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PhysioFunction setting the trend for telerehab

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Having been an early adopter of telerehab, PhysioFunction was perhaps less daunted than most at the prospect of responding to the COVID-19 lockdown and ensuring their clients’ needs were met.

The specialist neuro physiotherapy practice has, for the past year, used video calls to enable its clients to receive one-to-one sessions in addition to those provided in person, with its staff supporting them to install and use the technology remotely.

It is also an early adopter of the MindMotion GO, a first-of-its-kind mobile neurorehabilitation therapy system which uses gaming to support the recovery of brain injury and neuro patients.

PhysioFunction has reported strong levels of engagement and progress among clients as a result of its telerehab programme, which has increased in its use during the past few months amidst the pandemic.

From its specialist outpatient rehabilitation unit in Northampton, PhysioFunction supports patients from a 100-mile radius, which was a key driver in the adoption of virtual means of delivering therapy.

Claire Everett, clinical operations manager at PhysioFunction and a senior neurological physiotherapist, said: “For some time now, we have tried to embrace the use of online means for therapy, and it has really helped many of our clients. By doing sessions in their own homes, we see them taking ownership of their rehabilitation and it delivers benefits to them in their own settings.

“For example, we might be doing a session by video with a client on how to cope in the kitchen – but because it’s their own kitchen they’re in, that makes it even more relatable.

“It is a very useful way for some clients who perhaps struggle to get to us once a week, but cope much better with two half-hour weekly sessions by telerehab. We do carry out home visits, and will combine the remote sessions with hands-on therapy wherever we can, but some clients live quite a distance away or maybe it isn’t easy for them to get out of the house.

“By holding sessions by video, it doesn’t matter where they live, whether it’s round the corner or two hours away, and we’ve had a great response to our telerehab work. It’s changed our practice in some really positive ways.”

When lockdown came, while for many organisations a swift and seismic move to the adoption of remote communication was needed, PhysioFunction were in the enviable position of being able to build on what they had already created.

“With us already being established with many clients, we didn’t have to start from scratch, and we could look at how to build on what we had already done. By extending our telerehab programme, we could continue to support our clients effectively,” says Claire.

“The team were able to take our classes online from a very early stage, with Taher Dhuliawala and Keiran Cox very much holding the fort during lockdown. The classes followed the same format as in person, with small numbers of participants so we can easily spot if someone needs help, but we were able to increase the frequency of them. Being able to do these kinds of sessions in your own living room was really welcomed.

“With clients who were already able to use video, we also were able to introduce the MindMotion GO, which is fantastic as we can interact with the technology and, for example, increase the intensity as required. But at the start of the pandemic, we still had some clients who didn’t use video, and the fact we have supported them to use it meant they had an extra channel of communication with their family during lockdown, and that was a lovely extra benefit.

“Even aside from COVID, with the flu and winter weather coming, we are expecting further demand for our telerehab sessions. We’re currently running a blended approach of online and in-person sessions, although a few people are still choosing not to come in at all, but they have found our telerehab so effective that they’re still progressing with their therapy.”

While remote working was a ‘needs must’ for many practices during lockdown, and to help mitigate ongoing restrictions, PhysioFunction intend to continue to build telerehab as a core function.

“We are very into innovation and technology here and our team have worked really hard to do what we’ve done, I’m really proud of what we’ve achieved,” adds Claire.

Brain injury

Has UEFA done enough to protect player safety at Euro 2020?

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The collapse of Denmark’s Christian Eriksen due to a cardiac arrest during his team’s opening game at Euro 2020 shocked football fans worldwide and raised many questions about player safety. Here, sports disputes lawyer Barrington Atkins examines football authorities’ approach to the safety of players and asks whether UEFA has done enough to protect those competing at Euro 2020

 

Concussion safety was meant to be at the forefront of the Euro 2020 finals. 

All 24 teams committed to following the recommendations of the Union of European Football Associations (UEFA) Concussion Charter, which was a commitment to player welfare and player safety. 

All 24 teams agreed to implement the serious measures recommended by UEFA to provide care for players who experience concussions or have injuries on the pitch. The message of the Charter was clear: if a player is suspected of concussion, they must be removed from the field of play.

UEFA’s focus on concussion follows a growing awareness of the greater risk footballers’ face of neurodegenerative diseases from head injuries. Research commissioned by the Football Association and the Professional Footballers’ Association found that ex-professional footballers are three and a half times more likely to die from dementia than people of the same age range in the general population.

The concussion and fractured skull sustained by Wolves’ Raul Jimenez following a collision with Arsenal’s David Luiz in November 2020 was the final straw that led to the implementation of the concussion substitutes rule in the Premier League. This new rule states that if a player has clear symptoms of concussion or video provides clear evidence of concussion, his team will be permitted to replace him with an additional substitute.

On 21 February 2021, Rob Holding became the first Premier League player to be replaced under the rule. The protection the rule provided to player safety was instantly demonstrated as Holding was confirmed to have concussion the following day.

Despite the proven benefits, UEFA decided against approving the concussion substitutes rule for the Euro 2020 finals. The injuries football fans have witnessed during the European tournament have undoubtedly challenged UEFA’s decision and called into question whether the Concussion Charter is effective enough for player safety.

The first incident occurred when France’s Benjamin Pavard sustained a head injury following a collision with Germany’s Robin Gosens. Pavard received treatment for several minutes before being given the green light to continue playing. Pavard later revealed that he was knocked out for 10 to 15 seconds. Controversially, UEFA confirmed that the correct concussion protocols were followed.

Only six days later, Austria’s Christoph Baumgartner received a blow to the head, went back on the pitch and was then substituted. His coach later admitted that Baumgartner had been experiencing dizziness. 

Russia’s Danila was the third player in the tournament to collapse to the ground following a head injury. He was cleared to play on but was withdrawn at half time. These incidents demonstrate that football authorities need to do more to protect players’ health.

Cardiac conditions too are highly significant here, being the leading cause of death in professional footballers. Data has revealed a prevalence of sudden cardiac death of seven in 100,000 football players.

Quick application of a defibrillator can improve a patient’s survival by 75 per cent. However, when Cameroon’s Marc-Vivien Foé collapsed during the 2003 Confederations Cup in France, it took six minutes before attempts to restart his heart began. The lack of awareness of the need for speedy care contributed to Foé’s death, but the incident spurred football authorities to implement changes to reduce the risk of cardiac arrest on the field.

The English Football Association has now increased screening frequency so that players are tested between the ages of 14 and 25. For incidents where cardiac conditions slip through the net, sporting organisations have pitch-side defibrillators and medical staff trained in CPR to help resuscitate a player if they suffer a cardiac arrest.

Player safety was brought to the forefront on 12 June 2021 when Christian Eriksen experienced a cardiac arrest during Denmark’s game against Finland. Thankfully, football authorities’ understanding of the need for urgent medical attention in cardiac emergencies helped save Eriksen’s life.

The Euro 2020 finals have shown that football authorities need to take further urgent action to protect player welfare and player safety. However, as Christian Erikson’s recovery happily shows, player safety can be achieved when football authorities apply the correct protocols and have appropriate medical equipment in place.

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Life after lockdown – what comes next?

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As we prepare to emerge from lockdown in less than two weeks, attention is turning to what the ‘new normal’ will be like. Margreet Wittink at Renovo Care shares some reflections from the pandemic and thoughts on what may lie ahead

 

The 19th of July 2021. More than just any date.

We all have certain dates that are important to us, like birthdays and anniversary dates. However, this year we have been governed by dates set by the government trying to get back to a normal life post-COVID.

We seemed to be going in the right direction but then the Delta variant presented itself. The infection rates started to go up again and continue to rise but with far less hospital admissions. Opinion seems to be divided on whether we need to remain cautious and wait or return to normal life whatever it may bring.  The British Medical Association is calling for caution and is asking for ongoing use of face masks and new ventilation standards.

The 19th of July 2021 will mark the fourth and final stage of lifting lockdown in England. It makes me reflect on the period since March 23 2020 when the first lockdown started.

A birthday present my son didn’t want. Being an essential worker continuing to drive to Hollanden Park Hospital on an empty M25 and A21, seeing a banner thanking those who continued to work which I appreciated so much. Taking staff temperatures which was thought to be needed for just three months but lasted so much longer.

The absolute low of the period? Losing a much loved colleague and being unable to pay the traditional respects. But never losing sight of the most important aspect of our work; keeping our patients at Renovo Care safe.

Will life get back to normal? But what is normal? Hasn’t COVID shown us all that life can change dramatically in a short period of time?

That is something that is all too familiar to our patients who come to Renovo Care for their neurological rehabilitation following stroke, traumatic brain injury, Guillain Barre Syndrome to name a few of the diagnosis we treat.

We know how important family support is to our patients and how difficult it has been for them to be at our hospital without seeing their loved ones regularly in person. The use of Zoom and Microsoft Teams has given us a way to be in touch and being able to share therapy sessions, but it has been a poor substitute.

Recently we have been able to allow family members, who take on a carer role, in again nearer the discharge date to work together to prepare for a smooth transfer from Renovo Care to home. This has made such a difference to them to know what can be expected when their loved one comes home following a major event that changed their life.

Normality. What will it look like? No more face masks or social distancing? Are we ready for it?

I think that staff and patients alike will welcome staff not having to wear masks. When one of our patients left, he actually asked one of the therapists if she could remove her mask for a moment so he could see what she looked like.

Not wearing face masks will allow us all to see facial expressions again which is so important for communicating with each other. Hats off to our speech and language therapists who had to adapt their way of working around the COVID restrictions.

Will our visiting return to the way it used to be? Successful neurorehabilitation requires 24-hour support of all the parties involved which includes family. Being able to get hugs, to be held and to be seen face-to-face by your loved ones when you are working hard to regain your independence is so important to keep the focus on the goals they are trying to achieve.

It will require a transition from staff as we’ve had a dedicated visitors’ areas away from our patient rooms and rehab facilities for such a long time now, that it will be a novelty to have visitors back in these areas again.

The 19th of July 2021; the final stage of England’s COVID lockdown roadmap. The final review will happen on the 12th of July following analysis of the latest data. The Delta variant is on the rise but so are the vaccination numbers. Renovo Care has had a successful vaccination programme for staff and patients.

It looks like it is really happening and here at Renovo Care we will be ready for whatever comes and will make sure that our patient best interests are at the heart of what we do. 

  • Margreet Wittink is head of therapies/ lead occupational therapist, at Renovo Care Group’s Hollanden Park Hospital

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Insight

‘Like bees collaborating in a hive, achievements in rehab should be shared’

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Achievement in rehabilitation should be shared and celebrated with supporters to help sustain and encourage progress, says Lisa Beaumont, whose own ten-year recovery from stroke continues with the support of family, friends and therapists

 

Rehabilitation works best when it is not undertaken in isolation.

Over the past month, I have been thrilled by the progress that I have made towards my goal to walk without a stick, my posture has improved significantly during lockdown and I have enjoyed walking in the garden in June’s sunshine. 

My progress has reminded me of the saying, “it takes a village to raise a child”. I would like to adapt that expression to become: “it takes a village to deliver successful rehabilitation, many people have important roles to play”.

Just like bees cooperate in a productive hive, it is helpful for the patient to share their achievements with supporters, because their affirmation gives encouragement for renewed progress.

From the outset, I have been very fortunate that I’ve had the support from family, friends and therapists throughout my ten year recovery. 

An important feature of the rehabilitation platform Neuro ProActive is that it makes it easy to share a patient’s progress with  each of the key players in their recovery programme. For me, it looks like this:

My team is my neuro-physiotherapist, Jane Cast (neurorehabkent.com)

My representatives are my carers and sister. It is a bonus that I can keep everyone who is in my support bubble informed about my progress privately, by sharing photos and videos securely within the fully-encrypted platform.

Neuro ProActive is also a key player. Recently named as a Strategic Partner for UKABIF, we are now also part of the Criminal Justice Acquired Brain Injury Interest Group.

Prepared with assistance from Paige Gravenell (neurorehabkent.com)

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