Neuro patients are suffering “avoidable, unnecessary disabilities” through a lack of access to specialist rehabilitation during the COVID-19 pandemic, new findings have revealed.
With the country plunged into lockdown in March, therapists were redeployed into critical support roles across the NHS and tens of thousands of patients across the country saw the cancellation of sessions and appointments crucial to their ongoing recovery, with reports that many regressed due to the lapse in support.
Recent research from the Stroke Association revealed that through the lack of access to therapy resources during the lockdown period, “many could lose out on the opportunity to make their best possible recovery”, which neuro professionals have confirmed extends beyond stroke patients and affects their whole clientele.
Lack of rehabilitation, especially physiotherapy, could increase demand for care for several years, adding huge pressure to already stretched resources, confirmed the research.
Juliet Bouverie, the charity’s chief executive, said: “Despite the tireless efforts of frontline clinicians who have gone to herculean efforts to maintain services under extremely difficult conditions, some treatments still became unavailable and most stroke aftercare ground to a halt. This means more stroke survivors are now living with avoidable, unnecessary disability.”
Neurophysiotherapists have echoed these findings, with the restrictions on their ability to continue their usual support to clients having a potentially long-term impact.
“There was only so much we could all do during that time as NHS services were reprioritised to save lives. Access to therapy resources for many of my clients was massively impacted upon and we are now having to deal with the results of that,” says Deborah Harrison, group clinical lead and specialist neurophysiotherapist at Neural Pathways
“One of my clients, as well as having a brain injury, was due to have a new specialist neuro-orthotic fitted. This has been going on since last November.
“He has had appointments cancelled, we can’t progress his rehab as he isn’t yet able to get up and walk, so he can’t progress his life.
“People can’t progress until the equipment or resources they need become available, and that’s increasingly difficult to achieve as many NHS services are still on hold pending a potential second wave of COVID-19.
“For this client’s situation to have gone on for almost a year would have been unthinkable last November, but these are the circumstances we have to deal with, and that’s just one example.”
To enable a person’s recovery to at least be maintained, neurophysiotherapists are having to turn to a host of alternative measures, reports Deborah.
“I have one client who I do spasticity work with, and with that inevitably comes pain. He used to access a hydrotherapy pool three times a week, but that has been closed for the past six months so we’ve had to look at other ways to manage it, including neuro acupuncture,” she says.
“We have also delivered a huge amount of clinical oversight remotely and will continue to take a ‘remote first’ approach. However, as we have moved further into the pandemic, it is clear that clients are becoming physically worse and harm is occurring without hands-on therapy.
“With a very big gap in being able to see people face to face and usual therapy services still on hold, there is the risk that if people continue to not get the therapy they need, secondary complications can occur.
“This includes things like people getting pressure ulcers and contractures in joints from not being moved enough.
“Without a carefully planned 24-hour posture and positioning plan and other personalised rehab they will probably deteriorate, and that is very difficult to see happen when you are used to being able to help clients on their road to recovery.”
Due to the lack of availability of NHS resources, some patients have resorted to finding private rehabilitation, meaning that people with stroke and other neurological problems are using their own funds to top up their rehabilitation where NHS services are still on hold.
“One particular client has chosen to pay for more private therapy, which is the only way of ensuring they can continue to make progress without their usual NHS rehabilitation” says Deborah.
With COVID-19 cases rising again across the country, and local lockdowns being implemented around the country – with mounting speculation of another full national lockdown being enforced – neuro professionals are having to do all they can to prepare for such a scenario.
“In my team, we prepared quickly but very well for the first lockdown, and developed a comprehensive COVID risk assessment protocol before the restrictions were imposed.
“As we are classed as essential workers and had rapid access to PPE, we were still able to maintain our duty of care to our most clinically vulnerable clients – these were the clients who would have ended up in ITU if we couldn’t carry on seeing them,” she adds.
“Compared to the beginning of the pandemic, rehabilitation teams are far more prepared and can now safely see more clients face to face, with a fully reasoned risk assessment and correct PPE in place.
“We are hopeful that, alongside remote support, we will see the volume of safe face to face therapy resume nationally, allowing people who have missed months’ worth of essential treatment to be get back on with their recovery and back on with life once again.”
