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Letters - 23 October 2013

Get involved now by sending your contributions by email to or write to Letters, Frontline, 14 Bedford Row London WC1R 4ED.  Letters should be no more than 250 words. Frontline reserves the right to edit letters. Please ensure you include your name, address and a daytime telephone number.

Under pressure

I am a community physio and have become part of a multidisciplinary community rehab team in recent years.

The service is part of the government’s initiative to treat more people in the community but is insufficiently funded.

We struggle to try and manage our workload and I spend more and more of my time completing risk assessments, depression scores, pressure area checks, filling out form after form, justifying myself, proving my effectiveness.

The one thing I do less of is treat patients as a physiotherapist.

When I read David Guthrie’s article (page 34, 2 October), I could empathise completely.

I am frustrated that I cannot provide the levels of rehabilitation that patients should be receiving. I think that it is all too easy to dismiss a patient’s rehab potential as progress slows if we and our service are under pressure.
Jeremy Hunt ... are you listening?
Jane Tavinor

Sinking feeling

I read the article about Rita and David Guthrie’s struggles with aftercare treatment with a sinking feeling (page 34, 2 October).

I am not surprised that they had such lack of success in getting the treatment that Rita needed following her stroke.  

This is a story I have heard before. Two friends recently had similar experiences when their mothers both had serious strokes and were not able to get the long-term post-trauma care that they needed.   

As a result, both ladies, who previously led full active lives, now live in residential nursing homes and can do very little for themselves.

They weren’t given a chance to see if they could get back to anything like their old lives, because not enough therapy was available to help them make the best recovery possible.

When I did my neurological training many years ago, I remember being told that the central nervous system had the ability to continue recovery for up to 18 months post-trauma.  

We were also told that treatment should continue this long if the maximum recovery was to result. Now it seems that most stroke patients have some treatment for about six weeks (if they are lucky) and that is it.  

They are then deemed to have reached their ultimate potential and no further treatment is available.  

Further treatment may be possible in the private sector, but that is dependent on whether suitably trained therapists are available in the area that the patient lives in.

I know that there are specialist stroke care centres where good results can be achieved, but these do not seem to be available for many patients nationwide.

Early intervention also plays a part but with so many A&E and trauma centres being closed or downgraded, this is  not available to the majority of stroke sufferers.

When will this be rectified? We trained to help patients to overcome their injuries/trauma and reach their maximum  recovery potential – this does not seem to be possible at the present time, especially within the NHS. 
What can we as therapists do about this? Suggestions please!
Name withheld at author’s request

No sun but good care

There are many private physios in this country like me who provide good positive treatment for strokes (see David Guthrie’s article, page 34, 2 October).

Over the years I have seen many patients who have been told that they have achieved their full potential after a few weeks but go on to achieve much more.

I can usually start treatment within a couple of days at their home or clinic and as frequently as required.

My treatment includes advice on equipment, strategies and treatment plans as well as showing carers what to do between treatments. This is as good as South Africa without the sun.

Ironically, I have been waiting for a diagnosis for my hemiplegia for five years and, at long last, I am now on a waiting list – 18 weeks!
Name withheld at author’s request

You’ve ADDed...

Outgoing CSP Council chair Dr Helena Johnson’s plea for physio staff to listen to their patients in the last issue of Frontline triggered the following message from Hannah Rooney.

I was frustrated to read Dr Johnson’s article regarding the stroke standards and therapy provision.

Since the first stroke standards were published, in 2008, stroke physiotherapists have been working hard to develop services to ensure we are meeting the guidelines.

However, that’s all they are, guidelines, often without a robust evidence base behind them.

While experienced stroke physiotherapists know that with ongoing rehabilitation there are likely to be further improvements in function made, we are limited by the pressures to meet the ‘targets’ set within the guidelines.  

We can also only work with the staff skill mix and service level we are funded for by the trusts.

The arrival of the stroke rehabilitation guidelines should help us to further improve our patient pathways and therapy input, however I do not think it’s physiotherapists the CSP should be lobbying.

The CSP needs to help its members to highlight to the clinical commissioning groups and commissioners the importance of physiotherapy intervention in stroke care.

Only then may we be able to provide the level of therapy input these people require.

Commenting on a report on the Founders’ lecture at Physiotherapy UK 2013, in which Emma Stokes called on physios to think creatively (see page 9), Karen Fechter wrote:

  • Empowering and inspirational. 
  • Fantastic Founders’ lecture by Dr Emma Stokes. 
  • Still thinking about how to create my own ‘cabinet’!

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23 October 2013

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