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Community neuro rehabilitation (Richmond)

Community neuro rehabilitation team (CNRT) is an NHS service for adults with a neurological condition who are living at home. The team works with patients and carers to help them achieve maximum independence in all aspects of daily life. Therapy is delivered to patients in the most appropriate setting, either as an outpatient at Richmond Rehabilitation Unit, or at their home or workplace setting.

Acceptance Criteria:

Adults (18 years+) registered with a Richmond GP and who have an acquired or long-term neurological condition. The main problem identified must relate to their neurological diagnosis. 

CNRT is not appropriate for:

People whose primary diagnosis is:

  • learning difficulties

  • mental health problems

  • substance misuse
  • dementia  (however SLT service do provide input for these patients, please see Departments & Services) 

 

The CNRT team consists of specialist therapists and nursing (please see Departments & Services for more information):

  • Neuro-Physiotherapy

  • Occupational Therapy

  • Speech and Language Therapy (SLT)

  • Dietetics

  • Multiple Sclerosis Nursing

  • Parkinson’s Nursing

  • Neuro-Psychology

Stroke Early Supported Discharge Team (ESD)

In addition to the CNRT, there is also an Early Supported Discharge (ESD) Team based at Richmond Rehabilitation Unit. This is an intensive rehabilitation service for stroke patients to facilitate early discharge home from hospital.

There are also links to the Continence Nurse Specialist and Podiatry Service.

 

Physio with patient

Who we are

We are highly specialised physiotherapists with experience in treating people with neurological conditions. Our assessments and treatment programmes use detailed analysis of movement and how it impacts on every day function.

The aim with all treatment programmes is to facilitate the service user to self-manage their condition as much as possible and to support care givers.

The physiotherapists are:

  • Erica Momcilovic

  • Sarah Coleman

  • Amber Hirons

  • Mike Stanner

  • Lynsey Sharp

  • Papiya De

  • Baljit Daffu

 

What we do

The key elements that we provide for patients with neurological conditions are: 

  • Detailed and specific assessment of postural control and normal movement to include muscle flexibility, strength, tonal changes, and joint range of movement

  • Assessment of motor skills - bed mobility, transferring, sitting and standing balance, walking, managing stairs and getting up from the floor.


This is achieved by:

Task specific practice and strengthening programmes in home or gym environment including practice with carers. 

Re-education of balance and gait. 

Provision of appropriate walking aids including orthotics and/or referral to a specialist clinic. 

Spasticity Management including -
           Individually tailored stretching and positioning programmes. 
           splinting and provision of equipment.
           Referral on to spasticity clinic  
           Provision of timely rehabilitation following Botox injections.

Positioning and Posture Advice to include education on 24 hour positioning and posture to carers.  This aims to maximise function and aid recovery, prevent secondary complications e.g. contractures, deformity and pressure sores.  

Group Therapy

Several exercise groups are run at Richmond Rehabilitation Unit which include the General exercise class and the Balance class.  The aim of these groups is to promote maintenance and/or improvement in optimal level of physical ability, support individuals through group interaction and encourage people as well as adopting a self- management approach to healthy living and exercise.


Who do we see

We see people diagnosed with a neurological disorder and who have a Richmond GP.

Who don’t we see

People whose primary problem is any of the following:

  • Learning disability

  • Mental health problem

  • Substance misuse

  • Dementia

  • Traumatic injury or new medical condition unrelated to their neurological condition. E.g. a fracture or pneumonia

  • Multiple active unresolved medical needs taking priority over their underlying neurological condition

  • Peripheral neuropathy related to alcohol or diabetes

  • Single nerve palsy related to trauma

  • Nerve root involvement related to disc protrusion

  • Non-organic conditions and M.E

   

OT and patients

Who we are

We are a team of specialist Occupational Therapists trained to assess and treat neurological disorders:

  • Vicky Bruckner

  • Shelley Garrett

  • Roisin Hyde

  • Alison Hipkiss

 What we do

Occupational Therapy  (OT) provides practical support to help increase peoples independence, enabling people to do the activities (occupations) that matter to them. This could be essential everyday tasks such as looking after yourself, work or leisure.

Areas of intervention can include

  • Personal care tasks

  • Household tasks

  • Productivity and leisure activities, including guidance on employment and driving

  • Arm and hand function

  • Functional mobility and transfers

  • Fatigue management 

  •  Adapting to changes in vision, visual perceptual difficulties (e.g. homonymous hemianopia, figure ground.)

  • Cognitive rehabilitation (e.g. memory, attention)

  • Equipment to aid independence

 

Who do we see
We see all patients registered with a Richmond GP who have a neurological condition (e.g. stroke, Parkinson’s, multiple sclerosis) and are having difficulty participating in everyday tasks.

Who don’t we see
Patient’s whose needs are for equipment or environment adaptation only- please contact Richmond Social Services Adult Access  team, 020 8891 7971.

Speech and Language Therapy

Who we are

We are a team of neuro-specialist Speech and Language Therapists trained to treat communication and swallowing disorders: 

  • Cate Campbell
  • Kirsty Catling
  • Jo Deakin
  • Natalie Cother 

 

What we do

We assess, diagnose and, where appropriate, provide goal-led therapy programmes. We manage and encourage patients to self-manage the following acquired disorders:

Dysarthria (slurred speech):
- difficulty with articulation resulting from muscle weakness or sensory problems


Dysphasia (language impairments):
- difficulties understanding and expressing spoken or written language


Dyspraxia of speech (motor programming impairment):
- difficulties with the learnt volitional movements of speech 


Cognitive Communication Disorder:
- communication disorder primarily associated with cognitive impairment
 

Dysphonia (voice problems):
- difficulty achieving clear or loud voice secondary to a neurological condition e.g. Parkinson's or Multiple Sclerosis 

 

We provide direct therapy which may be 1:1 or group therapy. We also provide education, advice and support to family and carers.  

In addition, we can refer into local communication groups that offer long-term support e.g. Moving On Stroke Club, Dyscover, Integrated Neurological Services

Who do we see

We see adults with a neurological diagnosis, who are registered with a Richmond GP and who present with communication or swallowing difficulties.

In addition, we see people with dementia and other non-neurological conditions for assessment and advice. 

 

Who don’t we see 

Patients with non-neurogenic voice disorders: please refer direct to ENT and voice outpatient clinics at West Middlesex Hospital and Queen Mary’s Hospital.  

Patients with a developmental or acquired stammer:  please contact us for signposting or see the British Stammering Association website www.stammering.org 

HRCH Richmond

Who we are

  • Mary Brown - Dietitian

 

What we do

  • To integrate patient’s nutritional treatment into their overall CNRT care

  • Provide impartial and evidence based advice about nutrition and health for a range of neurological conditions.

  • Advise on food related problems, treatments and disease.

  • Advise on dietary management to limit future neurological events e.g. stroke

  • Ensure dietary advice is person specific and meets nutritional needs

  • Raising awareness of importance of good nutrition with patients, carers, health and social services, family and friends.

  • Work jointly with other team members and other professionals e.g. Speech and Language Therapists for patients with dysphagia (swallowing problems)

  • To support and counsel patients throughout their  decision regarding artificial nutritional support e.g. Percutaneous Endoscopic Gastrostomy (PEG)

 

Who we do not see
 
Kingston Hospital Dietetic Department  has the funding for enteral tube feeding e.g. PEG for patient’s registered with a Richmond GP.

MS Nurses Richmond

Who we are

  • Jenny Richardson - Multiple Sclerosis Nurse Specialist
  • Joanna Smith - Multiple Sclerosis Nurse Specialist  
  • Rachel Hurley-Love – MS Clinic Co-ordinator  
  • Wioletta Kironde - MS Administrator
  • Kerstin Eikenberry –  Volunteer website editor    

 

What we do

  • Support,advice and information for patients who have recently been diagnosed with MS

  • Ongoing support for patients with MS and their carers via telephone or direct contact

  • Specialist nursing assessment and advice on the management of MS, working closely with therapy colleagues within the Community Neuro-Rehab Team      

  • Links between community and hospital services      

  • Case management for patients with complex needs      

  • Links to other services supporting people with MS, making referrals when required 

  • Education and training for health and social care professionals involved in MS 

 

Find more information on our webpage

Parkinson's Nurse with patient

Who we are

  • Neda Rahmani-Khezri - Parkinson's Nurse Specialist 


What we do 

The Parkinson’s Nurse Specialist provides patients with information and advice to support and help self-manage condition.

This local service in Richmond is aimed at helping maintain a good quality of life for patients  and their family/carer through:

  • Advocacy

  • Support for patients, families and carers

  • Facilitating medication management

  • Management of symptom control

  • Providing co-ordination of care with other professionals that are involved

  • Education about condition and how to self-manage

  • Information and advice

  • Telephone advice line 

 

Who do we see

The service is available for patients who:

  • Are registered with GP in Richmond

  • Have a confirmed diagnosis of Parkinson’s

  • Are already known to the service so self-referrals are accepted

  • Are experiencing problems associated with Parkinson’s

 

The Parkinson’s Nurse Specialist can provide advice over the phone, at clinic or at home for house bound patients.

Find more information on our webpage:

HRCH Richmond

Who we are 

  • Dr Olivia Breen - Clinical Psychologist

 

What we do
We work with individuals who are experiencing emotional, cognitive or behavioural issues as a result of their neurological condition.

Areas of intervention can include:

  • Neuropsychological formulation, treatment planning, and sign-posting, e.g. head injury

  • Formal cognitive assessment to inform mental capacity assessment

  • Formal cognitive assessment for the purpose of functional gain, e.g. vocational rehabilitation, driving

  • Assessment and management of neuro-behavioural risk and challenging behaviour

  • Assessment and brief psychological intervention for emotional difficulties resulting from the neurological condition

  • Specialist neuropsychological rehabilitation for the purpose of functional gain, e.g. vocational rehabilitation, social integration


Who do we see 
We see new stroke patients in the Early Supported Discharge Team who are registered with a Richmond GP and present with emotional, cognitive or behavioural issues that require specialist assessment and treatment.

Who don’t we see

  • People who require a cognitive assessment for the purpose of diagnosis e.g. dementia.

  • People whose difficulties are not predominantly related to their neurological condition.

  • People presenting with medically unexplained symptoms.

  • People who present as a high risk to themselves or others. 

Physio with patient

What we do


The stroke early supported discharge team provides an early, intensive rehabilitation service for stroke patients.

The team helps patients to leave hospital more quickly and return to their own homes so that patients can maximise independence as quickly as possible after their stroke.

Patients are referred directly from stroke units or rehab units and are assessed within one working day (Monday to Friday).

Treatment is intensive in the home for the first two weeks. After this time treatment will gradually reduce in intensity over the next four weeks.

Patients may also be supported by a care package or district nurse if needed and must be organised prior to discharge. Any equipment must also be organised prior to discharge.

Find more information on our webpage:

Contact details

 Team Manager - Sue Newman

Tel:  020 8614 7356         
Email: susan.newman@hrch.nhs.uk

Richmond Rehabilitation Unit

Tel:  0208 614 7350
Fax: 0208 332 6793

Address: 

Richmond Rehabilitation Unit,
22 Evelyn Road,
Richmond,
TW9 2TF

Opening times:

  • Monday to Friday. 8.30am – 5pm


Making a compliment, suggestion or complaint: 

The trust’s Patient Advice and Liaison Service (PALS) provides advice and support to patients, their families and carers. It also provides on-the-spot help to sort out any problem you may have with local health services.

You can contact PALS on Freephone 0800 953 0363 FREE or by email: pals.hrch@nhs.net

Physio with patient

How to refer

All referrals to the community neuro rehabilitation team should be made via Single Point of Access (SPA) using the HRCH single referral form.   

Your Balance DVD: Exercises to help prevent falls 

The 'Your Balance' DVD is aimed at patients who are at risk of falls. The film is made up of a series of guided short exercise routines for patients to work through - which will improve your strength and balance and reduce the risk of falls in future.

 The Your Balance DVD 'Exercises to help prevent falls' was produced by Hounslow and Richmond Community Healthcare NHS Trust's community neuro-rehab service. 
Physio with patient

Courses available 

Fatigue Management 6 week course (2 hour sessions)

If you are a new patient please ask to be referred through your GP, if you are an existing patient please call the MS Nurse and express your interest.

Getting to Grips with MS Course –at diagnosis
If you are a new patient please ask to be referred through your GP, if you are an existing patient please call the MS Nurse and express your interest.

Symptom Management Courses
If you are a new patient please ask to be referred through your GP, if you are an existing patient please call the MS Nurse and express your interest.

Balance Class 6 week Course
If you are a new patient please ask to be referred through your GP, if you are an existing patient please call 02086147350 and express your interest

Exercise Class 6 week Course
If you are a new patient please ask to be referred through your GP, if you are an existing patient please call 02086147350 and express your interest

Arm and Hand Group Group 6 weeks
If you are a new patient please ask to be referred through your GP, if you are an existing patient please call 02086147350 and express your interest

Information available

Patient Information booklets for CNRT & MS Nursing Services, HRCH NHS Trust: 

Courses Information: