brain injury rehabilitation
Brain injury rehabilitation was the very beginning of Rehabilitate Therapy, back in 2005, given Dr Kate Heward’s expertise in this area.
While our expertise and focus is now much wider than brain injury rehabilitation, it remains at the very centre of who we are as an occupational therapy service.vocational rehabilitation
An individuals vocation whether that be paid or unpaid work, a learning environment or any occupation that is productive, is usually a massive part of their identity, after a brain injury that con be completely shattered due to a range of issues, from psychological, behavioural, cognitive and physical or a combination of these. Vocational rehabilitation is an important part of occupational therapy rehabilitation. At Rehabilitate Therapy we lead on vocational rehabilitation, collaborating with our MDT colleagues.
self care
Our therapists will assist clients in exploring their needs regarding self-care, this can include activities such as, personal care (washing dressing and feeding), functional mobility (how they transfer and mobilise to get from activity to activity) and community management (managing transportation, finances and shopping etc).
leisure
Our therapists enable the client to look at quiet and more active leisure pursuits. Quiet(er) leisure can include hobbies, crafts and reading, whereas active leisure might include participating in sports, outings, travel and holidays. We would also consider socialisation with others, including their networks of family and friends and correspondence with others. Our therapists, in the last three months, has fished, sang, and sailed with clients. We are passionately client centred and open minded in our approach.
independent living skills
We are proactive in seeking out, and interpreting, what a person would like to achieve from their rehabilitation programme. Our brain injury rehabilitation uses a client centred measure called the Canadian occupational performance measure (COPM) to help assist clients in looking at their living skills that can include anything from self-care (for example washing and dressing), productivity (for example, work or house management) to leisure and recreation (from fishing to blacksmithing – we have so many example of areas client have been energised to engage in). We also look at how their body functions (physical, cognitive and psychosocial) impact on their independent living skills.
independent living trials
Working with complex conditions, we work in partnership with our client, their case manager and their multidisciplinary team. We are highly experienced in the setting up, running and evaluating of an independent living trial as part of our brain injury rehabilitation. Working with the client (and case manager) in searching for and securing the most appropriate property, assessing the client’s functional ability in order to guide support and rehabilitation needs, in conjunction with the client evaluating and amending the support throughout as skills change or develop. Finally evaluating the whole process in order to give future recommendations with regards to ability to live independently.
physical rehabilitation
Differences in our clients’ physical ability to participate in their functional activities are common, and can include muscle weakness, reduced range of movement and changes in neurological status - such as muscle tone. These can have a big effect on how our clients participate in their everyday activities, within different environments, including home, school, work and social.
Our therapists look at how these body functions can limit a client in their activity and participations and build a bespoke brain injury rehabilitation programme, often in partnership with the multi-disciplinary team members, to maximise rehabilitation potential.
productivity
We support clients to consider their daily routine, particularly concerning areas of paid or unpaid work (vocational roles, sick leave or medical retirement), household management (cleaning, laundry and cooking for example) and learning, especially around to what level of study they achieved and if they consider relearning or returning to learning, due to their current situation.
cognitive rehabilitation
We work with a client and their families to produce an individualised rehabilitation programme, often in collaboration with a neurological psychologist. The programme looks at specific cognitive skills linked with their function, and this can – typically – include specific cognitive training and education, practice and can include strategies our clients can use in their everyday skills. Key cognitive areas, focused upon, include attention (concentration), visual processing, information processing, memory and executive functioning. We facilitate self- awareness into their strengths and issues and how this can link with their behaviour.
anxiety management
We recognise and understand the holistic nature of how long-term conditions can affect an individual’s mental health and how anxiety can impact a clients’ life. The design of bespoke fatigue/lifestyle management plan, for our clients and in collaboration with our psychology colleagues, are crucial and impactful. They can include education, identifying anxiety and in what situations, specific anxiety management strategies and practicing these in different environments.
budgeting and money management
We assess and assist our clients in key skills including money recognition, money handling, calculation, managing source of income, budgeting and banking – also common areas such as impulsive spending. If the client lacks capacity to manage their finances, we often work in collaboration with the client’s financial deputy and case manager to empower them to manage a small budget (usually in conjunction with support worker intervention under therapy guidance) as they struggle with impulsive behaviours and vulnerability.
fatigue management
Fatigue can be an invisible symptom for our clients and can be masked in the guise of physical or cognitive symptoms (such as speed of information processing, memory, attention). Often people describe this as ‘feeling more than tired’, describing it as “walking through treacle” or “having brain fog”. Substantially affecting their ability to participate in everyday daily activities. We design bespoke fatigue/lifestyle management plans that can include routine planning, how to manage their energy effectively to participate in important roles and activities. Also, how to pace and grade, – and most importantly how to manage this independently, including relapse.
sleep education and management
Many clients experience persistent sleep difficulties after a brain injury or other neurological injury. If an individual is experiencing sleep issues, they will struggle to participate in active rehabilitation. We are able to provide clients with bespoke education and intervention regarding their sleep and make recommendations to enable them to improve sleep pattern. We work in an interdisciplinary way to support a client improve their sleep pattern. We also have experience of referring for Actigraphy studies, working closely with the actigraphy service at referral, through assessment and through treatment implementation.
vestibular assessment and rehabilitation
Some of our clients have issues with their vestibular system, that basically relates to the balance control centre in the brain - with information from our inner ear, vision and spatial orientation. This can range from cerebellar issues in the brain, proprioception issues with standing in function, to conditions affecting the inner ear that cause dizziness - for example Benign Paroxysmal Positional Vertigo (BPPV). Any vestibular issue can have devastating effects on how a person can function and perform their daily living activities. We have trained therapists that can assess and provide a personalised rehabilitation programme that can elevate or adapt vestibular issues to enable our clients to regain and maintain their skills in occupation.
return to driving
We provide bespoke programmes (off road) to our clients, looking at learning to, or returning to, driving. We would assess a person’s physical, sensorimotor, cognitive and psychosocial skills which can affect their wish to drive, liaise with the driving assessment centres on timing or appropriateness of a driving assessment and also if required accompany them to a driving assessment at one of the regional driving assessment centres and recommend vehicle selection and required / recommended adaptations. We can also assess car passenger transfers and seating whilst out in a vehicle to maintain their independence. We have good links with approved driving instructors so are able to work with the driving instructor and client to ensure therapy outside the driving lessons supports the skills required for driving, we are also able to help individuals with cognitive difficulties in relation to driving theory, breaking down the task, and facilitating cognitive strategies.
community management/skills
Our therapists assist clients to identify skills they would like to work on, including shopping, budgeting, transportation eg public transport training programmes, socialisation, functional mobility. These are then developed into goals and graded to ensure clients are supported and enabled to develop these skills which are crucial to them achieving other goals, perhaps relating to leisure and vocation.
upper limb functional electrical stimulation (FES)
We have an accredited therapist that can assess and treat an individual’s upper limb with Functional Electrical Stimulation (FES). FES is the process of neuromuscular electrical stimulation, where a muscle that is innervated, but paralysed, can be stimulated to produce functional and purposeful movement in activity. FES can be an important part of regaining functional movement in the upper limb to reduce pain and include in functional occupation.
neuro splinting and casting
We follow national guidelines in the splinting and casting of neurological clients produced by The Royal College of Occupational Therapy. We provide assessment and fabrication of bespoke splints and casts in collaboration of the multi-disciplinary team. We provide the material, written guidance and training to establish use of the splint/cast within their rehabilitation programme. We might undertake this as one part of a therapy programme, we are working on, or we are often approached to deliver this stand-alone specialism when the client already has an occupational therapist for their other rehabilitation goals.
support-worker / rehabilitation assistant training and supervision
Support workers and rehabilitation assistants are an integral member of the multi-disciplinary team, often directly employed via the client’s case manager. Our therapists assist support workers through education, direction and supervision to provide bespoke support for our clients to regain, enable and maintain purposeful activities. This is, for example, very important when conducting independent living trials, whereby the support workers produce the evidence through their notes of how they are supporting the clients, which we then use to analyse ad consider optimum support needs. We would also provide training for the support worker or rehabilitation assistant in how to carry out the ongoing rehabilitation with the client in specific areas, whether that be physical facilitation or implementing cognitive strategies in a functional activity.
basic assistive technology
Assistive technology can include assistive or adaptive equipment, from applications on a phone, to equipment that allows people to turn a light on/off to systems that control their environment, at home, school and work. At Rehabilitate we have an information technology expert and also occupational therapists that can offer advice to the client about technology that may enable independence within their different environments. We also have key relationships with partner companies such as Steve Wiseman Associates who we work with regularly and would refer to for more complex issues.