South East Coast

Managing Falls- avoiding the need for conveyance to hospital with early community therapy and specialist paramedic intervention, a winter initiative.

Falls with minor injury are common within the ageing population and a common cause of fragility fractures. Following a fall many older people suffer a loss of confidence and reduction in independence and reduced function. Older people admitted to hospital following a fall may also experience further challenges such as hospital induced disability and deconditioning as a result of admission. SPPOT, specialist paramedic, physiotherapist and occupational therapist service was developed to provide a specialist intervention for the assessment treatment of people over the age of 65 who fall at home with the aim of reducing conveyance of this group to the emergency department.

Increasing long-term participation in sports based activities in children and young people with acquired brain injury.

Participation in sports can play a key role in a child’s quality of life, development and learning (Willis, 2018). Children and young people (CYP) with acquired brain injury (ABI) face significant barriers in accessing sporting and leisure activities.  This reduces the likelihood of participation in regular sporting and leisure activities (Anaby,2018),  both in the recovery period and the later stages (Willis, 2018).

This is a quality improvement project that explores the implementation of a sports based group in a neurorehabilitation centre for CYP with ABI.

Best practice for serial casting to increase ankle range of movement following Botulinum Toxin in children with Acquired Brain Injury.

Loss of range of ankle movement is commonly seen in children following acquired brain injury (ABI), due to altered muscle tone and prolonged periods of immobility. Reduced ankle range of movement can impact a child's ability to sit and stand, and therefore participate in all areas of daily living.

Serial casting following Botulinum Toxin injections (Botox) is recommended when injections are used with the goal of increasing range of movement. Although casting was routinely used in this rehabilitation setting, there were inconsistencies in the timescales, duration and frequency of casting post injections. Aim: To develop and pilot a local protocol for serial casting post Botox, based on a review of evidence and expert opinion.

 

Feasibility of a self-developed online training tool to deliver specialist training

Delivering additional training to build specialist skills within a workforce can be challenging due to time restraints, staff availability and other service demands. Working in a community trust brings additional challenges due to the dispersion of staff across a county.

Online training tools are frequently used as part of mandatory training but are not routinely developed by services for specialist use. Multiple online platforms are available to host such training tools for free. These could be utilised to build tailored training programmes on specialist topics, which could be accessed remotely by staff.

An online training tool for the use of neuromuscular electrical stimulation (NMES) in stroke rehabilitation was developed and evaluated as a pilot project.

Therapy Timetabling, an evaluation of outcomes following implementation at the Oxfordshire Stroke Rehabilitation Unit.

The Oxfordshire Stroke Rehabilitation Unit (OSRU) provides short term inpatient rehabilitation for patients following acute stroke.

Intensive rehabilitative interventions improve functional outcomes (Barrett et al, 2018) but despite this, patients are often described to be 'inactive and alone' in hospital (Bernhardt et al, 2004).

Historically OSRU struggled to achieve the recommended 45 minutes per therapy, five days a week, as described in the National Clinical Guideline (RCP, 2016).

The ReAcT study (Clarke et al, 2018) reported positive effects of therapy timetabling on patient engagement, caseload prioritisation and minutes' therapy provided.

The Implementation of an advanced practitioner therapist Role within a community independence service.

In Central Southampton, demand for Comprehensive Geriatric Assessment (CGA) was higher than capacity so GPs were sent requests such as medications review.

Audits showed that 60% of requests were not actioned, impacting on rehabilitation whilst waiting for a GP appointment.

This delay on patient care presented an opportunity to train a therapist to complete CGAs and enhance career development opportunities.

The Validity of Neurodynamic Tests to Identify Nerve Dysfunction in the Upper Limb

Upper limb neurodynamic tests (ULNT) are used to examine patients with suspected cervical radiculopathy (CR), carpal tunnel syndrome (CTS) or cubital tunnel syndrome. Understanding the validity of these tests is critical if they are to be used to diagnose these conditions in clinical practice.

The purpose was to critically and systematically assess the literature on the validity of ULNTs in identifying nerve dysfunction in the upper limb.

A Rapid Review of evidence for management of patients that frequently attend Emergency Departments with Chronic Pain.

Frequent attenders (FA) (defined as individuals that attend more than 5 times per annum) of ED have been reported to account for 13% of the total cohort. A common reason for presentation is chronic pain. Guidelines recommended that Frequent Attenders are identified, that case management may assist with involving other services and that multidisciplinary case conferences may aid patient engagement.

  • To critique evidence for case management of patients that frequently attend ED with chronic pain.
  • To utilise the evidence to support an innovative rapid access pathway to a pain rehabilitation service.

Does Patients' Perception of Improvement following a Pain Management Programme, Match Reported Minimally Clinically Important Differences?

Clinical outcomes for patients attending a pain management programme were evaluated to determine whether patients who rated an improvement on a Global Impression of Change Score, achieved mean changes in BPI that were consistent with 'acceptable' change, and to determine mean changes on other outcomes in this population. It is suggested that a mean change of 2.09 in pain interference, as measured by the Brief Pain Inventory (BPI), could be considered acceptable to patients. Currently data is unavailable for changes in pain acceptance.

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