Specialist Amputee Rehabilitation Service PDF

Westminster Cross Party Limb Loss Group
to inform Members of Parliament so that they may Promote the Prevention of Limb Loss and the
Provision of Prosthetic, Orthotic, Wheelchair/Special Seating, Medical and other vital Rehabilitation
Services to persons of all ages suffering Limb Loss and associated Disabilities in the United
Kingdom and Internationally
Rt. Hon. Cheryl Gillan MP (Chair); Rt. Hon. Lord Hunt PC OBE; Lord McColl CBE;
Baroness Tanni Grey-Thompson DBE; Baroness Thomas; Lord Rennard MBE; Richard Bacon MP;
Crispin Blunt MP; Kirsty Blackman MP; Dr. Lisa Cameron MP; Peter Kyle MP; Ian Lucas MP;
Dame Angela Watkinson DBE MP
VERY SPECIAL AMPUTEE
REHABILITATION CENTRE
The special interests of the Westminster Cross Party Limb Loss Group, and its Officers
who are all amputees, include the provision of
rehabilitation services for elderly Patients who lose
a limb or limbs, through for example diabetes,
vascular problems or cancer, and who need
treatment and care and further support to give
them independence and the highest possible quality
of life on returning home from hospital.
We are therefore privileged and delighted to publish
the attached good news from the Specialised
Amputee Rehabilitation Services and ReEnablement Services Centre based at Pine Cottage
on the Colman Hospital site in Norwich, and where
the artificial limbs are provided by Opcare.
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Copyright © CES 2016 All Rights Reserved
We praise the outstanding caring skills of all the National Health Service professionals
who provide these
superb services. We
are sure they will
seek to join with us
in sending a
message of good will
to the now retired
Dr. Ramakrishna
(affectionately
known as Dr. Ram)
who was a leading
Founder of the Service. We have happy memories of Dr. Ram holding Peers and MPs spell
bound when he gave a presentation about the Service in the Palace of Westminster.
For further information please contact:
The Colman Centre for Specialist Amputee
Rehabilitation Service,
Pine Cottage, Colman Hospital,
Unthank Road, Norwich
NR2 2PJ
Tel: 01603 251260
Feedback about this news release or any other item can be provided by via
email: [email protected]
‐‐‐ENDS‐‐‐
Page 2 of 2
Copyright © CES 2016 All Rights Reserved
Specialist Amputee
Rehabilitation Service
Colman Centre for Specialist Rehabilitation Services
and Re-Enablement Services Centre (Norwich)
www.norfolkcommunityhealthandcare.nhs.uk Looking after you locally
Service Overview
Meet Malcolm
The Specialist Amputee Rehabilitation Service provides treatment and care for people who have
lost a limb and who need further support before returning home from hospital. It is based at Pine
Cottage on the Colman Hospital Site.
Malcolm lives with his wife and small dog on the outskirts of the city. He is in his 60’s now and
although passed retirement age, he enjoys a part time job locally.
The service aims to help patients recover quickly and enable them to get back to a life which is as
normal as possible.
Malcolm has diabetes and vascular disease.
Here is his story;
Our Prosthetics Service provides assessment and provision of upper and lower limb prosthesis to
people with amputated arms or legs.
The expert team also supports people who are to undergo an arm or leg amputation or people with
congenital deformity of limb.
The team is available to patients across Norfolk and some of Suffolk, with clinics in Norwich and
Ipswich.
The staff at Pine Cottage and the Re-Enablement Services
Centre wish to extend their grateful thanks to Malcolm for sharing
his story.
Elective Amputees
Acute Stage
All known Elective amputees are offered a
pre-operative consultation with the specialist
multi-disciplinary team. Where appropriate
a home exercise plan, assessment of home
environment and medical management are
commenced prior to amputation.
We are working hard to improve links with
the local acute hospital to make this process
seamless and to provide a better service for all
of our patients.
Advice is given to operating surgeons regarding
appropriate levels of amputation to optimise
rehabilitation and future limb-wearing. The
patient is visited in the acute hospital postsurgery by a specialist rehabilitation nurse.
Expectations are discussed and goals set for
rehabilitation
Malcolm spent 7 weeks in the acute
trust due to complications with
healing. This is common in amputees
with diabetes
Malcolm lost his right leg below the
knee 8 years ago.
This was as a result of infection in his
foot.
Malcolm lost his left leg above the
knee in 2015.
Every year approximately 115 people are newly
referred to the re-enablement services centre
for assessment.
Approximately 60% of amputees in Norfolk are
diabetic.
In-patient Rehabilitation
All staff at all levels and professions are trained
in specialist amputee rehabilitation so that the
process of recovery and gaining independence
starts the moment the patient arrives at Pine
Cottage.
as an amputee on the ward and looking at risk
assessments, transfers and prosthetic issue.
Managing people’s expectations is a key skill
that staff require when working with this client
group.
Discharge to the Community
A clinical psychologist assists us with guidance
of psychological issues. All staff have
experience of working with amputees and the
psychological challenges of recovery.
Malcolm was discharged home after
2 weeks in rehabilitation. He returned
to managing all activities of daily
living independently.
We also have input from our clinical
psychologist in our clinical supervision. This
gives us better skills to deal with issues such
as suicidal feelings and ability to return to the
community and feel a useful part of society.
There is a specialist team at Pine Cottage who
all play a part in rehabilitation of the amputee
from the initial pre-amputation consultation right
through the preparation for the operation to
the rehabilitation to independent living whether
that be with or without a limb and supporting
discharge from hospital with follow up as
necessary.
Within the community patients receive specialist
physiotherapy in order to prepare for mobility
with a prosthesis
He spent 4 weeks learning to walk
again with the help of the specialist
physiotherapy team.
Malcolm’s primary aim in
rehabilitation was to return home to
his normal family life.
He was determined to continue
prosthetic use and embark on the
challenges of mobilising with two
prosthetic limbs
All staff have received a training programme
which is designed to help them understand
the challenges the patients face on a daily
basis. This includes going out in a wheelchair;
shopping; role play getting washed and dressed
51% of our patients go on to wear a lower limb
prosthesis
Each year around 100 people are accepted for
inpatient rehabilitation at Pine Cottage
Ongoing management
All patients are offered a specialist multidisciplinary review six weeks after hospital
discharge regardless of whether or not they use
a prosthesis
Malcolm has returned to driving
his hand control adapted car and
part time employment. He regularly
supports the team at Pine Cottage
with education sessions, enabling
staff to offer opportunities to
local professionals learning about
management of amputation.
The Colman Centre for Specialist Amputee Rehabilitation
Who are we?
As part of Norfolk Community Health and Care NHS Trust, our professional staff offer care to
patients from in and around Norfolk/Suffolk within an inpatient unit and outpatient services based
within the Colman Hospital site, on Unthank Road, in Norwich, and with prosthetic services offered
at the Re-Enablement Services Centre on the Julian Hospital Site.
Who will provide care within the Amputee Rehabilitation Unit?
The care will be provided by a team of health and social care professionals who have the
experience, skills and knowledge to offer a complete rehabilitation service. Support may come
from some of these professionals, or all of them. The team includes:
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Consultant lead medical team
Nursing team
Physiotherapists
Occupational therapists
Assistant Practitioners and nursing assistants
Clinical psychologist
The aim is to progress recovery as quickly as possible to enable people to get back to a life which
is as normal as possible. Whatever age people are, we will help and support them to achieve this.
We will treat patients with dignity and respect.
Malcolm wants people to be treated equally and hopes that
one day he will be eligible to receive a prosthesis with sensors
to enable him to walk independently without aids. He feels this
would enable him to return to full time work and reduce the need
to rely on others for financial support.
Specialist Occupational Therapy
Wheelchair Assessment
OT’s assess the patient’s
mobility in relation to
wheelchair provision soon
after admission to hospital.
Health Care Assistants and Assistant Practitioners
Signposting
OT’s empower people
to take responsibility for
achieving goals, signposting
to organisations that can
facilitate change or benefit
patients.
Assessment of Care Needs
Recommendations and
referrals are made following
assessment for care needs
after discharge from hospital
Discussion and Activity
Groups
Provides a forum for patients
to share experiences and offer
peer support. Practical advice
is shared and information
regarding healthy lifestyles
promoted.
Rehabilitation Prescription
Goals are set and progressed
with each patient to enable
them to work towards an
achievable aim in preparation
for discharge from hospital
Home Access Visits
The patient’s home
is assessed and
recommendations made
regarding required
adaptations and equipment for
wheelchair access and safe
transfers
Progression of Goals
Routine Care Needs
Patient Assessment
Our team attend to daily
care needs in a professional
manner, ensuring patient’s
privacy and dignity is
maintained throughout.
Our assistants perform
regular observations on all
our patients and alert qualified
staff when there may be
concerns. Our assistants
are all competent in carrying
out dynamic risk assessment
ensuring patient safety is
maintained.
Our team respond to each
patient as an individual,
supporting them to maintain
or progress their functional
independence.
Support the team
Our assistants are
competent in alerting staff
to emergencies, assisting in
the event of a fall or medical
emergency.
Equipment Prescription
Therapy Support
Manual handling, daily living
and pressure care equipment
is prescribed by the OT for
delivery to patient’s homes in
preparation for discharge from
hospital.
We have dedicated assistants
that work across nursing
and therapy roles to ensure
a seamless transition and
progression of function from
therapy to ward.
Education and Discussion
Our team are always available
to patients and their families
for on hand practical advice
and discussion
Listening and Responding
Our team take the time to
listen to patient’s concerns
and reflections on their
amputation, guiding them
through positive experiences
where able.
Specialist Rehabilitation Nurse roles
Rehabilitation Medicine
Pain Management
Listening and Responding
Wound care
Our team take the time to
listen to patient’s concerns
and reflections on their
amputation, guiding them
through positive experiences
where able.
Our nurses have expertise
in the management of
challenging wounds and under
the guidance of the Consultant
Surgeon and Consultant in
Rehabilitation medicine use
their skills to promote effective
wound healing.
Medical Assessment
Nutritional Management
Pressure Care
Nurses closely monitor the
nutritional intake of all patients
offering support and advice
to maintain a healthy diet and
referral to specialist dietetic
services where needed
Through a careful combination
of monitoring and treatment
our team aim to reduce the
risk of developing pressure
areas and promote healing of
existing pressure areas.
Our specialist team of Doctors
assess all our patients and
offer specialist intervention
and opinion to improve or
maintain health.
Specialist Advice
Doctors have specialist
knowledge in the
management of pain and
apply this where appropriate
including phantom pain
management
Prosthetic Limb
assessment
Our Doctors are able to
advise medical colleagues
across acute and community
services regarding the medical
implications for amputation
and onwards management.
Our Consultant in
Rehabilitation Medicine
is expert in assessing for
suitability of prosthetic limb
provision
Pre-assessment
Health Promotion
Support and Advice is given
to promote healthy lifestyles
including care of residual limb,
foot care, smoking cessation
and activity levels
Education and Discussion
Diabetes Management
Education
Patients are supported to
manage their own continence
aids in preparation for
discharge from hospital. A
self medication program is
offered to all patients where
appropriate.
Our team work with the
diabetes specialists to
offer expert advice and
management in diabetic care,
often referring to the podiatrist
to pre-empt diabetic foot
complications and subsequent
amputations.
Our medical team take time to
meet patients and families on
a weekly basis to discuss their
medical management , new
diagnoses and progress in
rehabilitation
Our team is able to offer
pre-assessment and advice
to teams managing complex
cases waiting for amputation
or rehabilitation services
Rehabilitation Prescription
Goals are set and progressed
with each patient to enable
them to work towards an
achievable aim in preparation
for discharge from hospital
Specialist Physiotherapist Roles
Patient Opinion Quotes
“Recently due to septicaemia and gangrene I had to have my right leg amputated.
Falls Management
Our team offer advice
regarding falls prevention and
skills to reduce injury in case
of a fall. Patient’s where able
are taught how to get up from
the floor safely after a fall.
Outcomes/reviews
Transfers/Mobility
Patients learn how to transfer
from wheelchair to bed / toilet
/ chair and practice wheelchair
mobility. Patients are
assessed to their individual
physical capabilities regarding
mobility progression.
Team use the Get up and go
and 10m walk, LCi-5 and Amp
Pro to record progress with
the amputees after limb issue.
Pre-Prosthetic rehabilitation
Our physiotherapists prepare
able patients for walking.
They offer advice and
information to help them to
make decisions about whether
limb wearing is appropriate for
that individual and their likely
outcomes
Stump care/Remaining Limb
care
Physiotherapists prescribe
stump shrinking socks (Juzo).
Our team are experts in stump
management and empower
patients to manage swelling
in the stump and care of their
remaining limb
Community Resources
Fitness
Our team prepare patients
for discharge back into the
community seeking to regain
or improve levels of fitness
through individually tailored
exercise programs carried out
in specially equipped gym.
Listening and Responding
Our team are honest and
open about expected
progression with patients
and help patients set realistic
mobility targets.
Our team encourage patients
to maintain their fitness levels
and pursue leisure interests
after discharge from hospital.
This may involve signposting
to community facilities or
referrals to community
schemes and services.
Luckily I was referred to Pine Cottage in Norwich for nursing and convalescence as well as
physiotherapy from the James Paget Hospital.
I had spent roughly 5 weeks in the local acute hospital (with 11 days in intensive care) so when I
arrived at Pine Cottage my physical condition was quite poor due to such a long period confined to
a bed.
On my arrival at Pine Cottage, I was informed that I should do as much as I could myself and
that there would be nurses on hand to help me with the 'other' necessities. I must say that the
professionalism of the nurses at Pine Cottage was excellent, I basically wanted for nothing.
The nursing care was delivered with precision, dignity and punctuality and even with a degree
of good humour which I found assisted me with my rehabilitation. I tried not to ring my alarm bell
too often, but when I did it was always answered within a couple of minutes, unlike at the acute
hospital where it often wasn't answered for 10-15 minutes.
So all in all I have absolutely no worries about advising other amputees to go to the Pine Cottage,
they will be treated like royalty.
With regard to the physiotherapists, they took in a near 60 year old, whose physical condition had
deteriorated badly due to septicaemia and gangrene (and several weeks of confinement to a bed)
who couldn't get out of his wheelchair to a stage where he could get onto his feet and walking
(with aid) all within about 5 weeks - a remarkable achievement.
Yes, I did put in the effort, but the physiotherapists were always there for me offering
encouragement and advice, as and when needed.
I would never have achieved the level of mobility in the same timescale without their help,
understanding and patience, that's for sure.
In summary, I feel that the care I have received has been of the highest level and I am so pleased
to know that these people are there for me (if I need them) both now and in the future.”
“All the wonderful staff, at every level, at Pine Cottage who conspired to welcome me and spoil
me for the few days I spent there until I was discharged. Special thanks to Emily and Wayne who
recognised my capabilities and allowed me to go home only one week post-op!
I'm now in the capable hands of the Re-enablement Services team. Sue and her dedicated team
of physios are working me hard to ensure I am as fit and ready as I can be when my wound is
healed enough to take a cast for my new leg.”
“After having my right leg amputated below knee I had the privilege of being looked after by the
team at Pine Cottage Norwich. Without their support, excellent care and motivation I truly don't
know where I'd be today.
From the moment, I arrived I was looked after exceptionally. My every need was met and I was
treated with true dignity and compassion. The nursing staff ensured my health and emotional wellbeing was cared for, and the fantastic physio team pushed, motivated and encouraged me to do
my best.
Sue lead physio and her team Debbie Wayne and Kate looked after me for 2 weeks. When I got
my prosthesis, the opportunity arose to be able to come back for a further 5 days, to get me back
on my feet, and I jumped at the chance!
I walked gingerly the 10 m with 2 sticks in 54 secs on day one, but with the whole team's support
and my determination, on day 4 it took me just 10 secs. Amazing!
Thank you, Pine Cottage, I have my life back now. What was a scary time, but you made it so
much more bearable and Sue gave me the hope that I would do just fine, and I have.
What I really love about this unit is they were there for the whole family. From the OT visit with my
mum and kids, to the nursing staff getting me in touch with social services to enable me to remain
a good mum. First class team all round.”
“I was struggling at home after being given a prosthetic limb last year and I went to the Re
Enablement Services Centre, I was seen by the physiotherapist who suggested that I came in for
a quick burst of therapy.
I was looking forward to arriving but very apprehensive about managing but as soon as I arrived
I was greeted by the nursing staff who were very welcoming and knowledgeable about what had
happened to me and put me completely at ease as they seemed to know a lot about everything I
had been through.
The encouragement and motivation I received from everyone on the ward was great. It gave me a
fantastic feeling and I gained a lot of confidence from just being in an environment where everyone
understood what I was I going through. I arrived walking with one stick and I left walking by myself.
Everyone was wonderful and friendly and helpful, everyone had time to stop and talk to you and
no one made you feel like they didn't have time for you. It was not like being in hospital at all.
I had physio twice a day to improve but in between the nursing staff helped me to walk and
explained what I was doing wrong. So everyone helped”
“Was a normal day at work, then got hit by a forklift truck dragging my lower leg into the wheel
arch. Ambulance on scene, these people were brilliant and soon had me calmed down. The air
ambulance doctor turned up to ride to hospital in the ambulance with me. When you that scared
it's great to have someone confident and capable there.
In A&E, the people were amazing. They soon had my pain under control. The consultant made
everything clear to me as things progressed, and I was then off to theatre. I woke up with my wife
next to me. My lower left leg was gone but I had expected that after the damage from the accident.
Nine days in the acute hospital with some great care. I had a visit the Head of a Physio team at a
place called Pine Cottage. She told there was a bed there and they could help with my recovery.
Well that was such an understatement! I got wheeled off to Pine Cottage. I met the staff, OTs
and rest of the physio team. I get a little emotional taking about my time in Pine Cottage and the
amazing amount of nursing care and physio and encouragement I received.
Every member of staff at that unit offer something a bit special, they looked after me, my family
and even had time to talk to friends who visit. This unit specializes in amputation. I have met
people who I am still friends with there, the care is second to none.
I now have a prosthetic leg and thanks to their hard work and encouragement can now walk
unaided and have the confidence to carry on with my very changed life. The day I was discharged
I said let me stay another week, they thought I was joking, what a place and amazing staff from top
to bottom..”
“After leg amputation my husband was referred to the Colman rehabilitation hospital, Pine Cottage
unit Norwich. He was assessed as suitable for prosthesis, returned to the unit as an inpatient for
physiotherapy and to be measured and cast for his prosthesis. He returned to the unit for a further
four nights as an inpatient to get used to his new leg.
I just want to say how wonderful the service was and continues to be: I am convinced my husband
would have made significantly slower progress without his experience of the whole team at Pine
Cottage”
“I was sent to the Pine cottages at the Colman Hospital in Norwich for my rehabilitation. From
the moment I arrived I was treated like royalty, the staff were just amazing and very caring for my
needs. At the acute hospital one time I have waited for 25 minutes for a nurse to arrive, after I
pressed the call button. At the Pine Cottage when I pressed my call button a nurse would be there
within 30 seconds.
What is really the best thing is the Physiotherapy help that is available to make me stronger all
over, so when I receive my prosthetic leg I will be ready to walk again like a normal person. I am
still going to Physiotherapy today, but what was truly amazing is seeing all the people who have
got there prosthetic legs and how normal they all looked and walked.
I really am truly grateful to Sue, Debbie and the crew for getting me to this stage. I have two weeks
to wait for my prosthetic leg, then I will be walking again.
Being wheel chair bound is very demoralising and very difficult not to mention very depressing,
everything has changed from getting around the house which is not wheel chair friendly to
shopping for food etc.... I am (and loads of other people are)so glad that Physiotherapy part to the
Pine Cottages is there.
Finally I thank the nursing staff for there amazing care that I and everyone else received while I
was there.
Once again I thank the Physiotherapy staff for what they have done so far.
Looking forward to walking again very shortly.”
The Colman Centre for Specialist Amputee
Rehabilitation Service
Pine Cottage
Colman Hospital
Unthank Road
Norwich
NR2 2PJ
Tel: 01603 251260