Neuro-rehab professionals acted fast in the coronavirus crisis, according to Chief Allied Health Professions therapies advisor for the Welsh government, Ruth Crowder.
“Instantly, we realised the implications of the pandemic,” she says.
“We looked at what we could do remotely with services and developed a rehab framework really rapidly,” Crowder says. “We identified that this was going to become an issue, so Wales moved really quickly to implement a framework.”
The Welsh government supported the introduction of ‘attend anywhere’ video consultation and telephone advice for primary care across a range of services across several provisions, including numerous Allied Health Professionals in neuro rehab.
It’s been rolled out for a year to test its suitability, with a view to continue using it in the future, Crowder says.
“We introduced a number of electronic tools to assist people, including remote telephone assessments where people can phone up for advice whenever they need it, and some services put advisory videos online to help people undertake rehab in their own environment when they’re not coming into services.”
Most services looked at a major risk assessment of who needed to be seen because of an urgent or critical need, and who can be safely managed remotely, Crowder says.
“There were different tools around different ideas, so it was about matching tools to individuals. It’s important we don’t leave people out and alone but that everyone can equally access support.”
The rehab framework AHP published has considered four main population groups.
“We identified a need for rehab for those recovering from Covid-19, those admitted to hospital, and who were managed in community, and also a demand for people with other conditions who may have had services paused or delivered in different way.”
“There’s also potentially going to be rehab needs for those who may not have come forward but had developments during this period.
“A&E attendances went down, and we don’t know at the moment if there was a drop in incidents or if people didn’t present at services because of lockdown, so we don’t yet know what the rehab demand will be for that.”
The fourth group is the population that have been shielded and are isolating and probably haven’t undertaken as much activity as they normally would do, Crowder says, who were coping without intervention before but, as a result of reduced activity levels, have become more deconditioned.
“We’ll need to think carefully about what the demand is and how we respond to that with timely services.”
The experience of staff since the beginning of the pandemic, Crowder says, has been dependent on how services adapted in response to the initial crisis, and the rates of Covid- 19 cases in and around Wales and the kinds of surges that were anticipated or experienced.
Some Allied Health Professionals were redeployed to deal with acutely unwell people, and boards and trusts across Wales are now planning how they return staff to services, as well as how rehab services will meet demand.
“Our expectation of the pandemic is increased demand for neuro rehab, and growing evidence is showing the range of needs people have following Covid-19.”
However, the hard work and adaptability of professionals working across neuro rehab services has given Crowder confidence that the next challenges will be met.
“If any good comes out of this horrendous situation, it’s the way people have worked flexibly and creatively to identify the needs of patients. It’s been inspirational to be part of,” she says.
“Getting the framework up and running came down to an amazing collaborative and multi-professional approach.
It’s been a well-integrated process; not just clinicians, but also service planners and managers, who’ve worked as huge collaborative group.
“I’m the lead but that’s nominal – it’s been a huge team effort, really worked outstandingly, where working collaboratively across boundaries, keeping the patient centre of all planning, has been exciting, and I hope this continues.”
Non-invasive technique ‘could replace need for brain surgery’
The new PING approach could help treat some of the most challenging and complex neurological diseases
A new non-invasive technique has been developed to remove faulty brain circuits that could allow medics to treat debilitating neurological diseases without the need for conventional brain surgery.
If successfully translated into operating theatres, the breakthrough has been hailed as potentially revolutionary in the treatment of some of the most challenging and complex neurological diseases, including epilepsy, movement disorders and others.
The PING approach, developed by the University of Virginia and Stanford University, uses low intensity focused ultrasound waves combined with micro-bubbles to briefly penetrate the brain’s natural defences and allow the targeted delivery of a neurotoxin.
This neurotoxin kills the culprit brain cells while sparing other healthy cells and preserving the surrounding brain architecture.
“This novel surgical strategy has the potential to supplant existing neurosurgical procedures used for the treatment of neurological disorders that don’t respond to medication,” said researcher Dr Kevin S. Lee, of UVA’s departments of neuroscience and neurosurgery and the Center for Brain Immunology and Glia (BIG).
“This unique approach eliminates the diseased brain cells, spares adjacent healthy cells and achieves these outcomes without even having to cut into the scalp.”
PING has already demonstrated exciting potential in laboratory studies. For instance, one of the promising applications for PING could be for the surgical treatment of epilepsies that do not respond to medication.
Around a third of patients with epilepsy do not respond to anti-seizure drugs, and surgery can reduce or eliminate seizures for some of them.
Dr Lee and his team, along with their collaborators at Stanford, have shown that PING can reduce or eliminate seizures in two research models of epilepsy.
The findings raise the possibility of treating epilepsy in a carefully-targeted and non-invasive manner without the need for traditional brain surgery.
Another important potential advantage of PING is that it could encourage the surgical treatment of appropriate patients with epilepsy who are reluctant to undergo conventional invasive or ablative surgery.
A key advantage of the approach is its incredible precision. PING harnesses the power of magnetic-resonance imaging (MRI) to let scientists peer inside the skull so that they can precisely guide sound waves to open the body’s natural blood-brain barrier exactly where needed.
“If this strategy translates to the clinic,” the researchers write in their new paper, “the noninvasive nature and specificity of the procedure could positively influence both physician referrals for and patient confidence in surgery for medically intractable neurological disorders.”
“Our hope is that the PING strategy will become a key element in the next generation of very precise, noninvasive, neurosurgical approaches to treat major neurological disorders,” said Dr Lee, who is part of the UVA Brain Institute.
QEF’s accessible technology wins international awards
The new Care and Rehabilitation Centre in Surrey, developed by Queen Elizabeth’s Foundation for Disabled People (QEF), has won 2 international CEDIA awards for its innovative use of accessible technology, which was supplied by technology solutions partner Imperium Building Systems Ltd.
These awards recognise the improvement technology can make to the lives of disabled people, which is reflected at a UN event that forms part of this year’s International Day for People with Disabilities. The global UN awareness day today (December 3) highlights the challenges and discrimination disabled people face around the world, and pushes for positive change towards greater inclusion, accessibility and equality for disabled people.
This year on December 3, the UN is co-hosting an event specifically looking at ‘Reducing Inequalities through Technologies’ noting that: ‘persons with physical, sensory, cognitive/learning or invisible disabilities represent nearly 15 per cent of the world population’ 1 and that ‘for some kinds of disabilities, assistive devices/technologies are key “equalizers” that promote inclusion and full participation in all industries and dimensions of life’. 1
The event also highlights that ‘One billion persons with some form of disability can benefit from assistive technologies that can facilitate their social, economic and political engagement, including their participation in decision-making processes that affect their lives and ambitions’ 1
QEF’s Care and Rehabilitation Centre provides neuro rehabilitation for people after an acquired brain injury, stroke, incomplete spinal injury or other neurological condition and clients are supported by expert staff to relearn core skills, so they can rebuild their lives and be as independent as possible.
QEF’s vision for the new Care and Rehabilitation Centre was to use technology to give each person greater control over their personal space, no matter what a person’s impairment may be. It’s easy to take for granted being able to close the blinds when the sun is in your eyes or turn the lights off when you want to go to sleep – until you can’t do it for yourself. QEF wanted a system that empowered clients to have a greater sense of self-determination and influence over everyday activities during their rehabilitation.
Imperium developed the project with QEF, producing a cost-effective ‘smart home’ solution, using easily available technology that is adaptable to each persons’ specific requirements. Five connected smart devices have been installed in each bedroom which can be controlled in different ways; either with standard voice commands, pre-programmed accessible switches or programmable text to talk commands.
Ann, a client at QEF’s Care and Rehabilitation Centre, says: “I wasn’t sure about it at first – it was odd to sit in my room on my own and talk to something, but now I use it all the time. You can have the blinds down, lights on or off or the TV on or off. It’s another step on the journey of independence, so I don’t have to ask someone to do it for me.”
Chris Thorne, director of Imperium, says: “The technology we have installed for QEF will allow service users to have control over the lights in their room, temperature, day light via shading blinds, and audio-visual equipment. So, someone could stay in one position and manage their entire room, either with switches or voice controls. It also needed to be technology that service users could easily access after they left the service; creating independence that could continue beyond QEF’s walls.”
The international CEDIA awards recognise technical excellence and product innovation in the home technology industry. Imperium’s project with QEF was announced in November 2021 as winners in the ‘Multi Dwelling Unit Design’ category and also went on to win the overall award for ‘Life Lived Best at Home’ which reflects the project that gives the best experience for a client.
Judges for the Life Lived Better at Home award said: “This entry is outstanding for its sensitive and pragmatic response to the brief and for the way the technology meets the changing needs of the users. And all this achieved on an extraordinarily tight budget. I hope there will be many more projects like this in the future!”
Karen Deacon, QEF’s chief executive, says: “Our new Care and Rehabilitation Centre gave us an opportunity to use technology in an innovative way that would directly benefit clients as they relearn core skills. Adapting to life after an acquired brain injury is challenging for anyone and if technology can help give someone back their sense of control over everyday activities then we wanted to be able to offer that as part of our neuro rehabilitation programme.”
- Reducing Inequalities Through Technologies: A Perspective on Disability Inclusive Development https://www.un.org/development/desa/disabilities/wp-content/uploads/sites/15/2021/11/IDPD2021ConceptNote.pdf
Webinar to explore the future of brain injury rehab
Join our panel of expert guests as we discuss the challenges and opportunities in improving patients’ lives
The future of brain injury rehabilitation and how patients can be supported in new ways is to be examined by leading experts from across the sector at an event held next week.
Brain injury rehab has made huge strides over the years, innovating and developing to better meet the needs of people living with life-changing injuries.
Through changes in technology, developments in medicine and the advances in neurorehabilitation, brain injury patients should face an outlook which is better than ever before.
However, the lack of resource within health services, exacerbated by the ongoing impact of COVID-19 and mounting pressures on the NHS, mean that progress and change is not being seen at the rate many would hope for.
In 2020, the British Society of Rehabilitation Medicine (BSRM) identified the increased pressure on neurorehabilitation, highlighting the “unquantifiable additional case-load of patients with post-Covid disability presenting with a wide range of problems due to cardio-pulmonary, musculoskeletal, neurological and psychological/ psychiatric complications of the disease.”
In an upcoming webinar – What does the future of brain injury rehabilitation look like? – to be held on Wednesday next week (December 8th) and organised by NRC Medical Experts in association with NR Times, this matter will be examined to assess the scale of the challenge, the opportunities that exist, and what more can be done to better support patients.
The panel will comprise:
- Dr Edmund Bonikowski, founder of NRC Medical Experts, who will chair the event
- John Davis, consulting principal lawyer at Slater + Gordon
- Catrin May, co-founder and director of Breakthrough Case Management.
- Ian Pearce, director of NeuroProactive
The live hour-long event, from 4.30pm to 5.30pm, will include a panel debate, with questions welcomed from the audience.
“Health and social care services have been under increasing pressure from an ageing population for decades and this has now been exacerbated by the disruption created by COVID-19,” says Edmund.
“Brain injury rehabilitation services have always been poorly resourced in the UK, and are now under increased strain while professionals are diverted into the acute management and rehabilitation of COVID-19 patients.
“It is essential therefore that we consider how to improve service delivery models so that people with brain injury do not fall further behind in the queue.
“Technological innovation in its many forms offers much potential here, but realising this will be a substantial undertaking for which we are as yet ill-prepared.
“During this webinar we will explore some of the major opportunities and problems.”
To attend the webinar, registration is required in advance. To sign up, visit here
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