Neuro-Rehabilitation Services in West Hertfordshire: the patients perspective

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1 Neuro-Rehabilitatio Services i West Hertfordshire: the patiets perspective Dr Kryshai Ferado Cosultat Neurologist Watford Geeral Hospital Hertfordshire

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3 Neuro-rehabilitatio The successful maagemet of MS requires a multi-discipliary approach with ivolvemet of specialists i medicie ad euro-rehabilitio. Stretchig ad physical exercise are essetial for maitaiig muscle toe ad bulk ad alleviatig spasticity. Speech ad swallowig problems require iput from speech ad laguage therapists, dieticias etc. Social ad psychological support both for patiets ad their carers is also crucial. Studies have show that the beefits of itese ipatiet rehabilitatio last for up to 9 moths after the cessatio of therapy (Freema et al., 1999).

4 Beefits of Neuro-rehabilitatio Neurology. 1999: 52:50-6. Ipatiet rehabilitatio i multiple sclerosis: do the beefits carry over ito the commuity? Freema JA, Lagdo DW, Hobart JC, Thompso AJ. Prospective sigle-group logitudial study. 50 patiets with progressive MS udergoig ipatiet rehabilitatio were followed for 12 moths after discharge. Assessmets were udertake o admissio (A), at discharge, ad subsequetly at 3-moth itervals for 1 year (1Y) with a battery of measures addressig eurologic status, disability, hadicap, quality of life, ad emotioal well-beig. The time take to retur to baselie level was calculated usig summary measures, ad treds i performace levels were plotted. Twelve-moth data were collected for 92% of patiets. Although eurologic status declied (media Expaded Disability Status Scale scores: A = 6.8, 1Y = 8.0), improvemets were maitaied i disability ad hadicap for 6 moths, emotioal well-beig for 7 moths, ad health-related quality of life (physical compoet) for 10 moths. The beefits gaied from rehabilitatio were partly maitaied after discharge despite worseig eurologic status. Carry-over of beefits, however, declied over time, reiforcig the eed for cotiuity of care betwee the ipatiet settig ad the commuity.

5 Neuro-rehabilitatio West Hertfordshire Hospitals NHS Trust provides acute healthcare services to a core catchmet populatio of approximately half a millio people livig i west Hertfordshire ad the surroudig area.. The Trust also provides a rage of more specialist services to a wider populatio, servig residets of North Lodo, Bedfordshire, Buckighamshire ad East Hertfordshire. As a employer of over 4,000 people the Trust is oe of the biggest employers i the area ad sees early a millio patiets each year.

6 Lagley House Neuro rehab cetre (Neuro Commuity Therapy ad Specialist Nursig) 16-bedded ipatiet uit for people with eurological eeds. specialist urses, physiotherapists, occupatioal therapists, cliical psychologists, rehabilitatio assistats, dietitias ad speech ad laguage therapists, supported by a admiistratio team. provide patiets with a cetralised service providig multidiscipliary eurological care i this area. ipatiet ad outpatiet uits are ow ext door to each other, streamliig the discharge process ad helpig staff to commuicate effectively Trasitio from ipatiet to outpatiet services easier Caseload: There are 1,200 outpatiets o the case-load

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8 Hertfordshire Wellbeig Service NHS Hertforshire Partership rapid access to psychology services self referral or via GP/Hospital referrals experieced metal health professioals icludig Health Professioals Coucil (HPC) Registered Psychologists, High Itesity Workers Psychological Well-beig Practitioers Psycho-educatioal Workshops Computerised Cogitive Behavioural Therapy (CCBT) Sig-postig to other commuity resources Facilitated self-help Self-help Iformatio Idividual Cogitive Behavioural Therapy/CBT (12 sessios) Wellbig Teams are located across Hertfordshire ad cliets are see i GP surgeries ad other commuity settigs.

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12 Patiet Demographics N 57 patiet 20 Wome, 37 me Barthel score 80 (10 to 100) Age rage 20 to 88 % Multiple sclerosis 8 14 Parkiso s disease Epilepsy 6 10 Fuctioal 3 5 Spodylosis 4 7 MND GBS CNS vasculitis Stroke TBI Others 7 12

13 N 11 Did ot retur survey N 5 Icomplete

14 What was Good? Treatmet Staff..carig, professioal MS urse MS module at Lagley house Neurologist SALT Physiotherapy, OT Vestibular rehabilitatio Parkig at Lagley house

15 What eeds to be improved? WAITING TIMES Parkig at hospital Too expesive, lack of spaces Moder equipmet i gym MORE SESSIONS with physiotherapists Treatmet of relapses i A&E Trasport Better access to psychologists MORE support groups/educatio Cotiuity of care Miimise variatios i care Chairs with arms

16 SERVICES that improved Quality of life? Neurologist Staff..carig, professioal MS urse SALT Physiotherapy, OT Psychology/CBT Home adaptatios Carers Respite MS module at Lagley house Pai maagemet Starlight service at Peace hospice weekly physiotherapy midfuless Parkiso s UK, Local MND/MS support groups

17 New services... Treatmet..hyperbaric oxyge Epilepsy urse/cousellig Massage Specialised Neuro Physiotherapy Educatioal sessios Exercise classes

18 Refereces Freema JA, Lagdo DW, Hobart JC, Thompso AJ. Ipatiet rehabilitatio i multiple sclerosis: do the beefits carry over ito the commuity? Neurology 1999 Jauary 1;52(1):50-6. Mahoey FI, Barthel D. "Fuctioal evaluatio: the Barthel Idex." Marylad State Medical Joural 1965;14: Used with permissio. Loewe SC, Aderso BA. "Predictors of stroke outcome usig objective measuremet scales." Stroke.1990;21: Gresham GE, Phillips TF, Labi ML. "ADL status i stroke: relative merits of three stadard idexes." Arch Phys Med Rehabil.1980;61: Colli C, Wade DT, Davies S, Hore V. "The Barthel ADL Idex: a reliability study." It Disability Study.1988;10:61-63.