In a new series of articles, Robert Millett speaks to physios who are re-thinking rehab and leading the way in different sectors
Private practices, charitable enterprises and NHS services are all innovating to provide high quality community rehabilitation services.
Rehabilitation and engagement in activity are widely recognized as essential components of long-term mental and physical health. But people living with long-term conditions, or recovering from injuries or acute conditions, often struggle to access the service they need – and these gaps are particularly evident outside of acute hospital settings.
As a result, across the UK, there is a commitment to boost out-of-hospital care and integrate local care systems, in order to provide a more joined up approach to health services.
The CSP believes that all patients should have access to high quality, person-centred community rehabilitation in the right place at the right time and we know that physiotherapists working across all sectors are well placed to make this happen.
Members across all sectors have come forward to tell us about how they are using innovation to develop their community rehabilitation services, while also driving up standards of practice, meeting government guidance and providing essential support to adults who live with long-term conditions.
In this new series of articles, we highlight examples of innovative, exciting and inspiring community rehab services that members have shared with us, to demonstrate how CSP members are leading the way.
In an average one hour session, patients can walk up to 4,000 steps
Neuro physio Sarah Daniel, is the director and founder of intensive rehab providers, MOTIONrehab Ms Daniel’s company provides multidisciplinary neurological rehabilitation services across the Yorkshire and Humberside region.
In 2018, she launched the UK’s first intensive robotic neurological rehabilitation centre (in Leeds) and last year she was invited to speak about her work at the World Congress for Neurorehabilitation.
MOTIONrehab has been recognised by the Financial Times and Google awards as one of the Top 100 companies pioneering digital innovation in Europe.
What type of patients do you treat?
We are a private outpatients facility that pick up clients in the community and through NHS referrals. We see adults and paediatrics for any type of neurology or neurological disorder – predominantly strokes, head injuries, spinal cord injuries and children with cerebral palsy.
We provide our intensive rehab clients with an hour a day of hands on therapy and three hours a day of rehab augmented by technology – and they attend three to five days a week, for a period of 80 hours.
What led to you providing robotic-led intensive rehab?
I spent some time looking at what Nick Ward [professor of clinical neurology and neuro-rehabilitation at UCL’s Queen Square Institute of Neurology] and his team were doing with their upper limb programme and they were very much an inspiration.
I also visited clinics across Europe to see how they were integrating technology and delivering rehab.
All of that led to the idea of integrating our therapy with new technologies, to allow us to offer high repetition, high intensity training for our clients.
What sort of technology do you use?
Our intensive rehab centres, in Leeds and Hull, both have a robotics and virtual reality (VR) suite that contains a selection of devices.
The Leeds clinic was the first in the UK to have the LYRA, which is a robotic gait trainer, and our clinic in Hull was the first to have the LEXO robotic gait trainer.
We also have devices and robotics that provide bio-feedback. This allows patients to be engaging in some sort of gamification, which is calibrated to a suitable, tailored movement pattern.
Are there guidelines or research that backs up your service model?
Yes. The evidence base for intensive rehab is growing, and even our national guidelines are highlighting intensity. For instance, the NICE Quality Standard for stroke  says “higher intensity stroke rehabilitation therapies can improve the quality of life for adults who have had a stroke”.
What we know from all of the research is how important repetition is. The more you do the better you get.
Why does your approach to intensive rehab require robotic technology?
There is data to suggest that in an average treatment session a patient may walk about 200 steps. For us, in an average one hour treatment session they can walk about 3,000-4,000 steps. And that is highly reproducible, as they are doing the same gait pattern for all of those steps.
Intensity is not about the number of hours you do. A patient could do four hours of rehab in a traditional hands-on environment, but they wouldn’t be able to do 4,000 steps in an hour with only a physio facilitating them – it’s humanly impossible.
So, to have truly intensive rehab, I feel you have to incorporate robotics and VR devices, because it’s not about how many hours you do – it’s what you’re able to do in that time that counts.
How do your therapists work alongside the technology you use?
I think some of the reservations about using robotics and VR is the idea that you strip out all your therapists and stick machines in instead. But actually it’s all about complementing what you do.
Our clients are constantly supervised when they are using the devices. A physio or a technical instructor is always with them, so they can evaluate their movement pattern, provide one-to-one input, progress what they are doing or put their hands on to facilitate.
So we still use all of the critical and clinical skills of physiotherapists.
What does your approach aim to do – and how does it benefit patients?
What we aim to do with our programmes is essentially condense two years of rehab into four weeks, so we can accelerate functional gains – and what the technology allows us to do is mass repetition.
All of our programmes are bespoke to the individual and led by patient-oriented goals and the type of device(s) clients use is driven by what we see at assessment and constant evaluation.
With more acute patients, we often see them achieving their goals very quickly. But with the chronic patients we still see an acceleration in their progress and in their functional independence.
Do you find that the gamification aspect helps with patient motivation?
Yes. One of the powerful things about using the robotics and VR devices is that users receive real-time feedback.
A lot of times a physio can say “that’s great, well done!” but the patient may not see or feel it themselves. But when they’re engaged in a game they can see that “yes, I got 20 per cent that time and now I’ve got 40 per cent”.
So it’s very clear they’ve improved. That provides a lot of internal validation, which helps to motivate patients in a way that is sometimes difficult for therapists to maintain.
Why did you think new approaches to rehab, like yours, are needed?
Nationally, the demand for community rehab is growing – and even more so with Covid-19.
So we all need to think about how we can optimise outcomes when rehab time maybe limited.
If we can accelerate a person’s rehab journey then we can reduce the burden of secondary complications, by preventing re-admission to hospital, and easing pressure on both informal care, like family support, and social care services.
Cutting edge rehabilitation
Rachael Wadlow, CSP professional adviser, says: ‘Seeing an innovative, evidence-based independent rehab facility working in collaboration with NHS services to provide patient-centred care in the community is fantastic.
‘It is inspiring to see a physiotherapist use their clinical expertise and entrepreneurship to provide patients with cutting edge multidisciplinary rehab, whilst showcasing what exciting opportunities exist within community rehab for the physiotherapy workforce.’
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