Supporting people with neurological conditions in returning to work Greater Manchester Neuro-Rehabilitation Operational Delivery Network Supporting people with neurological conditions in returning to work

Learning objectives Understanding of the incidence, types, causes and impacts of neurological conditions Appreciation of the impacts on the lives of people with these conditions Knowledge of how to better support people with these conditions in returning to work

What is vocational rehabilitation? A process ‘whereby those disadvantaged by illness or disability can be enabled to access, maintain or return to employment or other useful occupation’ Can include education or volunteering

Why is returning to work so important? Essential part of normal function for many people Impacts greatly on a person’s health and well- being Is therapeutic and helps promote recovery and leads to better health outcomes, particularly in long term conditions Is cost effective and impacts on the wider health economy – costs associated with social, informal care giving and lost productivity estimated at £4 billion/year in UK

Incidence of neurological conditions 10 million people in the UK have a neurological condition 12,000 new diagnoses of a neurological condition in Greater Manchester each year ~43% of patients with neurological conditions and 25% of stroke patients need help with returning to or finding alternative employment If unemployed >2years, unlikely to ever return to work Only 37% of NHS community services currently address work needs Saka et al (2009); Playford et al (2011); Stroke Association (2012); Kendall et al (2006); Johnstone et al (2003); Waddell & Burton (2006b); Robinson et al (2009); Busch et al (2009); van Velsen et al (2009) presented in the Greater Manchester Stroke and Neuro Operational Delivery Networks’ Improving Vocational Rehabilitation for Stroke & Neurological Patients in Greater Manchester document

Examples of neurological conditions Neurological disease or injury of sudden onset, including: Stroke Acquired brain injury e.g. car crash, accident Central nervous system infection Guillain-Barre Syndrome Spinal cord injury Progressive neurological conditions, including: Multiple sclerosis Motor neurone disease Myasthenia gravis Parkinson’s disease Neurological condition from childhood, including: Spina bifida Cerebral palsy Acquired brain injury Vascular disorders e.g. stroke patients with complex rehabilitation needs Prolonged Disorders of Consciousness (PDOC)

What are the impacts? People may present with some or all of the following : Physical deficits: including muscle weakness or abnormal tone, sensory disturbance, problems with walking, sitting and carrying out normal daily living activities e.g. toileting, dressing etc Cognitive deficits: including impairments in thinking, memory, concentration, problem solving, behaviour and fatigue Visual deficits Swallowing and nutritional deficits: may require artificial feeding or modified diet Communication deficits: both understanding and speaking Respiratory deficits: requiring tracheostomy and/or supplementary oxygen

What treatments are there? Physical Activities to improve movement, muscle control, walking and balance Exercise programs Speech therapy Pain management Spasticity management Complex seating assessments Respiratory chest management Bladder and bowel retraining Cognitive Cognitive assessments Activities to improve cognitive impairments e.g. concentration, memory Stress, anxiety and depression management and emotional support Fatigue management Social Social and behavioural skills retraining Help with obtaining assistive devices e.g. splints Patient and family education and counselling Basic environmental control assessments Specialist vocational rehabilitation assessment and intervention Support to improve activities of daily living e.g. eating, bathing

How does the NHS support patients returning to work? Local community neurorehabilitation and stroke teams support patients in the longer term They are trained in vocational rehabilitation but may have limited capacity or knowledge of some areas Usually supported by Occupational Therapists: working with other agencies to provide vocational assessment offering support and guidance on returning to, remaining in or withdrawing from work/education referring people with complex needs to specialist vocational rehabilitation services where appropriate Not all areas of Greater Manchester have community services that can offer this

Local services often in place National helpline: 0303 3033 100 www.stroke.org.uk

01706 825802 www.buryspeakeasy.org.uk gill@buryspeakeasy.org.uk Therapy, support, and opportunity for people affected by aphasia (commonly a result of a stroke) Based in Bury and supporting people across GM 01706 825802 www.buryspeakeasy.org.uk gill@buryspeakeasy.org.uk Aphasia – affecting the ability to communicate using language

BASIC Specialist rehabilitation: gym, virtual reality, therapies, groups Based in Salford but supporting people with any brain injury (including stroke) across GM 0161 707 6441  enquiries@basiccharity.org.uk

National charity supporting people with brain injuries Local branches: Salford & Trafford, South Manchester & Stockport and Wigan & Leigh 0808 800 2244 www.headway.org.uk/

Returning to work after a brain injury – Gavin’s story (8 mins) Returning to work after a stroke – Lucy’s story (11 mins)

In groups How could you better support people with a neurological in returning to work? How could you improve relationships with the NHS so agencies can work better together in supporting people?

www.gmsodn.org.uk www.gmnrodn.org.uk @GMStrokeODN @GMNeuroRehabODN More information www.gmsodn.org.uk www.gmnrodn.org.uk @GMStrokeODN @GMNeuroRehabODN