Brain Injury Rehabilitation During COVID-19 – rethinking the unthinkable!

As we end 2020, and are warmed by the news that a vaccine is being rolled out this week and scientists refer to “the beginning of the end” of this pandemic,  we reflect on 2020 and was it has meant from our perspective.

For Susan Pattison, as Director of SP Therapy Services and a Neurological Physiotherapist in private practice Covid-19 brought the unthinkable; to not use our hands. “Hands-on” is synonymous with neurological physiotherapy, as we use our hands to guide, stretch, inform, measure, reassure and motivate a patients with movement difficulties after brain injury, literally every step of the way. But unlike our NHS colleagues, at the start of Lockdown 1.0 in March 2020, the message from our professional body was virtual only, not only did it go against every instinct in us as physiotherapists but also there was very limited evidence or guidance as to how this might happen or how effective to might be. But as unthinkable as remote therapy via video link at this stage appeared, the alternative was to furlough our clinical team and leave our vulnerable patients to struggle, that was even more unthinkable.

But in addition to having highly skilled hands, Susan knew her team of experienced physiotherapists and occupational therapist thrived on challenge, were phenomenal problem solvers who were used to finding novel solutions to complex problems. So whilst the world grappled with learning to work from home, the challenges of home schooling and shared home office space , the therapy team at SP Therapy Services grappled with how to make remote therapy via video link safe, meaningful and realistic. Our team did not need a desk but a flexible work space enabling them to demonstrate and support their patients. For us working from home was more than the challenges of  a neighbour destroying a meeting by choosing to trim a hedge or a cat wandering across a key board. We needed to problem solved viewing angles and support devices to hold phones and laptops at just the right angle. Therapists needed to be able to see what the patient was doing and for them to see our demonstration and instruction. This was not just another version of Joe Wicks – we needed to work out what was safe, after all, if a patient lost their balance it was not a simple as just reaching an instinctive & intuitive hand through the screen. But those were just our in-house issues, we also had to support our patients to come on board, get technologically connected and find a safe space to work. So whilst recognising our skill as problem solvers we also had to acknowledge we were not tech savvy and to avoid straining therapeutic relationships with our patients, George (Practice Administrator) provided initial technology support and road tested. Our patients were amazing, their uptake and willingness to travel on this shared experimental journey with us  inspiring and each week the confidence of our team and our patients improved. The results we achieved were unthinkable back in February 2020, and whilst we will always be hands-on physiotherapists and occupational therapists we have added a tool to our box.

In a recently published article “Hands On to Hands Off”, Susan Pattison joins 4 other health care professionals who made a similar decisions. They discuss how they continued to provide rehabilitation to their patients during Lockdown 1 of the pandemic. They discuss whilst the move from Face to Face to remote therapy via video link was not a natural process is was essential to continue rehabilitation to our brain injured clients. Being innovative, creative and dynamic at a point of adversity had enabled the these individual practices to adapt and the collaborative support they shared was an essential component. In digging deep to find a solution in the article, the group reflect on their learning and consider the positive and negatives of remote work via video link and discuss how this will become a new addition to their services for the future.