Therapy
Music therapy expedites ankle foot orthotics rehab
Children with Cerebral Palsy who are receiving post-operative physiotherapy support at the Portland Hospital for Women and Children, London, having undergone Spinal Dorsal Rhizotomy (SDR), are benefiting from Chroma’s music therapy sessions as they experience elevated rehabilitation sessions.
Children, aged between 2-7 years, seen in joint sessions with Dorset Orthopaedic, one of the UK’s leading providers of private prosthetic and orthotic rehabilitation, typically struggle to sit still to allow measurements to be taken.
While they are being measured for prosthetics and orthotics, Chroma’s music therapist, alongside the physio team, engages with the children to ensure their treatment meets their needs.
SDR is a specialised neurosurgery that treats lower limb muscle stiffness (spasticity) in children with cerebral palsy by dividing sensory nerve rootlets in the spinal cord.
Intensive physiotherapy is crucial following SDR to practice movement patterns in the absence of spasticity and build up muscle strength; the use of music therapy expedites their rehab.
Typically, ankle foot orthotics target the ankle and shin - strengthening and supporting the ankle in its position and promoting the position of the knee – essentially helping support the children with their standing. This makes a huge difference to their walking.
Children undergo an intensive three-week therapy programme following surgery, not only to ease rehabilitation from the surgery but more importantly, to support the new pathways that have been developed following the surgery, facilitating the way the children move.
Integrating music therapy within physiotherapy sessions further supports the children in re-learning how to move, how to shift their weight, balance, movement, and walk – it really is working from the ground up and starting again because their legs feel very different.
Additionally, for younger children, music therapy helps to normalise the child’s experience, offering new and changing ways of motivating and engaging them in rehabilitation and building relationships. It also builds confidence in movement and to be confident in their bodies. And of course, music primes movement. It’s intuitive without necessarily using words.
For each child’s journey, music helps increase their stamina enabling them to be in a position longer than they would do outside of therapy.
Jon Fever, a music therapist at Chroma, said: “Music therapy is a completely different medium to work with and something that doesn’t require words to explain what you want the child to do.
“Music therapists create a musical atmosphere – a song, a story, or could be using the music through pattern sensory enhancement (PSE) as a directive for the children to go up or down depending on the intensity of the music – it becomes intuitive. The music tells them how to move which is a fun alternative to quite often monotonous, painful (but necessary) exercises.”
“Working as part of the multi-disciplinary team - Chroma, Dorset Orthopaedic and the physiotherapists at The Portland Hospital - help reduce anxiety in children by creating fun and engaging stories. For example. we’re all members of the child’s band, which shifts any sense of power or hierarchy between child and therapist. This will often impact and support the child’s engagement and confidence.”
"Using music therapy as an engaging medium within a gruelling rehabilitation journey is essential to support better rehab outcomes and ensure orthotics are optimal for each child - supporting the very best outcomes for these amazing children.”
To find out more, please visit wearechroma.com.
Chroma, supporting therapists' resilience
By Rachel Smith, music therapist, Chroma
Chroma is leading the way in ensuring creative arts therapists receive the tools they need to develop resilience in the work they are carrying out each day.
Therapists work with a variety of clients, all of whom have their unique issues, of which Chroma therapists provide unwavering support to help them overcome these and move forward positively.
But as is the case with talking therapies, it can take its toll on the mental health of the therapists. And, Chroma, established by practicing arts therapists, understand all too well the mental burnout and fatigue that can occur as a result of the job. This is why they have ensured their therapists receive the very best support, in-house, that can help prevent stress and promote self-care.
All HCPC registered creative arts therapists need to access their clinical supervision, but the clinical team at Chroma offer additional management supervision. This support can occur weekly if the case is particularly difficult or stressful, but typically every eight weeks.
If the case the therapist is working on is particularly challenging, support can even be provided daily – so therapists never feel alone and always feel heard and supported in their role.
During these sessions, the clinical management team will find out how the therapists’ case is going and what needs further exploration – supporting therapists to think about their goal setting.
Chroma also provides an on-going monthly CPD programme offering training on all aspects such as report writing, working with families, short-term work, dealing with funding, autism etc. This helps therapists, especially new therapists, hone in their thinking about the work they are doing and understand the importance behind what they are doing, whilst receiving guidance on the support they are providing clients – they’re not alone to fend for themselves – Chroma is always on hand to help.
No one is left to struggle, and with that level of support therapists build their resilience towards the work they do every day and to better support their wellbeing at work and, outside of it.
To find out more, visit wearechroma.com.
20 years of PhysioFunction
The 27th of August 2023 marked an enormous milestone for PhysioFunction, our 20th birthday!
From humble beginnings, offering a domiciliary service to clients in Northamptonshire and the surrounding area, emphasising hands-on therapy (Bobath, N.E.T.) and exercise to continue with rehabilitation after NHS discharge, PhysioFunction has grown into a leader in neurological rehabilitation provision with our flagship clinic based in Spratton housing a vast array of world leading rehabilitation technology and our expert team.
Throughout PhysioFunction’s evolution, clinical provision has remained at the forefront of our service and in 2006 our Clinical Director, Jon Graham coined the term – Rehabilitation Triad - to describe the combination of handson therapy, technology and exercise.
The key to physical rehabilitation is refining the prescription and delivery of these components at various phases during recovery.
To support this PhysioFunction began expanding its services to incorporate technologies, beginning with the Saeboflex and Odstock Footdrop FES, and expanding to incorporate a wide range of rehabilitation and functional technologies to support both physical recovery and day to day function.
Over the years PhysioFunction has also expanded its geographical coverage beyond the bounds of the Midlands to Bedford, Oxford and London through an associate network and to Sheffield, Harrogate and York with a franchise network, before refinement and focus of the service around a commitment to exoskeleton technology, beginning with the REX and ReWalk in 2016 and being enhanced by the addition of the FREEWalk in 2019, led to a move to a centre of excellence at the Chris Moody Centre at Moulton College in 2017.
With this centre of excellence came to opportunity to add larger, less portable rehabilitation technologies to the service including an AlterG antigravity treadmill, Tyromotion Pablo Station, FES bike and cross trainer, LiteGait and MediTouch BalanceTutor.
As well as a gym area and consulting rooms, we had access to a hydrotherapy pool, a warm-water exercise pool, and a 25 metre swimming pool. Our clients were delighted with the new facility, and for those who couldn’t travel we continued to provide home-visits.
The clinical team was able to closely collaborate on a daily basis. Our admin team could meet clients and see their progress over their visits.
In August 2019, we were advised that Moulton College could no longer accommodate us as the facility was to be repurposed by the local council as a community leisure centre. We wanted to remain in a rural setting and did not want to relocate to a commercial building on an industrial estate.
We were lucky to take vacant possession of two neighbouring converted farm buildings with spectacular views over the rolling Northamptonshire countryside, a factor not always instantly considered important in a rehabilitation facility but is the first thing mentioned by almost every first-time visitor to our clinic.
After full internal refurbishment during the winter of 2019 – 2020 lead to an “open day” we were ready move and open our brand-new facility just as the first lockdown was announced! Thankfully, due to our embracement of rehabilitation technologies, we are able to continue to deliver high quality remote rehabilitation, including using home-based technologies such as the MindMotion GO.
Once restrictions were eased and we were able to welcome patients back to our clinic with appropriate PPE and enhanced infection control procedures, we began to grow the new facility in earnest.
Alongside diversification to provide local essential workers or concerned members of the public with access to PCR and fitness-tofly testing, helping 100s of people travel out of the UK for business or leisure, PhysioFunction has continued to grow and expand its range of technologies to welcome the Desmotec D-Line and V-Line, and GMove suit, as well as expand our clinical team.
To provide further support for our current and prospective clients, we have established PFit to provide personal training, sports therapy, massage and nutritional coaching services to maximise health and fitness.
PhysioFunction is a hugely dynamic and responsive rehabilitation provider with the mission of helping individuals achieve the best physical and emotional recovery from serious illness or catastrophic injury, and providing career opportunities for those who share this vision, so whether you are a prospective client, a case manager looking for the right place for your client’s rehabilitation, or a healthcare professional looking to work as part of a team dedicated to promoting recovery and optimising wellbeing in all of our clients, and accessing so world leading rehabilitation technology whilst doing so, look no further than Physiofunction.
Cheers to the next 20 years.
To find out more, visit www.physiofunction.co.uk.
Therapies in action - the importance of multi-disciplinary working
NR Times learns more about the role of speech and language therapy and physiotherapy combining to support patients at Nottingham Brain Injury Rehabilitation Centre to exceed expectations, regain independence and rebuild their lives
In supporting a person to rebuild their life after brain injury, or in the event of neurological illness, the input from the multi-disciplinary team and their specialism across a breadth of aspects of neurorehabilitation is vital.
Two of those disciplines, physiotherapy and speech and language therapy (SLT), can work particularly closely, supporting each other to restore some of the independence in communication and movement which can make such a huge difference to a person’s life.
At Nottingham Brain Injury Rehabilitation Centre, SLT and physio work together on a daily basis with clients across its residential, slow stream rehab and high dependency units, supporting them from the very earliest stages of recovery to secure outcomes often beyond all expectations.
The impact of the individual disciplines can be powerfully felt within the wider rehab picture - both as inpatients within the centre, and as outpatients, with the re-launch of its specialist outpatient service - enabling clients to establish the channels of communication and movement which will allow them to move forward.
“We work with a very complex client group and are dealing with cognitive impairment. It’s essential that from the start we establish communication in whatever way we can,” says Eden Akiatan, a senior neurophysiotherapist at the 59-bed centre, owned by Active Care Group.
“For this reason, we work hand in hand together with SLT. Once we have that communication, then we can engage with them.” “It’s building that relationship and building the trust,” says speech and language therapist Nicholas Sobieraj.
“The more we can work together as an MDT, the more we can support them in their recovery.
“Often our patients come to us and they can tolerate five minutes of something, sometimes not even that. So by working on different aspects of therapy you can build the tolerance. Over time, you suddenly realise they can now do something for half an hour, even an hour. And it’s about giving the support for them to get to that point.”
Eden adds: “We want our patients to live their lives, that’s what we want to help them achieve. I always tell them ‘Let go and just live’. Live your life and do what you love.
“That’s our aim, to help them to get there, and working together we can help them to do that.”
Sarah* arrived at the centre in a minimally conscious state after a left-side stroke which left medics fearing for her future. After discharge from hospital, Sarah, who is in her 50s, was unable to communicate and had severely limited movement on her right side. She also had a tracheostomy in place.
Progress was slow, with no major improvement for over a year. But while Sarah’s rehab potential may have been questioned by some, for Eden, Nicholas and the Nottingham team, they resolved to continue rehab and wait as long as it may take to support Sarah in achieving the long-awaited breakthrough.
“Even during the time we were seeing no progress, we continued to work,” says Eden.
“We did a lot of bed exercises. We supported the rehab assistants in working on a passive range of movement, we worked with the occupational therapists to do hand work and upper limb work.
“Even if you can’t see them responding, we keep believing that the bits we are doing will add up to something.”
And the persistence of the MDT paid off, with significant improvement coming suddenly, after more than a year of Sarah being at the centre and in a minimally conscious state.
“It was sudden, but then we had the momentum. And from there, she was able to do more of the things that we're asking for,” says Eden.
“We were no longer doing the passive work for her. She was doing more and more herself. The momentum in therapy really picks up.
“Everything we do is based on the individual person’s tolerance and endurance, working within their capability and levels of fatigue.
Fatigue can be very difficult, but by working at a pace that is right for them, we can make great progress.”
Sarah’s tracheostomy has also been removed and she is managing well with her consumption.
“We worked with her as an MDT and looked at deflating the cuff, we considered very carefully when was the right point in her rehab journey to do this. We trialled removing the cuff and monitoring her saturation levels so they didn’t decrease too much,” says Nicholas.
“This went well so we started to look at eating and drinking again, starting really slow with teaspoons of water then building up from there, really working on the swallow - the more you’re able to practice it, the more it will improve.
“We cautiously monitored everything over the weeks and months, and she is now on a pureed diet. The goal is to improve as far as we can go. We have reached a point where things have been constant for a while, but that is not to say things will not improve further.”
Physically, Sarah is also making great improvements in her right side strength.
“She still uses the hoist but she has made good progress with the upper and lower limb. Initially when she came to us she had no movement on the right side, but now she can fully use her right lower limb and can pick up with her right hand,” says Eden.
“When sitting, her balance is brilliant. She can sit independently on the edge of the bed for 30 minutes and she can also do sit to stand with us.”
The motivation seen in Sarah, alongside the support of her family have been key factors in her strong progress.
“She can now have conversations with her family and has a much better quality of life now than when she first came to us,” says Nicholas.
“She is very motivated and wants to progress, which does make a difference, alongside the fact she has a very supportive family. They give us a lot of feedback and we have very open channels of communication with them - if there is ever anything they want to raise, they know they can discuss it with us.
“If they aren’t visiting, they’re video calling every day, which really helps with the cognitive side of the recovery as well. The stimulation from the family and the familiarity are very important.”
While two years ago when Sarah came to Nottingham, the outlook was very uncertain, now the topic of discharge is being considered.
“We will always work with the family in achieving this, and the family in this case will be ready to give the support that is needed,” says Eden.
“But when we look at discharge back home, we will do a home visit to look at whether the home is appropriate for this person’s needs. We need to make sure we are discharging with the appropriate support there. We can make referrals to community teams if there are needs that need to be met.
“But with our outpatient service, we can always be there with further rehab, if a person maybe still needs some physio or OT input. That way they can be independent, but with the support when they need it.”
Committed to person-centred therapy Working across the three units at the centre - Millwood, which specialises in slow stream rehab; high dependency service Fernwood; and Hazelwood, the residential care service - the needs of clients in therapy can differ greatly.
But from the very earliest point, the approach to person-centred care and rehab is the same, whatever a person’s level of injury or need.
“We will always do what we can for the client and their needs and interests,” says Eden.
“We recently bought a boxing bag because one of our clients used to go to the gym before the injury. He was a bit apprehensive when he came to us, there was a lot of anxiety around him engaging.
“So one way of getting the most of our people is engaging them in something they really enjoy. We bought the boxing bag for him and he is loving it.
“It’s great for him because it’s working on the upper limb, working on the standing tolerance, working on the core, while at the same time working on the cognitive performance and cognition. You’re able to look at the entirety of the person, which is the approach we like to take.
“For this client, just as one very recent example, this approach has worked very well.”
Nottingham has a range of support mechanisms available to help clients, from assistive technology and eye gaze devices, through to cutting-edge sensory equipment to give feedback on posture and movement. This is in addition to the expertise of its in-house therapists, nurses and rehab assistants.
“The needs of people in Millwood can be very different to those in Fernwood, there can be a very different level of communication difficulties, but all of our sessions are designed on getting to know the patient and support them as best we can. It’s very bespoke,” says Nicholas.
“This starts from the very first point, when we will do an assessment from head to toe,” says Eden.
“Cognition, orientation, movement, communication, everything is assessed. We work very closely with SLT and OT to establish the impairment, usually mostly cognitive impairment, and work out how we go forward from there.
“We will consider every way in which we can progress. It might not be quick, but we’ll look at the techniques and equipment we can use to support that. We want our clients to engage with us and communicate with us in whatever way they can - and from that relationship comes progress.”
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