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Therapies

Askham: delivering life-changing rehab step by step

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From meeting people at their most vulnerable, facing an uncertain future after devastating injury or illness, Askham Rehab has a stellar track record in supporting them to achieve positive life-changing outcomes. 

From the very start of their rehabilitation journey, the Askham team unite behind each resident, helping them to achieve their personal goals and look to a more positive future than the one they believed lay ahead when they arrived. 

Such is the reputation of Askham, based near Doddington, Cambridgeshire, that residents come from across the nation, with the compelling combination of person-centred rehabilitation – which includes hydrotherapy and the latest in robotic innovation – helping to deliver significant results, often within a 12-week placement. 

And at the heart of the service Askham delivers is its team. From the care, nursing and therapy teams, through to the housekeepers and facilities support, everyone has a role in ensuring the Askham journey is the best it can be for each and every resident. 

“What we do here starts with one person and ends with one person – the resident – but it goes so far beyond that during their time with us. The team we have here is incredible and we couldn’t achieve what we do without them,” says Luke Cook, head of rehab and nursing at Askham Rehab.

“Our care team have the most time with the residents, more eyes and hands on our residents than anyone else, the role of carer is impossible to define and they do one million roles rolled into one. They support with; personal care, mobilisation, therapy, personal issues, they holistically support our residents with absolutely everything – and more. 

“Often they will be the first and last person a resident will talk to most days. Care teams don’t get mentioned as much as they should, and I don’t think even they realise how much their involvement influences everything else.

“From sharing past experiences, to being about the encourage participation in certain activities as of the relationships formed, through to making the ‘best cup of tea’ – it’s sometimes the little things that have a really big impact.

“Our nursing team, with the support they provide with pain management, corresponding with MDTs and enhanced levels of care, alongside our therapy team – so the SLTs, OTs, physios and neuropsychologist – are crucial in the support, leadership and expertise they give our residents. 

“But around that is our support services. We have a seven-acre tranquil environment, but it wouldn’t be that if not for the facilities team. If the boilers didn’t work and the lightbulbs weren’t changed, we wouldn’t function as we do. Likewise with our housekeepers, without them the service doesn’t work – and after 18 months where infection control was absolutely paramount, without them, we couldn’t have done the job during the pandemic we have done.

“Importantly, these are very relatable people, someone for our residents to have ‘normal’ or ’non-clinical’ conversations with. We know our residents really value that.

“Our team all support each other, they very much rely on each other, their roles are interlinked and we all work together to make sure everything we do is as meaningful as possible for the residents. I’m so proud of the role they all play.” 

While many people may not have heard of Askham until such time they need its specialist support, its dedication to securing the best possible outcomes means its work begins as soon as they arrive – with discharge already planned for even before that time.  

“The sad truth is that people don’t know about us until they need us. People come from far and wide, because of our nursing-led support as well as the rehabilitation we provide. We are very niche and with a strong reputation, which is increasingly growing with the outstanding work the team consistently delivers” says Luke.

“It all starts with an illness or injury, a life-changing event which, after discharge from hospitalisation, will enable us to work with that individual and support them. We make sure we have all the information we need to commence the pathway and start to create what they want the outcomes to be and what that journey will look like.

“The discharge planning starts as soon as we do the pre-admission assessment, and what that may look like – whether they will go home, if their home needs to be adapted, or whether they will need longer-term care. 

“Residents have a finite amount of time here, so it’s important we commence their plan at the earliest opportunity, which is
then reviewed after eight weeks, but again it’s very personalised and there is no set timeframe for recovery. You could have two people of the same age with a brain injury, but it could impact them very, very differently. It is all about the individual and how they progress during their time with us.” 

Upon transition to Askham, each resident is assessed by its in-house therapy team – comprising speech and language therapy, physiotherapy, occupational therapy and neuropsychiatry – to set out the goals during their time there, with support given on a daily basis in making them possible. 

“It can sometimes be a challenging conversation to talk about what is realistic to achieve,” says Luke. 

“We want to give people hope, but not false hope. They will have as much time, support and therapy as they need, which is tailor-made to help them achieve the results they want. 

“But without the resident and their desire to achieve, we wouldn’t be able to make the progress. We offer the tools and they do the work. There aren’t always good days in rehab, a patient could regress or feel they’ve taken steps backwards, but they are always outweighed by the positives.”

To increase its support for residents nearing the end of their time at Askham, and in preparation for their return to home, four apartments have been created on site to help the transition, which also offer the opportunity for residents to be joined by loved ones. 

“We make the flats as much like home as we can so we aren’t setting people up to fail,” says Luke. 

“If someone is going to succeed at home, they need to experience what it will be like, so we try and make it as similar and user-friendly as we can – the benches in the kitchen are the same height as they would be back at home, for example, but it’s in a supported safe environment.  

“We have one resident at present who is living there with her husband, she’s someone not from a million miles away but this is definitely a step in the right direction for her. She has been there with her partner for two months and this is an invaluable opportunity for them both to see what life will be like beyond Askham. 

“Having a loved one on site with a resident is wonderful, and it’s another string to our bow to be able to offer this.”

As a small and very close community, inevitably many of Askham’s former residents keep in touch with the team post-discharge, such is the bonds that are routinely created during a person’s time there.  

Indeed, Askham has recently named its first ambassadors, four former residents who are now Experts by Experience, who will share their experience with current residents to help inspire them through what may seem a long and difficult journey.

“By the time they leave, some people see us as an extension to their family. After such an experience, you cannot help but form a positive relationship with our team,” says Luke.  

“It is wonderful for our staff to see where that person is now, and we hope to go back to being as open as we were in 2018 at some point, so we can welcome many more former residents back.  

“Some of our residents have had outstanding outcomes and some are now our first Experts by Experience, who are invited back in to share their stories directly. It is probably the most empathised conversation you could imagine, hearing from someone who has lived that reality. 

“Every lesson not learned is a lesson lost, and those who have lived it are now sharing it, which is for the benefit of everyone.” 

Interviews

HELP: Empowering people to live their best lives with pain

Think Therapy 1st discuss their pioneering results-based pain management programme

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Through the launch of the Holistic Education for Living with Pain (HELP) programme, Think Therapy 1st is helping to give new hope to people living with pain. NR Times learns more about the first-of-its-kind initiative which is set to change the lives of countless people who too often suffer in silence

 

While pain is something that is all too often dismissed, leaving people struggling to manage their daily lives with few places to turn for practical support, for Think Therapy 1st (TT1st) comes the opportunity to use their expertise to make a life-changing difference. 

As pioneers of a pain management programme which saw 100 per cent of participants report improved functioning as a result, and vast decreases in the level of pain in daily activities such as socialising – where the pain rating reduced from an average of 7.6/10 pre-programme to 2.6/10 afterwards – the team wanted to create an even more compelling offering for those in need of bespoke support. 

While the initial pain programme was an occupational therapy (OT) only project, now, with the launch of the Holistic Education for Living with Pain (HELP) programme, TT1st have extended their MDT to include psychologists and physiotherapists.

A HELP participant

A unique programme in the field of pain, HELP is delivered on a one-to-one basis over a four-to-six month period, and importantly is delivered in a person’s own everyday environments. 

Participants are empowered to live their lives through the power of education, with the onus on the activities and tasks they can do, rather than what their pain has restricted them from, re-opening the possibility of returning to leisure, work or the employment market. 

And while TT1st does not make any claims to reduce levels of pain through HELP, the vast majority of participants do experience a reduction in pain as a result of their involvement. 

For Helen Merfield, managing director of TT1st, the expansion of the initial pain programme is a welcome opportunity to tackle the issue of pain in new and impactful ways. 

“We got awesome results from the programme, but we could only help a small cohort. We felt we needed to reach out to more people with a wider spectrum of conditions, pain is something I feel very passionately about and people need support,” she says. 

“I’ve always felt that people with pain get a bad rap, they’re often just told it’s all in their mind. And while the mind might play a part, no one consciously chooses to be in pain, they don’t get up in the morning and decide ‘I’m going to have pain today’. 

“We want people to be living their best lives in spite of – or as I like to say ‘to spite’ – their pain. We HELP them to recover a life that has meaning and purpose.

“We wanted to help a wider population but wanted to test it on a smaller scale first. And because the results were so great, we have invested in making it even better – and hopefully the results will be even better too.”

Leading the HELP programme, which launched earlier this month, is Steph Fleet, a pain specialist OT who joined TT1st in 2020 and who Helen credits with “taking the bull by the horns” in breathing new life into the company’s pain offering. 

Through adding in psychology, with TT1st working alongside neuropsychology specialists at Sphere Rehab, HELP is bringing together experts in their field to deliver the best possible results to clients.

Dr Katherine Dawson, director at Sphere, said: “Partnering together in the development of a stepped care functional model to inform when therapy is indicated (as well as identifying different levels of intensity) is a great opportunity to deliver positive client experiences and outcomes.

Steph Fleet

“We are also really looking forward to exploring how technology can help with early interventions in the functional management of pain.”

Under Steph’s guidance, HELP has been created to be tailored to the needs of each client. If psychology input is required, their needs are determined through the use of a newly-developed algorithm by Sphere. 

Clients will be screened at the assessment to determine which mix of disciplines they require, OT only, OT and physiotherapy, OT and psychology or all three.

With a fixed fee pricing structure, HELP can be completed in a timescale to suit the needs of each individual client, with a specially-designed workbook and a raft of resources – including podcasts and video – to support them through the process. 

“Pain is something that doesn’t get talked about like it should, I feel really strongly for anyone experiencing any level of pain that unless you talk about it and develop some strategies, then it’s just going to keep continuing and holding you back,” says Steph, who won the rising star accolade at the Advancing Healthcare Awards 2022 in recognition of her client-focused work.

“They’re going to learn how to manage their pain, so that they’re able to do the things that they need to do, but also the things that they want to do, despite their pain experience. They will learn lots of techniques and develop tools to do that.

“We wanted to create a programme that was flexible and exactly what people want and need, and already, although HELP is new, we are seeing some brilliant results.

“I’ve got a client who’d been standing in an almost brace-like position, her knees and back have been bent, as if she’s about to run. 

“The physical reason for this position had resolved, so we talked about it in terms of her brain being hyper-alert to danger, therefore she was defaulting into this position essentially being ready to run. 

“I helped her see she no longer needed to be ready to run and the danger had passed and it was safe to straighten up.

“She has done that for a week and her pain experience has dropped massively, because she’s standing in the right position again and recognising that she’s not in imminent danger.  

“So that conversation, and the strategies we came up with, have enabled her to see positive change.”

The client, Juliet from Dorset, said: “The key thing I’ve been taking away to help me when Steph’s not with me is becoming aware of my standing position. 

A HELP participant

“I’m telling myself that I can stand up straight and I recognise that I’ve been locked in my traumatic experience. I’m now much more aware which has helped me to progress. 

“Improvements are being made and my perception of pain has reduced a lot”.

Helen continues: “It’s all about tailor-making it for everyone. 

“Although there are fixed components, there are more components than required because not everyone will need everything. Some people will need more of one type of support than another. 

“But what we see is that because it’s tailored, they start seeing improvement almost from day one, there’s so much education involved that we are teaching them to be their own therapist, putting them back in charge of their pain experience rather than it running their life.” 

One big difference to other pain management programmes is the delivery in a participant’s own environment, be that their home or places they spend time or need to access. 

“The majority of current programmes on offer are great, but they’re not delivered in an environment where people are actually living their lives, they’re often in a a completely different environment,” says Helen. 

“While people may get a solid two or three weeks to focus solely on education and therapy, they leave and have to come back to real life. The programme finishes and they just go home. They’ve learnt all of this information, but how do you actually apply that when you’ve got a family, kids, a dog running around?

“What you thought could transfer quite easily because it all made total sense when you were on the course now goes out of the window, and you find that within three or four months they’re back to where they were before.

“That’s why delivering it in a person’s own environment, with all of their daily routines and tasks around them, is so important. So that even after

A HELP participant

we leave them, when they have a new environment, whether it’s a new job, they’ve moved house or they’re just going to a different cafe, they’ve got the tools they need in their toolkit to keep them safe in that environment.”

Steph adds: “HELP is also unique when compared to others which are in a group setting. There’s nothing wrong with a group session, but this makes it so individualised and so accessible for the person.”

“And then we take the education and learning we have delivered and we put it into practice, with support from an OT, physio or psychologist, depending on what they need. We’re going to do it with them, in their environments with the world happening around them and model it with them, which is why we get such great results.”

And with such a pioneering programme to work with, Steph, who has a Masters in rehabilitation, is delighted to have the opportunity through TT1st to make a difference. 

“All the clients I’ve worked with over the years have experienced pain to some degree, whether that’s psychological pain or physical pain,” says Steph. 

“And I’ve always found it really interesting how it can really limit people’s abilities and last longer than many of the physical challenges they manage to overcome. 

“Rehabilitation is my absolute passion but pain kept on coming back as something that affected so many people and doesn’t get talked about. The individual often feels that it’s their fault – and then I came to TT1st and had the opportunity to really jump into helping them.” 

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Therapies

Chroma supporting schools with mental health and creativity

Chroma is implementing arts therapies into schools, supporting children through collaboration with teachers

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Arts therapies provider Chroma is implementing arts therapies into schools to help support children’s mental health, creativity and resilience through collaboration with teachers.

Based on experiences working within schools in Beijing, Bangkok and Singapore, learning consultant Nici Foote believes that creativity and collaborative teaching and learning experiences motivates students to think critically, help them with authentic problem solving, and provide students with greater opportunities to use higher-order thinking skills to support understanding.

“Children were more engaged and tuned in through an inquiry learning process,” she said.

“The Primary Years Program, sees students follow their own ideas, researching and undertaking different activities around the classroom to get children activating their own choice and voice within learning.

“In Singapore, Bangkok and Beijing, the schools are forward thinking and innovative. They use the Inquiry Process, whereby students lead the way in their own learning journey.

“Collaboration between teachers and students, within lessons, offers an innovative approach to education that helps build and create ‘trust’ between all parties. Supporting students creatively, helps steer them towards gaining a better understanding of a topic or subject.”

Chroma aim to implement arts therapies into schools to achieve similar effects for students.

Daniel Thomas, managing director at Chroma, said: “Arts therapy sessions implemented within schools will help support children in self-expression and build self-confidence, both of which have become even more important factors due to the mounting pressures children face at school.

“Role-play in dramatherapy, for example, can help students explore issues they may be dealing with within school or at home; art therapy activities support self-expression allowing children to discuss their feelings and music therapy develops confidence, helps develop healthy bonds between students and teachers, and facilitates positive changes in emotional wellbeing.

“Above all else – these sessions are fun and provide students with a necessary pause from schoolwork. Following arts therapies sessions, children feel motivated and inspired, creating a positive attitude towards the rest of the school day.

“Teachers are also encouraged to participate in sessions, to help build trust between teacher and student and to gain a better understanding of their students’ emotional wellbeing and needs. With this, teachers can identify the ways in which they could change their approach to teaching to help facilitate a more amiable learning experience – one that is vibrant, passionate, student-focussed and where all students can thrive.

“Teachers, mentors, teaching assistants and arts therapists should work together and support students’ learning journey to help children develop resilience in a supportive environment – where they can learn without a fear of failure.”

Nici adds: “In order to be a great teacher, you need to consider yourself a facilitator. Changing the language of teaching is the first step.”

Arts therapies promote creativity, collaboration and innovation between teachers and students, which when applied towards learning outcomes, could offer teachers the opportunity to teach innovatively and students to learn – creatively.

 

 

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Therapies

How visualisation can support emotional wellbeing

Chroma assess how guided visualisation can enable clients to overcome mental and emotional challenges

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Imagination may hold the key to improved quality of life as it can help alter perceptions of difficult issues in a positive way.

Chroma Dramatherapist and mindfulness practitioner Katy Weston implements guided visualisation into her sessions, in essentially the same way – allowing clients to ‘play’ in ways they may not be able to in everyday life, for instance, if they are cognitively and/or functionally impaired.

Katy finds cards with images help guide sessions, as she can determine which image resonates with a client that day, for example, a boat, tree or plane, and steer the session from there.

“I have a client who suffered a catastrophic brain injury. I use cards for guided visualisation in our sessions to determine if there is a story we can make up from it and discuss the image,” she says.

“For instance, if the client chooses ‘the sea’, I ask ‘Are we swimming? Are there dolphins?’ From there I will jump into the water and ask her if I can hold the client’s arm to imitate swimming (I will always ask a client so they know they have control of what is happening).

“Movement is encouraged during our sessions where possible, and from there, we can swim with dolphins and venture on a journey together.”

Guided visualisation follows the theory that ‘if you can see it, you can feel it’. It has the ability to transport the mind to the idea of alternate possibilities – where you can escape your own reality – even if it’s just for that moment.

With guided visualisation, it is possible to gain a new perspective on a particular issue, condition or life moment, which may be difficult to come to terms with.

Katy recalls a client in palliative care who described herself as ‘sitting in a waiting room merely waiting for death’.

Through guided visualisation, the client was able to draw the room, its windows, its doors, plants, reading material and so on.

Staff commented that following that session, the client was like a different person – approachable and talkative. She allowed people into her room to chat. Following the initial session, she continued to imagine doors and paint them.

In the client’s own words, she said she now ‘felt in control to make this experience different’. She felt empowered.

Guided visualisation, part of Chroma’s portfolio of arts therapies, allows people to explore issues in a safe way, which helps create an unconscious shift that can present the client with a different perception on an event and help them overcome the mental and emotional issues surrounding them.

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