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Ask Kate: What can the UK learn from Spain’s approach to rehab?



Last month, I wrote about how stroke survivors are being left behind as the government wakes up to the value of rehab for long Covid.

Well, that blog seems to have touched a nerve. A number of you contacted me to tell me of your own disappointing experiences with community rehab, including stroke survivor, Louise Hulbert.

Louise has some thoughtful insights on rehab here in the UK, as well as in Spain.

This is what she had to say.

“After their few weeks of community rehab, individuals who are motivated to continue working on their rehab often have no choice but to invest their own money into private physical therapy which is neither readily available nor financially accessible to most.

“My own experience after discharge from hospital was three months of excellent support and physical therapy from a local early supported discharge team, followed by a few weeks of reluctant support from the community neuro team.

“I pursued the private support route, over the next two years spending between £10000 and £15000 on twice-weekly sessions with a neuro physio.

“I was just grateful I could afford to continue my quest to get back to something approaching a ‘normal’ life. Even this substantial investment of time, energy and money was not the complete solution.

“I have made fantastic progress over the years and am now regularly walking for pleasure rather than function and have even started to play golf again.

“Unfortunately, my upper limb has shown very little improvement and I have very little functional use of my affected hand, although a lot of gym work has made my arm much stronger.

“My experience of working with private physiotherapists has been that they are very comfortable working with stroke survivors on balance and mobility, but far less confident in upper limb rehab.

“Two of the three physiotherapists I worked with seemed to exhaust their repertoire of strategies after a couple of months and when they didn’t bring about desired improvements, suggested that I should continue to work on my own and save myself some money.

“Both were very busy and would soon fill the space with another hardworking survivor, so there seemed to be very little incentive to find more ways of getting my upper limb working more effectively.

“I have been lucky enough to find neuro therapists in Spain who have been very happy to continue working with me and never seem to run out of ideas.

“My therapeutic relationship with Northern Spain began in 2015, when, during a trip to San Sebastian to see my in-laws, I went to a sports centre in the town in which both the gym and the pool were specially adapted to suit people of all abilities, including those with TBIs.

“I really liked the look of hydrotherapy and immediately booked myself a session with the neuro physio there.

“I continued to work with Ainhoa during my frequent trips to San Sebastian over the next five years, fitting in as many sessions as I could, either in the pool or on land as I always felt that my individual needs were being fully addressed.

“Ainhoa was always focused and very creative in finding useful and engaging activities for me to do I always returned home feeling like I had made observable progress.

“Ainhoa has now left the sports centre, so more recently I have worked with another neuro physio called Rosa. However, the transfer has been seamless, which makes me feel that, even after eight long years it’s still worth trying to make improvements on my affected upper limb.

“Sadly, I haven’t always felt that degree of motivation in my physio here in the UK.

“In fact, one physio that worked with me within a year of my stroke, when asked if we could focus more on my upper limb in sessions looked horrified and said, ‘well let’s face it, you’re never going to use that hand again, are you?’

“Fortunately she is in a small minority and I put her insensitivity down to the fact that she was just not equipped to do the job she was being paid for, lacking both the skills and motivation to help me.

“Let me be very clear: This is by no means meant to be a swipe at the profession of physiotherapists.

“The great majority of physios I have met are both incredibly hardworking and well intentioned and many are as frustrated with the flawed system within which they have to operate.

“However, I do question whether the preparation physiotherapists undergo in their training equips them adequately to be able to drive the long term rehab of the many highly motivated stroke survivors in the system.

“If the majority of their practical training is through hospital-based short term placements, where they have to focus on doing whatever it takes to get the patient mobile enough to be able to return home safely, how do they learn about the longer term needs of stroke survivors in the community over the months and years ahead?

“How much emphasis does the Chartered Society of Physiotherapists place on long-term stroke rehab?

“Are they pointing out to the government that Long Covid clinics are diverting resources desperately needed by stroke survivors who experience very similar symptoms for year after year?

“Finally, why is it that the three physiotherapists I worked with in Spain have been able to work creatively over years and maintain a motivated and purposeful approach, making me feel significant and valued in a way that I  haven’t experienced here in UK?

“Is there something we can learn from them that will be of benefit to professionals and long term stroke survivors?

“Ultimately, long term rehab should be a rite of passage for all stroke survivors – not some mythical destination.”

Have you undergone rehab in another country? How did it compared to your experience in the UK? Let me know on Twitter @KateAllatt

– Dr Kate Allatt

GripAble ambassador
Inspirational health speaker
Internationally published author