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Delivering at-home physio during lockdown – the challenges and opportunities

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For those providing rehab services, lockdown has presented many challenges in how to continue treatment in light of ongoing restrictions. Here, Ben Ruby, owner of Ben Ruby Neuro Physio, discusses how he has adapted his way of working to ensure his clients continue to benefit and how telerehab can help people discover new possibilities.

“Provision of therapy services since March 2020 has shifted due to COVID-19 and the restrictions put in place by the government. Working within the private sector and providing specialist neurological physiotherapy input, I often spend prolonged periods of time within my clientshome.

Providing rehabilitation within peoples homes can generate fantastic results as its possible to make treatments specific to the individual’s needs and is more relevant to their day to day lives. This is something that cant always be replicated within a rehabilitation unit, for example.

Restrictions put in place during lockdown meant I had to adapt to the climate and seek ways of providing similar input to those who needed support.

Due to the population of individuals I treat, a proportion of them fall under the at riskcategory. Because of this, carrying out clear risk assessments and wearing the appropriate PPE is essential to protect them and myself. PPE in itself has had an impact on communication with my clients, as a mask and visor hide not only your mouth, but also your facial expressions which people often use for reassurance and respond accordingly in conversation.

I have had clients who have moved to online sessions, which at first was a challenge to adjust to. Being a physiotherapist, you are so used to working with people in close proximity and being able to analyse and interpret movements in person. Relying on camera angles and WiFi connection can make things harder to respond to in real time.

Despite this, there are certainly some positives to this way of working other than the reduced risk of COVID-19 transmission. There are times when you have been working with clients for some time, that they can become dependent on your presence to move or carry out other tasks during the day.

I have found that being removed from them has enabled them to a degree. Where someone may not have had the confidence to stand without having me there before, they have attempted this whilst following my instruction via a Zoom call.

There is a degree of risk associated with this, and utilising family members when able to reduce this risk helps. This in turn has had a positive impact on family members who may have been anxious about helping someone move. Rehabilitation takes many forms and is not only about the person being treated, but also those around them and how they interact.

The neuro population can be very vulnerable and even in normal times experience isolation due to not being able to get out of the house or a lack of support network around them. Being able to communicate with them via technology and seeing a familiar face can make a huge difference to their mood and motivation.

While there are limitations in what I am able to deliver online from a physical standpoint, it can help in other aspects of our role which as therapists we do all the time but may not be so aware of.

Things have got easier since March partly because of adaptation, and due to guidance from governing bodies being a little clearer, which has enabled me to make more face to face contacts for sessions.

I still have those who I see online, which works well, especially if someone is located in a higher risk area and have greater restrictions in place. This enables me to continue seeing them without increasing my exposure risk and continue to see my other clients.

When you are not working within the NHS, you must rely on the guidance from your governing body, other therapy colleagues but also common sense. I am not given specific rules to follow from a manager because I am my manager!

I have friends and colleagues who have continued to work within peoples homes throughout lockdown and who follow the same procedures I do when entering peoples homes. Knowing what to look out for and risk factors involved with COVID-19, you are able to continue to deliver a good service, even if it might look a little different to normal.”

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