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Rehabilitation

Regional Hyperacute Rehabilitation Unit

The Regional Hyperacute Rehabilitation Unit (RHRU) is a Level 1 complex specialised rehabilitation service commissioned by NHS England situated within the NHS London North West region.

It comprises a fully integrated facility of 24 beds primarily for patients with severe complex physical disability including those with tracheostomy, low awareness state (Prolonged Disorders of Consciousness, PDOC).

We regularly admit patients from Major Trauma Centres, Hyper-Acute Stroke Units, Neurosciences Centres as well as District General Hospitals in London, Eastern (Bedfordshire, Hertfordshire and Essex) and South (Berkshire) regions.

The typical length of stay is around four to six weeks for assessments, and two to six months for complex specialist rehabilitation or highly complex disability management. For patients requiring specialist rehabilitation, they need to be able to engage in intensive rehabilitation activities and the service is often more suited to patients in the younger age range.

Rehabilitation is underpinned by evidence based practice, with support from Clinical Specialists and an active research team based at the RHRU and King’s College London.

The Team

The interdisciplinary team consists of a rehabilitation Nursing team, a Medical team (including Medical Consultants trained in rehabilitation medicine), Neuro-Physiotherapists (including a Consultant Physiotherapist), Neuro-Occupational Therapists, Speech and Language Therapists, Neuro-Psychologists, a Social work team, Dietitian and administrative support/secretarial staff.

The team works with patients and families to develop intensive, individualised rehabilitation programmes for adults with severe, complex disability. The majority of patients come from acute hospitals and without such specialised rehabilitation would remain in hospital.

The RHRU service can prevent further admissions and the potential development of secondary complications which impact on patients’ management in the longer term. Given the sudden onset of acquired severe brain injury, the Unit’s work involves considerable support for families, especially children.

Scope of the service

The overall aims are:

  • To provide an effective and high quality service for people with severe and complex disability, who require assessment and / or intensive interdisciplinary rehabilitation in a level 1 service, and whose needs cannot adequately be met by their local rehabilitation service.
  • To involve patients as fully as they are able in their own rehabilitation process, with due regard to their physical, emotional and cultural needs.
  • To optimise recovery of function in terms of physical, communication, cognitive and psychosocial abilities.
  • To facilitate the patient and family’s adaptation to residual disability and maximise independent function.
  • To modify environmental factors where possible and identify the need for specialist equipment to help maximise function.
  • To plan discharge in close liaison with local rehabilitation teams, referring physicians, GPs, local Social Services and any other agencies involved in the person’s ongoing care.
  • To provide support and advice to local teams immediately following discharge to ensure smooth transition between hospital and home and to ensure (where possible) that rehabilitation continues after discharge from the RHRU.
  • To provide a service outside the unit to:
    • assess patients in other hospitals, private homes, Residential and Nursing Homes as appropriate.
    • provide advice, support and recommendations to hospital and care staff regarding the care of people with complex needs, including advice on ongoing care packages.
  • To provide advice to referrers on alternative rehabilitation and/or management options if admission to the RHRU service is inappropriate.
  • To be a regional, national and international focus for rehabilitation research across all professions.
  • To provide advice on service developments for other rehabilitation facilities nationwide.
Areas of expertise
  • Acquired brain injury of any cause, including stroke, trauma, anoxia, encephalitis, meningitis, vasculitis, toxic causes, etc
  • Partial spinal cord injuries, especially non-traumatic in origin
  • Peripheral neuromuscular disease e.g. Guillain Barre Syndrome, critical illness neuropathy, polymyositis etc
  • And, where the service is appropriate to meet the individual’s needs:
    • Some progressive conditions e.g Multiple Sclerosis etc
    • Other conditions e.g. medically unexplained conditions.
Other areas of expertise include
  • Complex nutritional management including feeding gastrostomy, specialist dietetic input with direct access to St Mark’s Hospital, a national referral centre for intestinal and colorectal disorders.
  • Complex spasticity management requiring holistic inter-disciplinary intervention and provision of botulinum toxin intervention, tendon releases, serial casting/splinting.
  • Severe cognitive, communicative and/or behavioural problems in the context of severe physical disability.
  • Assessment of patients in a Low Awareness State (Prolonged Disorder of Consciousness, PDOC) using standardised tools such as the Sensory Modality Assessment And Rehabilitation Technique (SMART), Coma Recovery Scale (CRS-R) and the Wessex Head Injury Matrix (WHIM).
  • Neuro-palliative care
  • Vocational assessment and return to work
  • Symptom management including Depression and Hemiplegic shoulder pain
  • Specialist facilities including Electronic Assistive Technology (EAT), specialist wheelchair and seating, Harness treadmill training and Hydrotherapy.
Exclusions include
  • Very severe behavioural problems or severe cognitive problems without physical disability
  • Patients treated under section of the Mental Healthcare Act
  • Patients for whom achievable rehabilitation goals cannot be identified.
Outreach service

In 2000 the Outreach Service was developed to provide rehabilitation support and advice to community and residential/nursing home teams managing the continuing care of complex patients. This service also provides assessment and advice for patients regarding prognosis, progression, placement and admission (or re-admission) for specialist rehabilitation.

This service covers:

  • A comprehensive assessment and advisory service to guide the management of patients with severe complex disability, whether or not they require in-patient rehabilitation.
  • Advice or support for community teams in the management of people with complex disability and on-going follow-up.
  • Outreach surveillance (life long) of people with severe complex brain injury in nursing home placements and in their homes.
  • Specialist assessment of patients who are identified to be in a Low Awareness State (Prolonged Disorder of Consciousness) and who require further review.
Location

The Regional Hyperacute Rehabilitation Unit is situated at Northwick Park Hospital (ward block, level 6), Harrow, Middlesex, HA1 3UJ (London North West University Healthcare NHS Trust).

Contacts
  • Lead Secretary, 020 8869 2801 (Monday - Friday 8.30 - 4.30)
  • Ward Administrative Assistant, 020 8869 2811 (Monday - Friday 8.30 - 4.30)
Senior Management Team
  • Professor Lynne Turner-Stokes, Director/Consultant in Rehabilitation
  • Dr Charlie Nyein, Consultant in Rehabilitation (Outreach)
  • Dr Andrew Thu, Consultant in Rehabilitation (In-patient Service)
  • Dr Ejessie Alfonso, Acting Consultant in Rehabilitation (In-patient Service)
  • Mrs Hilary Rose, Head of Therapy Services
  • Ms Chris Dungca, Clinical Nurse/Service Manager
  • Mrs Rita Santhirarajah, Clinical Nurse Manager
  • Dr Stephen Ashford, Consultant Physiotherapist and Clinical Lecturer
Heads of Service
  • Dr Patrick McKnight, Consultant Neuropsychologist
  • Katrina Clarkson, Principal Speech and Language Therapist
  • Aideen Steed, Principal Physiotherapist
  • Chantelle Pieterse, Principal Occupational Therapist
  • Fiona Zinger, Specialist Social Worker
Links Training Days

Course dates in 2018

For an application form for any of the above courses please contact      Merry Wright.

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