When Hayley Trotman walked out of Askham Rehab into her husband’s arms, having been able to move only a couple of her fingers four months earlier after being struck by Guillem-Barre Syndrome (GBS), her recovery marked a huge achievement.
As well as the remarkable progress made by Hayley, who had exceeded all expectations for her progress in that timeframe, her journey also showed what can be possible with specialist rehabilitation, even during the COVID-19 pandemic and its stringent restrictions.
While for many patients around the UK and indeed the world, their rehabilitation was paused or delayed, at Askham, if anything, the team’s work with their residents intensified, ensuring that even during some of the most challenging conditions healthcare has ever faced, their recovery was allowed to continue.
“The satisfaction of seeing a young mother walking back to her family, after first joining us only being able to move a couple of fingers, was wonderful. I must admit there were tears,” says Sara Neaves, clinical lead and outpatients service manager at Askham.
“It was such a struggle for her at first, she had such a severe case of GBS, but progressed so much quicker than any of us imagined. She had all of the disciplines of therapy, plus hydrotherapy and access to the robotics, and because there were no visitors, we had more time for rehab – and we made the very most of that.
“To hear her say ‘Thank you’ as she walked into her husband’s arms was truly special. I was one of the first therapists she met at Askham and she asked me to walk her out as she left. That is why we do it, and why so many of our team made so many sacrifices during the past year – for moments like this, where our residents can go home, knowing we have helped to make that happen.”
Hayley, who was with Askham from November 2020 until March this year, is one of many residents who secured hugely positive outcomes during the pandemic, supported by the Askham team.
Such was their dedication to the cause that staff routinely went over and above what could be expected – there are stories of nurses sleeping in their office over Christmas, not seeing their own families to help protect the residents who are at the centre of the ‘Askham family’.
“I think that speaks volumes about how we work. We are one big family and did everything we could to keep our residents safe while making sure their rehab continued. We have some really vulnerable people here, but we have a real family ethos at Askham and COVID highlighted how important it was for us to work as a community,” says Sara.
“Once we decided to lock down in March, probably a week before the official lockdown came, we had to change the way we worked and adapt pretty instantly, so we grabbed it by the horns and just went with it.
“Our residents needed us, there were still people having strokes, road traffic collisions, falling down the stairs and having spinal cord injuries – they needed us for rehab so we had to be there. In the absence of their family visiting, we took on those roles too. We have held their hands, wiped away their tears, laughed, chatted.
“We have given the physical and emotional support as best we could amidst a huge amount of uncertainty, particularly at first – and while at first some of the changes were hard to get used to, some of them are now really effective and will continue.”
While traditionally, residents from each of the units would collectively use the facilities including the gym and hydrotherapy pool, overnight that came to a halt in March 2020 – and while rehab would continue, it would be in a different way.
“We had to think outside of the box, so split the gym equipment between the units so each one had its own gym. We also divided the therapy team so they could still carry out their sessions – everyone continued to have access to full rehabilitation and all four disciplines of the therapies throughout the pandemic. There was no cut in provision whatsoever,” says Sara.
“The goals and SMART goals they were set all continued. We have some beautiful grounds at Askham, you are surrounded by trees and can hear the wildlife, it is a fantastic setting for recovery, and we made the most of the outdoors how we could. We have installed some gazebos in which we hold some exercise groups, following the COVID rules around distancing, which has increased what we can do even further.”
Technology has played a major role for Askham during the pandemic – from the creation of Askham’s dedicated robotics suite, through to the use of video calling, the positive impact has been realised in many aspects of the team’s working practices.
“Investing in robotics has been fantastic and is already assisting our outcomes. There is so much research that shows in stroke rehabilitation, it’s all about repetition, and robotics delivers that every single time. With human interaction, I might be able to deliver 10 reps, maybe 12, but the robotics will do 300. The impact is amazing,” says Sara.
“Technology has been used in so many forms. We invested in a lot of iPads and tablets at the beginning of lockdown, and while we’ve always done ad-hoc photos and videos, suddenly we were doing them all the time and capturing some amazing moments.
“We had people taking their first steps post-recovery, saying their first words again, saying ‘I love you’ in a message to their family. It was quite heartbreaking at times, but it’s something we will continue to do even after the pandemic.”
“My eyes have been really opened to the benefits of technology. I’ve always been very practical, I’m a bit of a technophobe and as a physio am used to being hands-on with rehab, not sat in front of a computer having meetings.
“But suddenly, from doing handovers face to face as we’d always done, we were doing them online. We would have clinical reviews with funders on site, but suddenly they had to be virtual too. It was very strange to adjust to, but with some of the meetings with funders, or even with families, technology plays a big role.
“We now have residents from as far afield as Liverpool and Stockport, so to have a virtual meeting can help avoid a seven-hour round trip. Again, that is something we will continue.”
And its newly-discovered use of technology has enabled it to support families during the heartbreaking separation from their loved ones.
“Visitors could come and go freely before the pandemic, there were no set visiting times, but all of that changed and of course families still wanted to know what was going on. We came up with some ideas for that to continue as best we could,” says Sara.
“Usually, families would just stop us in the corridors for a chat, but now that was being done by email and phone calls. I recall making weekly update phone calls to families on evenings and weekends, as we’re mindful that they work and have commitments too, so we had to be flexible around that.
“It was so important we kept in touch, not just to update them with feedback from the therapy team, but also to find out information about the person, what treatment they’re having, what the plan for discharge might look like.
“We had a series of virtual Meet the Therapist sessions, where the same questions a family could ask in the corridor could be discussed, although in a more formal setting, but it was still very good for addressing their questions and having impromptu discussions.”
Happily, the Askham Rehab community is now returning to many of the things it missed – the hydrotherapy pool has re-opened, visiting is now allowed again, although the cafe remains closed – with a few changes to be taken from the experiences of the past year.
“The sessions in the gym in each unit work really well, so we will continue with those, and I think the experience of the pandemic has brought the nursing and therapy teams closer together. It has enabled us to identify ways of working better together, and we’ll continue to work this way,” says Sara.
“There is also absolutely a place for technology, we’ve had to embrace it but now I have learned I can set up a Microsoft Teams meeting and it works! We have got past the ‘scary’ bit of using technology and seen the benefits in communicating with people over distance.
“One thing I’m really looking forward to is the return of visiting on site. I like interaction and noise, and our cafe is a great little place, which is open to the public, and does the world’s best cakes. A group of four gentlemen came in regularly and we’d always say hello – I can’t wait to see regular faces come back. It’s the little things you realise you miss.
“But while we have had to pause some things, our residents have continued to progress and our rehab has been just as it always has been, and if anything our capacity to deliver it increased. Seeing such great outcomes, like with Hayley and many others, has been probably the biggest silver lining to a really difficult time.”