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Neuro rehab insights

Patient pathway – Askham Rehab



Here, Sara Neaves, Clinical Lead and Outpatients Service Manager at Askham Rehab, gives SR Times insight into the services Askham Rehab provides for stroke patients.

Can you please give us a brief overview of your stroke pathway, in terms of where you are positioned on the post-stroke journey and the types of interventions you provide (in no more than a few hundred words please)? 

Askham Rehab is positioned between the acute sector and the community teams. We accept referrals from acute trusts, and although we are based in Cambridgeshire, we accept referrals from all different counties — such as Norfolk, Suffolk and Lincolnshire to name a few. We will receive the referral paperwork and triage the information from both a nursing and therapy point of view, ensuring the patient can gain the best possible outcomes with us. 

We work alongside the acute trusts to gather a detailed handover and when the patient arrives with us, we start all our own assessments. The team works collaboratively to assess all of the patient’s needs from a nursing and therapy perspective. We ensure to actively listen to the patient’s goals and post-assessments, whilst also setting collaborative SMART goals to ensure we are all working in a patient-centred manner. We meet regularly with the funding parties, the residents and their family and friends to ensure open dialogue is had in regard to progression, rehab potential and goals. We will ensure referrals are made for teams that are required post-Askham, such as wheelchair services, social care and ongoing therapy.

Are there any elements to your approach that you believe sets you apart from other such services – or which other stroke care providers could learn from? 

Askham Rehab strives to work collaboratively as a full MDT with the resident at the centre of everything we do. We do this with the availability of great rehab opportunities, including hydrotherapy and access to state-of-the-art technology, such as functional electrical stimulation (FES) and robotic therapy.  There are only a handful of inpatient settings that have both upper and lower limb robotics and we are the only provider in the East of England which allows us to explore a greater therapy input.

What would you say are the biggest barriers/challenges to you in delivering the best possible patient outcomes? 

Funding is limited for rehab in all areas and stroke rehab is one area that has an initial period of funding, with discharge always in the back of your mind. We are fortunate at Askham to have a good relationship with all the local funders and due to our clear collaborative goals and outcome measures, we can highlight when a resident has the potential for further progression and requires this funding to be extended.

Please tell us about the make-up of your team in terms of roles/skills / multi-disciplines etc. Has this skillset changed in recent years? If so what are the reasons for these changes? 

Askham Rehab has developed and grown, with the therapy team expanding considerably to adapt to this growth and exciting changes. There are physiotherapists, who have gained further qualifications in hydrotherapy, robotic therapy, FES and splinting to name a few. Our occupational therapists are very experienced and have advanced skills in physical, sensory and cognitive training — positioning them to advise on seating, posture, tone management and equipment. Our speech and language therapists have skills in both swallow and communication, including tracheostomy care and dysphagia — and again, enjoy working with assistive technology. The clinical psychology team has fantastic skills in regard to mood, anxiety and cognition. They too utilise technology and group therapies to engage and motivate all of our residents. These therapists are all supported by rehab assistants, with specific training in each discipline, as well as rehab support workers. This allows for a 24-hour rehab approach.

Please describe your approach to families and loved ones of patients in terms of a) harnessing their support for the benefit of your patients/clients and b) supporting them through the difficult period after a stroke. 

It is really important to ensure that residents have their family/friends engaged with the rehab process as this aids with motivation, mood and opportunities for rehab. Following our initial assessments, families are invited to a meeting so we can ensure they meet the full team and understand the rehabilitation process — whilst also being clear on the goals that have been set by the resident. It’s important that families understand what has happened to their loved one so they know why someone may be acting slightly differently, may have differences in their personalities, and why a limb may not be working as it was. It means that they have a better understanding of what life may look like for them all post-discharge from Askham. We encourage families and friends to be involved in the whole process and welcome them on-site at any time. We do not have strict visiting hours and enjoy meeting families for community trips — which is a great way of starting to introduce our residents to the next part of their recovery.

With stroke rates rising, are you experiencing growing demand for your service? How are you meeting this demand? (I’ll answer combined) 

It has become clear to us all that over the last few years, for whatever reason, more people are having strokes. But thanks to the wonderful developments in medicine, more people are surviving. This has increased the demand for both inpatient and outpatient neuro rehab. Here at Askham, we are increasing our bed capacity so that we can accept more residents and they can access our rehab facility — whilst also developing an outpatient service. This will be open for either a residential opportunity or regular sessions, and these patients will be able to utilise all of our equipment to ensure they have access to the intense rehab they need.

‘Patient-centred’ is a term often overused in neuro-rehab – please explain what this really means and how you embrace it as a stroke care service? 

Rehab should be patient-centred and the term should mean exactly that. The patient, or resident as we call them at Askham, is at the centre of everything we do and they should have a voice at every point of their journey. They are involved in the assessments, our collaborative SMART goals are all based on their personal goals, and we discuss our treatment plans and how they will impact their goals. They are involved in meetings and when it comes to discharge, they are involved in all discussions with their family, friends and external agencies in regard to how their wishes will be achieved.

Is your use of technology changing, or has it changed recently, to better serve your patients? 

Research over the last few years has highlighted that if you want to make positive changes post-stroke, you need to utilise neuroplasticity, and this is all about high repetitions.  Research and evidence-based practice all point to the use of technology to assist with this.  Here at Askham, we have invested in robotic therapy to do just this. Not only do you get an experienced therapist, but you also get the opportunity to use some of the most advanced robotic therapy for your upper and lower limbs.

Patient case study

A 57-year-old former bus driver and mother of two from Cambridgeshire who suffered a life-changing bleed on the brain in July 2022, is regaining independence thanks to the specialist rehabilitation team at Askham.

Through a combination of regular physiotherapy and wellness sessions, we have been working closely with Isabel to restore her motor functionality and improve her mental well-being following what she describes as “one of the most challenging times of my life”.

Isabel, who was very active before her stroke, was referred to Askham Rehab for an initial 8 weeks and since discharge, now attends its outpatient service to fulfil her ongoing rehab goals. Since joining she has come on leaps and bounds — overcoming the challenges of being restricted to full use in just one arm and leg.

Upon arrival, she required assistance to sit, stand and maintain balance due to a right-sided weakness, which was more pronounced in her upper limb. The priority was to centre her treatment around active movement, focusing on things like wrist flexion — using state-of-the-art robotic equipment, such as the Pablo system — an interactive therapy device.