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Empowerment through therapy

The role of specialist rehab OT in leading the MDT



Through a focus on functional rehabilitation, Think Therapy 1st are supporting clients to regain the maximum levels of independence possible after serious or life-changing injury, equipping them with the skills and tools they need to move on with their lives.

Here, NR Times discovers the importance of specialist rehabilitation occupational therapy (SROT) and its role in leading a multi-disciplinary team (MDT)


For Jada, a 14-year-old girl whose dream was to move into higher education to study music, those ambitions looked to be potentially shattered when she sustained a brain injury.

As she battled to recover, her school grades deteriorated significantly, and her vast potential was put at risk. With a school struggling to get to grips with Jada’s new challenges, and complex family dynamics, the future which had seemed so bright was overshadowed by the impact of brain injury.

“The main challenge was around executive dysfunction; difficulties with initiating and completing tasks, maintaining attention and switching between activities, and regulating her emotions; all of which led to low self-esteem and her withdrawal from her friendship groups and support networks,”says Penny Wosahlo, managing director of Think Therapy 1st (TT1st).

She was a musical prodigy, and after her brain injury she could still play, but her other subjects in school began to suffer.

“Her grades dipped, her relationships with other people were breaking down, she was very frustrated and couldn’t work out how to handle those emotions, which is so common in young people with traumatic brain injury. 

“But because she appeared to be OK, the school were not able to give her the support she needed initially.”

Having been appointed jointly by her solicitor and the insurer, TT1st introduced its unique approach to rehabilitation into Jada’s life – with truly transformational impact.

Through its focus on specialist rehabilitation occupational therapy (SROT) and devising a range of functional activities for Jada, which would engage her in practical tasks while enabling her to rebuild her life, TT1st proved vital in its role in assembling and leading the multi-disciplinary team (MDT).

Penny Wosahlo

“We introduced functional cognitive rehab in our sessions, and she had sessions with a neuropsychologist to help regulate her emotions and address other aspects of her executive dysfunction. We worked with the school to introduce an Education Support Plan. She needed some help with her vision, so we brought in a neuro optometrist. We made recommendations and sought agreement from the referrers and got all of those things in place,” says Penny.

“We recommended the insurer give us a budget for us to support her with rebuilding independence, which might seem quite an odd thing to ask, but because we were looking at her being able to go into higher education, independence and money management were really important.

“Her occupational therapist Fiona accompanied Jada out Geocaching. Geocaching proved really important as part of her cognitive rehab, thinking and following clues, and there were also some vision aspects to it through reading maps.”

And through TT1st’s approach, despite the outlook looking particularly challenging for Jada, she was able to gain a place at a prestigious higher education institute to study music – a golden moment for everyone involved, the pinnacle of what she was working so hard towards, and it was achieved.

Jada spoke of how “I feel like I’m able to make my own decisions now and my life is going great…  I feel more able to know when I need help, and also more importantly, I know what to do when I need help and don’t just bury my head in the sand”.

“It was so lovely to be involved in this, it really did change everything for her. It’s heartening to see where she is now, off living her life and being able to cope with the day-to-day challenges her brain injury presents which she was not able to at one point,” says Penny.

With its unique take on OT, and results-driven outcomes measured against goal achievement, TT1st facilitates strong outcomes for clients throughout the country.

Taking last year as an example, of the clients who completed their therapy with TT1st – more than 20 in number – only two needed ongoing support; one of whom already had a longstanding case manager in place at the point of referral.

And its results, combined with the SROT approach which can positively support every aspect of a client’s life, mean TT1st regularly undertake leading and coordinating the MDT.

“For most people, they hope to return to how their life looked before their injury, or as close as they can get to that. Ideally, that’s what we want to help them get back to through restorative rehab, so we will assess every aspect of their life now and look at what the issues are,” says Penny.

“Our SROT approach delivers some life-changing results, but we can’t support a person alone. Evidence and best practice indicate that the best recovery will involve an MDT, with the client at the centre of that.

“The MDT will be based entirely on the bespoke needs of the client; no two clients are ever the same. We work across brain injury, amputations, orthopaedic trauma and often times with psychological trauma. We work with both children and adults, and everyone needs a different construction of an MDT to reflect their needs.

“We assess the person functionally, and look at the impact their injury has had on each bit of their life. We do that in their own environments – be that their home, their workplace, their school, wherever is crucial to them being able to live their life – and look at the activities they used to do, in addition to the day-to-day reality of living their life. They may want to go to the gym, they may want to go nightclubbing, they may have hobbies they want to return to.

True to TT1st’s approach of empowering people to regain independence and being able to complete activities on their own – Penny says they will never do anything for a client they can do themselves, preferring to encourage them to be self-sufficient and confident rather than do something for them – this is also reflected in the MDT they build.

“Clients are in a position at first where their lives have been turned upside down, so of course they will need a huge amount of support. But as their situation changes, the role of the MDT and the people working within it changes, and we need to reflect that,” says Penny.

“At the nucleus of the MDT is the client, that is constant, everything will always revolve around them. Because of the work we do and our role in the team, we will be in the inner circle, often alongside the person who will have a close link with their claimant solicitor. We consider ourselves a joint coordinator of a client’s rehab, working in full conjunction with them. We’re teaching them and working side by side in doing that.

“But others in the MDT will move around in terms of the position they occupy. Because it’s multi-agency and multi-disciplinary, we have to respond to what is needed. We all overlap to some extent in the role we play.

“For example, at first after their injury, their orthopaedic surgeon may be in the inner circle, but their role will lessen as time goes on. Physio input may vary throughout, so they may be in the inner circle sometimes, but then their involvement may reduce, and they move to the extended team.

“By heading up the MDT we coordinate services, ensure goals are aligned and ensure the different specialities are working cohesively to optimise outcomes and recovery.

“We naturally use our OT skills to therapeutically plan and coordinate input from other teams and specialities by introducing treatment and interventions at the most appropriate stages of the client’s recovery and holding regular All Party/ Way Forward meetings at frequencies tailored to the clients’ needs.

“We include the client in every step to develop their self-efficacy, streamline their progress and ultimately optimise their achievements with the client becoming the expert in their own recovery, with the ultimate aim of learning valuable transferable life skills along the way.

“We need to respond to the needs of the client so they are best served, and as a progressive business focused entirely on maximising the outcome and independence for the injured person, that is our priority.

“We all need to be focused on the same goals and delivering those for the client. It may seem strange to include the insurer or defendant solicitor in the extended team but in joint instructions they will agree funding for rehab and services and so it makes sense to include them in that extended capacity.

“We always have a plan in place, and do update reports every month, which the client also contributes to. We have space where we input feedback from each provider, so we can review how things are going, we’ll be able to track progress, looking at the goals and whether they being achieved or not.

“Practically, with everyone working so symbiotically together, every month we are seeing progress – and if we’re not, we’ll ask the client, look at the feedback and review the outcome measures to understand why and make the necessary changes to benefit the client.”

In line with its commitment to working side by side with a client, TT1st – a growing national provider – appoints OTs based locally to the client.

“In our own work, and in leading that of the MDT, it is important to have people working in the area and with knowledge of the structures in place,” says Penny.

“Each area will have its own pathways, which can be very frustrating, but local knowledge can help to negotiate this and often find new support structures. If we don’t know someone in this particular area, it won’t take us long to build those relationships. We’re a national service and very well connected, so we will always be able to find the professional or service the person needs.

“And by using therapists who are local to the community the client lives in, that can be important to their rehabilitation. Humans who are very isolated do not flourish. We are not remote, we do everything face to face as much as possible, we get to know the client and there are no barriers there.

“That’s the level of service and client focus we are committed to delivering – and that’s why what we do works.”