REHABILITATION FEATURE
‘In normal times that would have probably taken us one or two
years to organise. That was achieved in the matter of a week’.
The speed and proficiency at which staff shifted focus onto
creating new ways to connect to our vulnerable community
and multidisciplinary team members in the continued delivery of
services has been inspiring.
We worked through our list of 800 plus caseload to screen
their vulnerability and identify an action related risk level.
All low to moderate patients were identified as suitable for
a self-management approach. They were sent a letter with
signposting information and details of how to contact an
occupational therapist or speech and language therapist within
the team. In addition, all new referrals were triaged and screened
over the telephone.
With the fears of contracting COVID-19, many patients have
disengaged in social occupations, resulting in increased isolation
and dependency. CNRT’s role moving forward will need to
address new ways of connecting people, ways to bring about
hope and new ways of being, becoming and doing.
Re-entry into the provision of long-term neurological
rehabilitation will be problematic. Many progressive neurological
patients will have become deconditioned and there is a
real concern that they may have developed secondary
complications, due to spasticity and poor postural management.
This will, for some, have resulted in potentially devastating loss
of function that they may never regain.
The additional debilitating effects of COVID-19, such as
fatigue, cognitive dysfunction, communication difficulties and
psychological issues, will place increased demands upon the
service.
This, however difficult, will highlight more than ever the
importance of specialist community rehabilitation and provide a
platform to showcase the vital role occupational therapy has in
providing an occupation-focused approach to the treatment and
rehabilitation of this patient group.
Technology may be able to offer help for influencing change, as
it has become omnipresent in society. Time devoted to potential
innovations and obstacles going forward may be worthwhile.
We are keen to embrace technologies and approaches to
empower our patients, support their relatives and enable continued
rehabilitation. We are aware that others are utilising technology to
conduct virtual assessments, provide educational sessions and
information packs to support rehabilitation goals and promote
wellbeing. We are also looking towards these innovations.
However, we feel there are additional considerations and
that these approaches may not be the answer for our most
vulnerable patients.
Wolverhampton has areas of high socio-economic
deprivation and literacy is an issue within our population (City
of Wolverhampton Council 2016). It is pertinent therefore
to consider patients’ accessibility to technology for virtual
assessments and their reading skills and ability to understand
written information.
We cannot take for granted the access or skill set some of
our patients may have to technology. We want patient-centred
empowerment, not to deepen existing inequality.
We need to find what works best in uncharted territory. We
need to review all of our unique occupational therapy skills and
contributions. We need to re-examine our resources and how
best to use them.
Self-management is thought to be a necessary element of
healthcare provision in order to respond to the number of people
living with long-term neurological conditions. Promoting selfefficacy
and supporting the drive for patients to be responsible
for self-management is not an easy task for the community of
patients we serve.
During the COVID-19 lockdown, our low to moderate risk
patients have been forced to take responsibility for the selfmanagement
of their condition. We are keen to gather patient
perspectives and strategies on this increased responsibility and
the value they have found in this during lockdown.
This approach may afford us the resources to focus on where
we are needed the most. Fostering a culture of self-management
should remain a key focus.
We need to give ourselves time to reflect as individual
practitioners, as well as a wider multidisciplinary team, to focus
on what has worked well, what has not, and what has pushed
us outside of our comfort zone, and is worth pursuing in the
future.
CNRT colleagues who have been redeployed, who are due to
be repatriated back to the team, will likely also have valuable new
skills and experiences to share with the team.
Allied health professionals within CNRT are expertly poised to
provide a co-ordinated approach to community rehabilitation for
people with long-term neurological conditions.
Our response to the pandemic has demonstrated how
occupational therapists can respond proactively to an emergent
change and demonstrates the breadth of skills that the profession
can bring to the NHS in these times of uncertainty.
We have fostered a culture of flexibility and we need to
continue to be courageous and experiment beyond our
established confines. It is important we continue to think laterally
about how we engage with our community and rapidly adapt to
change to ensure we are still providing proactive preventative
neurological rehabilitation.
References
City of Wolverhampton Council (2016) [Online] Available at: https://insight.
wolverhampton.gov.uk/Help/JSNA [accessed on 8 June 2020]
Royal College of Occupational Therapists (2017) Keeping records:
Guidance for occupational therapists (3rd ed) London: RCOT.
Nicola Matheson, lead occupational therapist/CNRT team
leader, and Laura Willis, senior occupational therapist, West Park
Rehabilitation Hospital, Royal Wolverhampton NHS Trust, email:
[email protected]
OTnews July 2020 37