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Self-management system improving neuro-rehabilitation care

The Community Neuro Rehabilitation Team (Richmond) who provide the Trust's Early Supported Discharge Service

Wednesday 11 December 2013 

An innovative patient information pack is helping local people to manage their long term neurological conditions and regain their independence more quickly. 

Developed by the Trust’s Neuro-Rehabilitation Service, the patient folders provide key information to enable people to self-manage their conditions and proactively incorporate their rehabilitation goals into their daily lives.  

The packs contain important self-care information - such as personal exercise routines and action plans - in a structured and customisable folder, tailored for the patient’s needs. 

Since the initiative was launched in 2011, the average length of time that patients have needed to spend with the service has reduced by nine days; while the number of patients recovering sufficiently to be discharged from the team’s care has increased by 19%. Once known to the service, patients can self-refer back whenever necessary - enabling the team to remain responsive to patients’ needs. 

The folder has also received overwhelmingly positive feedback from service users - in the most recent patient survey, 92% of patients either ‘strongly agreed’ or ‘agreed’ that the treatment folder had helped with their rehabilitation. 

Sue Newman, Clinical Service Manager for the Richmond Neuro Rehabilitation team said: “We are delighted that our audit results show that our patients are finding these folders to be useful tools in managing their conditions.  

“The team develops each folder in accordance with the individual patient’s needs, which means the therapists and patients jointly set structured goals and objectives to work towards. In addition, exercise plans are provided that are tailored to the patient and their condition.” 

She adds: “Evidence shows that supporting and enabling patients to self-manage their conditions results in improved confidence, independence and a better quality of life.” 

The community neuro-rehabilitation team provides rehabilitation and support for patients who suffer from conditions such as Parkinson’s, multiple sclerosis, stroke, motor neurone disease, and brain injuries - and offers a range of therapy to help people recover and achieve maximum independence in all aspects of their daily lives. 

The multidisciplinary team is made up of physiotherapists, occupational therapists, speech and language therapists, dietitians and specialist nurses – who work together to provide the coordinated specialist care and rehabilitation required by patients. 

For more information, visit: www.hrch.nhs.uk/neuro-rehab-richmond