While the healthcare system rightly initially focused on saving lives and stopping the spread of the virus, there is an array of patients that remain with unmet needs which The Community Rehab Alliance, a consortium of 22 charities and professional bodies – has submitted a joint response addressing.
Having identified that many COVID-19 survivors are being discharged without any rehabilitation plan in place, the report gives a series of recommendations for services that support rehab across a range of conditions to aid getting the country back on its feet and back to work.
It has been argued that this is a time to learn from the pandemic to shape rehabilitation services for the future, as well as addressing the weaknesses within the arguably under-developed part of the current healthcare system.
Rehabilitation is the process of assessment, treatment and management of a patient’s condition, within which they are supported to reach their maximum potential for physical, cognitive, social and physical participation in society and quality of living. Rehab needs to empower people to recover and build up resilience at their own pace which, for COVID-19 survivors is wide-ranging.
While there are some excellent examples of regional and local responses and pathway development, overall planning and guidance on COVID-19-related rehabilitation appears inconsistent and disjointed. The Rehab alliances recommends a national, strategic approach including integrated care systems carrying out audits, agreement on common rehab needs assessment frameworks and building up multi-disciplinary community rehab teams with the skills and staff required.
By redeploying the workforce – permanent and temporary – back into the community, it is more possible and likely to deliver commitments that will increase step-down rehab capacity.
During the crisis, it hasn’t been only coronavirus patients who have required healthcare. Throughout the pandemic, people are still having falls and fractures, strokes, heart attacks, preparing for cancer treatment or recovering from it, having accidents and illnesses that result in spinal cord and brain injuries and having exacerbations and acute episodes related to long term conditions, including cardiovascular, respiratory, musculoskeletal, rheumatology and neurological.
In all these situations, early, timely and sufficiently intensive rehabilitation will often be critical to people’s long-term recovery and the level of wellbeing and independence people regain or maintain. For older people timely rehabilitation is key to support people to prevent decline, optimise independence, prevent hospital admissions and the need for long-term care. Rehabilitation enables people (including key workers) to return to work and participate in society after lockdown.
During the pandemic, some essential and time-urgent elements of rehabilitation have continued, while supporting shielding and social distancing.
Local managers need consistent advice and time to assess when rehabilitation interventions are essential and on how community rehabilitation can recommence fully. National support and guidance for the provision of telehealth and digital rehabilitation options where appropriate is necessary, with professionals bodies needing to play a critical role in providing guidance on how practice might be adapted from face-to-face rehab from outpatients centres to home, as well as finding alternatives to clinic-based appointments and services.
As services recommence, there should be a positive risk approach, supporting ongoing guidance on social distancing, testing for professionals and carers, PPE at the appropriate level, and prioritisation on the phasing in of aspects of services.
The pandemic is shining a light on the poor state of community rehabilitation provision. While there are many excellent services, access to rehabilitation is a postcode lottery, with services being under- resourced and under-developed for decades. Planning and commissioning is inconsistent, and there is significant variation in standards.
There must be a plan to meet the wave of pent-up demand for health and care services that have been delayed due to the coronavirus outbreak, as well as meeting demand for additional mental health services.
As part of this plan, the Rehab Alliance recommends that there is a strategy to expand both community rehabilitation provision and, where necessary, retain planned additional capacity for step-down (bedded) rehabilitation units.
Through the forthcoming NHS People Plan, deliver an expanded rehabilitation workforce, including allied health professionals with advanced practice skills, support workers and care assistant trained to add capacity, sports and exercise professionals, postural stability instructors, coaches working in the voluntary sector and rehabilitation medicine doctors.
Because COVID-19 is a multi-systemic condition, with significant physical and mental health consequences, it illustrates very well the continued importance of shifting an approach to rehabilitation away from one that is based on neat medical specialisms and condition silos.
The experience of Covid-19 recovery should provide an impetus to adopting a personalised, multi-condition, biopsychosocial approach that can respond to the needs of increasing numbers of people having multiple conditions impacted by multiple factors. This approach needs to support greater inclusion of vulnerable and hard-to-reach groups, who have the worst health outcomes and experience barriers to services. This includes people with learning difficulties, dementia and serious mental illness.
Services need to make reasonable adjustments to make them accessible – for example, adapting communication.
The pandemic has necessitated a shift at scale to online management systems in the community and tele-health. As services get back to normal, it is highly likely, this could be continued to make this a much more prominent option for people in how they access and receive services.
This must be appropriate, evidence based and result in increase choice and access, not in greater marginalization of some groups and increased health inequality.
Learning from the experience of the pandemic should be captured by robust research and shared so that evidence underpins the future shape of rehabilitation. These should include the perceptions of the patients, staff and carers as well as their clinical effectiveness.
So while there is a certain amount of support available, the necessity to address and reform the rehabilitation services available throughout the UK is significant and immediate.
The Rehab Alliance, which includes industry bodies and charities such as Age UK, the Royal College of Psychiatrists and the UK Acquired Brain Injury Forum, is working to see a change across all rehab services offered nationwide to combat the challenges faced as a result of COVID-19 and strengthen those survivors in the best possible way, setting a new standard and practice in services that will better serve residents across the board.
The dancing Queen who refused to give up
A spinal injury should have brought Erin Pollitt’s professional dance career crashing to an untimely end but she ignored the doubters and proved everybody wrong, as NR Times reports.
Erin Pollitt suffered a serious spinal injury in her second year of professional dance training.
While practicing a difficult move during rehearsals at the Northern School for Contemporary Dance in Leeds, she fell to the floor and suddenly felt a sharp pain at the base of her spine.
She was booked in to see the school’s physio the next day, feeling the full impact of the fall after being unable to walk properly or move as she normally could.
Here began the long process of getting to the bottom of what was wrong with her.
After numerous trips to the physio and multiple scans, it was eventually revealed that she had compressed a spinal disc in her lower back which was pressing against a nerve.
Furthermore, there was ligament damage in her pelvis leaving Erin, 24, in serious pain.
After seeing a top consultant for spinal injuries she was given the news she had been dreading.
Erin was told she would likely need to end her career as a dancer.
Most would see this as a chapter of their life ending and reluctantly accept what had been lost. But Erin simply saw it as a challenge.
Speaking to NR Times, Erin says her approach to dealing with her injury completely changed after her conversation with the consultant.
“I didn’t take no for an answer,” she says. “Up until then I had just been fumbling through the pain and hadn’t really put anything in place to help rehabilitate myself.
“But after he said that, I thought I’m going to really focus on getting better so that I don’t have to stop my dance career.”
From here Erin began what was a year long rehabilitation process, beginning with restoring simple and small movements.
Then she progressed to a short dance session, where her pain would only allow her to practice for just ten minutes initially.
“It was very slow, tiny movements to start with,” Erin says. “Very slowly, I’d do around ten minutes of dancing and then it had to stop. And then the next week maybe I’d push it to 15, so it was so slow.
“It was a really long process of core strengthening and Pilates and relearning how to support the muscles around my spine.
“The process wasn’t necessarily learning to move again, but I was learning to articulate that part of my body in a much safer way.”
The rehabilitation process was not only physically painful for Erin, but it was also a mental struggle.
Having to sit on the sidelines and watch her peers was difficult, particularly amid the fear that she may never be able to join them again.
“It was incredibly tough, and also very lonely because everyone else was training and I had to sit every day and watch them do what I couldn’t.
“Because we were all in a three year training programme together, I just felt like I was missing out on so much time and watching everyone else get ahead of me.
“The thought of never being able to dance again and thinking I’m going to have to live with this pain for the rest of my life was really scary.
“I remember so many times thinking ‘I don’t know how I’m going to carry on with this level of pain’ or not being able to do what I’ve always wanted to.”
Having persisted with her rehabilitation, Erin eventually returned to the Northern School for Contemporary Dance where she was able to graduate.
She then went on to complete a Masters at London Contemporary Dance School where she used her experiences to complete her thesis on the psychological impact of injury on dancers.
Erin spoke to numerous others who had endured something similar and her work was of such a high standard that it was published in the Journal of Dance Medicine and Science.
“I thought about how I can do some research that may benefit people going through a similar thing, so I began reading about how injury can affect a dancer’s mental health.
“It was so difficult for me not only physically, but to just keep going and keep believing that I will get better.
“Eventually I put something together that felt quite important, to talk about the fact that injury is something that most dancers will go through and it’s actually really traumatic to deal with.
“I feel quite proud that, although at the time it was awful, something positive came about and I’ve been able to contribute to the conversation around that.”
Erin has since set up her own dance school, Matter of Fact, which launched last year.
After graduating she also went on to perform with a range of contemporary dance companies across Europe, in countries such as Portugal, Switzerland and Italy.
This adds to her already impressive career, having competed at international level in rhythmic gymnastics as a teenager.
“I’m looking forward to doing lots more performing now that the theatres are opening up again, because I am healthy now and I am getting back on that stage.
“I’m also looking forward to growing my company and doing more performances and choreographing for different organisations and companies.
“With the research I did for my thesis I’d really like to, in time, progress that further and see what else I can do.
“In many years time I’d like to work with injured dancers, helping them through a tough time and being that person there to support them.”
Parliament launches concussion in sport inquiry
A Parliamentary inquiry is to be held to examine the link between sport and long-term brain injury.
The Digital, Culture, Media and Sport (DCMS) Committee will look into the issue over two sessions, the first of which will be held next Tuesday.
Through the inquiry, the cross-party group of MPs will consider scientific evidence for links between head trauma and dementia and how risks could be mitigated.
It comes at a time when legal actions across football and both rugby codes are being considered or have already been launched, and follows the 2019 FIELD study which found professional footballers were three-and-a-half times more likely to die of neurodegenerative disease than age-matched members of the population.
Announcing the inquiry, DCMS Committee Chair Julian Knight MP said: “This inquiry will consider scientific evidence to link sport with the incidence of long-term brain injury.
“We will look particularly at what role national governing bodies should be taking and their responsibilities to understand risks involved for players and what actions might be taken to mitigate them.
“We’re seeing a number of cases involving brain injury in sport likely to reach the doors of our law courts and we will also look at the implications for sport in the longer term of any successful legal claim.”
Among those invited to contribute to the inquiry is brain injury charity Headway, which has campaigned on the issue of better safety in sport for years.
Chief Executive Peter McCabe will outline the charity’s long-standing Concussion Aware campaign and its aims of improving concussion awareness, particularly at grassroots and junior levels.
He will also call on the Government to encourage sports’ governing bodies to do more to address the issue.
“Increased scrutiny from this influential cross-party group of MPs is very much welcomed. We hope it will lead to greater pressure on all sports to do more to instil a cultural change in the way head injuries are perceived and treated,” he says.
“It has taken many years of campaigning and Headway repeatedly speaking out in the national media to get to this stage.
“There has been progress in that time, but there still remains a lot to do in terms of elite-level sport consistently setting a good example for grassroots sport to follow.
“We look forward to sharing the charity’s views with the Committee.”
Dr Michael Grey, UKABIF trustee, will also be taking part in the inquiry.
“We are really pleased to be involved in this inquiry,” he says.
“UKABIF has been raising issues surrounding brain injury in sport for a number of years and devoted a section of the APPG Report: Neurorehabilitation and Acquired Brain Injury: A Time for Change to this subject setting out some clear recommendations.
“We will be able to ensure that our evidence-based recommendations are heard at the highest level.”
‘I’ve seen the effects of stroke personally and professionally’
As a nurse working with stroke patients, Chloe Hammond supports people in their recovery every day – but the effects of stroke have also touched her own family. Here, she shares her reasons for fundraising for survivors by walking 1.2 million steps.
A stroke nurse has committed to walking 1.2 million steps to raise money for the Stroke Association, having dealt with the effects of stroke in both her personal and professional life.
Chloe Hammond is completing the challenge as a symbolic reminder of the 1.2 million stroke survivors in the UK, and aims to complete it by walking 10,000 steps a day for 120 days.
Chloe, a nurse at Sunderland Royal Hospital, works in neurorehabilitation but is currently deployed to the hospital’s acute stroke ward, where she sees first-hand the impact that stroke can have in the earliest days of recovery.
And with two members of her own family having had a stroke, she is well aware, both personally and professionally, of the impact it can have on individuals and their loved ones.
“Being on the acute ward and seeing the acute side has been quite challenging, as usually I’m working with patients while they’re in recovery and having their rehabilitation,” says Chloe.
“I absolutely love seeing the progress they are making in neuro rehab, but I’m really pleased to be in the acute setting giving these patients support in the very early stages after their stroke.
“I’ve had two family members who have had haemorrhagic strokes, so I know all too well the effect this has on a person and their family, I’ve been there myself and experience it first-hand.
“So by raising money for the Stroke Association through the Stride for Stroke challenge, we can hopefully make a big difference to them after they are discharged from hospital.”
Currently, with restrictions on visiting, Chloe and her colleagues are giving medical, practical and emotional support to patients in the absence of visits from their families.
“The pandemic, and particularly the lack of visits, has definitely taken a massive mental health toll on a lot of patients,” says Chloe.
“Often, where they could have further rehabilitation in hospital, they say they don’t want it as they don’t want to be here, they want to be with their family at home. So that’s hard, but we support them every step of the way while they’re with us.
“I think for families too, as they can’t come in and see their loved ones, they don’t fully know the impact the stroke has had on them as they haven’t seen the effects for themselves. So they don’t really know what to expect when their loved one comes home.
“But we’re always on hand to give all the support we can, and we often help patients use the technology like FaceTime so they can have those calls with their loved ones, which are now more important than ever.”
Through the Stride for Stroke challenge, Chloe is aiming to raise vital funds, as well as awareness of the importance of exercise which can prove crucial in reducing risk of stroke.
“I’m trying to walk to and from work and do a little bit more exercise than I normally would on my days off to get to the 1.2 million target,” says Chloe.
“I’m enjoying going on some longer walks with my pug Rodney too, he gets me out even despite the bad weather and snow we’ve had recently.
“But exercise is so important, and particularly working on the acute stroke ward at the minute, it reminds you of how important it really is to keep active, and do all you can to reduce the risk factors.”
* To support Chloe in the Stride for Stroke challenge, visit www.justgiving.com/chloe-hammond6
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