Improving life and endoflife care in advanced neurological conditions: The Rehabilitation Perspectiv

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Improving life and end-of-life care in advanced
neurological conditionsThe Rehabilitation
Perspective

• Rory OConnor MD
• Consultant Physician in Rehabilitation Medicine
• Airedale General Hospital

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Introduction

• The role of rehabilitation
• Specialist rehabilitation in Airedale
• Organisation of services
• Our role in improving life and end-of-life care

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Rehabilitation
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Rehabilitation

• Goal-orientated educational process encompassing
  a wide range of multidisciplinary interventions
  with the potential to enhance the quality of life
  of people with long-term conditions

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Benefits of Rehabilitation

• Promotion of team-work and recognition of the
  complex interactions with pathology, disability
  and functioning
• Avoids the reductionist approach
• Patients, family and carers benefit

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ICF Model
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ICF Model
Advanced Parkinsons disease
Tremor Swallowing Constipation Dementia
Using utensils Eating Diet restriction Conversatio
n
Meals out with family at restaurants
Access Distractions
Anxiety Depression
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UK Rehabilitation Physicians
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UK Rehabilitation Physicians

• 79 of rehabilitation physicians provide care for
  progressive neurological conditions
• 60 provide end of life care
• Rehabilitation physicians see palliative care as
  insufficiently skilled and lacking in therapists

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Airedale Specialist Rehabilitation
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Airedale Specialist Rehabilitation

• In-reach to wards and critical care
• Consultant physician in rehabilitation
• Inpatient rehabilitation
• Ward 5
• Dedicated team and therapy space
• Specialist Primary Care Trust staff
• Pick-up new referrals
• Monitor care plans of known patients

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Community Provision

• Outpatient services
• Consultant clinics
• Therapy sessions
• Multidisciplinary Assessment Clinic
• Hospice/nursing home/domiciliary visits
• PEG pathway bridges home and hospital

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Personnel

• Core team
• Consultant physician in rehabilitation
• Principal physiotherapist and occupational
  therapist
• Clinical lead for rehabilitation (PCT)
• MS specialist nurse (PCT)

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Personnel

• Wider team
• Speech and language therapy
• Dietician
• Continence services
• Wheelchair services
• Neuropsychology (Care Trust)
• Social services
• Orthotics (Peacocks)

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Our Role in Improving Life
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Our Role in Improving Life

• Symptom control
• Spasticity, pain, incontinence
• Activity management
• Mobility, seating, feeding
• Participation enhancement
• Leisure, education, vocation

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How to Refer

• GP/consultant to AGH Rehabilitation Consultant
• Therapist to therapist
• GP, therapist, specialist nurse to specialist
  nurse
• Referrals discussed weekly

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Principles for Today
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Principles for Today

• Patients needs are paramount
• Need to differentiate between direct
  rehabilitation care and rehabilitation skills
• Clinical need will always outweigh resources
• The art is matching the service to local
  resources and needs