FEATURE REHABILITATION
Rehab in a ‘ real world environment ’
Stuart Wilkin , Serena Conway and Rachel McLaughlin write about the value of independent living flats during the COVID-19 pandemic
Redford Court is a 24-bed specialist brain injury unit that provides community-focused rehabilitation to individuals with acquired brain injuries in the city of Liverpool . The service , part of The Disabilities Trust , is founded upon a neurobehavioural approach and focuses on enabling service users to function more independently , develop their lives as they choose , and to participate in as many of their previous roles and activities as possible .
The service provides multidisciplinary input including occupational therapy , psychology , physiotherapy and speech and language therapy . Service users are referred under three pathways – restorative , compensatory life skills and wellbeing – ranging from higher functioning individuals to those with slower stream rehabilitation needs .
The current COVID-19 pandemic has had a significant impact on everyone ’ s lives in the last year . As occupational therapists , we have therefore had to adapt the way that we work in order to continue to provide high quality and effective treatments for the individuals that we work with .
A particular challenge in our service has involved the provision of assessment and rehabilitation of functional abilities in ‘ real world environments ’ in preparation for discharge , when visits to the home environment are severely restricted .
The national clinical guidelines for rehabilitation following acquired brain injury highlights that to maximise rehabilitation ‘ activities should be practised in a naturalistic and realistic environment – ideally in the patient ’ s own home and local environment ’ ( RCP and BSRM 2003 ).
Furthermore , when we consider the types of individuals that our service works with , that is , potentially significant brain injuries that require an extensive period of rehabilitation , this is even more vital .
For example , a study examining the views of occupational therapists on the importance of completing pre-discharge home assessments with stroke patients ( Whitehead et al 2014 ) found that the level of cognitive function played a particularly important part in deciding whether a home assessment visit was needed .
One of the most fulfilling and rewarding parts of the occupational therapy role is enabling the individuals we work with to be discharged home . However , prior to that point of discharge there are always some uncertainties and anxieties about how that individual will manage when they return home , especially when there is a limited resource of community support .
Under ‘ normal ’ circumstances we would complete an environmental home visit , followed by graded periods of home leave , both of which act as vital tools in our assessment and discharge planning .
Although the pandemic has restricted us from carrying out this valuable strand of the rehabilitation process , it has made us reflect and focus more on what we do have at our disposal , namely our four independent living flats .
In comparison with the main unit setting , the opportunity for individuals to continue their rehabilitation in their own self-contained flat can have a significant impact , both in terms of their rehabilitation , but also our ability to accurately assess their abilities and potential risks .
Crucially , it enables the team to more precisely grade the support being offered in a realistic home environment . For example , helping to answer key questions such as : Can they initiate activities of daily living without the regular interventions from the staff support on site ? Can they self-occupy and establish their own routine ?
Here , we share two contrasting service user examples that demonstrate the important role that the independent living flats have played in the past year with the limitations that the team has faced .
Preparation for discharge home A year prior to admission to Redford Court , Chris had a parietal intracerebral haemorrhagic stroke . Following a previous short period of inpatient rehabilitation , he was discharged home to live with his parents , due to reduced inpatient rehabilitation capacity at the beginning of the pandemic .
As a result of his brain injury , he had an impaired short-term memory , difficulties in attention and some behavioural issues . The aim of his admission to Redford Court was to enable him to establish an independent daily routine to both assess and prepare him for discharge home to return to his wife and children .
As his discharge destination was home , a move into the independent living flats allowed for a far
46 OTnews May 2021