1. 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

2. 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

3. 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

4. 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

5. 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

6. 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)

7. 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

8. 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

9. 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

10. Local services often in place
National helpline:

11. 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
Aphasia – affecting the ability to communicate using language

12. BASIC
Specialist rehabilitation: gym, virtual reality, therapies, groups
Based in Salford but supporting people with any brain injury (including stroke) across GM  

13. National charity supporting people with brain injuries
Local branches: Salford & Trafford, South Manchester & Stockport and Wigan & Leigh

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

15. 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?

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