Health February 6, 2020
Patient success at the Royal Bucks

By Fabian Sutch-Daggett - World Healthcare Journal

Around the world, life-changing injuries happen every minute of the day. No-one wants to know that they, or someone they care about, cannot live their normal daily life as the result of an accident.

For this reason, since 1994 the Royal Buckinghamshire Hospital (Royal Bucks) has dedicated itself to helping patients recover from spinal, brain, and neurological injuries so that they can resume their lives.

Owing part of its original building design to Florence Nightingale, the pioneer of modern nursing, the treatment which defines the Royal Bucks is steeped in tradition and history, putting the patient at the heart of treatment.

With an array of dedicated, highly-trained specialists, Royal Bucks strives to provide quality transitional care to patients with a variety of highly complex injuries and conditions.

Chris Campbell, Business Development Director at Royal Bucks, has worked extensively with the team to develop the hospital’s model of care into one that can be used on not just a national, but international basis. “We are up there with the best rehabilitation centres in the world and we offer what we call ‘transitional, step forward care’,” he says.

Here, the Royal Bucks outlines three success stories, detailing how patients have benefitted from their rehabilitative programmes after sustaining life-threatening injuries.

Patient success stories: Mr G

In late 2017, Mr G was travelling as a passenger in a light aircraft. During landing, the aircraft stalled and crash-landed in a field. He suffered severe injuries and was airlifted to Leeds General Infirmary where he underwent immediate surgery. His injuries were extensive:

  • Anterior C2 fracture
  • Left lamina C6 and C7 fracture
  • T12-L3 fracture with disruption at the twelfth costal transverse joint
  • T7 comminute vertebral body fracture
  • L1 crush fracture with retropulsion and cord injury
  • Anterior L4 fracture
  • Posterior 4FR and rib fracture
  • Anterior rib fracture
  • Sternal fracture

Mr G was discharged from hospital at the end of March 2018, 4 months after his initial rehabilitation. He self-referred to the outpatient department at Royal Bucks, seeking further physiotherapy input to elevate his recovery to a higher level or, in his words: “a full recovery”.

Mr G was highly motivated, determined he would one day walk again unaided, despite the fact that on his initial assessment he was using a wheelchair and Zimmer frame.

He presented with both legs showing substantial weakness and impaired sensation, bilateral foot drop, and lower back pain which worsened when walking for long periods. He was mainly relying on his upper body and lower back strength to be mobile, which had a severe impact on his posture.

After the initial assessment, Royal Bucks discussed Mr G’s goals and aspirations with him, and it was recommended that he should start an intensive physiotherapy programme. This consisted of three days per week, each day comprising four one-hour treatment sessions, including physiotherapy and hydrotherapy.

The programme was focused on returning strength to his legs, correcting his walking pattern, gait, balance, posture, and review the orthotic tools in use to continually enhance his walking.

Alongside his intensive rehabilitation, he was introduced to specialist equipment and gait reeducation strategies, using an exoskeleton and an antigravity treadmill, then progressing to a cross-trainer and body weight support mechanism.

Mr G returned in full to his working and personal life, and now currently moves under his own steam with good postural control and walking pattern using two crutches. He has now progressed to a current programme of three sessions per day, once a week, working on selective movement - aiming towards the possibility of walking unaided. He has also returned to his hobbies, resuming his flying habits, and skiing.

Patient success stories: Mr R

Earlier this year, Mr R was involved in a road traffic incident which resulted in an L3 fracture - and as a result, suffered from impaired sensation and muscle power in both legs.

After the accident, he underwent a spinal fixation at a major trauma centre in London. He then transferred to his local NHS trust for 3 weeks in an acute ward, and afterwards to the community hospital for further rehabilitation.

Prior to discharge, Mr R contacted the Royal Bucks Hospital and attended a multidisciplinary assessment, seeking specialised rehabilitation input. The team discussed their findings with him and developed a plan to admit him for intensive rehabilitation after his discharge from the community hospital.

Mr R started the programme 12 weeks after his injury. His goals were to be able to drive, walk without crutches, and to return to work. He arrived in a wheelchair, moving up to 50 metres with bilateral ankle support and crutches. His walking pattern, besides being very unstable, was also very much reliant on his upper limb strength.

His rehabilitation programme was structured so he would have daily strengthening sessions to help him walk unaided. His walking pattern and gait were improved through treadmill use and aquatic therapy, as well as indoor and outdoor walking practice. With the intensity of input he started showing rapid improvement in leg strength, which demanded constant adaptation and review of exercises and aids to support his foot drop.

By the time of discharge, Mr R had made significant improvement in walking quality and was accessing the community on foot. He left Royal Bucks using only a foot drop support on the right foot, and a walking pole on the left side - walking with a safe and nearly symmetrical pattern. He went home by himself using the train - and was due to attend a festival at the weekend with his friends as soon as he got home.

Mr R was able to resume his favourite leisure activities, and safely and actively participate in all aspects of his personal and working life.

Patient success stories: Anne

Anne was only 17 when she was involved in a serious car accident, which resulted in a complete spinal cord injury.

Anne was paralysed from her neck down and connected to a 24/7 ventilation device – which she was completely dependent for all aspects of her daily life.

After being discharged from hospital she was sent to a nursing home where she would spend most of her time in bed watching DVDs and not interacting with others besides her family.

Last year, Anne came to the Royal Bucks and was aided by a comprehensive team of clinicians involving rehabilitation consultants, nurses, physiotherapists, occupational therapists, speech and language therapists, and psychologists.

At her first physiotherapy session, she was assisted with sitting upright in her bed. She managed to hold her head for 10 seconds, just as her grandmother entered the room.

This was the first time her Grandmother had seen Anne sitting upright and holding her head independently - which brought tears of joy to her eyes.

Slowly but steadily, Anne started to trust the team - and progressively started sitting upright daily.

The team developed a communication plan with her, that allowed her to be proactive in expressing her needs: from nursing to personal requests, and the Royal Bucks began to witness Anne’s journey to be the best she could be.

Through the initial six months, Anne relearned the ability to speak and swallow again, as well as exploring power-wheelchair and ventilator-free breathing solutions, which Anne and her family had been told was not a viable option previously.

One year after her admission, Anne is currently being weaned from the ventilator and can maintain up to 10 hours of breathing off the ventilator.

Furthermore, she is no longer fed through a tube and currently consumes an ordinary diet - allowing her to enjoy her favourite food and drinks. Anne has successfully progressed her head movements using virtual reality alongside strengthening exercises, and she now has a better overall posture. She has successfully trialled a head-controlled power wheelchair and is also exploring alternative ways to expand her communication and autonomy using environmental controls.

The team also managed to help Anne fulfil her dream to watch an Arsenal game at the Emirates stadium. The game was followed by shopping and being with her family in the community, which has now become a routine activity.

Anne is currently in the process of discharge and is set to return to an adapted property which is close to her family and friends.

Moving forward

The life-changing accidents which Anne, Mr G, and Mr R underwent are unforeseeable events But accidents happen every day, everywhere around the world - so the need for first-class rehabilitative care to get people back to the life they want is absolutely essential.

“Our job is to keep improving what we do by measuring real-life outcomes – do they allow patients to go back to work, or if not, live a different but full life? ” says Chris Campbell.

“We are constantly striving to improve patient outcomes more quickly, through whatever mechanism is required, and it is this focus that separates our business from others. ”


Contact:

Chris Campbell, chris.campbell@royalbucks.co.uk

www.royalbucks.co.uk


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