World-leading neurological recovery

Dr Jozef Jarosz [pictured below, right], Joint Director of King’s Health Partners Neurosciences, explores how neurorehabilitation plays a key role in providing a world-leading service for patients recovering from neurological conditions.

What is neurorehabilitation?

Dr Jozef JaroszNeurorehabilitation focuses on the impact that a neurological health condition, development difficulty or disability, has on a patient’s life rather than focusing solely on their diagnosis.

It involves working closely with patients and those important to them so that they can maximise their potential and regain independence in their own lives.  

At King’s Health Partners Neurosciences we have a range of neurorehabilitation services:

  • intensive specialist inpatient neurorehabilitation,
  • community based services for patients living in Lambeth and Southwark,
  • a neuro navigation service across south east London.

In the mental health setting we have a service called the Lishman Unit, which provides specialist beds for patients with an acquired brain injury as well as beds for neuropsychiatry.

Outcomes focused recovery

Neurorehabilitation’s goal is to maximise recovery from neurological conditions or injury, so that patients can live as independently as possible, doing the things in life that are important to them.

Measuring outcomes is central to driving improvements in care and our neurorehabilitation services are an exemplar in this respect. Collecting data when patients enter our services, their target treatment and discharge scores can be used to better inform future patient healthcare experiences.

We submit patient outcome data to the national clinical database, the UK Rehabilitation Outcomes Collaborative (UKROC), which routinely collects key information about every patient admitted to a specialist rehabilitation unit in England.

The UK Functional Impairment Measure/Functional Assessment measure (FIM+FAM) forms the principal outcome measure for the UK national database for specialist rehabilitation in patients with complex disabilities. This 30-item outcomes measurement tool provides detailed information on mobility, self-care, cognitive and communication function and psychosocial needs, as shown in the figure below.

image one 

Over the last four years, data from our highly complex patient cohort has shown mean gains in mobility of 34% and mean gains in cognitive function of 14%.

These gains significantly exceed benchmarking data provided by UKROC, where gains for a similar service are 24% and 11% respectively. Gains in physical and cognitive function lead to a reduction in dependency, which in many cases makes all the difference to patients allowing a greater level of independence and participation in family and community life.

Measures such as those developed by UK ROC highlight how patients have been able to demonstrate significant improvements in physical and motor gains following neurorehabilitation.

As mentioned above, the UK FIM+FAM consists of 30 items. Each item is rated on seven levels with a score ranging from one —‘Total dependence’ to seven —‘Complete independence’.

Scores are rated by the multidisciplinary team, according to the published scoring manual, within 10 days of admission and within the last seven days before discharge from the rehabilitation programme. Take a look at some composite results for our services below:

image two          

image 3 - FIM-FAM 

image four - FIM-FAM

Using data to advance patient pathways

We further improved collecting data on outcomes in inpatient and community neurorehabilitation settings by introducing the Mayo Portland Adaptability Inventory (MPAI-4) used in the inpatient setting and the Mayo-Portland Participation Index (M2PI) used in community. These measure patients’ recovery journey from their early gains in strength, speech and cognition through to improvement in mobility and personal independence and then return to normal life and work where possible.

The MPAI-4 and M2PI measures are recorded not only by health care professionals, but also by patients and their families. The goal is to achieve outcomes that are truly meaningful for patients, such as patient independence, returning to work and enhanced participation in family and community life.

Data collection is in the early stages across our services and will be analysed and used to identify service priorities and define unmet need.

The role of digital technology in patient care

Our work on patient pathways opened opportunities for innovative practices and piloting new methods of providing care.

An example is our MindMotion GO pilot, used in neurorehabilitation services at the Pulross Centre in Brixton, the Frank Cooksey Rehabilitation Unit and Ontario Ward at Orpington Hospital.

Randomised control studies have demonstrated that early intensive rehabilitation

improves patients’ outcomes and has a direct correlation with length of stay. Delivering high-dose and high-intensity training in neuro-rehabilitation is a challenge. MindMotion GO is a virtual reality computer system, which is a useful adjunct to a specialist inpatient therapy programme to increase activity through goal-orientated exercise. 

Designed by a multidisciplinary team of neurologists, neurotherapists and neuroscientists, the programme provides an enriched environment with multiple stimuli to enhance the impact of physical and cognitive goal-orientated therapy.

Patients found the MindMotion GO sessions enjoyable and felt motivated and focussed during the sessions. Staff reported that the programme was great for intensity and cardiovascular activity, very helpful for upper limb control and helped patients significantly with balance and stability when standing. Due to this positive feedback from patients and staff, we will embed MindMotion GO into daily therapy sessions and for independent use with plans to establish out of hours provision.

How partnership working improves neurological recovery

We continue to look at ways we can make the most of what we learn from the resources and expertise available to us by encouraging closer working across our partnership.

Ward twinning between acute neurology services at King’s College Hospital NHS Foundation Trust and the Lishman Unit for neuropsychiatry and brain injury at South London and Maudsley NHS Foundation Trust is a great example.

Pairing up these services means more staff opportunities for shadowing, study sessions and cross-partnership learning. In turn, our staff are better equipped with new competencies in evaluating ward practices and how to improve patients’ experience of mental and physical healthcare.

Dr Jo Jarosz said:

These examples from neurorehabilitation show how we’ve begun to pave the way for world-leading neurological recovery using a range of new approaches and encouraging partnership working.

King’s Health Partners Neurosciences is using their collective expertise to become a global top ten Neurosciences Institute. Read about how the Institute delivers outstanding research and education, and drives excellence in care for patients with neurological conditions.