After experiencing an acute stroke, patients come to the 20-bed Oxfordshire Stroke Rehabilitation Unit at Abingdon Community Hospital as part of their care pathway. They normally stay at the service, run by Oxford Health NHS Foundation Trust, for around four weeks before they’re discharged home or to other locations in the community.
Follow-up rehab is usually provided by the county’s community therapy service, but with the Covid-19 pandemic in March came a national focus on patients being discharged from hospital, and rehab services were put on the backburner.
“At the same time, two of our allied health professionals were shielding, and couldn’t work face-to-face, and we had patients discharged without being followed up,” says Emma Garratt, clinical lead physiotherapist and interim ward manager at Oxfordshire Stroke Rehab Unit.
The team decided to set up its own follow-up service, aiming to provide advice and support, and ongoing rehab. They have since followed up almost 80 patients who have been discharged from the service.
Garratt says they have seen some ‘brilliant’ success stories so far, with patients who have made great progress, including getting back to driving and work.
“Covid forced a lot of services to innovate and look at how they work. This was an idea one week and put into action the next. We thought, ‘We have staff who can’t work on the ward, and patients who need support, so let’s find a way to do that’.”
The follow-up starts with a phone call, then remains either telephone follow-ups or transfers to video calls. Garratt says there’s an effort to move on to video calls for as many patients as possible, although for some this isn’t feasible.
“For some patients, it’s been more about advice and support, acting as a signposting service, answering queries that have cropped up, that they’re not sure who else to ask.
“For other patients, it’s been very much a rehab-focused process, with one or two sessions a week to progress their exercise programmes, mobility and independence” she says.
“It very much feels like the service meets a need, and it does different things for different people.”
Now, Garratt feels the programme is at a point where it needs evaluating, and the team is collecting patient data with the aim of measuring its impact. Staff are also collecting feedback from patients, which Garratt says has been ‘overwhelmingly positive’. A patient discharged home during lockdown said: ‘The remote sessions have given me exactly what I need, and I feel that I am making steady and good progress towards my aim of a very good recovery to a pre-stroke situation’.
There isn’t a specialist community neurological rehab service in Oxfordshire, so before the pandemic, patients leaving the stroke rehab unit would be followed up by a generic community service that doesn’t necessarily specialise in stroke.
The new service allows patients to be followed up by clinicians who normally work in the rehab unit, and who are familiar with the patient pathway, the service and its staff. This allows good continuity of care, Garratt says.
Garratt, who also has a good knowledge of the patients, has been having weekly meetings with the therapists working in the follow-up service, giving them advice where needed.
“Continuous care is really valuable for patients. It helps them feel like they’re not being passed from one group of people to another, and that the whole process isn’t starting again. Ideally, we would like the process of people moving through the stroke pathway to feel quite seamless for them, even if we’re juggling things behind the scenes,” she says.
“Simple things, like a therapist having access to a patient’s admission notes and having direct links with that service, helps with this. The programme isn’t currently using any extra resources, it’s simply making use of staff who are shielding, who otherwise would have been at home or redeployed.”
They’ve had a locum filling in for this on the ward, Garratt says, but otherwise, the service hasn’t had any additional funding. In order to run the service long term there would need to be extra resources, which Garratt is currently looking into, as staff will be needed on the ward to maintain quality of care.
One challenge with community services is the time-consuming nature of travel, Garratt says. There is potentially a group of patients that could be supported through such a remote service, and this may free up capacity for face-to-face community teams to meet other patient’s needs.
“Being optimistic, I’d like to think this is longer term than the virus, as it’s meeting a patient need. A lot of research shows us that, when patients leave in-patient services they feel ‘abandoned’ and like they ‘drop off a cliff’.
“They feel unsupported – often because community support post-discharge is lacking, due to insufficient resources.
“We’re seeing that this project helps bridge that gap a bit. There is definitely a cohort of patients who need face-to-face input as well, so it doesn’t solve everything, but having someone to talk to proactively, to get advice from, and guide ongoing recovery, is helping our patients with the transition from hospital to home” Garratt says.
‘SLT took on even greater importance during lockdown’
Through community speech and language therapy continuing even during the height of lockdown, many patients received a “massive boost” from the progress being made in regaining or maintaining their communication and swallowing abilities.
While many therapies were stopped or conducted remotely, speech and language therapy (SLT) continued in-person throughout the pandemic, supporting people in their recovery from brain injury or stroke, as well as working with those with progressive neurological conditions.
“With there being a complete hold on a lot of NHS therapy during the first lockdown, speech and language therapy was very important to so many people, so to be able to progress in that area was a massive boost during a difficult time,” says speech and language therapist Jennifer Benson.
“For many patients I saw, they felt that there was so much focus on COVID they had been forgotten – but to have a voice is such a fundamental part of life, and for a lot of patients, particularly those with progressive conditions, it can’t wait.
“It’s a privilege to be able to support people with this, but particularly to be there for them during the most trying times.”
The continued intervention of SLT during lockdown helped many patients significantly – but for therapists, their role was frequently, and unexpectedly, expanded with the cancellation of many other community services.
“We were finding we’d be going to people’s houses and our role was broadening, we’d need a double appointment to help get through the other issues they had and trying to offer support,” says Jennifer, who worked in both private and NHS roles across Yorkshire and Lincolnshire during the pandemic.
“As speech and language therapists, we are very clear on our role boundaries, and we’re very keen to work with our MDT colleagues, but during those times we had to become used to dealing with things like recognising when a person needed end of life care, and supporting families when GPs weren’t coming out to see them.
“One case that really stands out was one gentleman with some early signs of Parkinson’s, he’d had a telephone appointment with a neurologist but nothing else.
“He’d then had a repeat prescription from his GP with some Parkinson’s medication on it. He queried it, saying this isn’t mine, but then got an email telling him he had Parkinson’s disease. He and his wife were in total shock.
“In ordinary times, there would be Parkinson’s nurses visiting to pick up on that, but in the absence of face to face appointments, SLTs were in a position of needing to offer more support and information about Parkinson’s in general. We know our stuff and we’re good at explaining things simply to people, so it was a natural extension of our skills.”
Against a constantly-changing situation during the pandemic, assessing the need for visits against the safety factor of not doing so, was a fine balance.
“All through the pandemic, face to face appointments have been risk assessed, and SLTs all over the country have risen to the challenge of using teletherapy when this has been the safer option,” says Jennifer.
“It’s a balance between reducing contact to keep people safe, and maintaining contact to keep people safe.
“Very often our swallowing assessments and interventions would be helping to prevent a hospital admission, so we were also doing our bit to keep people at home and prevent more strain on the hospital system, and keeping them out of the way of potentially catching COVID in hospital too.”
Jennifer, who has more than 20 years’ experience in the field, continued her appointments using PPE for the benefit of the patients who needed her.
“I became used to wearing a surgical face mask, plastic pinny and gloves, even though the mask made communication so much more difficult. I had a boot full of this equipment and many a day had to battle the North Sea wind while putting my pinny on!,” Jennifer recalls.
“But it was all such an unknown, and people were needing to be seen more than ever, very often I was all they had, so you just get on with it.
“It was only when I got my first vaccine that I realised what a relief it was. Working in the community, you rely on people reporting symptoms and of course many cases are asymptomatic. You have to hope your PPE really does keep you and everyone else safe.
“There were care homes I was in which had outbreaks two days later, and you maybe do think about your own safety, but I think it’s only on reflection you realise how anxiety-provoking it really was.
“I’m very pleased I have so many years of experience, I’ve seen a lot of things, so that helped me to get through that time – for those who were new to it, it must have been very hard.”
Music group launched to support BAME community
A music group established to support people living with dementia, memory loss and brain injury has received funding to launch an online project for the South Asian and BAME community.
Leicester Musical Memory Box (LMMBox) was founded in July 2018, and since that time has grown from one group in the city to six, providing interactive music sessions for people of all ages and backgrounds, including a group specific to the South Asian community.
The group – which has two staff members who are fluent in Gujarati, Hindi, Punjabi and Urdu – aims to provide the local community with a supportive network and a safe space to explore the unique challenges that a brain injury may bring to individuals, as well as their families and carers.
The new online music project is named ‘Geet Sangeet’ – translated as ‘Songs Sung Together’ – and will incorporate music and cultural references specific to the South Asian community, led by group leader Beena Masand from LMMBox.
Each session will begin with gentle exercises to warm up the body and brain, followed by singing and discussion about various music, songs, and media.
Attendees will also receive their own ‘musical memory box’ in a bag to help increase the interactivity of the sessions.
The project has received funding from the new Local Connections Fund, and is in collaboration with Headway Leicester.
Music has proven benefits for people with memory problems or a brain injury, including enabling people to connect with past experience and enabling freedom of expression, confidence and independence.
Attendance at the groups also helps to improve mood and reduce feelings of social isolation.
“We know we are providing a vital service to our members and receive enquiries regularly,” says Kyle Newman, group leader and co-director of LMMBox.
“In spite of the lockdown, we are thrilled to be able to once again provide a culturally specific group for the South Asian community.
“We also know that the group leader needs to come from that community and have the music and cultural knowledge to be able to engage participants effectively.”
“We are delighted to collaborate with LMMBox and reach out to more people across Leicester who have been affected by brain injury,” adds Mary Goulty, service manager at Headway Leicester.
“There is a clear need for a support service within the BAME community and that’s why we launched our BAME group last year, which is providing a vital lifeline to brain injury survivors we support and their families.”
To contact LMMBox, visit www.leicestermusicalmemorybox.co.uk
For support with brain injury in the Leicester community, visit www.headwayleicester.org.uk.
‘Huge positive progress – but change still needs to happen’
Having set up in private practice 22 years ago, SP Therapy Services has watched a burgeoning sector grow around it. Here, founder Susan Pattison shares her views on its progress, and why community rehab has an ever-increasing role to play.
“We’re no longer a child who is complaining without a strong voice – we’ve grown up into the teenager who can articulate themselves.”
Susan Pattison’s analogy of the specialist neuro sector is an interesting one.
From setting up in business in the very early days of development for private practice 22 years ago, she has watched a thriving industry grow up around her.
“When I first set up in business, it was said many times I was like gold dust,” she recalls.
“Setting up on your own wasn’t common at all, particularly as a neurophysiotherapist. At that time, physio was about sprained ankles, not complex brain injury cases.
“When I was in my previous job, I was discharging people home to nothing, which is why I wanted to set up in business. I never set out to be a business woman, I just wanted to do right by my patients.
“I still remember my husband and family shaking their heads and saying I had six months to make a go of it, it was not widely done at all. It was a risk.”
As a trailblazer for private practitioners, Susan has gone on to build a thriving neurological physiotherapy and occupational therapy business, SP Therapy Services.
From its base in Bury, its nine-strong team covers Cheshire, Lancashire, Greater Manchester, South and West Yorkshire, supporting patients in both clinical and home settings.
“Now, it feels like my business is just a little goldfish in a huge pond, it’s a long way from the early days but these are actually really exciting times,” says Susan.
“We have grown up as a community and are making a lot of noise in the right ways. We have UKABIF banging on Parliament’s doors, helping to make neurorehab a hot topic, we’ve got BABICM setting standards for brain injury case managers, we’ve got Headway with their list of solicitors – and everyone is working together to move forward.
“I think the private sector has now come up and is a beacon of light for the NHS, we respond to the need and are there in support.
“A huge amount has changed over the past 22 years, and it is still changing. We have to continue to change, to work hard and progress together.”
And that need for ongoing change is something Susan feels passionately about – particularly the need for investment in community rehab, to support the work of the NHS post-discharge.
“If we are going to invest in saving a life, then we need to ensure a quality of life for that person. These people need rehab to have that,” she says.
“We can’t keep front-ending and need to invest in the longer-term care once they are discharged into the community. Rehabilitation has to happen in people’s communities as that’s where they live their lives.
“But investment in community rehab can’t be seen as a luxury, or something that is nice to have. It’s absolutely critical to people and families being allowed to rebuild their lives.
“With the impact of the pandemic, hospital waiting lists are going through the roof, and that is going to be pushed out into the community.
“But with such a strong private sector now, which has grown from the child into the teenager, as I put it, the support is there, it’s in place. And we’ll keep being that beacon for community rehab, continuing to call for the investment is needs.”
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