Delivering online arts therapy sessions to clients with brain injuries will continue going forward to complement to face-to-face sessions, according to arts therapies provider Chroma.
Over the last 12 months, Chroma has had to adapt its therapy sessions to successfully deliver Neurologic Music Therapy (NMT) services in various settings, such as residents in specialist care homes and special schools for children with a range of complex needs including autism, brain injuries and learning difficulties.
The provider has said its online sessions were such a success it will continue diversifying the delivery of sessions, if and when circumstances permit, to add to its face-to-face offering.
Evie Mason, NMT specialist at Chroma, has been working at Voyage Care residential homes in Bristol and Tewkesbury for two years, delivering NMT sessions to haemorrhagic stroke clients, and has seen the biggest impact sessions have had upon the residents’ speech and language skills.
“When moving to online sessions, I noticed an immediate change in the speech output of my stroke patients. Focus had in fact improved as there were no other distractions – the client had to focus solely on me which helped improve their speech production,” says Evie.
For speech and language development, Evie would use techniques such as using a keyboard to play different chords and when the chord changed, the client then changed the word being said. They would work on specific vocabulary, using well-known tunes from songs.
And for clients with hearing difficulties, Evie delivered tailor-made non-verbal sessions which included imitation work to develop attention and communication skills. In these incidences, the client chooses a piece of music and the client and therapist take it in turns to lead and follow each other’s movements.
When leading, Evie creates moves encouraging the client to play instruments which work on movement patterns which develop the client’s flexibility and endurance in specific muscle groups, such as those affected by one-sided weakness.
Evie says: “There’s been some crossover using dance to music too. When I am working with clients to help improve walking, the client would choose a piece of recorded music, listen to it, and then follow my instruction to walk to the music.
“Unfortunately, due to time delays, I wasn’t always able to use live music during sessions. But working remotely brought a freedom to the role allowing me to try things I may not have normally tried, yet sessions were always client-centred focusing on what the client actually needed at that time, whether that was physical or psychological input.”
Lucy Collings Pettit, another Neurologic Music Therapist at Chroma, has been working at Pathfield School in North Devon for the past eight years, delivering NMT and MT to children aged 3–19 years of age with brain injuries such as brain tumours, Hypoxic Ischemic Encephalopathy (HIE), cerebral palsy and epilepsy.
The basis of her work is to improve functional outcomes to those pupils who have neurological conditions or suffered a brain injury. Rehabilitation helps children acquire or maintain functional skills, often for the first time in their lives. Rehab for pupils with a neurological condition is developmental focused, working to reduce or remove significant barriers to education and improve quality of life.
Lucy says: “Arts therapies are creative and as such, so are we, so adapting to the challenges faced as a result of the pandemic was possible. We found that online sessions, where appropriate to a child’s needs, really helped.
“I select interventions based on what will achieve the most functional and relevant educational outcomes. Specific techniques are used to maintain or improve children’s skills within the speech and language, motor and cognitive domains.
“To be able to bring all those factors online, sessions required more parental and carer guidance to help facilitate and ensure safety. This had benefits in itself as it has helped build alliances and make those bonds stronger. It has provided opportunities for primary caregivers to gain valuable insight into the work, including the difficulties faced by their child on a daily basis and how they can best support the work to contribute to positive outcomes.
“Of course, online sessions are not a suitable option for all pupils, especially some children with sensory difficulties. Yet, some children who have profound learning difficulties have flourished through working remotely. I think preparation is the key to success – ensuring the space is safe, the volume is right, the child can see me clearly – it all helps bring the experience to life.”
NeuroBall™: enabling progress in rehabilitation
An expert’s view of the rehab technology.
What impact can the NeuroBall™ have on rehabilitation? Claire Everett, neurophysiotherapist at PhysioFunction, shares her insights into its benefits
What are the main benefits of NeuroBall™:
- For your clients/patients?
- For your clinic?
The main benefits to the clients are improvements to hand and upper limb function; working with the NeuroBall™ can assist with integrating the hand and upper limb into the whole body recovery.
We have also utilised the NeuroBall™ in therapy to assist with balance – e.g. training in both sitting and standing.
The NeuroBall™ allows the client to work at home independently following assessment and recommendations of a NeuroBall™ trained therapist.
Having a means of independently exercising can be empowering for the client and facilitates a more intensive rehabilitation programme.
The facility is able to remotely monitor use of the NeuroBall™ and adherence to an agreed exercise plan assists the therapist in managing a client’s therapy programme.
How do you decide which clients/patients are the best candidates for NeuroBall™?
A trained NeuroBall™ therapist who has experience is the best person to identify clients who will be good candidates for the NeuroBall™.
It is best practice to have identified patient goals and identified problems from a detailed assessment.
Clients need to be able to follow the instructions to engage with the therapeutic games and this forms part of the suitability assessment.
The NeuroBall™ can assist in those with both high and low tone in their hand and upper limb, however regular input either face to face or via Telerehab is required to maximise the client outcomes and ensure good technique and patterns of movement in the arm and hand are achieved.
Challenges: The size of the client’s hand to fit in the NeuroBall™ must be at least 15 cm long with a palm at least 8 cm wide so that may prevent some smaller or paediatric clients from using NeuroBall™. I’d also like to have more games to work on hand opening.
What expectations do you set with clients about:
- How often and for what length of time they should train with NeuroBall™?
- What improvements in activities of daily living they should see if they follow your recommendations?
Length of time and intensity of training is tailored to the individual and monitored and adjusted by the experienced NeuroBall™ Therapist.
Improvements in daily living activities will be individual and personal goals are set in liaison between client and therapist.
Expectations are best managed by a thorough assessment, an individualised training programme and regular input with a trained NeuroBall™ Therapist. In general, our clients have enjoyed the games and the feedback on their progress. Clients have reported that using NeuroBall™ benefits their hand function and balance.
How have you used telehealth in your NeuroBall™ home program?
We have integrated the NeuroBall™ into our extensive Telerehab offering. It has had the most benefits in those clients who have regularly engaged with 1:1 sessions with an experienced NeuroBall™ Therapist.
What have you heard from your clients about how NeuroBall™ has impacted their rehab and their lives?
Our clients have given a variety of feedback, some found whilst using the NeuroBall™ their hand was more engaged with their body, and they noted improved hand function. Some also noted improved balance.
Some clients experienced minor discomfort with use and others felt over time the games became less engaging and motivating. However, with further input from an experienced NeuroBall™ therapist, adjustments to improve comfort and suggestions on how to keep the games engaging usually addresses these issues.
For more information on the NeuroBall™, visit here
N-ROL’s telerehab delivers ‘significant’ progress to survivors
A pioneering telerehabilitation initiative which enabled people recovering from acquired brain injury to continue their therapies during the pandemic has reported significant progress for participants during the programme.
The evaluation of Neuro-Rehabilitation OnLine (N-ROL) and the fact participants “significantly improved on the two planned quantitative outcome measures” provides further academic analysis to support the hugely positive anecdotal evidence about the impact of telerehabilitation, which has grown exponentially in its use during the past year.
N-ROL, a multidisciplinary group-based programme, was established in response to the reduced access to continued rehabilitation for people living with the effects of ABI, including stroke survivors, during the COVID-19 pandemic, at a time when their need for support was increasing.
A three-way collaboration between University College London (UCL), University College London Hospitals NHS Foundation Trust (UCLH) and brain injury recovery charity SameYou, N-ROL offered a range of groups that encompass the main areas of unmet need for patients with ABI including physiotherapy, occupational therapy, speech and language therapy, neuropsychology and neurology.
N-ROL is now being rolled out into East Lancashire Hospitals NHS Trust, working alongside the University of Central Lancashire, and again financed by SameYou’s fundraising.
In the findings of its pilot project at UCL, over a 15 week period, 86 stroke survivors participated in N-ROL after being referred by community or hospital-based rehabilitation teams, receiving therapy remotely through the programme.
Their progress was charted against two outcome measures – the 13-question Stroke Self-Efficacy Questionnaire (SSEQ) and the seven-question Neuro-Rehabilitation OnLine Outcome Measure (N-ROLOM) for patients and two for carers or family – which set targets and aspirations for patients to work towards.
Now, in an evaluation of the project published in the BMJ, patients who took part in N-ROL – which was led by Professor Nick Ward, from UCL Queen Square Institute of Neurology – are found to have “significantly” improved on the two defined outcome measures during the period.
“The post hoc analyses suggest that participants gained the most from (1) psychoeducation around ABI, including hearing other people’s stories; (2) gaining advice on how to better structure their day; and (3) perceived improvements in their motor function (meal preparation, balance and walking),” the report states.
Each patient attended on average 27.1 sessions through N-ROL, a mixture of physical and talking therapies, with an average of 5.4 patients per group.
The evaluation concluded: “N-ROL, like all therapist-delivered rehabilitation, is complex with many interacting components. Each group was delivered by highly skilled and specialist neurotrained therapists.
“We speculate that key elements to its success are (1) the multidisciplinary structure of the team; (2) using groups, which allows participants to gain and identify with each other; and (3) the holistic and systemic nature of our therapeutic approach (treating patients in their own home and targeting their carers for specific interventions).”
Jenny Clarke, CEO of SameYou – the charity founded by her daughter, world-famous actress Emilia Clarke after surviving two brain haemorrhages, to give a voice to fellow brain injury survivors and to deliver better holistic rehabilitation care – says: “SameYou’s mission has always been to develop better recovery treatment for survivors of brain injury and stroke, but when COVID hit, we knew that something needed to be done fast to help survivors impacted.
“We are immensely proud of our work with Nick and his whole team at UCL. Their vision and ambition to help patients, and to do so under the enormous pressures of COVID, is first-class. We look forward to seeing N-ROL grow and reach more patients across the UK and beyond.”
How the use of outdoor activities makes Calvert Reconnections unique
Speaking at Calvert Reconnections’ recent Zoominar for case managers and solicitors, activity lead Rob White made a compelling case for rehabilitation in the great outdoors
“The use of outdoor activities makes our rehabilitation service unique,” said Rob.
“Working with leading clinicians and academics, our service combines traditional multi-disciplinary clinical therapies with physical activity in the outdoors to support individuals in their recovery from brain injury.”
Rob brings over 20 years’ worth of outdoor coaching experience to the Calvert Reconnections team. He has always been a strong advocate for using outdoor activities to facilitate personal development and this underpins his practice. In 2018, he qualified with an MSc in Psychology.
He researched the influence of rock climbing on people’s mental wellbeing and this highlighted the transformative potential of the outdoors. Rob uses his knowledge when designing and delivering programmes, focusing on maximising wellbeing by using adventurous activities and the outdoor environment.
“At Reconnections, participants are involved in every aspect of the activities they undertake,” he continued.
“They complete meaningful tasks, from concept to completion, in a real-world setting.
“If, for example, the activity is canoeing, we’ll look at the weather forecast, the number of boats required, where to journey and whether to take a packed lunch. Participants will be involved in the planning and decision-making process throughout the day.”
Rob went on to outline how physical activity promotes neuroplasticity and fitness while outdoor environments and exercise have a positive impact on mental wellbeing.
Extensive research also suggests that outdoor activities can help individuals in their recovery from brain injury.
One paper found that physical exercise has the potential not only to improve physical health but also to have a positive effect on mental alertness and mood in the general population. Exercise can result in an increase in self-esteem and self-worth in all age groups from children to older adults.
Studies on the benefits of outdoor activity in addressing problems associated with Traumatic Brain Injury (TBI) also point to improvements in self-esteem, self-confidence, increased control, memory and planning.
A one-year outcome study of a three-day Outward-Bound Experience recorded a range of positive outcomes.
At the one-year evaluation, 83 per cent of the participants ranked themselves above their pre-course rating in an understanding of their strengths and limitations. Other positive changes over the same time span included: ability to rely on others (50 per cent), higher self-esteem (58 per cent) and improvement in problem solving (50 per cent).
It was commented that the outdoor challenge course allowed therapists to help the participants recognise and acknowledge their thoughts, feelings and behaviours during the course and that one year later the participants were calling on this understanding to improve their daily functioning.
Another UK pilot programme incorporated a context-sensitive approach to cognitive rehabilitation with a focus on goal planning with goal attainment as an outcome measure. The results revealed a high level of achievement (over 80 per cent) on selected, identified, specific and mainly practical goals.
In discussing the results, the authors considered the strength of the project appeared to lie in partly in the motivation provided by the outdoor activity course, which appeared to later encourage participants to work towards broader goals.
Concluded Rob: “Participants, clinical staff and our specialist team of coaches will work together to plan, undertake and maximise the benefits of challenging activities in the unique environment of the Lake District. The focus will be on achieving personal goals and enhancing cognitive and executive skills.”
Calvert Reconnections opened on 21 June, 2021.
Visit www.calvertreconnections.org.uk for further details.
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