Author: Wendy Stuttle
Working with people who have brain injuries, learning difficulties or progressive neurological diseases, such as Multiple Sclerosis or Motor Neurone Disease, is an extremely rewarding job. Each individual has unique needs and therefore requires different types of therapy intervention. These include speech and language therapy, occupational therapy, physiotherapy or hydrotherapy. Interventions are tailored to suit each resident.
Chest Round
A typical day begins at 8:30 a.m. with the physiotherapists doing their daily ‘chest-round’. Many of the residents are bed or chair-bound and therefore have reduced mobility, poor posture and difficulty managing their own secretions. Therefore, the likelihood of getting a chest infection is increased and the physiotherapists may need to treat the residents to help clear their chests. Some residents rely on tracheostomies and/or ventilators to breathe, so these residents are also routinely checked.
The speech and language therapist (SLT) will occasionally join the chest-round since her role is also fundamental in chest care. The SLT will observe the resident’s chest status first thing which enables her to compare secretion management, airway protection and risk of aspiration etc at varying times throughout the day. Aspiration occurs when food or fluid travels into the lungs, instead of to the stomach and can lead to chest infections or pneumonia. A multi-disciplinary team approach, including nursing and care staff, is vital.
Assessments
The physiotherapists assess each resident’s physical status including tonal changes, muscle length/strength and joint ranges, posture, functional activities (for example sitting, standing, walking, upper-limb activities etc), respiration and wheelchair needs.
The SLT assesses communication (understanding, reading, writing and speech) and swallowing abilities. The therapy service aims to offer individualised therapy programs catering to the needs of the resident e.g. group sessions, one-2-one, programs for family involvement etc. Within Speech and Language Therapy, where possible, the residents will lead/decide the group themes and are encouraged to participate in projects and outings to facilitate achieving their goals.
Treatments
Throughout the day, residents attend physiotherapy and/or speech & language therapy in the therapy gym, the lounge, in their bedrooms, outdoors (weather permitting) or the sensory room. The sensory room is dedicated to relaxation and to stimulating the senses and there is a water bed, various lighting effects, music, a vibrating mattress and a water feature. Treatments to stimulate taste, smell, sound and touch sensation (including massage) are often done in this room. In the gym, residents concentrate on functional tasks, such as re-learning how to walk or to transfer from their wheelchairs.
Group sessions such as the ‘breathe and stretch group’ or ‘standing group’ also take place. For individuals who are minimally conscious and more dependent, treatments are based on maintaining muscle length and joint ranges and the priority is to make sure that they can sit in their wheelchairs comfortably and in a good position.
Other roles
Other roles that the therapists have, include making splints, sorting out wheelchair issues (a very complex job supported by two knowledgeable therapy assistants and a visiting seating specialist), helping the nursing staff to change tracheostomies, outings (including hydrotherapy, sailing and horse-riding to name a few!), attending multidisciplinary meetings, writing reports and giving training sessions. Therapists also support the local University by supervising physiotherapy students. An Outpatient Service for physiotherapy and SLT is also offered at the centre. Activities co-ordinators arrange big events such as the recent ‘circus day event’ as well as providing activities for the residents.
RRU Visit
A monthly visit from a Regional Rehab Unit Outreach Team can also occupy a whole day. The visiting specialist physiotherapist and neuro rehab-consultant support the therapy team and they do specialized treatments such as injecting botulinum toxin. Botulinum toxin temporarily relaxes specific muscles so that the muscle can be lengthened through splinting and/or stretching.
Each day at can be very different, very unpredictable and often emotional but fun. Neuro-therapists, particularly those involved in long-term, complex care, need to be creative and have good problem-solving brains! Things are never simple, so having a team of 9 therapists and 15 assistants allows a great deal of discussion of ideas and treatments as well as support so that the residents can achieve their maximum potential. In neuro-therapy, achieving small changes can have huge impacts on quality of life and it can be so rewarding to see such changes.
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