all the new behavioural, political, and environmental drivers of the ‘Covid-19 game changer’.
Providers and their people need to respond to this opportunity and reposition from fighting fires and coping around how things have always been, to repositioning ahead of the curve and innovating services towards what will be a new normal.
To date the adoption of digital technology to help improve productivity and efficiency across the system has often faced multiple cultural barriers, with people often sabotaging initiatives as they either feel their role, profession or revenue streams are threatened.
Covid-19 has forced everyone to look at the current barriers in a virtual way and employ different ways of working. Hopefully, this perceived threat now presents a clear opportunity for providers and professionals to deliver complimentary and long-term hybrid solutions for their clients and staff teams that embrace the best of digital and face to face interventions, training and support.
The delivery of community rehab has always faced productivity and efficiency challenges relating to logistics and the supply of and access to suitably skilled professionals, especially in more rural and harder to reach communities.
The proposed long-term somatic marker of Covid-19 now requires services and providers to be nimble to create longer term holistic solutions of their own, coordinating the much- fragmented array of technology options.
There is a need to embrace AR/VR/AI/IOT and to learn from and adopt best practice solutions from the UK and abroad to ensure much-needed efficiency, productivity and value are provided at the same time.
The positive outcome of this burgeoning digital transformation, like Covid-19, is also multi layered.
Offering a renewed focus on flexible working, employee support, management and an array of ‘wellbeing’ opportunities for staff recruitment and retention.
This digital transformation is most keenly required to help support and shape the future of various healthcare settings.
Existing commissioning and strategic planning intentions were already focused on provision away from hospitals and more institutional environments towards community settings with more holistic and social models of care.
The impact of Covid-19 will now hopefully see this process accelerated.
Although the wider roll-out of Covid-19 testing and potential vaccines is critical, providers need to review how the design and operation of care homes can be focused on delivering a ‘Covid-19 free’ moniker.
Enlightened providers need to ensure that cross infection mitigation and the flow of people, process and supplies are given an increased priority. The ability to offer digital triage and re-establish a more effective working relationship with GPs and primary care is essential to plan both avoidable admissions to and discharges from hospital and to provide the level of clinical support that has so often been missing during this pandemic.
Repositioning care homes from what has been perceived as the riskiest place for people to be towards being the safest environment possible has to be a clear goal; as well as a PR opportunity.
A focus on delivering flexible and safe space within residential services is essential to provide for increased independence, community and family integration and improved social inclusion.
New building designs in development need to respond to this now, and existing services will need to take a more strategic review of their estate for the medium and longer terms.
New models of care already seeking to deliver coordinated pathways from hospital to home, need the potential integration of health and social care to truly flourish and develop, but the vision must not stop there.
The extended integration and creative use of housing options is essential along with digital transformation to maximise potential clinical and financial outcomes and deliver the best quality of life for people. There is a lot to be learned from each other.
Previously fragmented sectors need to look vertically up and down patient pathways and supply chains, flex their services, upskill and share staff, embrace elements of isolated good practice and design into their own facilities and services.
Embrace the somatic change
To maximise value together, disruptive innovation driven by Covid-19 needs to be embraced. The independent sector can fully support NHS strategy by complimenting the NHS and building on the many successful collaborative partnerships developed during this pandemic.
Significant public goodwill and the potential political momentum to finally drive health and social care integration can now be leveraged to force past the multiple barriers to change.
Opportunity exists for game changers willing to take advantage of keen investor interest for a market that has proven to be the most resilient in the face of a global pandemic.
This inward investment into our sector can only be a further benefit forcing much needed change, new competition and opportunity to drive service innovation.
Ultimately and most importantly this will deliver better impacts and outcomes for service users, their families, and our colleagues.
We cannot afford to stand still and need to respond to the wider behavioural impacts of Covid-19 to reposition services, partnerships and networks to ensure new models of care and rehabilitation are (re)designed and delivered in more flexible and digital enabled environments.
This will ensure that proactive providers can truly respond to the future needs of customers, service commissioners and an emerging new normal to deliver even stronger, sustainable business models.
Proactive and future proofed business models are what any Investor from owner operators, to specialist private equity and bank funders will be looking to support and develop.
Hopefully, this article will help stimulate some debate and more ideas so we can share best practice and experience together.
Impact during TBI can have effects years later – study
The force exerted on the brain during traumatic injury is linked to damage years after the initial event, research has revealed.
Findings of the new study have been hailed as having the potential to predict the severity of brain injuries and help influence new approaches going forward, particularly in the field of sport.
TBI has a number of immediate impacts, including physical effects like unconsciousness and bleeding, alongside the ‘hidden’ symptoms of memory loss, mood and personality changes, which may take much longer to develop.
However, the link between the mechanical forces that act on the brain during TBI and the resulting long-term changes is poorly understood.
Now, researchers from Imperial College London have shown a clear link between the forces acting on the brain during TBI and its associated long-term changes.
The study – ‘From biomechanics to pathology: predicting axonal injury from patterns of strain after traumatic brain injury’, which is published in Brain – combined a computational model of brain injury with experimental studies on rat brains.
“The initial damage during a traumatic brain injury takes only milliseconds to occur, but it triggers many changes that result in ongoing effects which can be felt years later,” says Dr Mazdak Ghajari, from the Dyson School of Design Engineering.
“Understanding the link between the two is crucial for predicting who is at risk for long-term damage, and how protection may be better designed to prevent this damage.”
The findings have the potential to make positive impacts in protective equipment, such as in the design of helmets.
Professor David Sharp, from the Department of Brain Sciences, says: “We are also looking at how the type of impacts experienced by American football players affects whether they lose consciousness, and whether new helmet designs might protect soldiers from the effects of blast waves following explosions.
“These types of studies can also help explain whether repeated small impacts, such as heading the ball in football, could lead to similar long-term brain injury.”
Previously, the team had built a human computer model to predict the location of long-term brain damage following TBI, focusing on the ‘white matter’ of the brain, which contains nerve fibres called axons which play a large role in the brain networks that are altered in long-term brain damage.
Now, they have tested this modelling approach to see if it can accurately predict the pattern of white matter damage in rats given mild or moderate TBI.
They simulated the rats’ brains during injury, revealing the location and duration of mechanical forces linked to damage. Using a precise experimental model, this damage was induced in the rat brain and followed up after several weeks, which correlates to years of changes in a human brain.
They found that the effect of shear stresses on the white matter helped to predict the location of long-term damage. Shear stresses push two parts of the same object, in this case the brain, in different directions.
The intensity of the shear at different locations caused by different impacts, for example what angle they come from, predicts where the most severe white matter damage will occur. This could potentially help doctors predict the likely long-term effects in patients who have suffered a TBI.
“Different types of injuries will cause different kinds of shear. With this new model we can now more accurately predict which injuries will cause severe, long-term damage, and potentially avert it,” continues Dr Ghajari.
“For example, motorbike accidents involve a lot of rotational movement, which causes lots of shear. We are studying dozens of bike helmets to see which best protect against excess rotation.”
First-of-its-kind post-Polio service created
A specialist neurophysio service to support people with Post Polio Syndrome (PPS), believed to be the only programme of its kind in the country, has been created.
PhysioFunction has established a dedicated offering for people who have had polio earlier in life, but for whom some effects have returned years later with the onset of PPS.
The programme, which incorporates aquatic and land-based physiotherapy, has attracted a number of people from around PhysioFunction’s base in Northampton, but through the addition of telerehab during lockdown, has involved participants from a much wider area.
PhysioFunction engages members of the British Polio Fellowship in its programme and has also secured funding from Rotary International in recognition of its innovation.
Led by neurophysiotherapist Kirsten Good, the specialist service was created in response to the needs of one client initially, but expanded once the demand for such bespoke therapy was realised.
PPS is estimated to affect up to 50 per cent of those who have had polio in younger years, and its symptoms can include decreasing muscular function or acute weakness, pain and fatigue.
“Initially, it started with one client who had a hip replacement after a fall, but wasn’t recovering as expected, he went to St Thomas’ Hospital in London and was diagnosed with PPS. He had polio as a child, but the effects of the fall, combined with the operation and the recovery process, had triggered PPS,” says Kirsten.
“Having developed something very specific in response to his needs, involving our hydrotherapy pool for aquatic physiotherapy, as well as land-based physio which includes the use of our Alter-G treadmill, we saw how well this approach worked.
“I had never worked with anyone with polio or PPS previously, but it has many symptoms in common with neurological conditions I regularly treat, and working with this client inspired me to develop an interest in this area.”
From there, PhysioFunction devised a programme built to the exact needs of people with PPS, incorporating sessions of up to 30 minutes involving hydrotherapy and equipment-based exercise.
“We have a number of polio survivors attending our groups every week, and the funding we have had to subsidise the programme has made it very affordable for them,” says Kirsten, who was named a Paul Harris Fellow by the Rotary Foundation of Rotary International for her work in developing the initiative.
“It has been very warmly received and our participants have such a fantastic ‘get up and go’ attitude. Perhaps because many had polio in childhood , they have always grown up with the long lasting effects and have learned to get on with their lives – but when we say ‘Have you tried this?’ they’re really keen to give things a go. It’s a very positive group.
“Some people initially aren’t confident in getting in and out of the pool, and the adversity to temperature changes is another big factor caused by polio, so we can vary it between land and water-based as is required.
“We also have some fitness and endurance sessions, which we offer more widely at PhysioFunction, but overexertion in exercise can exacerbate PPS symptoms, so again, this has been tailored and developed to the requirements of this condition.”
The addition of telerehab to the PPS programme during lockdown was initially greeted with some scepticism, but has now been embraced.
“I’m not sure everyone was 100 per cent keen on it initially, but it has worked well. We are able to involve new participants from some distance away, who may not have travelled to our sessions, and it has continued to build our community,” adds Kirsten.
STEPS makes great strides in its growth
A residential rehabilitation centre has increased staff numbers by 300 per cent after securing investment to boost its development in the three years since its opening.
STEPS Rehabilitation was established by sisters Toria Chan and Jules Leahy to address the lack of facilities for younger patients in need of intensive neurorehabilitation.
Since opening in 2017, the Sheffield-based centre has now become a national centre of excellence for people with neurological conditions, stroke, spinal cord injuries, acquired brain injuries and other complex trauma injuries.
To date, the centre, which also offers day services, has supported over 200 people with their rehabilitation.
The 23-bedroom centre has a range of facilities to enable it to deliver specialist therapy to its clients, including a therapy gym, hydrotherapy pool, alongside social space to facilitate social interaction.
Through securing a £250,000 loan, STEPS has been able to vastly develop its offering to clients, as well as develop its operational processes behind the scenes, and staff numbers have increased from 35 to to 140 in tandem.
After an initial investment of over £1.6 million in the creation of the specialist centre, on the site of a former Sheffield engineering works, the three-year loan enabled STEPS to get to its next level of development.
The investment, from NPIF – Mercia Debt Finance, managed by Mercia and part of the Northern Powerhouse Investment Fund, has now been fully repaid.
“We have been on an incredible journey since we launched in 2017 and we are thrilled to have been able to make such a huge impact on our clients’ lives,” says business development and founder Jules.
“NPIF has been an important part in helping our dream come to fruition, with its funding helping to facilitate considerable operational improvements to help get us to where we are today.”
Pete Sorsby, investment director at Mercia, said: “STEPS is a unique business.
“Toria, Jules and the management team have put in many years of hard work and investment to make the centre what it is today – a nationally recognised rehabilitation facility.
“With future expansion plans in the pipeline, I have no doubt that STEPS will continue to go from strength-to-strength, and we are pleased to have been on that journey with them.”
“NPIF was launched in 2017 and STEPS was one of our earliest investments, so it has been excellent to watch it grow and excel over the last few years,” adds Sean Hutchinson at British Business Bank.”
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