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How has COVID-19 altered clinical practice in neuro-rehab?

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After the onset of COVID-19 changed healthcare forever, what has been its impact on neuro-rehab? Specialists at Neurokinex assess the situation for NR Times 

 

Most of us can remember where we were upon hearing the news we would be heading into a brief lockdown to help reduce the spread of an emerging global virus. It is unlikely that any of us could have imagined the long-lasting effect it would have on our lives. 

More than two years on, we are still feeling the impact of the virus in clinical settings. This is especially the case in how it has required us to adapt the delivery of our services to provide rehabilitation as unopposed as possible. 

 

Rehabilitation from afar 

The COVID-19 pandemic posed an immediate, urgent question. How do you deliver rehabilitation to those in need, whilst socially distanced and potentially not even in the same room? The answer, in part, was telerehabilitation.

 

Hayley Bray at Neurokinex Gatwick

Alongside the rest of the world, our rehabilitation was adapted to allow for completion over telephone, video conferencing calls and through data logging to track people’s progress. Instructional videos gave clients in-depth instruction on how to carry out exercises safely and efficiently remotely with household items. On live video calls, trainers and specialists answered questions and assessed movements, providing feedback and reassurance.

Whilst an immediate solution to cover the short-term unknown, a more long-term solution was needed to allow for face-to-face rehabilitation to resume.

 

You, me and PPE 

As COVID testing became part of daily life, restrictions eased and vaccination studies progressed, face-to-face rehabilitation began again – albeit, with some subtle (and some less subtle) changes.

Clinical spaces in rehabilitation centres were segregated, allowing for multiple clients to be trained simultaneously but safely apart from each other. Clinicians were required to extensively plan sessions and pre-book equipment required for each session to reduce potential contact with other clinicians and clients. 

The most visually noticeable change to the rehabilitation landscape was the mandatory incorporation of Personal Protective Equipment (PPE). During and in the wake of the pandemic, masks, gloves and aprons became the norm to protect clinical staff and clients alike. Whilst hygiene was always at the forefront of best clinical practice, during and post-covid stringent disinfection protocols were put in place, including isolation of equipment post-disinfection for 12 hours. 

Whilst delivering rehabilitation physically may not have been altered vastly post-covid, the daily running of centres underwent a comprehensive re-structure. Ideas such as having contingencies should a clinician need to isolate were put in place to reduce any impact on clients.

Monetary funds to aid in the financial burden of coping with private healthcare or costed rehabilitation have also been established, to reduce financial hardship as a result of COVID-19. In primary care outpatient, COVID positive and negative routes of rehabilitation have been established.

Ella working hard at Neurokinex

 

The future 

The British Society of Rehabilitation Medicine (BSRM) aided organisations to structure their return to work and created suggestions to help in the delivery of rehabilitation following the COVID-19 pandemic.

Patients should have access to rehabilitation both in hospital and community settings with acute rehabilitation providing early intervention. Patients requiring long-term rehabilitation should have access to rehabilitation prescription to assess physical, cognitive, neuro-behavioural and musculoskeletal needs.

This should be delivered alongside a complex needs checklist to provide a long-term framework addressing the patient’s needs. Once ready, community rehabilitation should be integrated into the patient’s care pathway. 

At a clinician level, as guidelines ebb and flow, the clinical spaces will likely see changes to pandemic measures such as social distancing and the wearing of PPE.

As cases drop, we may see a reduction in PPE and fuller clinical spaces; conversely, with any further increases in cases or identification of new variants, masks and other PPE may be re-introduced alongside more stringent social distancing measures.

The use of telerehabilitation provides the potential for more flexible rehabilitation for clients, with further income streams for clinical centres.

There is hope that the increased learning that occurred following the first waves of the pandemic mean clinical centres are better equipped to deal with COVID-19 and similar outbreaks. This will hopefully reduce the impact any future waves of COVID-19 might have on providing rehabilitation in both hospital and community settings.

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