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Peak practice

Nikki Adams and her team of 11 neuro-specialist physios provide services across 10 English counties. Sally Priestley heads north to investigate

How many neuro physios does it take to cover services for clients of personal injury solicitors across 10 counties?

Adams Neuro Physio’s team currently stands at 11, or 12 if you include founder and director Nikki Adams.

Mrs Adams set up her company in 2003 to serve the increasing demand from solicitors for a community-based neuro rehab service.

Since then, she has been bringing together some of the best physios in the business to work together under one umbrella.

Her specialist team now covers a huge area: Derbyshire, Lincolnshire, Nottinghamshire, Leicestershire, Staffordshire, Lancashire and the four ‘counties’ of Yorkshire.

The practice chiefly works with patients in receipt of personal injury claims who are at the later stages of traumatic brain-injury rehabilitation, and are living at home or in a care home, with the support of a solicitor, case manager and a support worker team.

A typical client might be a young person with a condition such as cerebral palsy, or someone who has had a brain injury in a road traffic crash.

‘The transition period between childhood and adult statutory services can be a key time when our services can come into play, or provide continuity,’ she says.

‘NHS paediatric services have a cut off, which varies depending on the geographical area. Often when school finishes there is nothing for the person to go to.

We can help with the move to supported living, for example, at what is often a hugely difficult time for these families.’ 

Therapeutic activity

The central aim of the practice is to support therapeutic activities in the community, typically matching up clients’ interests with the facilities that are available locally.

Mrs Adams has been working in physiotherapy for 30 years, as a clinician, a senior lecturer and, for the past decade, in an NHS community physical disability team. In the last 10 years she has marked out new territory in the private sector.

‘My main desire was always to be able to work in the community, but in my previous role, working for a community team in Wakefield, West Yorkshire, I had a huge caseload and I couldn’t see them or treat them to the extent I wanted to.

It was very frustrating.

‘When I changed to working half time, after maternity leave, I started thinking about other options for work. I took on some private clients and started to see a pattern of patients who needed neuro rehab in the community.

They needed more than they could get through NHS care – and that’s how the business began.’

Her clients typically have multiple trauma and brain injury. The cases are often complicated and the routine of exercise helps, Mrs Adams explains: ‘Exercise gives them a clear focus.

The exercise is included in the person’s day and becomes a framework for the cognitive therapy input from other team members, including occupational therapist, neuro psychologist and the support workers.’

Business model

All 11 associates at Adams Neuro Physio are self-employed and work in other (usually NHS) roles too. Mrs Adams runs the practice from her office in Wakefield and work is sub-contracted to the most suitable team member as the clients come in.

This simple business model also sees all the practitioners working in the community, rather than out of a clinic.

‘In community settings you can get the practice and repetition of movement going properly, such as practising standing up out of a chair with them,’ says Mrs Adams.

Mrs Adams has established a solid reputation in this area of rehabilitation. Cases are typically referred to the practice through word of mouth and solicitors or case managers will contact her directly to talk through a new client’s needs.

Neurology has always particularly interested her, and she has a specific interest in visual perception. ‘I noticed that brain-injured people and those with multiple sclerosis frequently over rely on faulty visual perception, and it’s affecting their balance.

‘I was one of only a couple of physios on a course run by US occupational therapist Mary Warren, on visual perceptual dysfunction in adult brain injury.

There is such a lot of crossover with occupational therapy work in this area of practice, and I’ve adopted this into my work.’

Riding horses to support rehabilitation is just one example of the many novel approaches offered by the practice. Elizabeth Beckerlegge, the first physiotherapist to join Mrs Adams’ team, offers this specialist therapy.

A physio with 35 years’ experience, Mrs Beckerlegge has practised and lectured extensively on the potential of using the horse’s movement to rehabilitate people with neurological conditions.

She also specialises in vestibular disorders and has been working part time as an extended scope practitioner in The Balance Centre at York Teaching Hospital Trust for the past 10 years.

Mrs Beckerlegge has been involved in the Riding for the Disabled Association since her teens. She now offers hippotherapy – using the movement of a horse to provide graded motor and sensory input and improve neurological function and sensory processing.

Benefits of riding horses

‘Riding is great because of the three dimensional and degree of movement the rider experiences,’ says Mrs Beckerlegge.

‘There is a lot of natural input in the moving of the pelvis, and through this we can work on postural control, core stability, symmetry, balance training and strength. It’s really useful for a lot of the neurological patients I see.

‘Nikki’s practice provided the opportunity for riding therapy to be recognised in medico-legal world, and I’m always looking for ways to make it more professional.’

Not every client is suitable for the treatment. ‘But for those who do enjoy it, and engage and comply, there is a high success rate and so many wider benefits’.

‘It’s so exciting for me to have so many interesting areas to work in at this stage of my career,’ she adds.

‘What’s great is that all my jobs are linked, but the private work offers more flexibility so it’s a really nice balance.’

Nicola Hunt is a more recent addition to the fold. Joining the Adams Neuro Physio team in 2011, her specialist skills include respiratory care, and acupuncture for neurological conditions.

After qualifying and doing both junior and senior medical rotations, she took a course in the physiotherapy management of acutely ill patients, and worked in an intensive care unit where she saw a lot of spinal injuries.

Opportunity to join established team

In 2004 Ms Hunt moved to work at Newark and Sherwood Primary Care Trust (now Nottinghamshire Healthcare Trust), a position she still holds part-time.

Here she became a clinical specialist in long-term conditions with a mixed caseload mix of respiratory and neurology patients with progressive diseases, brain injury and spinal injuries.

‘I started to take on private patients around eight years ago. Then in 2005 I completed acupuncture training, followed by further training in using acupuncture in neurology, palliative care and respiratory

‘I had developed quite a specialism, but when I saw the position advertised with Nikki, I thought it would be a really good opportunity to join a network of other neuro specialists.’

But Ms Hunt likes having a foot in both the NHS and private camps: ‘All sides of my work knit together well – there are loads of benefits to still working in the NHS, the peer support and being based in a full multidisciplinary team, in particular, are really helpful.

When a new medico-legal case comes in the physio will visit the client twice to look at their physical abilities and disabilities and also cognitive function, and manual handling.

Following the assessments, all the specialists involved in the case (for example, a neuro-psychologist, speech and language therapist, occupational therapist, the physio and case manager) discuss the case jointly, and meet regularly to talk about the client and their progress.

‘It’s a bonus of being in private practice that we can offer a variety of services, and that we see them for as long as they need treatment, often a considerable length of time,’ says Ms Hunt.

‘We are often the end of the line for these patients,’ says Mrs Adams. ‘What we can offer is huge flexibility and a huge resource as a highly specialist community neuro team – which is exactly what these patients need.’ fl

See: www.adamsneurophysio.org.uk

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