Brain Injury Rehab - Depression and Treatment after ... · Web viewJayne Brake (Conference...
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JOURNAL NO 48 DECEMBER 2015 EDITION
Transcript of Brain Injury Rehab - Depression and Treatment after ... · Web viewJayne Brake (Conference...
JOURNAL NO 48 DECEMBER 2015 EDITION
Contents
Letter from the Editor 3
Specialist Section Neurological Practice Information 4
Contacts 5
National Executive Committee Reports 8
Clinical Forum Reports 12
Regional Reports 16
Changes to study evening charges for members 19
Summarised Annual Report COTSS-NP 2014-2015 19
SSNP Conference 2016 advert 20
West Midlands Cognitive Rehabilitation Workshop advert 21
SSNP Annual Conference Report 2015 23
Development of a TBI Pathway within a Major Trauma Centre 36
International Perspectives on Dropped Head Syndrome for People with Motor 39Neurone Disease
Splinting for the Prevention and Correction of Contractures in Adults with Neurological Dysfunction: Practice Guideline for Occupational and Physiotherapists 41
A Guiding Hand on How to Do Constraint Induced Movement Therapy 43
Cognitive Rehabilitation - External Memory Aid Training after TBI 44
Brain Injury Rehab - Depression and Treatment after Traumatic Brain Injury 45
Dealing with the Unexpected - Executive Function 46
Starting Out in Stroke Course, Danesbury 47
Requests 48
A survey exploring the current practice in the assessment and provision of assistive devices for people with neurological disability by health care professionals in United Kingdom
Discharge Liaison Occupational Therapy
Newsletter Submissions 49
Adverting in the Newsletter 49
CPD Record of Significant Reading 50
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Letter from the EditorDear All,
Welcome to the December Edition 2015, Journal No 48, Specialist Section Neurological Practice News and thank you to all the members who have contributed to this newsletter, this is much appreciated. I hope you find this edition of interest.
We are pleased to announce that the ‘Occupational Therapy and Neurological Conditions’ book is now at the proof-reading stage and is due to be published in Spring 2016. The front cover will be purple with the same design as the second edition of ‘Occupational Therapy and Stroke’. This is to indicate that the books are part of a series. We will circulate further details when they become available.
Dates for your diary – 2016 SSNP Annual Conference will be held in Scotland in the Edinburgh area on Thursday 29th and Friday 30th September. The conference will focus on Stroke. Details and the programme will be circulated in due course.
Please remember that as SSNP has on-line membership, each member’s year is according to the date they emailed their membership application. Consequently, December editions of the newsletter will be available for members who have joined by 30th November and June editions will be available for members who have joined by 31st May. This ensures that all members receive two editions of the newsletter each year. The deadline date for submissions for the June edition will be 30th April 2015.
Best wishes,Judi Edmans Dr Judi Edmans, SSNP Newsletter Editor
SSNP Email AddressesBrain Injury Clinical Forum: [email protected]
Chair: [email protected] Forum Lead: [email protected] Organiser: [email protected]
Education: [email protected] Long Term Conditions Clinical Forum: [email protected]
Membership enquiries: [email protected] Secretary: [email protected]
Newsletter: [email protected]: [email protected]
Regions: [email protected]: [email protected]
Stroke Clinical Forum: [email protected]: [email protected]
Website: [email protected]
DisclaimerPlease Note …..
The Editor reserves the right to edit all material submitted. The views expressed in this journal are not necessarily those of the Editor nor those of the Specialist Section Neurological Practice. Any advertising or courses contained within this journal does not imply endorsement of the advertised product by Specialist Section Neurological Practice or its members. Whilst every care is taken to ensure that the data published is accurate, neither Specialist Section Neurological Practice nor the Editor can accept responsibility for any omissions or inaccuracies, or for any consequences thereof.
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What is Specialist Section Neurological Practice?Introduction
Specialist Section - Neurological Practice is one of the largest specialist sections of the College of Occupational Therapists (COT). We are proud to have a growing membership who actively support and promote new ideas within the field of neurological practice. Neurological Practice provides professional and clinical information relevant to occupational therapy for people with neurological conditions. Our Aims
To inform and promote best practice in occupational therapy for people with neurological conditions
To develop awareness of up to date approaches to assessment and treatment of neurological conditions as applied to occupational therapy
To promote / encourage continuing education and development of research, guidelines and standards in the field of neurology
How we work
An elected and co-opted National Executive Committee (NEC) represents the membership. The NEC works to promote best practice by actively contributing to policy making on a national and multi-professional level. The NEC responds in conjunction with COT to national initiatives and government directives relevant to neurological practice (including the development of national standards and guidelines) drawing on the expertise of its membership to provide a well-informed response. SSNP also promotes research into a range of issues faced by people with neurological problems, seeking to establish a more robust evidence base.
Networking
Regional groups throughout Britain provide a local focus for the work of Neurological Practice. Many groups are actively engaged in running a programme of events during the year that promote and facilitate a valuable exchange of knowledge and expertise. The NEC aims to run two to three national training events per year to ensure and promote best practice.
Clinical Forums
Clinical forums have been developed to provide a specialist focus for occupational therapists working with specific neurological conditions such as stroke and brain injury. Benefits include: networking with fellow professionals working in the same speciality; an opportunity to contribute to the national agenda and development of occupational therapy specific standards of practice and guidelines in conjunction with COT; enabling occupational therapists to benchmark their services and help guarantee equity and quality of service provision nationally.
Member benefits
Access to a national representation with a regional networking structure
Online registration and management of membership via COT linked website
Up to date information, news and events on the COT Neurological Practice website
A copy of a bi-annual newsletter which contains practice related articles, conference and study day reports and research developments
Reduced fees for Neurological Practice study days and conferences and attendance at regional meetings
Regular e-mail bulletins updating members of national committee and other Neurological Practice business
Raising standards
Not only do we have a new name but also a new face, aiming to be more dynamic and passionate about promoting Best Practice for Occupational Therapists working in the field of Neurology. Catching on to the 21st century technology, we are the first COT Specialist Section with a paperless administration system, one example of being one step ahead in new advances.
If you are an occupational therapist or support worker with an interest in Neurological Practice, we are the Specialist Section to meet your professional learning and development needs, as well as enabling you to share best practice.
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National Committee 2015-2016
Chairperson / COTSS-NP Business & Clinical Forum Lead - Jenny PrestonConsultant OT, Douglas Grant Rehabilitation Centre, Ayrshire Central Hospital, Kilwinning Road, Irvine, KA12 8SSTel: 01294 323040 Email: [email protected]
Treasurer – Jo Evans4 St Peters Road, Birkdale, Southport, Merseyside PR8 4BYTel: 01704 566876Mobile: 07973 633049 Email: [email protected]
Minutes Secretary – Vanessa AbrahamsonCentre for Health Services Studies, George Allen Wing, Cornwallis Building, University of Kent, Canterbury, Kent CT2 7NFTel: 01227 827760 Email: [email protected]
Regions Officer– Susan HughesTel: 07879 400175 Email: [email protected]
Public Relations Officer / Conference Organiser – Rupert KerrellDepartment of Allied Health Professions, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1QUTel: 01227 767700 x2035 / Mobile: 0780 182 3869 Email: [email protected]
Website Officer – Jill Ferrie42 Dartmoor Road, Westbury, Wiltshire, BA13 3UTTel: 01373 858257 / 07876 032036 Email: [email protected]
Newsletter Editor – Judi EdmansDivision of Rehabilitation and Ageing, University of Nottingham Medical School, Queens Medical Centre, Nottingham NG7 2UH
Email: [email protected]
Research & Development Officer – Jane HorneDivision of Rehabilitation and Ageing, University of Nottingham Medical School, Queens Medical Centre, Nottingham NG7 2UHTel: 0115 8231458 Email: [email protected]
Education & Practice Officer – Clare TaylorProfessional Lead for Occupational Therapy, Bournemouth University, R601, Royal London House, Christchurch Rd, Bournemouth BH1 3LTTel: 01202 962136 Email: [email protected]
Membership Enquiries:Braintree Management Services, PO Box 315, Leatherhead KT22 2BA
Email: [email protected]
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Chairs of Clinical Forums 2015-2016
Brain Injury Clinical Forum – Donna MalleyThe Oliver Zangwill Centre for Neuropsychological Rehabilitation, Princess of Wales Hospital, Lynn Road, Ely, Cambs. CB6 1DNTel: 01353 652165 Email: [email protected]
Stroke Clinical Forum – Louise ClarkHead of Occupational Therapy Rehabilitation/Stroke, South Wing Level 1, Dorset County Hospital, Williams Avenue, Dorset DT1 2JY
Email: [email protected]
Long Term Neurological Conditions Clinical Forum –Alison Wiesner Lead Occupational Therapist, Hertfordshire Neurological Service, Danesbury Neurological Centre, School Lane, Welwyn, Herts AL6 9SB Tel: 01438 841840 Email: [email protected]
Regional Representatives 2015-2016East Anglia – Angela Lee
Email: [email protected]
Isle of Man – Vacant
London – Trudi PickinEmail: [email protected]
North – Lynsay DukeAdvanced Occupational Therapist, Walkergate Park, Centre for Neurological Rehabilitation and Neuropsychiatry, Benfield Road, Newcastle upon Tyne NE6 4QDTel: 0191 287 5044 Email: [email protected]
North East – Philippa ShawEmail: [email protected]
North Thames – Jacquie PottsAcquired Brain Injury Team, Jacketts Field Rehabilitation Unit, Jacketts Field, Abbots Langley, Herts WD5 0PA Tel: 01923 299124 Email: [email protected]
North West – Jorgie WilliamsonThe Willows, Ashton Road, Norley, Frodsham, Cheshire, WA6 6NY.Tel: 01928 787617 Email: [email protected]
Northern Ireland – Vacant
Oxford – Alison BraggOT Department, Neurological Rehabilitation Service, Oxford Centre for Enablement, Windmill Road, Oxford, OX3 7LD
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Tel 01856 737382 Email: [email protected]
Scottish East – Sheena GlenYoung Disabled Unit, Liberton Hospital, Lasswade Road, Edinburgh EH16 6UBTel: 0131 536 7847Fax: 0131 536 7846 Email: [email protected]
Scottish North – Lynne Ewing Email: [email protected]
Scottish West – Vacant, Not an active region at present but contact can be made through:
Email: [email protected]
South East – Danni Williams Email: [email protected]
South West – Beth CookeEmail: [email protected]
Trent – Vacant
Wales – Sally Lloyd Email: [email protected]
Wessex – Jill Ferrie42 Dartmoor Road, Westbury, Wiltshire BA13 3UTTel: 01373 826252 / 07876 032036 Email: [email protected]
West – Heidi Bowcher Dean Farm, Court Road, Brockworth, Gloucestershire GL3 4QZ Tel: 0794 193 2470 Email: [email protected]: skybowchsky
West Midlands – Susan WillsEmail: [email protected]
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Plea to Regional RepresentativesWe would like to take this opportunity to urge you to please inform SSNP NEC (Susan Hughes or
Jenny Preston) if you change your Regional Representative.
Whilst we endeavour to keep our Regional Representatives list up to date, we cannot do this if we are not told of any change.
COTSS-NP National Executive ReportsChairs Report
As I put the finishing touches to the Annual Report I reflect on another year of activity within the COTSS-NP. It is often said that as you get older the years go faster, so I guess I’m reaching an advancing age as this year has definitely whizzed past before my eyes.
Yet again it has been a busy year and I know the NEC and our Regional Reps are feeling a significant increase in the amount of activity expected them. I know I say this every year, but sometimes it is easy to forget that they all contribute on a voluntary basis, and just like all our members they are also juggling with the challenges and demands of their day jobs within clinical, academic, research and education. I know we don’t always get it right for our members but please be patient with us, this is a transitional period and honestly we have our members’ interests at heart. I would like to take this opportunity to thank the NEC for their unrelenting support, even when I am demanding more of them, they still respond politely, although I’m sure at times they could see me far enough! Thank you.
One of our greatest achievements over the last couple of years has been in the development of the relationship between the NEC and the Regional Reps. Susan Hughes has been pivotal in supporting this, and it was quite apparent to me at the Annual Conference in September just how much the Regions were now part of the COTSS-NP family. That feels very positive for me as I fully appreciate how much activity takes place within the Regions and how critical this is to the success of the COTSS-NP.
I was talking to someone recently who asked me if there were any ‘lighter’ roles on the NEC and at one time I would have been able to say ‘yes’. That is no longer the case and every single member of the Committee is contributing immensely in their own way and I want to formally acknowledge the sterling work of Alison, Clare, Doreen, Jane, Jill, Jo, Judi, Louise, Rupert, and Vanessa. As many of you will be aware sadly this year we are losing Doreen Rowland, OBE as our Chair of the Brain Injury Forum after 11 years. Doreen has been an outstanding advocate for Brain Injury and the COTSS-NP and her retirement will create an immense gap within the NEC. We would all like to thank Doreen for her outstanding contribution and to wish her well in her
retirement. Just in case you thought it was that easy, Doreen will continue to support the Brain Injury Forum as an ordinary member! As one door closes another opens and in true succession planning (typical Doreen) Donna Malley was being prepared for the role and I am delighted to welcome Donna as the new Chair of the Brain Injury Forum. Donna has shadowed Doreen at the NEC meetings for the last year, and despite knowing what lies ahead Donna was still keen to join us. Welcome aboard Donna.
This year has seen the COTSS-NP continue to provide clinical and strategic leadership, raise the profile of occupational therapy in neurology, and remain ambassadors for the profession while developing resources and ensuring value for money. We believe that we are achieving this and I hope you agree. You will see a summary of the Annual Report within this newsletter but the fuller version is available on the website at http://www.cot.co.uk/cotss-neurological-practice .
It is always hard to pick out highlights from the year but for me some of our real achievements this year have been: the submission of the manuscript for our next book “Occupational Therapy and Neurological Conditions” which should be on sale in the Spring 2016; the recognition of Professor Pip Logan and Anne Brannigan OBE, in the COT Annual Awards; and of course our very own Thérèse Jackson delivered the Elizabeth Casson Memorial Lecture at the COT Annual Conference.
As I complete my first term of office and move into the second as Chair of the COTSS-NP I reflect on my own ambitions when I took on this role. My main aim was to provide transformational leadership which would guide the COTSS-NP as a credible and contemporary organisation recognised as a key player in the field of neurology. While we may not be quite there yet I remain annoyingly excited and passionate about this role. Thank you for helping me to realise this key ambition and making me feel proud of our group.
Best Wishes for Christmas and the New Year
Jenny PrestonChair
Treasurers Report8
I was aware at conference that my Treasurers Report was short and did not allow for any substantiation of the changes and figures presented. I therefore hope that the following will clarify any concerns or queries.
COTSS-NP’s closing balance as of the end of August 2015 is £73,367.
COTSS-NP’s accounts, along with all other specialist sections, were amalgamated into the COT central accounts in 2012-13. The transition into working in this way with COT has been insightful but as Treasurer, one of the main issues I have observed has been the difficulty in reconciling our accounts against our budget due to the difference in the nominal coding used by COT and the specific work areas the COTSS-NP budget allocations needed to utilise for our annual work plan.
Last year following a meeting I had with COT finance representing the specialist sections they agreed that each specialist section could be allocated a ‘number’ and 10 codes within which they could allocate their work plans.
It was agreed that in 2015-16 COTSS–NP would ‘test’ this system on behalf of other specialist sections and to enable COT to have some working knowledge of how this would look.
Our specialist section has been allocated the number 81 and we have been allocated 10 codes (A- J).
This is not actually enough for all the projects that we allocate work and therefore finance to but we have agreed to proceed in this way initially.
I have set our budget out this year against the codes so that by the end of the 2015/16 financial year (30th September) we will be able to reflect on our 2015/16 budget spend. This will allow the NEC to evaluate how / where membership money is being directed and reflect on whether this has provided COTSS-NP membership with more access to the information they require in the format they require be that through education, standards and guidelines, conferences, R&D.
COTSS-NP new codes set against activity with reference to COT nominal code
COTSS-NP New Code Income Activity Expenditure Activity
A : Regional activity Evening courses, day training
Evening courses, day training, expenses for travel of speakers, speaker fees, venues, refreshments
B: Conference activity Delegates, exhibitors, inserts, advertising
Venue, accommodation / rooms, speakers fees, NEC, forum and RR attendance, travel expenses, conference PR gadgets, conference gifts, conference meal, conference refreshments
C: Stroke forum Meetings travel expenses, accommodation, subsistence
D :BI forum Meetings travel expenses, accommodation, subsistence
E: LTC forum Meetings travel expenses, accommodation, subsistence
F: Education Delegates, exhibitors
Venue, speaker fee, speaker expenses, printing, refreshments, accommodation, supporting other educational activities and professional conference attendances
G: Membership Members, capitation
Administration of membership
H : Administration Organisation of events, online payment, certificates, feedback, venues
I: Royalties Books Updating, honorariumJ: Other NEC travel expenses, R&D, printing, subsistence,
accommodation, travel and expenses associated with R&D
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Income and Expenditure Budget planned for 2015/16 allocated against new codes
COTSS-NP New Code Income £ Expenditure £
A: Regional activity Regions income 11,000 Regional expenses 6,000B: Conference activity Annual conference 14,000 Annual conference 14,500C: Stroke forum Stroke forum meetings 3,000D: BI forum BI forum meetings 3,000E: LTC forum LTC forum meetings 3,000F: Education BI study day 4,000 Study day 1 (BI forum) 2,500F: Education Education 9,000 Education 7,000F: Education Study day 2 SOS
(Stroke)3,000 Study days 3 (SOS) 3,950
F: Education Study day 3 (LTC roadshows)
F: Education Rewrite of Parkinsons guidance
600
G: Membership Membership subscriptions
29,000 Membership administration
11,000
H: Administration Secretarial support 7,000I: Royalties Publications
(Neuro book)2,000 OT and Neurological
Conditions book2,000
I: Royalties Publications (Stroke book)
2,000
J: Other Advertising / Newsletter
1,000
J: Other NEC 4,000J: Other R&D 10,000J: Other P.R. 1,500J: Other Neuropsych conference 500J: Other UKSF annual conference 500J: Other Reserve 5,000J: Other Bank interestJ: Other COT capitation 1390.50
TOTAL income 76,390.50 TOTAL expenditure 85,050.00
If you have any questions regarding the new system or the COTSS–NP accounts Jo Evans would be happy to discuss on 07973 633 049.
Jo EvansTreasurer
Regional Reps Coordinator ReportWe are nearing the end of another year. I would like to extend my thanks to the Regional
Reps and their committees for their commitment and enthusiasm once again! I
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think it is important for members to be aware that their Regional Reps and committee members volunteer their time to be in their posts and organise and arrange local events for members. We often hear from members that they are frustrated at the lack of events running in their regions. Your region is only going to get stronger if we get members more involved. There are regions being managed by one person and they would really value support. If you are able to help get in touch! Get involved and make your region flourish! It is a great networking opportunity. Areas that need some assistance are:
East Anglia Scottish East South East South West Wales West
You can contact me in the first instance if you think you want to get involved and I can put
you in touch with your local rep. Email me at [email protected]. We have a completely vacant post for Regional Rep in the TRENT region. Come on someone, I know you are out there! We will support you every step of the way and there are no expectations for what you need to achieve and you can develop the role and the region at the pace you feel comfortable with.
I would like to welcome and thank Angela Lee, who has taken on the post of Regional Rep for EAST ANGLIA and Danni Williams who has taken on the role of Regional Rep in the SOUTH EAST. Get behind them folks!
Best wishes
SusanRegional Reps Coordinator
Research and Development Report
Hi all,
Brain Injury Conference September 2015
Lovely to meet up with those of you who not only were successful with abstract submissions for the recent conference, but were able to articulate your research projects with impact during the poster presentation session. All those who were involved in the organisation of the conference were really impressed with your presentation skills to such a large audience. I know that the content of the posters, are presented elsewhere in this newsletter, suffice to say, thank you for your contributions and hopefully your experience might encourage other occupational therapists to follow in your footsteps at the next conference.
Members Neurological Research Projects
We are always delighted to facilitate and promote research projects through our membership. I would like to take this opportunity to remind you of the criteria that needs to be met, prior to accessing our database in order to recruit occupational therapists to your research.
1. You need to be a member of COTSS-NP, and we will need proof of membership
2. Your research needs to be considered of an appropriate quality and topic for neurological members to participate
3. You need favourable ethical approval; therefore a copy of an approval letter is requested.
Once this simple criteria is in place. We will be happy to facilitate your requests. Recent research projects that have accessed our database have included, evaluating current practice in acquired brain injury, equipment provision for people with neurological disability and the use of Saebo orthoses in upper limb rehabilitation, to name a few examples. We look forward to hearing from researchers.I was fortunate to receive the new researcher’s 2015 award from the College of Occupational Therapists this summer, for my presentation at the COT conference. It was a welcome bonus in the final throws of writing up my PhD. It was fantastic to receive the award, and see the College looking so brightly decorated with flowers and engaging people.
I am looking forward to having more time to engage in the research agenda of COTSS-NP as we move towards 2016. Apologies if the report seems short this time.
Look forward to hearing about any research initiatives and ideas that we might be able to take forward.
Jane HorneResearch and Development Officer
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Website Coordinator ReportThank you to all those members who have supported the changes over the past twelve months with regards to the use of social media. We now have 176 members on our closed Facebook page with some interesting posts and responses. If anyone would like to be involved with this page please email [email protected] and an invite will be sent.
I am conscious that not all members will use all social mediums and the Twitter account will be developing alongside changes to the website.
In the coming weeks there will be a dedicated page on the website for news and another for events. To date these two items have been
included at the bottom of the first page of our website and are not clearly seen by visitors.
Can I encourage you all to take time to look at the website pages as there will be regular updates of information, events and useful links.
Please support the development of our social mediums. I am sure all members would welcome the sharing of information and learning and I’d welcome any relevant information, links or summary of learning that we can include in one of our mediums.
Jill Ferrie Website Coordinator
Clinical Forum ReportsBrain Injury Forum
We have had a busy six months organising the SSNP National Conference which took place in September (there is further information in the Newsletter about the conference). The feedback we have received has been very good overall regarding quality of speakers and content and there was a really positive atmosphere across both days. It was good to have a mix of both established speakers and those new to presenting at conferences, and we are grateful to everyone who participated in making it such a supportive, stimulating and successful event.
We received really helpful feedback on the evaluation forms regarding: Availability of slides and handouts in
advance rather than following the conference
Formalising time for networking opportunities
The committee will take this on board and plan to discuss this further with the NEC when organising future events.
Conference delegates should now have been able to access all presentations via Conference Collective.
In response to the SSNP Membership survey, we have also been working on a questionnaire to send to members to identify key priorities for training and information topics you would like SSNP to address in the coming years. This will be available later this year for all members to access via SurveyMonkey. It is a real opportunity for you to have your say in how we deliver information and training to members, so please do complete the survey.
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The Brain Injury Forum will be meeting in the New Year to plan the programme for 2016. We aim to run a study day, topic yet to be confirmed. There was a lot of discussion at conference about fatigue management and the NHS and case management interface. These two topics will be on the agenda for discussion in addition to responses to the questionnaire.
As many of you are aware, we hold a data base of clinicians who are able to respond to requests for information and input into national guidelines, policy documents and queries from members. We are keen to hear from anyone who would like to be on the contact list and have an input into BI issues as part of their professional development activity. We are looking for people with some experience in BI and an ability to respond quickly to the timeframes which are usually very short. We would be grateful if you could contact us if you would like to join this group. We will need to share your e-mail with the other members of the group so you need to let us know you are happy for us to do that.
At this year’s Conference Doreen Rowland stood down as Brain Injury Forum Chair. Donna Malley was unanimously appointed to the Chair Position. Doreen has been the chair of the forum for a number of years and is delighted Donna has been appointed to take
her place. Doreen will remain on the committee as retiring chair, as per NEC tradition, to provide some continuity. The committee wish to thank Doreen for her commitment and hard work to the forum for so many years and value her continued input on the committee to ensure we maintain the high standards of work she has aspired to throughout her career.
As of October 2015, the Committee is therefore:
Donna Malley (Chair) Ruth Tyerman (Secretary) Jayne Brake (Conference organiser) Angela Birleson (Education and Training) Julie Phillips (Research and Development) Doreen Rowland (Ordinary member /
Retiring Chair)
As a committee, we really value your feedback at any time to ensure we are addressing the priorities of our membership, so please do get in contact with us via Twitter (@COT_SSNPBIforum) or e-mail.
We want to wish everyone a Merry Christmas and Happy New Year.
Donna Malley ChairDoreen Rowland OBE retiring chai
Long Term Conditions Forum
Alison Wiesner Chair OT Lead Herts Neurological Service. Special
interest in PD, MS, stroke, self-management of health
Kate Hayward Secretary Senior Occupational Therapist, Vocational Rehabilitation Service, UCLH London. Special interest in vocational rehabilitation, MS, brain tumours and neuro-muscular conditions
Rebecca Devlin Research Birmingham and Solihull Mental Health Foundation Trust. Special interests in epilepsy, non-epileptic attack disorder, sleep disorders and Huntington's Disease.
Pam Bostock General member Consultant Occupational Therapist – Neurology. Team lead for Adult Ability Team – (progressive neurological conditions in East staffs). Special interest in MS and MND and self-management. Co-Chair of TiMS (Therapists in MS)
Nicky McNair General member Clinical Specialist Occupational Therapist, Regional Environmental Control Service Romford Essex with special interest in MND
Louise Oakley General member Birmingham and Solihull Mental Health Foundation Trust. Clinical specialist in neuropsychiatry with special interest in
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Huntington’s disease, epilepsy, non-epileptic attack disorder and functional neurological symptoms.
Could this be you??
Vacant Education post
Recently the LTC forum has: responded to members enquiries on
splinting, Huntingdon’s Disease positioning, outcome measures, and hypertonia
contributed to a briefing paper for OTs on Motor Neurone Disease
commented on the NICE Multiple Sclerosis Guideline consultation
started work on a Long Term Conditions course aimed at OTs new to LTCs
scoped what resource leaflets are available for OTs and people with LTCs
Some of the committee have also contributed to the Occupational Therapy and Neurological Conditions book
Sadly the committee is saying goodbye for the present to Fiona Kelly, who has contributed to the LTC committee since 2009. We thank her for all her efforts as education officer, and we hope we will see her again in the future if her time allows.
That has of course left a vacant post on the committee, and we have sent an invitation for OTs who specialise in the area of Long Term Conditions to apply to the committee. If you
are interested in this post, or would be confident and able to assist the committee by commenting on NICE and COT guidelines in your area of expertise, please do contact us with your details. All the posts on the SSNP committees are voluntary, but involvement does give you a chance to influence OT development at a national level, and is also an opportunity to demonstrate your personal development to the HCPC. We need as wide a representation as possible, both geographically and regarding type of expertise, due to the wide variety of neuro long term conditions. We have had some interest, and we may have filled the post by the time the newsletter goes to print. We would suggest you need at least 5 years clinical practice within your area of expertise, evidence of presenting on topics or input into special interest groups, and a commitment to evidenced interventions. See the above current committee special interests and work base – can you offer something extra to the committee or alternatively to an “expert database”?
Alison Wiesner
Stroke ForumCommittee members Louise Clark: Chair Thérèse Jackson: National guidance /
clinical practice officer Pip Logan: Research officer/rep for UKSF Karen Clements: General member/RCP
guideline link Charlie Chung: General member Jules Jeffreys : Secretary Jennifer Crow: Education officer
EducationStarting Out in Stroke (SOS) course updateThe next SOS course is scheduled to take place on 7th November in Hertfordshire. Contact: Alison Wiesner – [email protected]
Results back from the last SOS survey were presented at the May meeting. As a result of comments from this survey, we will be trialling a two-day course in Dorset next year.
COTSS-NP Stroke ConferenceThis will take place on 29th and 30th September 2016 in Scotland, venue to be confirmed.
ResearchPip Logan represents the COTSS-NP stroke forum on the UKSF committee. The committee runs a stroke conference in December and also oversees national stroke education.
The next conference is in Liverpool at the beginning of December. https://www.stroke.org.uk/professionals/uk-stroke-forum/uksf-conferencePip is always keen for ideas for next year’s conference or for potential speakers. Please get in touch - [email protected]
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Karen Clements is a member of the Intercollegiate Stroke Working Party (ICSWP) with Professor Avril Drummond, representing occupational therapists.
FES A consensus statement for the use of electrical stimulation for the upper limb was published earlier this year and reported in the June 2015 edition of OT News. To develop the consensus statement, a literature search was carried out and the evidence was used to provide specific guidance on the following applications:
The use of ES to restore motor control The use of ES for shoulder subluxation
following stroke parameters of treatment contraindications Electrical stimulation devices available
A Scotland-wide survey was undertaken which asked clinicians on whether they use ES and the factors which enhance or inhibit use. The development group which consists of an occupational therapist and physiotherapists has now met again to plan the next stage of development. This will include work to increase the awareness and application of the consensus statement to clinical practice and a second cycle of the audit to evaluate the impact achieved by the consensus statement.
The consensus statement can be accessed by using the link: Scottish Stroke Allied Health Professionals Forum Electrical Stimulation Consensus Statement
Selfhelp4stroke This is a free self-management website for anyone who has had a stroke. It was developed by Chest Heart & Stroke Scotland in partnership with NHS Scotland, stroke service users, Edinburgh University with funding from the National Advisory Committee for Stroke in Scotland. Thérèse Jackson and Charlie Chung from COTSS-NP provided input from the professional perspective. Information is displayed in video, audio and interactive formats offering support and helpful techniques from real experiences of people
who have had a stroke. Many of the resources are downloadable. This is a free resource with no login requirement, adverts or pop ups – www.selfhelp4stroke.org.
Dopamine Augmented Rehabilitation in Stroke(DARS) TrialThe study results were presented at the European Stroke Organisation Conference in Glasgow in April of this year and there was no difference in the level of movement recovery in the two groups (Cocareldopa v Placebo). End of study publications are awaited.
OCS Care A pilot study for developing and evaluating a care pathway for cognitive problems after stroke (Oxford Cognitive Screen-care), to assess the effects on outcome after stroke of giving a cognitive screen and developing a care pathway informed by any cognitive deficits. Follow up at 6 months at home.
Clinical Practice
Prescribing The College of Occupational Therapists are asking for any occupational therapists who are in a position where increased prescribing possibilities would be of benefit to contact Karen Tancock. Currently occupational therapists can supply or administer under a PGD or PSD e.g. mental health can prescribe if necessary and are first responders – also some hand and neuro specialists. This may apply for example to occupational therapists in the same role as nurses, such as care coordinators, where nurses can prescribe but occupational therapists can’t.
Other newsResponses to the NICE stroke standards update were sent to the working party on behalf of the membership.
Many congratulations to Thérèse Jackson for presentation of the Casson Award. She will be speaking at the SSNP conference next September. And finally - Happy Christmas to you all!
Jules Jeffreys, Secretary
Regional Rep ReportsLondon
We have had a number of successful study evenings over the past six months which have
included: visual assessment and treatment; environmental controls used with people with neurological disorders; an introduction to the new splinting guidelines; disorders of
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consciousness; and a brain injury survivor’s story. The London committee changed dramatically in January 2015, with many of the established members leaving and a large influx of new and enthusiastic volunteers arriving, this movement has continued with three further members joining last month. I am very grateful for the all the people who have supported London SSNP through volunteering their time on a regular basis but would like to remind all members of this region that we rely on suggestions for topics as well as knowledge of speakers to maintain the standard of education that we have become used to. If anyone knows of any speakers, for example a clinical lead with a particular specialist interest or anyone that has completed research or further education in a specific subject we would love to hear from you. As a committee we are very aware that the usual study day has not taken place and we are hoping to rectify this in the New Year, details will be available before the end of the year.
We have only had one study evening so far since the trial of free study evenings for members started; we will be monitoring attendance of those who have booked places and thinking of the best ways to get the maximum attendance for more popular study evenings. We welcome feedback on how you think this is going and will feedback to the executive committee as appropriate.
Trudi Pickin
North We are pleased that as a Region we are back up and running again after committee maternity leaves. We have had two evening events so far in 2015 including: Goal negotiation and writing; and Use of applications in neurological rehabilitation; with a mix of members and non-members attending. There was lots of lively discussion and sharing of information. We even had a prize of a Specialist Sections mug, post-its, torch and pens for the best goal written. Our next evening event is Occupational Therapy and Neuropsychiatry on the 19th November at Walkergate Park so look out for the flyer. For those who are technology savvy we want to try and be more present on social media so please ‘like’ the COTSS-Neurological Practice page where we hope to advertise more of the events and we will soon be setting up a SSNP North Twitter account – once we’ve figured out how!! Don’t worry the flyers will also be coming out via the normal routes. We are always keen for new ideas as well as new venues to host our events and committee
members so please do contact us on [email protected]. Lynsay Duke
North EastThis year the North East group have run a couple of large events including: Starting Out in Stroke; and Splinting with Harrisons. There are several smaller events scheduled for 2016 that will be circulated soon including, but not limited to: upper limb anatomy and treatment; vocational rehabilitation and relevant legislation; and mental capacity.
Our committee are looking for new recruits and we would welcome people to become more involved. Please contact us at [email protected] and keep an eye out for our events via email, SSNP Facebook and Twitter soon!
Phillipa Shaw
North ThamesWe have two new members for the North Thames SSNP committee and are beginning to rise from the ashes. In July 2015 we ran a very useful session on sleep problems with Dr Hugh Selsick from the National Hospital for Neurology Sleep Clinic. This was hugely informative with lots of practical ideas and I would recommend this topic to other regions. Dr Selsick recommended the book ‘Overcoming Insomnia and Sleep problems by Colin Espie’ if you would like further information.
We are also lucky to have the Starting out in Stroke course running at Jackets Field in Watford on November 7th 2015 and this is fully booked. We plan to run our next event in the New Year, more information to follow.
It was great to meet representatives from the other SSNP regional groups at conference. Following on from discussions there, would members from local regions like to check that they have North Thames as a secondary region as we can only circulate adverts regarding our events to members on our list from Braintree. As always, new members for the committee are very welcome, particularly from the Essex end of North Thames, we are aware that we are rather Hertfordshire-centric at present. Lastly, thank you to everyone involved for a great conference!
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Jacquie Potts
OxfordThe Oxford region has held two training events since the last newsletter in April. The first of which was a successful half study day at the Oxford Centre for Enablement entitled ‘Information Technology in Neuro-rehabilitation, Access for All’. Speakers included Steve Wiseman, of Steve Wiseman Associates. Steve provided an overview of the wide range of technology, focusing on access for all. Clara Buckle, Senior Occupational Therapist in the Community Head Injury team in Buckinghamshire gave a talk about the various apps used by the service. Clara also discussed current and future projects the team are running to implement use of technology more within the service. Philippa Feltham White presented case study examples of technology in practice. The final speaker of the day was Rob Livesley from Clinical Computer Sciences at the Oxford Centre for Enablement. Rob provided an overview of the service provided in Oxford and an update of the national guidelines for access to technology for communication. The event was well attended and all speakers well received by the group.
The region also held a study evening on 22nd September, entitled ‘A case example of a self-management programme within a neurological day hospital setting’. Lynda Pearce, Highly Specialist Occupational Therapist and Rachel Tams, Clinical Psychologist, both from the Oxford Centre for Enablement lead the evening. The session was enjoyed by those in attendance.
The Oxfordshire committee has planned one further event for November, focusing on sleep and brain injury. Details of this event will be circulated in due course however the event is likely to be held on 24rd November 2015, at the OCE in Oxford.
The committee welcomes any new members or ideas for forthcoming events. Please contact Alison Bragg Oxford Regional Rep on [email protected] or on (01865) 737380 if you would like to become involved either as part of the committee, to suggest a future topic for presentation, to present a topic yourself or to host an event.
Alison Bragg
WalesThe Wales Region is in the process of re-establishing its SSNP group. We are working
on drawing up a database of member’s interests and areas of expertise to enable us to network successfully.
The committee for Wales is to be chaired by myself Sally Lloyd SSNP Regional Rep. I have had volunteers for Vice-chair - Stephanie Gething, Treasurer - Julie Thomas and Secretary - Annest Owens. If anyone would like to be a part of the committee please contact myself [email protected] you would be very welcome.
There is continuing work on improving stroke services in Wales. The Wales stroke OTs are in the process of developing an all Wales stroke assessment. This will provide unity across Wales and an opportunity for OTs to embrace the introduction of electronic records.
During the recent Welsh stroke conference several poster presentations were submitted from members detailing: A trial to evaluate an extended rehabilitation service for stroke patients; Is early supportive discharge team for stroke effective; Development of the all Wales stroke OT assessment; Cardiff and Vale early supported discharge service for stroke; and An international standard set of patient centred outcome measures after stroke where Stephanie Gething presented on the topic.
As a group we are also planning to run the SOS course later in the year and a study day to look at a varied variety of interventions used by OTs throughout Wales to provide a networking opportunity.
Sally Lloyd
West Midlands The West Midlands committee have re-evaluated how to cater for member CPD and learning needs within the region. This is as a result of an email sent out earlier in the year to canvas opinions, attendance at the regional reps meeting in May and also the AGM at the brain injury conference last month.
We will be aiming to run approx. 2-3 large events per year (such as two-day courses) and 3-4 smaller evening CPD type events. This should hopefully cater for members who have difficulty getting time off work or funding for courses but will still enable them to contribute to their own CPD and learning. These evening events will be free to SSNP members so hopefully we will see lots of you there.
We are actively engaging with other speakers and in organising courses on the following:
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Braintree training in 2016 – one day workshop - ‘How to do cognitive rehabilitation’ on 12th January – see website and flyers sent out by region. Advertising also in the newsletter.
SOS - TBC
May I take this opportunity to inform members that I am stepping down as regional rep. Having been in this position for too many years to count, I am handing the reigns over to Susan Wills, [email protected]. Susan is a Senior Occupational Therapist at the Brain Injury Rehabilitation Trust (BIRT) at West Heath House. She has been on the committee for a while and I know will serve the role well. I will continue to be an active member on the committee and look forward to meeting some of you in January at the Braintree course.
The committee continue to try and run and organise courses but again would request that regional members please get in touch with what they would like to see organised and if there are any offers of venues/hosting, these would be very welcome. Please can we also request that members keep their email details up to date in the SSNP membership database, as this is the only way we can circulate information to all members
If anyone would like to attend future committee meetings or if members would like any further information regarding any of the events taking place, please contact Susan by e-mail. We now have six members on the committee but would like to see this grow and any input would be extremely helpful
Nicci O’Neill
WestBefore the summer, we did manage a couple of get-togethers, one networking evening at a
pub in Cheltenham :-), but didn't quite get the momentum going to actually plan anything yet. Thank you to all those who have attended so far and for all the proposals of ideas.
Adrienne Capener at The Dean Neuro Centre in Gloucester has kindly agreed that The Dean can be used (free of charge!) for any meetings we need at the Gloucester/ Cheltenham end of things.
I would like to invite anyone based in Bristol to come forward with a proposal with a second meeting point in Bristol; it doesn't have to be free (though that is of course preferable). More importantly, parking should be as easy as possible and preferably free as well.
Therefore, we would like to aim for four dates in the coming New Year, 2016, for evening meetings, and to put one study day together.
So.....we need one or two working parties for this.....certainly one Cheltenham based committee, and possibly a subcommittee in Bristol, who could be my 'co-chair'....any volunteers please come forward!! This group cannot get off the ground without your help :-)
Proposals for ideas so far: Goal setting in neuro rehab Updates in stroke rehabilitation Debate: to splint or not to splint...that is
the question!! Share a case study evening or skype
group discussion
ANY OTHER IDEAS PLEASE COME FORWARD!!
ANY TAKERS FOR THE TREASURER ROLE: Be rewarded with a free SSNP membership!!
Heidi Bowcher
Changes to study evening charges for membersAs a Specialist Section we continue to review our current activities and aim to ensure that our members get value for money for their annual membership fee.
We would also like to encourage non-members to join the Specialist Section. To this affect, and with guidance from the College of Occupational Therapists who governs all the Specialist Sections, the following changes will take place from 1st October 2015.
Attendance at small, locally organised regional meetings and study
evenings/afternoons will now be free for members to attend.
This will now be included in all communications regarding the advertising of regional events, and you will be asked to provide evidence of your membership of COTSS-NP. Non-members of COTSS-NP will be charged £10 to attend an event.
This arrangement will be in place for one year, during which time it will be monitored and reviewed to determine if this is sustainable for
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the ongoing future. The NEC are very keen to hear your feedback and the impact of this on attendance at regional meetings. If you have any comments please feed this back to your Regional Representatives in the first instance.
We hope this will ultimately be positive for all our current and future members.
COTSS-NP NEC
Summarised Annual Report COTSS-NP 2014-2015NEC Meeting Dates
27th January 2015, COT London 28th May 2015, COT London 24th September 2015, Double Tree by Hilton Hotel, Nottingham 25th September 2015 Annual Review Meeting, Double Tree by Hilton Hotel, Nottingham
Membership Data
BAOT/COT OTMember
StudentMember
AssociateMember
OverseasMember
Others Total Membership Number
Year Start1.10.14 835 50 2 1 3 891
Year End30.9.15 795 29 4 6 834
Activity
Supporting members practice, CPD and research
Continually updating COTSS-NP webpages, Facebook , Twitter
Produced two newsletters per year Annual conference Developed practice guidelines for splinting
neurological conditions Written book entitled ‘Occupational Therapy
and Neurological Conditions’ Improved clinical knowledge through SOS Extensive regional network of educational
events Repeated Technology in Brain Injury the
OT’s ever expanding role
Providing Leadership and increasing the profile of the profession
Advocate for members and their clients/patients within COT organisation and business
Represent COT as requested at events of relevance to the practice and research of occupational therapists working with people with neurological conditions
Disseminate and coordinate responses to national consultations
Continue to support COT in promoting NICE guidelines on neurological conditions
Raise the profile of the profession and the value of occupational therapy
Forge alliances which will promote the profile of occupational therapy
Responses to consultations:
• Responded to Children and Young People with Acquired Brain Injury, Current Practice in Occupational Therapy
• Responded to NICE Stakeholder Engagement Exercise MS
• Responded to NICE Stakeholder Engagement Exercise Stroke
• Responded to COT Falls Guideline• Responded to MS Trust Draft Report on
Survey of Allied Health Professionals working in MS
• Responded to NICE draft MND Guideline
Sustaining an organisation that is fit for purpose through good management and stewardship
Monitor Braintree membership administration services
Monitor income/expenditure against budget forecast and achieve break even at end of year
Representation at COT UK Branches Forum Produce annual report as required by COT
and present at AGM Retiring members to facilitate handover of
roles and responsibilities Ensure successful succession planning for
NEC Monitor changes in management of COTSS-
NP finances Regional Reps Workshop
Sustain and increase the membership of the COTSS-NP
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Review interaction and membership with regions and COT regional officers
Promote benefits of joining COTSS-NP at COT Annual Conference and relevant events
Promote the role and benefits of Clinical Forum membership
Work together with Braintree Membership Services to ensure satisfaction with provision
Responded to Membership Survey
A copy of the full annual report is available at http://www.cot.co.uk/cotss-neurological-practice
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COTSS-NP West Midlands Present
How to Do Cognitive Rehabilitation Workshop
By Kit Malia from Brain Tree Training
Date: Tuesday 12th January 2016 10am-4pm
Venue: Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB
£70.00 SSNP members £110.00 non members
This one day interactive workshop is suitable for professionals working with adults who have cognitive problems following brain injury.
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Annual Conference
and Exhibition
2016 This year the focus will be
on StrokeThursday, 29th
and Friday, 30th
September 2016
The 2016 conference will be held in Scotland in the Edinburgh area.
The Stroke Forum and NEC are currently
finalising the exciting programme and the
exact location but you should now save the date in your diary!
Updates and details about the location,
speakers and programme will be
provided by email, on our Facebook page and via Twitter so be sure to follow us via these social media avenues.
Right now it’s time to plan the study leave and budget for the annual conference
The course focuses on practical activities that can be used in the rehabilitation of attention, visual processing, information processing, memory and executive functions.
For further information on content: http://www.braintreetraining.co.uk
For more information contact: Nicci O’Neill at
nicci.o’[email protected] or07919 015166
Application form for 1 day ‘How to do Cognitive Rehabilitation’ Workshop
(12th January 2016)
Name
Job title
Email address
Telephone no:
Workplace address
COTSS-NP membershi
p no:
Please tick appropriate fee:
£70. 00 SSNPmembers
£110.00non members
PLEASE NOTE THAT WE DO NOT ACCEPT PAYMENT BY BACS.CHEQUE ONLY
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Please send cheques in with your application form made payable to:COT Specialist Section Neurological Practice
Return application forms & cheque to:
Nicci O’NeillOccupational Therapy Services, South Suite
Queen Elizabeth Hospital Birmingham,Mindelsohn Way, Edgbaston,
Birmingham B15 2WB
ArticlesSSNP Annual Conference 24-25 September 2015
Double Tree by Hilton Hotel Nottingham - Gateway, Nottingham
The SSNP Annual Conference was held at the Double Tree by Hilton Hotel Nottingham - Gateway, Nottingham and organised by the SSNP Brain Injury Forum. The focus was on the delivery of occupational therapy services to people living with an acquired brain injury, their families and carers within a challenging political, social and economic context. The conference was attended by 89 delegates with 16 speakers and 10 exhibitors.
There was a great atmosphere at the conference with lots of networking opportunities and discussions between delegates, speakers and exhibitors. We have received lots of positive feedback about the conference and currently are reviewing evaluation forms to guide future conferences and study days. We would like to thank everyone who organised and attended the conference.
Oral Abstracts100 years of brain injury rehabilitation: how far have we come and how far to go? Prof Barbara Wilson, Clinical Neuropsychologist - The Oliver Zangwill Centre for Neuropsychological Rehabilitation
This presentation begins with a brief history of rehabilitation. Modern rehabilitation for survivors of brain injury, began during World War One, continued in World War Two and, further progressed with the
development of holistic programmes as a result of the Yom Kippur War in 1973. We continue with a discussion of the current state of neuropsychological rehabilitation (NR). It is concerned with the amelioration of cognitive, emotional, psychosocial and behavioural deficits caused by an insult to the brain. It is NOT synonymous with recovery (i.e. getting back to what one was like before the injury or illness) and it is NOT synonymous with treatment (treatment is something we do to or give to people). Rehabilitation IS a two way interactive process whereby people disabled by injury or disease work together with professional staff, relatives and members of the wider community to achieve their optimum physical, psychological, social and vocational well-being. NR is (a) influenced by a number of theories, models and frameworks (b) evidence based (at least to some extent) (c) patient oriented and (d) able to improve quality of life. The presentation concludes with a consideration of how NR might progress in the future.
Disorders of consciousness from guidelines to practice Helen Gill-Thwaites, SMART Developer - Gill-Thwaites & Elliott Consultants Ltd and Royal Hospital for Neuro-disability London
The patient in Vegetative State (VS) and Minimally Conscious State (MCS) present with a complex range of both clinical and ethical challenges for those who care for them. There is a
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need for a highly skilled multi-disciplinary team to ensure accurate repeated assessment over time to provide accurate diagnosis and suitable planning for the future.
The 2013 Royal College of Physicians’ National Clinical Guidelines for Prolonged Disorders of Consciousness (2013) set out to identify the most recent clinical and legal developments such as the principles of the Mental Capacity Act 2005. The guidelines provides and outline of the definitions and criteria for diagnosis; describe the clinical assessment; describe the care pathway; address the ethical and medico -legal issues and consider end of life decision including treatment planning and care.
This presentation will summarise these developments and factors, describe the need for highly skilled assessment and explore the implications of the new guidelines on clinical practice. Who pays and why does it make a difference? Issues arising when private Case Managers work alongside NHS Rehab Teams Jackie Parker, Managing Director – JS Parker Ltd
NHS OT ‘The Case Manager is asking me all sorts of questions about this patient. I don’t have time for this.’ ‘It feels like I am being criticised.’ ‘Who is she anyway and what authority does she have to be involved with our
patient?’ ‘I feel under a lot of pressure and under scrutiny.’ ‘What is a Case Manager?’ ‘This Case Manager works for a legal firm.’ ‘We have discharge plans in the place. The whole team is agreed. So why is there a need for this Case Manager?’
Private Case Manager ‘No one from the NHS team will speak to me. I am being passed from pillar to post.’ ‘No one is returning my calls or answering my emails.’ ‘No one will tell me the plans.’ ‘I hear about MDT meetings after they have taken place. I am not invited to attend.’
Have you felt or said any of the above? This presentation will set out what can go wrong between a private Case Manager and an NHS team and seek to find solutions and promote effective practice, keeping the patient/client’s needs at the centre.
Upper limb splinting after brain injury – the lived experience Angela Lee, Occupational Therapist - The Colman Centre
for Specialist Rehabilitation Services, Norfolk Community Health and Care NHS Trust
As an Occupational Therapist working with brain injured individuals (in & out-patients) I have a particular interest in upper limb splinting to
facilitate independence to improve an individual’s quality of life; such as relieving pain and engaging in activities meaningful to them.
My driver behind completing an MSc in Clinical Research in 2013/4 was to explore my own professional conflict between empirical evidence versus my anecdotal experiences and the documented controversies surrounding upper limb splinting for acquired BI individuals.
Whilst I was studying for my MSc, the new guidelines for therapists regarding splinting for the prevention and correction of contractures were being revised by COT and CSP, following the cross-sectional survey by Kilbride C et al 2013, of contemporary splinting in the UK for adults with neurological dysfunction. This survey showed therapists still actively advocated upper limb splinting even though systematic reviews by Lannin NA (2003), Katalinic OM (2011, 2010) and Tyson SF (2011) concluded from the papers they had examined that splinting showed no significant statistically evidence for splinting to prevent nor treat contractures.
I initially started searching for qualitative research papers published exploring BI individual’s upper limb splinting experiences from their perspective and found very little reference to this. Therefore I was keen to take the opportunity of a NIHR funded CLAHRC fellowship to carry out a qualitative research project to explore this aspect further.
Concussion – A growing problem? Not as simple as a definition Col Alan Mistlin, Consultant Rheumatology and Rehabilitation Medicine - Defence Medical Rehabilitation
Centre, Headley Court
Mild traumatic brain injury/concussion has become the ‘new’ injury. A review of the incidence, diagnosis
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and why it has come into the public eye. Is it worth $750 million?
“It’s like a wave that sweeps over you out of nowhere”: Understanding fatigue after brain injury Donna Malley, Occupational Therapy Clinical Specialist - The Oliver Zangwill Centre for Neuropsychological Rehabilitation
Assessment and management of fatigue following acquired brain injury (ABI) is complex and challenging. Despite persistent fatigue being frequently reported by people following an ABI and impacting rehabilitation outcomes and their quality of life, evidence to guide clinical interventions remains inadequate. Survivors of brain injury report a lack of understanding and attention to this symptom. Fatigue following ABI is considered to be multifactorial, with biological, physical, psychological and social factors involved. A more coherent understanding of the relationships between factors associated with persistent fatigue following ABI to ensure personalised and proportionate assessment and intervention is required. This presentation will share current evidence, implications for assessment and management, a clinically useful model and ideas for intervention. Specifically it will discuss:
• What is fatigue? • Why is it important to address as part of
rehabilitation? • Who may be vulnerable to experiencing
fatigue? • How do we assess it? • What can we do to help individuals
manage it? • How do we evaluate outcomes of
intervention?
Deprivation of Liberty – the current position and spotting the priority cases Yogi Amin, Partner and National Head of Public Law - Irwin Mitchell LLP
The Supreme Court’s decision in the case of Cheshire West [2014] UKSC 19 has opened up before the court scrutiny of other similar cases, involving those who are mentally incapacitated and are potentially being deprived of their
liberty unlawfully. As a result many thousands of cases across the country have been brought purview to this significant case.
Yogi Amin will discuss and address the current position in respect of the deprivation of liberty safeguards, the key elements to take into account when considering the issue of deprivation of liberty and how to spot these priority cases.
Return to work: “I could not have done it without you” Dr Andy Tyerman, Consultant Clinical Neuropsychologist/ Head of Service - Community Head Injury Service, Buckinghamshire Healthcare NHS Trust An example will be presented to illustrate what can be achieved when all relevant parties
(person, family, brain injury rehabilitation team, vocational rehabilitation team and employer) work together to assist someone with severe traumatic brain injury (TBI) to return to work. Central to progress in
rehabilitation and a successful return to work was the contribution of the Occupational Therapist.
The client was working full-time when she incurred a severe TBI, orthopaedic and internal injuries in a road traffic accident. She was in neurosurgical intensive care for 16 days and in hospital for 11 weeks. She attended the in-patient rehabilitation service as a day-patient for a month prior to transfer to the Community Head Injury Service. After a period of core rehabilitation she progressed to the ‘Working Out Programme’ for specialist assessment and graded brain injury vocational rehabilitation before a phased return to the workplace: first in a voluntary capacity, then for a work trial and finally back to full-time time paid employment at 2.5 years post-injury.
The vocational rehabilitation process will be illustrated through edited video extracts with the client, her mother, the employer and the Occupational Therapist who supported her return to work.
The use of Fit Notes and the AHP fitness for work report Dr Carol Coole, Senior Research Fellow - University of Nottingham Dr Julie Phillips, Outreach Occupational Therapist and Research Occupational Therapist - Nottingham Traumatic Brain Injury Team/ University of Nottingham
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The Statement of Fitness for Work (more commonly known as the ‘fit note’) replaced the sickness certificate in 2010 to encourage GPs to focus on what a patient is able to do at work, so avoiding unnecessary sickness absence and facilitating return to work. However research to date suggests that it is not being used as intended, and is not reaching its potential.
The AHP Advisory Fitness for Work Report was launched in March 2013, having been developed in consultation with the Department of Health and the Department for Work and Pensions by the Allied Health Professions Network (specifically occupational therapists, physiotherapists and podiatrists). Early piloting suggested that the report would be a useful resource, however as yet there is no evidence as to the extent of its use, or its usefulness.
Carol Coole and Julie Phillips will present an overview of both tools, their potential use by occupational therapists in the rehabilitation of patients who have had a brain injury, and summarise the obstacles and facilitators to their use in practice.
Commissioning and developing a new ABI Service Lynne Barr, Design and Management of Inclusive environments, MBA. Independent Commissioner - Advancing Potential
The commissioning and delivering of a new ABI services is not for the faint hearted or impatient people. I will endeavour to help you understand how/where you can influence.
Recipe ingredients: Logical, rational, evidence based
argument the ‘right thing to do ‘ , credibility and integrity of those involved, risk taking relationships: meeting needs of various
stakeholders at different times team work passion and continuity to make a
difference
Method: Mix well together with an ability to learn, rise to the challenges and develop at an amazing rate!
Bake for 6 months at a moderate temperature (mobilisation period)
When ready: release to the public, launch on TV and manage contract (implementation)
Review: evaluation of the process for all involved (12 months)
The methodology of this development will be revealed through 2 key roles and the relationships between them.
Professional input: what happened ‘on the ground’ by an occupational therapist and her team leader, a neuropsychologist and other clinical professional people in a virtual network.
Commissioning perspective, roles and processes: across CCGs, within commissioning, market engagement with providers.
Defining the Interventions of an NHS Community Neurological Occupational Therapy Service Fiona Fletcher and Sarah Heathcote, Specialist Occupational Therapists - South Tees Hospitals NHS Foundation Trust
In the current environment of an open market for health services and promotion of ‘any qualified provider’ it is essential that services are transparent regarding their service provision.
A community neurological occupational therapy service carried out a service review. The catalyst for embarking on this work was twofold; firstly the changing commissioning climate and secondly the opening of an independent neuro-rehabilitation unit in the immediate locality. The aim was to raise the profile of the OT service and define the intervention it provided.
The review began by looking at the existing referral criteria. The service wanted to identify what was specialist and unique about its provision so a retrospective analysis of referrals for a twelve month period was undertaken. A systematic approach to a service re-launch was undertaken: a report was compiled and widely distributed; new service information was produced and distributed to stake holders.
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The presentation will describe the process and outcome of the service review, the streams of intervention defined and how this information was used to promote and re-launch the service in a competitive market.
Cost-outcomes and good value in brain injury rehabilitation Dr Andrew Worthington, Director of Clinical Services and owner of Headwise - Headwise Ltd
Healthcare resources are a scarce commodity and increasingly clinicians are having to take account of cost-effectiveness as well as clinical outcomes. This presents problems in neurorehabilitation where evidence is
often lacking and therapists may be unfamiliar with the means to critically evaluate their practice and demonstrate good value. This talk will cover the basics of economic appraisals, consider evidence for positive cost-outcomes and examine factors linked to best practice in rehabilitation.
Working with families affected by traumatic brain injury Dr Peter Hewitt, Clinical Psychologist - Oxford University Hospitals NHS Trust
The often devastating effects of traumatic brain injury are not only felt by those who suffer the injury, but also those closest to them. Understanding the impact of traumatic brain injury on families and working alongside
them to reduce distress and mobilise resources represents a huge challenge for healthcare professionals. In this presentation, Dr Peter Hewitt aims to outline why this challenge is worth undertaking. The effects of traumatic brain injury on the family system are first explored by sharing accounts of individuals and families and by looking at current research in this area. Issues including changes to relationships and roles, expectations of both recovery and rehabilitation and experiences of ambiguous loss are touched on. Ways of supporting family members who may be experiencing high levels of distress are then explored, before looking at benefits, limitations and important considerations when involving family members
in rehabilitation. Some of the challenges facing professionals in maintaining good working relationships with family members are also presented, along with developments in psychological interventions aimed at supporting families affected by traumatic brain injury.
Endocrine issues following brain injuryProf Mike Barnes, Professor of Neurological Rehabilitation/ Group Clinical Director - Christchurch Group
It has not been sufficiently recognised that after brain injury about 40% of people will develop symptoms of reduced pituitary function. This is most common in the days/weeks after injury but can occur in a sizeable number of people in the long term. The
symptoms can be highly varied and are often confused with the other common problems after brain injury such as fatigue, weakness, poor sexual functioning, etc. It is essential to recognise the problem as hypopituitarism is easily and successfully treated. This talk will highlight the problem and outline the symptoms and the diagnostic pathway and treatment possibilities.
Poster abstractsCaring hands research project – a pilot study Lyndsay Duke, Lucy Gibbison, Vicky McMahon – Northumberland, Tyne and Wear NHS Foundation Trust
Introduction
Caring for complex hands tightened by spasticity can be problematic. Opening the hand, keeping the skin clean and intact, cutting nails and reducing pain becomes more difficult if muscles are tight and short.
Methods
A pilot study recruited a total of 28 paid carers and 7 residents who had identified problems with a tight hand. Carers interviewed pre and post education about their confidence, skill and knowledge. Two education sessions: One discussing skin and nail care, consent, challenging behaviours, splints, pain and quality standards. The other joint with the resident, to address individual issues around opening the hand, hand care, positioning and splint use.
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Resident’s assessed pre/post intervention using outcome measures to indicate hand/nail condition, pain, quality of life.
Results
On average staff confidence improved 1.75 points and skill improved 1.96 points. Awareness of problems experienced by the residents had improved and they felt challenging behaviours reduced. Residents reported improvements in confidence in staff handling, pain and anxiety/depression, hand condition.
Nine narrative themes identified from the interviews: Pain, resident communication, skin integrity/hygiene, physical handling interventions, staff confidence, resident involvement/engagement, staff approach/attitude, challenging behaviours and staff training.
Conclusion
Specialist education in handling complex hands and individualised care planning are required to support staff to ensure that care of the complex hand is completed well. Involvement of staff and residents can lead to changes in confidence and outcomes. Greater literature on the topic is needed.
A smart phone as a memory aid following acquired brain injury Jenny Whitehead, Teesdale University, The Brain Injury Rehabilitation Trust
Introduction
Memory impairment is common following acquired brain injury (ABI), and leads to reduced independence. Limited improvements can be made to impaired memory, requiring clients to learn to live with associated difficulties by employing compensatory strategies. It appears smart phones are being used more in practice as a compensatory memory aid, although there is a lack of supporting evidence. To explore this gap in the literature, this study critically explores the experience of Occupational Therapists (OT’s) using smart phones as compensatory memory aids with clients following ABI.
Methods
This qualitative study used semi-structured telephone interviews with five participants to explore individual OT experiences. All interviews were audio-recorded and transcribed by the researcher. Thematic
inductive analysis was used to identify themes by coding data.
Results
Five key themes emerged from the data in relation to a smart phone as a memory aid: advantages of using a smart phone; disadvantages of using a smart phone; factors influencing the use of a smart phone; the use of a smart phone; and input from the OT and the clients’ team.
Conclusion
One memory aid cannot meet the needs of all clients. A client centred approach is required, as well as consideration of multiple factors. The vital contribution of this research identified if a smart phone is deemed appropriate, multiple benefits can be seen. Further research is required to explore its use with the ABI population, with this being viewed as a valuable contribution to a current gap in the literature.
Using the Kinect™ to measure changes in upper limb movement after stroke: an observational case series study Camilla Booth, Homerton University Hospital
Introduction
Kinematic analysis is increasingly utilised to evaluate upper limb (UL) function after stroke; however, it remains uncommon in clinical settings due to cost and expertise required. The inexpensive Microsoft Kinect™ is a potential alternative as it creates a 3-dimensional map of anatomical landmarks represented numerically or visually, and without the setup required for traditional kinematic measures.
Method
This NRES-approved observational case-series study evaluated whether the Kinect™ could detect changes in UL function following rehabilitation and whether these changes were associated with outcomes on the Action Research Arm Test (ARAT). Three stroke participants receiving rehabilitation were evaluated at baseline and at 7-weeks. Movement time, hand trajectory length, average hand velocity, trunk displacement and head displacement were obtained from four UL movements performed in front of the Kinect™.
Results
A bespoke visualisation programme rendered avatars from the raw Kinect™ data, revealing inaccuracies in tracked hand co-ordinates.
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Chi-square analysis indicated that movement type and the UL performing the movement influenced data accuracy. All participants demonstrated a statistically significant improvement using the kinematic variables of movement time, trunk displacement and head displacement. Two participants demonstrated a clinically meaningful change on the ARAT. Conclusion
Kinect™ data accuracy influenced study outcomes; therefore, it was not sufficiently reliable to detect change in UL function. Because of the discrepancy across participants, the outcomes detected on the ARAT do not conclusively compare to the kinematic results from the Kinect™. However, the bespoke data visualisation application could contribute to movement analysis in the clinical setting alongside established outcome measures.
A long term evaluation of vocational outcomes following traumatic brain injury: a five year study at the Defence Medical Rehabilitation Centre (DMRC), Headley Court Dr Emer McGilloway; Mrs Doreen Rowland; Ms Lizeli Olivier; Ms Jennifer Duncan-Anderson, Headley Court
Introduction The effectiveness of Vocational rehabilitation (VR) is well documented within Mental Health (1) and musculoskeletal conditions (2). Research surrounding VR and brain injury (TBI), by contrast, remains in its infancy. It is recognised that returning to work (RTW) is a key objective for TBI survivors, with research (3) indicating that the RTW rates across samples with mixed injury severities are as high as 70% (4). By contrast, the rate of maintaining employment for those with moderate to severe injuries lies between 34 - 46% (5). (6). It is therefore, return to work, but additionally the ability to remain in employment that should be used to evaluate success.
Methods
A semi structured telephone interview was used to collect employment data from patients discharged from the specialist military rehabilitation centre. Scores were reflected using the Mayo Portland inventory and the VIS Scale. To date this data has been collected for 2012 and 2013, with data collection planned until 2016 to evaluate employment status at 12, 24 and 36 months.
Results
Data collected from 2012/2013, provided a 43.35% response rate, with 65.3% in employment at 2 years post discharge. This included 7.7% in training, and 34.6% returning to pre-existing job roles.
Discussion
Vocational intervention is integral to the rehabilitation offered within this service, with support including therapist follow up, resettlement support, work placements, vocational counselling, employment fairs and work trials. To date, results of this study indicate a higher rate of sustained employment than has previously been documented in a civilian population.
References
Bond GR, Drake RE, Becker DR (2008) An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal 31(4):280-290
Wilkie R (2012) Improving work participation for adults with musculoskeletal conditions. Best practice and research. Clinical Rheumatology (2012) 26(5) 733-42
Van Velzen JM, van Bennekom CAM, Edelaar MJA, Sluiter JK, et al. (2009). How many people return to work after acquired brain injury? A systematic review. Brain Injury 23(6):473-88
Shames J, Treger I, Ring H, Giaquinto S. Return to work following traumatic brain injury: Trends and challenges. Disabil Rehabil. 2007;29(17):1387–95 [PMID: 17729084] http://dx.doi.org/10.1080/09638280701315011 18
Kreutzer JS, Marwitz JH, Walker W, Sander A, Sherer M, Bogner J, Fraser R, Bushnik T. Moderating factors in return to work and job stability after traumatic brain injury. J Head Trauma Rehabil. [PMID: 12802222] 2003;18(2):128–38. http://dx.doi.org/10.1097/00001199-200303000-00004
Drebing CE, Bell M, Campinell EA, Fraser R,
Malec J, Penk W, Pruitt-Stephens L. Vocational services research: Recommendations for next stage of work. J Rehabil Res Dev. 2012;49(1):101–20
Clinical reasoning regarding the use of psychosocial occupational therapy
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interventions in traumatic brain injury: A Delphi study Chloe Nelson, Occupational Therapy student, Sheffield Hallam University
Introduction
The greatest cause of economic burden following TBI is the cost of neurobehavioural disability, causing disturbances in mood, behaviour and executive function which can be socially disabling and isolating (James and Young 2013, Oddy and Ramos 2013, Worthington et al. 2006). Cattelani, Zettin and Zoccolotti (2010) argue rehabilitation of emotional, behavioural and social disturbances are considered supplementary rather than a core part of most rehabilitation programmes. American and Canadian OT studies indicate an increase in psychosocial interventions in TBI. However, there is minimal research into the distinct value of OT interventions in this area in the UK. The study aims to explore consensus between UK OTs regarding the application of psychosocial interventions and forms part of the researcher’s masters degree.
Methods
The study will utilise the Delphi method; a systematic approach to facilitating group agreement through multiple rounds of questionnaires and controlled feedback. Participants will be recruited through the COT-SSNP via an invitation email. Participants will complete three rounds of online questionnaires which will explore the factors guiding clinical reasoning, perceptions of the efficacy of psychosocial interventions and the challenges to implementing psychosocial interventions. Data will be collected from June-October 2015.
ResultsResults are expected to indicate the degree of consensus between participants regarding the application of psychosocial OT interventions in TBI in the UK.
Conclusion
The study is expected to contribute to the UK literature base on the use of psychosocial interventions in OT. The questions are designed to encourage reflection on and debate of current practices which will contribute to CPD.
References
Cattelani R, Zettin M, Zoccolotti P (2010) Rehabilitation treatments for adults with behavioural and psychosocial disorders following acquired brain injury: A
systematic review. Neuropsychology Review, 20, 52-85
James A and Young A (2013) Clinical correlates of verbal aggression, physical aggression and innappropriate sexual behaviour after brain injury. Brain Injury, 27 (10), 1162 - 1172
Oddy M and Ramos S (2013) The clinical and cost-benefits of investing in neurobehavioural rehabilitation: A multi-centre study. Brain Injury, 27(13-14), 1500-1507
Worthington A et al (2006) Cost-benefits associated with social outcome from neurobehavioural rehabilitation. Brain Injury, 20 (9), 947-957.
Exhibitors The COT Specialist Section Neurological Practice was pleased to extend its appreciation to the following exhibitors who supported this event.
The Bambach Saddle Seat Ltd Address: Unit 6, Prospect Business Park Langston Road Loughton Essex IG10 3TR Tel: 0800 581108 Website: http://www.bambach.co.uk
Gill-Thwaites & Elliott Consultants Ltd Tel: 07946 404 897 Website: http://gillthwaitesandelliott.com
Headway Address: Bradbury House 190 Bagnall Road Old Basford Nottingham Nottinghamshire NG6 8SF Tel: 0115 924 0800 Website: https://www.headway.org.uk/
Ipsen Limited UK Address: Ipsen Limited 190 Bath Road Slough SL1 3XE Tel: 01753 627777 Website: http://www.ipsen.co.uk/
Jacqueline Webb & Co. Address: Jacqueline Webb & Co Ltd 18-22 Barnack Business Centre Blakey Road Salisbury Wiltshire SP1 2LP Tel: 01722 329 156 Website: http://www.jwebb.co.uk/
Krysalis Consultancy Address: Unit 2, The Business Courtyard Pyle Farm, Marl Pits Lane, Trudoxhill Frome, BA11 5DL Tel: 01373 837263
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Website: http://www.krysalisconsultancy.co.uk/
Ottobock UK Address: 32 Parsonage Rd , Englefield Green, Egham, Surrey TW20 0LD Tel: 01784 744900 Website: http://ottobock.co.uk/
Pearson Assessment Address: 80 Strand, London WC2R 0RL Tel: 0845 630 88 88 Website: http://www.pearsonclinical.co.uk/
Revitalise Address: Business Design Centre, 52 Upper St, London N1 0QH Tel: 0303 303 0145 Website: http://revitalise.org.uk/ Unite Professionals Address: 17a High Park Place Southport PR9 7QP Tel: 0844 824 9007 Website: http://www.uniteprofessionals.co.uk/
Brain Injury Forum
Best Poster winner Jenny Whitehead
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Development of a TBI Pathway within a Major Trauma Centre (MTC)
Nicci O’Neill, Elizabeth Flahive, David Hacker, Queen Elizabeth Hospital Birmingham
The Queen Elizabeth Hospital Birmingham (QEHB) is world-renowned for its trauma care and has developed pioneering surgical techniques in the management of ballistic and blast injuries, including bespoke surgical solutions for previously unseen injuries. As a result of its clinical expertise in treating trauma patients and military casualties, in 2011 QEHB was designated both a Level 1 Trauma Centre (MTC) and host of the UK’s only £20m National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC).As a result of a rising number of complex traumas being directly admitted to the QE throughout the region, nationally and internationally, we are now seeing a significant number of patients with traumatic brain injury of all severity levels.
In the absence of a standardised pathway prior to the establishment of the MTC, revision of the NICE guidance and publication of the Occupational Therapy Acquired Brain Injury Guidelines (College of Occupational Therapists (2013) it was quickly realised that this was required within the service to ensure early intervention and management of this patient group with appropriate discharge planning and exit routes.
Previous standardised assessments used within occupational therapy were tests such as:
Rivermead Behavioural Memory Test (RBMT) Behavioural Assessment of the
Dysexecutive Syndrome (BADS) Cognitive Assessment of Minnesota
(CAMS)
However it was noted some of these have limited normative data, and are not co-normed such that comparison between performances on different tests is difficult within the same assessment. Alternatively, whilst functional assessments had the advantage of being arguably more ecologically valid (i.e. in the ‘real world’), it is difficult to simulate in all but basic situations in the acute setting.
The changes that were to follow are now reinforced through the Head injury: assessment and early management NICE guidelines [CG176] (NICE 2014) and Occupational Therapy Acquired Brain Injury Guidelines:
“As commissioning arrangements are changing, for example, within the NHS, there is a need to provide evidence that services deliver valued outcomes for people with complex problems as a consequence of acquired brain injury. While there is no one recommended outcome measure that adequately captures change in such a complex clinical population across the care pathway, Laver- Fawcett (2007) offers guidance regarding the principles of assessment and outcome measurement. The use of validated tools to support assessment and outcome measurement is particularly important to occupational therapy practice, where there is a lack of sufficiently robust evidence of the effectiveness of specific interventions within this clinical population” (College of Occupational Therapists 2013).
The neuropsychologist and occupational therapy team were aware of the lack of standardised structure in place for assessment of this complex patient group and therefore alternative assessments and outcomes were investigated and a TBI pathway agreed.
“…adequate neuropsychological input to support the team in management of patients with cognitive and/or behavioural problems”
(Turner-Stokes, 2003, guideline 15 1.6)
The TBI pathway at the QEHB consists of:
Review of records and initial assessment of patient for classification of TBI severity: mild uncomplicated; mild complicated; moderate and severe to assist determination of prognosis and appropriateness of cognitive screening (for example mild uncomplicated TBI typically involves full recovery by three months and inappropriate screening can cause iatrogenic effects)
Assessment of severity includes an explicit focus on the assessment and management of Post Traumatic Amnesia (PTA) including a structured prospective assessment tool to track emergence (including orientation, continuous memory and agitation) as well as retrospective assessment of duration of PTA once the patient has emerged
Patients are then triaged
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Mild complicated TBI with subjective complaints are assessed routinely as are moderate to severe TBI
Patients with pre-existing learning issues, unusually high premorbid function, cultural, language or motor/sensory issues that would confound interpretation of a standard cognitive screen (NAB-S) are referred to Neuropsychology for bespoke assessment. This is also the case where a specialist assessment of behavioural dysexecutive syndrome is required.
Recommendations are then made for rehabilitation in the acute and post-acute stages as well as issues of discharge destination and capacity
The protocol is underpinned by an MDT approach: MDT review of patients by Nursing,
Neurology, Neurosurgery and Neuropsychology on MDT ward round
Training and supervision of OT staff in PTA and cognitive screening by Neuropsychology who assist with interpretation of findings
MTC meetings The provision of an MDT TBI
outpatient clinic for follow-up of patients who may not necessarily require community rehabilitation teams or inpatient rehab but who may have ongoing issues that would otherwise remain unidentified. There is also a nurse-led TBI rapid access clinic to facilitate early discharge.
A specific Neuropsychology TBI follow up outpatient clinic for more detailed post-acute assessment.
Functional assessments by OT remain standard and include the Multiple Errands Test (Hospital version).
The Screening Module of the Neuropsychological assessment battery (NAB-S) was deemed the most appropriate assessment to use for TBI in our clinical setting.
The NAB has a large normative data set with a wide age range (18-97) and covers a range of domains of functioning: The NAB-S generates Index Scores covering the following areas: Attention Language Memory Spatial (reasoning and perception) Executive Functions.
Standardised scores are available for individual subtests and index scores and can
be adjusted for age and education (to control for premorbid factors). Research soon to be submitted by the QEHB team shows that the NAB screening module has very good validity in distinguishing TBI from control participants and also shows a dose-response relationship with severity of TBI. We fully integrate clinical practice and research to make our practice evidence based.
It was agreed that senior occupational therapists with appropriate level of skills and training (and over seen by a Band 7 occupational therapist) were adequately trained by neuropsychology to administer the NAB-S to then allow interpretation of the results by neuropsychology (this has been followed up with an extended practice protocol that has been ratified by the Trust). The above areas all significantly impact on a person’s level of function. The NAB-S supports and confirms the outcome of the deficits identified from occupational therapy functional assessments, allows for on-going goals through functional treatment to reduce the cognitive deficit and then can be re-assessed to determine the statistical improvement six months after the first administration.It takes around 40-45 minutes to administer and can be used comparatively with functional occupational therapy assessments to meet rehabilitation goals, utilise discharge and inform the need for on-going rehabilitation.
The pathway developed supports the National service framework for long term conditions (DH 2005) in respect of early diagnosis and treatment of this clinical group.
“People suspected of having a neurological condition are to have prompt access to specialist neurological expertise for an
accurate diagnosis and treatment as close to home as possible” (DH, 2005, pp15).
Following on from the development to the pathway we used some of the key reflections from the ABI guidelines to benchmark our current practice.
1. Do I work as part of a coordinated team to provide a person- centred service for people with acquired brain injury? Yes – we felt there is now a much more co-ordinated streamlined approach within this patient pathway.
2. Do I have sufficient knowledge and skills to make reasonable professional judgements suitable to my level of responsibility? Yes – we have developed an extended practice protocol in addition to highly experienced senior staff working with this
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client group who can provide support and education to other members of the team.
3. Do I have the necessary skills/knowledge/competencies to meet the needs of people with acquired brain injury? Yes – NAB-S training is administered and reviewed on a regular basis for all qualified staff from band 6 onwards and skills, knowledge and competencies all reviewed through regular supervision and yearly IPR.
4. Do I offer an equitable service in terms of time, opportunities and resources? Yes – we have the extended practice protocol and we are a large teaching hospital that allows us to provide additional training opportunities to maintain knowledge and skills.
5. Do I work to agreed protocols for common problems? Yes – we have consolidated the extended practice protocol and TBI pathway.
6. Do I base my practice on national guidelines and published evidence where possible? Yes and guidelines are constantly reviewing in line with any new development and changes. We have an active research team who have examined the validity of the NAB-S in terms of its sensitivity to TBI related impairment. This has led to a short form (20 minute version) of the NAB which is potentially more sensitive than the full screen. Further projects to examine the factor structure of the NAB in TBI are underway as well as to examine the screen’s properties in relation to a full, ‘gold standard’ neuropsychological assessment.
7. Do I monitor the performance and quality of my practice and/or service against relevant local, national and professional standards and guidelines? Yes – however this could be improved and is an ongoing piece of work in conjunction with neuropsychology research.
8. Do I use the results of my monitoring to improve my service? Yes - band 6’s clinical expertise is shared across clinical areas due to rotational positions. Outcome of NAB-S helps support
and determine suitability of functional assessment and guide rehab accordingly and to facilitating discharge.
9. Do I seek the views and opinions of people with acquired brain injury concerning their experience of the service I provide? No – a formal piece of work is required to follow up patients in the out-patient TBI clinic with the neuropsychology and medical team.
10. Do I work as effectively and efficiently as possible to be cost effective and to sustain resources? Yes – all TBI assessments completed on initial admission and reviewed where possible on a daily basis.
In conclusion
The development of the TBI pathway has enable the Occupational Therapy and Neuropsychology service to standardised our approach toward patient care, to ensure an efficient, effective and timely service to the highest standard possible.
For any further information regarding this development please contact: nicci.o’[email protected]@uhb.nhs.uk
With thanks to Dr David Hacker (Consultant Neuropsychologist) for his input in writing this article.
References
College of Occupational Therapists (2013) Acquired brain injury, a guide for occupational therapists. College of Occupational Therapists, London.
Department of Health (DH) (2005) National service framework for long term conditions, Department of Health, London.
National Institute for Health and Care Excellence (NICE) (2014) Head injury: assessment and early management NICE guidelines [CG176], NICE, London
Turner-Stokes L (2003) Rehabilitation Following Acquired Brain Injury: National Clinical Guidelines. Royal College of Medicine and the British Society of Rehabilitation Medicine, London
International Perspectives on Dropped Head Syndrome for People with Motor Neurone Disease
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Leisle Ezekiel1 and Jennifer Rolfe21Senior lecturer at Brookes University, [email protected]
2Specialist occupational therapist, Oxford MND Care Centre, [email protected]
Introduction
Motor Neurone Disease (MND) is a progressive neurodegenerative condition that affects approximately seven in 100,000 adults in the UK (Alonso et al 2009). The progression may vary from one person to the next and there are different types of MND. However progression may be rapid and life expectancy is three to four years following the onset of symptoms (NHS 2013).
Head drop (also known as dropped head syndrome) occurs when there is severe weakness of the neck extensor muscles. The person may be able to turn their head but be unable to lift their head up. The weight of the head unsupported causes extreme flexion of the neck and the person’s chin rests on their chest wall. This leads to soft tissue damage, sensory loss and pain as well as difficulties in walking, eating, swallowing and communication (Gourie-Devi et al 2003). Head drop may also be present in other conditions, for example Parkinson’s disease (Martin et al 2011)
Within the MND population, most people with trunk weakness will experience head drop. However, 3% of people with MND may be mobile but also living with head drop. Clearly such a presentation has a significant impact on the person’s ability to perform everyday tasks and is detrimental to their overall quality of life (Gourie-Devi et al 2003). It may be very challenging for occupational therapists to know how best to support and enable a person experiencing head drop and there is a dearth of research about this particular issue.
Head drop project
Jennifer Rolfe (specialist occupational therapist at the Oxford MND care centre) and Leisle Ezekiel (senior lecturer in occupational therapy) were part of an international colloquium to investigate the management of head drop in MND. The focus of the project was the provision of care in specialist MND centres in Oxford and Utrecht.
Key Issues in the management of head drop
Therapists from UK and Netherlands identified common issues in the management of head drop. These centred on the compromise between providing comfortable support and issues arising from immobilization. Therapists
needed careful analysis of the functional need for support balanced with the limitations incurred.
Head support: comfort versus supportThe weight of the head forms approximately 8% of a person’s total body weight. Attempts to support the head cause significant pressure through a small area under the persons chin, jaw or on their forehead; this limits their tolerance of the support. Consequently, any orthotic device results in a compromise between support and comfort. Less rigid materials reduce the discomfort but then provide less support for the persons head. Often people resolve this issue by using a range of different collars for different activities. However, in practice, all of the collars are difficult for a user to put on and remove independently.
Occupational performance limitations arising from immobilisationTherapists noted that there were often contraindications for using a head support in MND because of immobilization. Maintaining an upright head position reduces head and neck mobility and the force of the support under the chin may prevent the mouth opening, thereby affecting speech, eating and drinking. People with MND often report that wearing a collar feels ‘claustrophobic’.
Immobilization may also exacerbate swallowing issues as saliva is no long able to drain forwards out of the mouth and pools at the back of the mouth instead. This results in coughing or aspiration of the saliva.
Management of head drop in MND
Practice in OXFORD MND Care and Research CentrePeople living with MND in the south of England have access to the Oxford MND Care and Research Centre based in Oxford. The service provides a full multidisciplinary team including an OT who specialises in postural management. People experiencing head drop will have a postural assessment to review their seating and mobility needs.
For those people using wheelchairs, head drop is managed through a combined approach that addresses postural support in the seating, accommodating the spinal shape (Kyphosis); using tilt in space to off load the effects of gravity; using an effective head rest and using a collar. However, this approach needs
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monitoring as some people with MND are not able to tolerate being tilted backwards as it exacerbates their breathing difficulties.
In Oxford, Jennifer used a range of commercially available collars to assist with head support, including the Oxford MND collar, Hereford collar and the Headmaster collar (MND Association 2010). Jennifer also liaised with the local orthotics department who have manufactured The Oxford Lees collar (for use on an individual basis only and for people who were still able to walk).
Practice in UtrechtPractice in Utrecht was similar to the UK but therapists work in specialist teams and were able to develop their expertise in working with people with MND. They also worked closely with rehabilitation technologists and had more opportunity to design individual head supports. They reported some success with the design of a customised head support similar to the Oxford Lees. Their design used a prefabricated spinal brace which was customised by adding a head support and head band. The customised spinal brace was then fitted to the user by the rehabilitation technologist, thus ensuring a better fit than off-the shelf commercial collars.
Outcomes of the colloquium
People with MND in Netherlands tended to have access to specialist multi-professional teams, thereby enabling therapists to develop their expertise. In the UK, the provision was more variable and people might have had difficulty accessing occupational therapists with specialist knowledge of this area.
The team at Utrecht shared their customised spinal brace and head support with Oxford MND centre and this has been reviewed by the orthotics team in Oxford. They aim to customise a similar brace once a suitable person is referred.
In summary, the management of head drop in people with MND is complex and challenging and there is no single solution suitable for everyone. It requires therapists to have a sound knowledge of postural issues, the range of seating equipment and supports available, as well as thinking creatively about the best way to enable the person living with MND. The number of people presenting with head drop
(particularly those who are mobile) is relatively small and occupational therapist may need to consult with MND specialists for advice on how to manage this condition.
We would like to thank the family of Felicity Smith for funding this project in memory of Felicity.
Key messages
Head drop is in MND is a rare but distressing and disabling condition which is difficult to manage
There is no single solution for all cases Effective intervention from occupational
therapists requires holistic and creative occupational therapy practice and sound posture management skills. Specialist advice is often available from MND care centres
References
Alonso A, Logroscino G, Jick S, Hernan M (2009) Incidence and lifetime risk of motor neuron disease in the United Kingdom: a population-based study. European Journal of Neurology 16 (6) 745- 751
Gourie-Devi, Nalini A, Sandhya S (2003) Early or late appearance of "dropped head syndrome" in amyotrophic lateral sclerosis. Journal Neurology, Neurosurgery, Psychiatry 74(5):683-6
Martin A, Reddy R, Fehlings M ( 2011) Dropped head syndrome: diagnosis and management. Evidence based spinal care journal 2 (2) p 41-47
MND Association (2010) Head Supports for People with Motor Neurone Disease. Available at: http://www.mndassociation.org/wp-content/uploads/2012/04/Information-sheet-P1-Head-supports-for-people-with-motor-neurone-disease-v1.3.pdf. Accessed on 16.10.15
NHS (2013) Motor Neurone Disease. Available at:http://www.nhs.uk/conditions/Motor-neurone-disease/Pages/Introduction.aspx accessed on 4.06.15
Splinting for the Prevention and Correction of Contractures in Adults with Neurological
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Dysfunction: Practice Guideline for Occupational and Physiotherapists
College of Occupational Therapists & Association of Chartered Physiotherapists in Neurology, 2015
Over the past 5 years a group of occupational therapists and physiotherapists have been working hard to research and write new splinting guidelines. Previous guidance in this area was physiotherapy specific, outdated, and had been withdrawn from circulation (ACPIN 1998). The need for the new guidance was supported by a national online survey of occupational therapists and physiotherapists in neurology. Splinting for contracture management was the most commonly cited reason for splinting for both professions (Kilbride et al 2013). The guideline includes evidence for upper limb and lower limb splinting. The guideline also includes several different studies which have all contributed to the final document. A cross-sectional survey of the need for splinting guidelines; a Delphi survey of OTs and PTs reasons to splint or not to splint; a systematic review of the available evidence for splinting and a qualitative study exploring user experience. Chapter 8 includes recommendations in terms of outcome measure and Chapter 9 provides helpful implementation resources.
The new guidance promotes clarity of terminology in practice. Splinting is defined as the process of applying a prolonged stretch through the application of a range of devices, most commonly a splint or a cast. Specificity of terms is essential going forward in the evaluation of this intervention. The guidelines promote a more in-depth consideration of muscle physiology, biomechanical and neurological factors which are essential to grasp to ensure sound clinical reasoning and the rationale of splinting (Chapter 3 of the guideline).
The guideline used a NICE (National Institute of Health and Care Excellence) accredited process to develop the first joint practice guidance for occupational therapists and physiotherapists. It draws together the theoretical underpinnings, available evidence, service users’ perspectives, and 19 recommendations for practice. There are two different levels of recommendations which reflect the strength of the evidence related to the recommendation. ‘It is recommended…’ means most service users may want, or should receive, this course of intervention or action. ‘It is suggested…’ means the majority of the service users may want this intervention but not all, and therefore they should be
supported to arrive at a decision for intervention consistent with the benefits, and their values and preferences. We grouped the evidence into categories where splinting can be used for ‘correction’ of a contracture or ‘prevention’ of a contracture.
The majority of upper limb studies were stroke studies where thermoplastic splints were used compared to the lower limb studies that included more traumatic brain injury patients and casting was used. A small proportion of studies included patients with other neurological conditions. It is important to note that the guidelines apply to people with neurological conditions and they are not condition specific. The evidence relates to the biomechanical (non-neural) and neurological (neural) changes as a result of a neurological insult rather than a specific diagnosis. For example: A contracture is a common secondary complication of weakness and paralysis following nervous system damage, and defined as a limitation in passive range of joint movement (non-neural). The presence of features like spasticity (neural) can also play a role in the loss of range of movement. Contracture formation is complex and multi-factorial. Contractures are costly to the individual and society. It is estimated that inpatient treatment and surgery for one contracture costs in the region of £18,000 and thus conservative approaches to the prevention and management of contractures such as splinting where appropriate are needed. More information on this can be found in Chapter 3.
The guidelines emphasize the importance of having clear objectives for splinting. Objectives can relate to active or passive function. Active function is the performance of a functional task by the active movement of the individual’s affected limb, such as using a fork to eat. Passive function, (also referred to as ‘ease of care’) is when a task is carried out by the individual using their unaffected (or less affected) limb or by someone else i.e. a carer or a combination of two. For example the Goal Attainment Scale (GAS) can be used to evaluate ‘passive function’ as splinting could improve the ease with which hand hygiene can be carried out by a carer. As with all guidelines, this guideline should be used alongside therapists’ expertise in the
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application of the evidence to practice and the context of the specific circumstances, environment and service users. The guidelines do not replace the need to clinical reasoning and skill development.
Splint guideline resources freely available for download
Getting guidance evidence into practice is essential; dissemination and implementation resources are free from www.acpin.net and www.cot.co.uk (https://www.cot.co.uk/publication/cot-publications/splinting-prevention-and-correction-contractures-adults-neurological-dy) and include:
A PDF copy of the splinting guideline document
A quick reference guide that lists the recommendations and indicates their strength and the quality of the evidence leading to their development.
A continuing professional development session including ready-made PowerPoint slides
An audit form provides a template for individual therapists or services to audit and review their current interventions against the splinting process.
Further templates and guidance available for planning treatment and management and free to download include:
Key steps for consideration when splinting adults with contracture – a 7 stage review to assist with clinical reasoning
Identified factors for caution when splinting
Factors to consider when splinting would not be advised
Section on outcome measures for active and passive function
A patient information sheet Splint /cast wearing and monitoring
timetable
Reference
Kilbride C, Hoffman K, Tuckey J, Baird T, Marston L, De Souza L (2013) Contemporary splinting practice in the UK for adults with neurological dysfunction: A cross-sectional survey. International Journal of Therapy and Rehabilitation 20(11):559-566.http://www.magonlinelibrary.com/doi/10.12968/ijtr.2013.20.11.559
Dr. Karen Hoffman, Trauma Research Fellow, Centre for Trauma Sciences, Blizard Institute, Queen Mary University London, 4 Newark Street, London E1 [email protected] (@TraumaHoff; @AfterTrauma)
A Guiding Hand on How to Do Constraint Induced Movement Therapy
Susanna Robinson,Harrison Training, 3 Windyridge, Westwood, Bradford-on-Avon, Wiltshire BA15 2DU
Tel: 01225 309333 Website: www.harrisontraining.co.uk
Constraint Induced Movement Therapy (CIMT) is one of the best evidenced interventions for recovery of arm function after stroke (Veerbeek et al, 2014). It works on the
principle that people who suffer arm weakness after a neurological event, may try but fail in their attempts to use the weaker arm and so quickly learn to rely on the stronger arm. Even
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when some recovery is seen in the weaker arm over time and the person has the potential to use that arm, they may have already ‘learned not to use it’.
Learned non-use of a weaker arm is not just a phenomenon seen in acute neurological conditions; it can develop in people with long term conditions such as multiple sclerosis or incomplete spinal cord lesion. Many people with these conditions present with one arm that is slightly stronger than the other and over months or years develop a preference for using the stronger arm. These clients often report a growing gap emerging in arm use, which can result in the development of learned non-use of the weaker arm.
CIMT is designed to reverse learned non-use by putting the stronger arm on ‘holiday’ and the weaker arm on ‘boot camp’. Suitable participants are required to have some (albeit minimal) active movement at the wrist and fingers. The holiday for the stronger arm is achieved through wearing a mitt on the stronger hand to prevent dextrous use of it. The weaker arm is put on a boot camp through the practise of intensive exercises and everyday tasks, all of which are progressed regularly to keep the tasks challenging and engaging.
Many different ways of carrying out CIMT have been developed and CIMT currently appears in NICE guidelines for stroke rehabilitation (NICE 2013) and RCP guidelines for stroke (Intercollegiate Stroke Working Party, 2013) as an intervention that should be considered to improve arm function. It is yet to find its place however in every day clinical practice. Annie Meharg, a neurological physiotherapist, and Jill Kings, an occupational therapist working in neurological rehabilitation, feel that the lack of a simple guide on ‘how to do CIMT’ has hampered its introduction into regular clinical practice. Along with Harrison Training who have been offering courses in CIMT within the UK for some time, the two therapists have developed a practical guide that sets out to demystify CIMT, give therapists a clear understanding of the key components, and
provide a step-by-step pathway to putting a CIMT programme together.
The guide has also been evidenced with information provided by course participants who have successfully implemented CIMT in their own settings. Importantly, it emphasises the recording of the patient’s view of the CIMT experience and provides ‘top tips’ on enabling CIMT to work. Examples of the templates required to set up a programme are included in the guide, thus being time effective for clinicians wanting to readily incorporate CIMT into their practice.
Annie, Jill and Harrison Training hope that therapists will find ‘How to do Constraint Induced Movement Therapy: a practical guide’ an easy to follow text, with the overall aim of bringing what can be the ‘quite extraordinary’ effects - to quote one previous course participant (Bradshaw 2012) - of CIMT to more people with neurological arm weakness.
For further details about the guide, please contact: [email protected].
References
Bradshaw R (2012) Constraint Induced Movement Therapy (CIMT) – a feasible treatment option in an inpatient rehabilitation environment within the NHS? Synapse Spring/Summer
Intercollegiate Stroke Working Party (2012) National clinical guideline for stroke. Fourth Edition, Royal College of Physicians London, UK.
National Institute for Health and Care Excellence (NICE) (2013) Stroke Rehabilitation: Long-term rehabilitation after stroke. London UK
Veerbeek J, van Wegen E, van Peppen R van der PJ, Hendriks E, Reitberg M, Kwakkel G (2014). What is the evidence for physical therapy post stroke? A systematic review and meta-analysis. PLOS 9:e87987
Cognitive Rehabilitation - External Memory Aid Training after TBI
Memory Loss and External Memory Aid Training after Traumatic Brain InjuryAccording to Ribbers (2010) Traumatic Brain Injury (TBI) is the number one cause of mortality and disability in young adults in modern western societies. The figures used to collate this only account for those admitted to
hospital so do not consider those with mild TBI who are not hospitalised. With regards to memory, Dikmen et al (2009) undertook a systematic review to examine the
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relationship between TBI and cognitive impairment, including memory loss, and found a significant association between TBI and long term cognitive impairment. In addition Ribbers 2010 records that for a person suffering moderate TBI their chances of developing Dementia (of the Alzheimer’s type) is 2.32 times higher than someone without a TBI and 4.51 times higher for those with severe TBI.
Individuals who suffer memory loss as a result of TBI often experience difficulty participating in a variety of activities. Some of the approaches used by occupational therapists to address memory loss in this population include education, functional activities and compensatory strategies. In addition there are a variety of tools that tend to come under the umbrella of ‘external memory aids’ (EMAs). They can range from writing basic lists and steps for specific routines, wall and pocket calendars, daily planners, medication boxes, to digital tools such as smart phones and programmable watches.Recognising the potential for EMAs within rehabilitation for individuals with TBI, several studies have tried to identify which aids are the most effective.
One such study is that by Armstrong et al (2012) who looked at how occupational therapists train individuals to use EMAs after suffering a TBI. In this study they recruited eight participants, all occupational therapists, from a neurological support interest group whose working roles involved them providing cognitive rehab to individuals following TBI. Data was collected via several interviews where information was analysed following a three level system of coding and categorisation.
All eight participants agreed that in order for EMAs to be effective they identified that the process in which they are used should be ‘made real’. They also recognised three overlapping processes within this including developing client insight, getting client ‘buy-in’ and getting others on board, however, ‘making it real’ was found to have an impact on the other three.
‘Making it real’ involved training that utilises meaningful activities that ‘fit’ the client’s real world and are important to them. This study concluded that making it real is the most important aspect of training in memory aids because it optimises client motivation and
directly fits into the person’s life both inside and outside of rehabilitation.
Prior to Armstrong et al.’s 2012 study, Ehlhardt et al (2008) had reviewed the literature regarding training and instruction for individuals with neurogenic memory impairments. They found that over the previous 20 years there had been increasing research based evidence that different instructional techniques can facilitate learning in individuals with memory impairment due to acquired neurological conditions. Evidence was also mounting to show that neuronal plasticity can occur in response to structured input.
Although this literature has not specified which specific EMAs are the most effective they identify instead that benefits and successful outcomes tend to be associated with the techniques and processes used rather than the type of aid. References
Armstrong J, Kathryn McPherson K, Nayar S (2012) External memory aid training after traumatic brain injury: ‘making it real’. British Journal of Occupational Therapy, 75(12):541-548.
Dikmen SS, Corrigan JD, Levin HS, Machamer J, Stiers W, Weisskopf MG (2009) Cognitive outcome following traumatic brain injury. J Head Trauma Rehabil. Nov-Dec;24(6):430-8.
Ehlhardt LA, Sohlberg MM, Kennedy M, Coelho C, Ylvisaker M, Turkstra L, Yorkston K (2008) Evidence-based practice guidelines for instructing individuals with neurogenic memory impairments: What have we learned in the past 20 years? Neuropsychological Rehabilitation, Jun;18(3):300-42.
Ribbers GM 2010. Brain Injury: Long term outcome after traumatic brain injury. In Stone JH and Blouin M (Eds) International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/en/article/338/
Jo Throp BSc (hons) OTKrysalis [email protected]
Brain Injury Rehab - Depression and Treatment after Traumatic Brain Injury
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Considering the impact of the psychological consequences of brain injuryAccording to data 235 people per 100,000 across the UK and Europe every year sustain a Traumatic Brain Injury (TBI) enough to warrant hospitalisation (Tagliaferri et al, 2006). Long term disability following on from TBI has generally focused on neuro behavioural factors but Fann et al, 2009 highlight the co-morbid and significantly debilitating psychiatric problems such as depression and anxiety. Considerable research has shown that post TBI-depression is associated with a variety of negative correlates, both for those with TBI and their carers including: Poorer rehabilitation outcomes Greater functional disability Reduced activities of daily living Less employment potential Less social and recreational activity Exacerbate neuropsychological
impairment Impede cognitive recovery
Fann et al’s study systematically reviews and evaluates current literature and research in relation to depression following TBI. They recognise the impact depression can make on health, productivity and quality of life. The statistics are startling with major depressive disorder (MDD) being recorded at a prevalence of 33-42% in the first year after TBI and 61% within the first seven years, with an additional increased risk of suicide.
The article records how there have been extensive studies around MDD but this is limited when looking at those specifically with TBI. The review describes research over a range of treatment areas including pharmacological, biological (including ECT, low intensity magnetic field exposure, biofeedback and acupuncture), psychotherapeutic and rehabilitation interventions.
The outcome of the review summarises that it remains difficult to identify clear guidelines
about the treatment of depression following TBI because of the ‘paucity’ of adequately powered and controlled studies for evidence based outcomes. They recognise a multitude of challenges in this area such as the fact complex rehabilitation interventions often need to target multiple and complex outcomes regarding activity and participation and that it may be impossible to identify a primary outcome.
For rehabilitation professionals working with clients with TBI this review reminds us how prevalent and destructive a disorder depression can be. There is still a lack of understanding regarding the dynamics of post-TBI depression and the multi-factorial impact it can have on the person’s long term recovery and level of functioning. This article is helpful in reminding us about the potential for depression and how we need to be both mindful of this as well as making sure we assess and recognise the symptoms. As clinicians we need to ensure that we systematically, proactively and routinely assess our clients’ psychological needs and to enhance identification of depression, referral for specialist services and the timely use of the most effective treatment.
References
Fann JR, Hart t, Schomer KG (2009) Treatment for Depression after Traumatic Brain Injury: A Systematic Review. Journal of Neurotrauma, December, 26(12):2383-2402.
Tagliaferri F. et al (2006) A systematic review of brain injury epidemiology in Europe. Acta Neurochir, 148:255-268.
Jo Throp BSc (hons) OTKrysalis [email protected]
Dealing with the Unexpected - Executive FunctionRecently I have been thinking about ‘dealing with the unexpected’ and reflecting on how, in general, we have the skills to overcome many scenarios that we find our self in during the course of a week. Our executive function plays a major role in how effectively we deal with new experiences or problems. The reason for my reflection this week has come about as a result of a traumatic incident on the London Underground…..
I was sat on the train when I became aware of a disturbance at the other end of the train. In a nutshell a seven-year-old boy, excited to be in London during the summer holidays had jumped aboard the train minus his mother who was left standing on the platform! Obviously the situation was very stressful for the boy, even more so when the train started to pull away. I felt compelled to help the boy (particularly as no one else appeared keen!), who did not know me, had no idea how to help himself or how to get back to him mum.
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Personally I felt out of my comfort zone, anxious for the boy who was so obviously distressed and unsure what to do for the best. I decided to ask the other commuters for help and take advice, I used my stored knowledge/memory to try and make a decision and weigh up the potential consequences of my actions. I was using my ‘executive functions’.
Executive function is a set of mental processes that help to connect past experience with present action. It is essential so that we can perform activities such as planning, organising, problem solving, decision making, remembering details and managing our time and space. Our brain’s executive function ensures we ‘do’ in a safe and efficient manner. At a basic level it helps us work out how to wire a plug effectively and on the other hand will get us out of potentially unsafe situations even when we are experiencing heightened levels of emotion.
When I think about the young boy, he was obviously distressed; he appeared to be in shock and was helpless. He did not have the necessary skills or past experiences/memories to guide his decision-making, in effect he was unable to help himself. His brain was
overwhelmed by emotion and he was unable to find his way back to his family.
Our brain continues to mature and develop connections/skills well into adulthood. As we mature our executive function are shaped by both physical changes in the brain and by life experiences; and what we learn and experience at home, in school and in the world at large. As therapists we use therapeutic strategies and interventions with children and young people to develop efficient executive skills during daily tasks. As parents we often act as a coach and mentor, helping our children to develop the skills needs for adulthood whilst at the safe time trying to keep them safe.
Thankfully in this situation the decision I came too (by using my executive function) matched that of his mum and the London transport police! We all decided, independent of each other that meeting at the next station would be the most sensible option. The boy was very relieved to be reunited with his mum but not quite as relieved as she was to see him!
A big cheer for our executive function!
Jo Throp BSc (hons) OTKrysalis [email protected]
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Starting Out in Stroke Course, DanesburyCourse delivered by Karen Clements and Louise Clark, COTSS-NP Stroke Forum
The Starting Out in Stroke course was held in Danesbury on 7/11/2015. The course was for OTs just beginning a career in neuro, or who wanted a refresher in the field. It was a very full day, focusing mainly on the cognitive aspects of our role with stroke patients, and giving an excellent overview of the necessary evidence-based screening, assessments and interventions that should be done with this particular client group.
The whole day was intended to outline the specialist role of the occupational therapist within stroke rehabilitation – we talked about our unique selling point within the multidisciplinary team (‘USPs’ we identified included activity analysis, awareness of the importance of environment, a focus on function, and our consideration of the patient holistically).
An introduction reflected the key drivers and policies shaping our work in stroke, and how we fit into the stroke pathway. Karen and Louise suggested that the OT role fits with the main points of these policies, and that actually we are valuable throughout the stroke pathway, not just at certain points. Overviews of the International Classification of Functioning (ICF) model and the OT-specific Canadian Model of Occupational Performance and Engagement (CMOP-E) were given, and an explanation of how these can frame our thinking on a day-to-day basis. After a good discussion about the local and standardised assessments we use in our services, we then spoke about the differences between screening tools, assessments and outcome measures, and how our clinical reasoning would guide our selection of which to use with patients.
The approaches to OT intervention were divided into four types: education, process training (i.e. remedial/restorative), strategy training (i.e. compensatory) and functional re-training. These types were used to introduce potential interventions for all the impairments discussed throughout the workshop. A case study of a potential stroke patient was given, with a report of his performance errors in a kitchen assessment. We were encouraged to hypothesise about the potential deficits that may be resulting in the performance errors, (such as apraxia, visual field loss, attention difficulties and executive dysfunction). We then thought about further assessments in the
kitchen environment that could determine which deficits were resulting in the difficulties in performance. This helped us to see how particular stroke impairments may manifest in a typical OT assessment such as a kitchen task.
The next section of the workshop looked at post-stroke impairments, particularly vision, inattention and perception. We spent some time discussing the differences between visual inattention and hemianopia - in presentation, pathology, treatment approach and intervention selection. We thought especially about the classic assessment of asking a patient to draw a clock on paper, and hypothesised about the difference in assessment result between a patient with neglect, and one with hemianopia. Further in-depth talks about cognition used the cognitive hierarchy to frame information about attention, information processing and memory. A final section gave a brief overview of executive function, apraxia, language and the upper limb. We then had some time to reflect on the day and on how our learning may change our day-to-day practice. The main points we felt had provoked the most discussion or were pertinent to our daily work were the difference between inattention and hemianopia, the importance of using challenging, novel assessments for testing executive function, and the difference in presentation between executive dysfunction (such as sequencing errors) and apraxia.
Useful resources that were suggested: Stroke Engine: a Canadian website
which provides information on the evidence base around stroke interventions http://www.strokengine.ca/
My Stroke Guide: a digital self-management tool developed by the Stroke Association to support stroke survivors https://www.stroke.org.uk/professionals/commission-our-life-after-stroke-services/my-stroke-guide
Self-help 4 Stroke: a self-management website for people who have had a stroke http://selfhelp4stroke.org/
Kate Crossland, Early Supported Discharge Team, West Herts Neuro Service, Hertfordshire Community NHS TrustEmail: [email protected]
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Are you an Allied Health Professional working with people with neurological conditions?
Are you involved in the assessment for, and provision of, assistive devices for mobility and/or daily living?
We are interested in your opinions and experiences regarding this service provision.
We would value your contribution to our research entitled‘A survey exploring the current practice in the assessment and provision of
assistive devices for people with neurological disability by health care professionals in United Kingdom’
Ethical approval granted by FMH Research Ethics Committee ref: 20152016-1
The online survey will take approximately 5 minutes to complete. If you would like to participate please follow the link below;
https://www.surveymonkey.com/r/63GLWCL
If you require any further information please feel free to contact us at;[email protected] or 01603 591686
Bryony McLeningOccupational Therapist
Foxley Rehabilitation UnitDereham Hospital
NorthgateDerehamNR19 2EX
Discharge Liaison Occupational TherapyI’m a clinical specialist OT working in stroke and Neuro rehab in Powys. We have no acute
hospitals and as a result acute care comes from neighbouring trusts. Recently there has been an agreement that patients who previously went to Nevil Hall hospital will now all be
transferred to Prince Charles hospital. To date a discharge liaison nurse has been pivotal in the repatriation of these patients but the plan is to pilot an OT doing this role. This will include going to the acute trust, meeting up with the team and helping ascertain where best placed
their transfer/discharge will be.
I’m wondering if any other therapist has a similar role. If so would you be willing to share some of the good practice or challenges faced. I feel this is a great role opportunity for the occupational therapist and quite innovative from our management team to look outside the
nursing profession.
Many thanks, in anticipation.
Liz StewartNeuro Specialist
Occupational TherapistSouth Powys
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Newsletter Submissions
When submitting articles or material for the newsletter it would save a lot of time and effort and be a great help if the following guidelines were observed.
YESE-mail to [email protected] (attached MS Word version 2010 or below)
Printed on white paper (Font - Verdana at 10 point text)Pictures (subject to space constraints)
NONo Faxes - they don’t scan and have to be typed out by hand!
No Handwritten articles
Address for submissions: 37 Greenland Crescent, Chilwell, Nottingham. NG9 5LD
Advertising in Neurological Practice NewsletterThe only advertisements that can be included within the SSNP newsletter are:
Courses organised by SSNP National Executive Committee or Regions
Non-SSNP organised courses offering a discount to SSNP members
Other advertisements may be distributed with the SSNP newsletter as an insert (for details of costs, please see Neurological Practice Specialist
Section on College of Occupational Therapists website at www.cot.org.uk).
Job advertisements cannot be included either in the SSNP newsletter or mailed with the SSNP newsletter as inserts.
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AUTHOR(S)Surname(s) and initial(s) of each Author
TITLE OF BOOK OR TITLE OF JOURNAL ARTICLE
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OUTCOMES.HPC Standard 3 – How have you benefited from this CPD activity? E.g. aspects of your work changed, updated your knowledge, working safely?
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