1. Improving life and end-of-life care in advanced neurological conditions: The Rehabilitation Perspective Rory O’Connor MD Consultant Physician in Rehabilitation Medicine Airedale General Hospital

2. Introduction The role of rehabilitation Specialist rehabilitation in Airedale Organisation of services Our role in improving life and end-of-life care

3. Rehabilitation

4. Goal-orientated educational process encompassing a wide range of multidisciplinary interventions with the potential to enhance the quality of life of people with long-term conditions

5. Benefits of Rehabilitation Promotion of team-work and recognition of the complex interactions with pathology, disability and functioning Avoids the reductionist approach Patients, family and carers benefit

6. ICF Model Health Condition Body functionActivityParticipation EnvironmentPersonal factors

7. ICF Model Advanced Parkinson’s disease Tremor Swallowing Constipation Dementia Using utensils Eating Diet restriction Conversation Meals out with family at restaurants Access Distractions Anxiety Depression Health Condition Body functionActivityParticipation EnvironmentPersonal factors

8. UK Rehabilitation Physicians

9. 79% of rehabilitation physicians provide care for progressive neurological conditions 60% provide end of life care “Rehabilitation physicians see palliative care as insufficiently skilled and lacking in therapists”

10. Airedale Specialist Rehabilitation

11. In-reach to wards and critical care –Consultant physician in rehabilitation Inpatient rehabilitation –Ward 5 –Dedicated team and therapy space Specialist Primary Care Trust staff –Pick-up new referrals –Monitor care plans of known patients

12. Community Provision Outpatient services –Consultant clinics –Therapy sessions –Multidisciplinary Assessment Clinic Hospice/nursing home/domiciliary visits PEG pathway bridges home and hospital

13. Personnel Core team –Consultant physician in rehabilitation –Principal physiotherapist and occupational therapist –Clinical lead for rehabilitation (PCT) –MS specialist nurse (PCT)

14. Personnel Wider team –Speech and language therapy –Dietician –Continence services –Wheelchair services –Neuropsychology (Care Trust) –Social services –Orthotics (Peacocks)

15. Our Role in Improving Life

16. Symptom control –Spasticity, pain, incontinence Activity management –Mobility, seating, feeding Participation enhancement –Leisure, education, vocation

17. How to Refer GP/consultant to AGH Rehabilitation Consultant Therapist to therapist GP, therapist, specialist nurse to specialist nurse Referrals discussed weekly

18. Principles for Today

19. Patients’ needs are paramount Need to differentiate between direct rehabilitation care and rehabilitation skills Clinical need will always outweigh resources –The art is matching the service to local resources and needs