1. Specialist Therapies -Adults
Cathy Ingram – Service Manager

2. Three Pathways Complex rehabilitation Neurological rehabilitation
Multidisciplinary, incorporating the falls pathway
Neurological rehabilitation
Multidisciplinary, incorporating the stroke pathway
Musculoskeletal physiotherapy
Single discipline, incorporating new PBC & prison services

3. Complex and Neuro
Occupational therapy, speech and language and physiotherapy
Approx 40 staff, flexing across pathways
Illness, injury or disability affecting any of the following areas:
Personal care; Domestic tasks; Mobility; Leisure education work; Communication; Swallowing

4. Complex and Neuro
Aims – regaining independence, managing long term/ deteriorating conditions
Assessment, advice, treatment, support, health promotion and education to clients and care givers
Short term, outcome focused interventions
Single or multidisciplinary

5. Scope of Services 16 years up Lambeth resident/ GP
Open referral system
Home, intermediate care bed, care home, out patients, gym etc
Individual 121, group and MDT clinics
2, referrals per year
Single point of access with prioritisation criteria

6. Key Partnerships Intermediate care– community and bed based
Clinics- specialist older persons, falls, stroke, Parkinson's etc
Specialist teams- elderly physicians, nursing etc
Community matrons
Social services
Integrated care pathways with hospitals, Southwark PCT, LBL etc

7. Supporting Care closer to home Long term conditions Staying healthy
NSF long term neurological conditions
NSF older people
Stroke strategy
Demand management
NICE /RCP guidelines

8. Stroke Key Community Elements
Rapid, responsive access to specialist rehabilitation
Early Supported discharge with Economic & qualitative evaluation - ‘in reach’ to hospitals
Psychology
Specialist & integrated reviews post discharge/ acute stroke
Links with long term support/ peer support
User participation in service development

9. Overview of the Falls Journey
Discharge
Tests e.g Tilt
table, Dexa
scan, ECG etc
FUA for
results
Discharge
Decision
making
OT Home
assessment
Referral
Falls
Clinic
Specialist
assessment
Physio / exercise
Intervention:
PT led falls
Exercise & Education
Group
1:1 PTA Otago EP
When to Refer:
Hx of falls
Hx of near misses
Abnormalities of gait/balance
// Nice guidelines older people (>65) who present for medical attention because of a fall, recurrent falls in the past year or demonstrate abnormalities of gait /balance should be offered a multifactorial falls risk AX
Who Can Refer to the falls clinic
Therapist – (Now need to complete falls telephone screen and generic falls Ax form)
Doctors
Nurses
S/W
Self referral – forms on SLIPS Web page
Quick Reminder SPA
Walking aid AX Referral
Need to do Telephone falls screen – if falls / near misses/ fear of falling / abn in strength / balance highlighted
Refer onto falls clinic
What happens next:
Telephone screen – if appropriate
Decision re: Urgency
Clinic appt booked – mostly within location
Transport organised
Phone call on day to ensure attending
Falls Clinic day
Falls Clinic: Involves 1) Geriatrician 2) Falls Nurse 3) OT team 4) PT team and:
Investigates the course of falls
Identifies whether a more detailed examination is required from the dr / PT / OT
Identifies appropriate RX I.e Strength/bal exc, Med rev / OP RX / Adv Info / Home rev
Specialist AX consists of
Generic AX
+/- OT AX
PPA / PT AX
Consultant AX
Reasons for PT AX
TUAG >15 seconds
Need for W/A AX
Unsteady gait/balance/ red strength probs
Change in mobility status identified
1:1
Community PT or
Out-patient PT
Community Exercise
Group

10. The Falls Team 2008
LCCC
Whittington

11. Future Potential C &N Intermediate care community expansion
Integration with LBL
Integration with ALD therapies
Pathways / ESD for other conditions
Care out of hospital eg critical care in care homes, head and neck specialism
Prison SLT service
Technologies – assistive and therapeutic

12. Future Potential C & N 2
Accessibility for hard to reach groups- communication / cognitively impaired- language / homeless /refugee
Capacity building with voluntary and community groups & LBL
Vocational rehabilitation- return to work
Specialist resource within and outside PCT

13. Musculoskeletal Physio
Assess, treat and educate each individual (and as appropriate advise their carers / family) who present with a presumed musculoskeletal dysfunction
Return the individual back to his or her optimum functional potential
Clients are encouraged to be active participants in the management of their condition and SMART goals are agreed between therapist and patient
Single discipline- out patients only, 7 staff, 3000 patients

14. Examples of Conditions
Osteoarthritis, back pain, knee pain
Soft tissue injuries, sprains and strains
Rehabilitation following orthopaedic surgery e.G. ACL reconstruction/fractures
Sports injuries e.G. Groin pain
Frozen shoulder
Repetitive strain/ work related disorders

15. Recent Developments Orthopaedic triage service - PBC
Preferred provider for many GP’s increasing demand by 30% in year
Prison contract
Part of Musculo-skeletal steering group -pathway scoping /planning

16. Future Potential- MS Physio
Expand to 3 sites
Incorporate GP based physio’s within service
Self referral
Extend telephone advice service
Occupational health physiotherapy
Develop locality alignment, +/-
Single point of triage/ access to Musculo skeletal services

17. Questions??