Richmond Community Neuro Rehabilitation Team :: Hounslow & Richmond Community Healthcare

Richmond Community Neuro Rehabilitation Team (CNRT) is an NHS service for adults with a neurological condition who are living at home.

The team works with patients and carers to help them achieve maximum independence in all aspects of daily life. Therapy is delivered to patients in the most appropriate setting, either as an outpatient at Richmond Rehabilitation Unit, or at their home or workplace setting.

Acceptance Criteria:

Adults (18 years+) registered with a Richmond GP and who have an acquired or long-term neurological condition. The main problem identified must relate to their neurological diagnosis.

CNRT is not appropriate for:

People whose primary diagnosis is:

learning difficulties
mental health problems
substance misuse
dementia (however the SLT service provides swallow assessment and advice for these patients, please see Departments & Services)

The CNRT team consists of specialist therapists and nursing (please see Departments & Services for more information):

Neuro-Physiotherapy
Occupational Therapy
Speech and Language Therapy (SLT)
Dietetics
Multiple Sclerosis Nursing
Parkinson’s Nursing

Stroke Early Supported Discharge Team (ESD)

In addition to the CNRT, there is also an Early Supported Discharge (ESD) Team based at Richmond Rehabilitation Unit. This is an intensive rehabilitation service for stroke patients to facilitate early discharge home from hospital.

There are also links to the Continence Nurse Specialist and Podiatry Service.

How to refer

All referrals to the community neuro rehabilitation team should be made via Single Point of Access (SPA) using the HRCH single referral form.

Referral form

Who we are

We are a team of specialist Physiotherapists (PT) with experience in treating people with neurological conditions. Our assessments and treatment programmes use detailed analysis of movement and how it impacts on every day function.

The aim with all treatment programmes is to facilitate the person to self-manage their condition as much as possible and to support care givers.

What we do

We provide:

Assessment of postural control and movement
Assessment of motor skills - bed mobility, transferring, sitting and standing balance, walking, managing stairs and getting up from the floor.
Exercise programmes
Re-education of balance and gait.
Provision of appropriate walking aids including orthotics and/or referral to a specialist clinic.
Spasticity management including referral to spasticity clinic and provision of timely rehabilitation following Botox injections.
Positioning and Posture Advice
Exercise and balance classes

Who we see

We see people with a neurological diagnoses and whose primary presenting need is related to that condition. This service is for people who live in Richmond and have a Richmond GP.

Who we don't see

People whose primary presenting condition is:

Learning disability
Mental health problem
Substance misuse
Dementia
Traumatic injury or new medical condition unrelated to their neurological condition. E.g. a fracture or pneumonia
Multiple active unresolved medical needs taking priority over their underlying neurological condition
Peripheral neuropathy related to alcohol or diabetes
Single nerve palsy related to trauma
Nerve root involvement related to disc protrusion
Non-organic conditions and M.E

Who we are

We are a team of specialist Occupational Therapists (OT) with experience in treating people with neurological conditions.

The aim with all treatment programmes is to facilitate the person to self-manage their condition as much as possible and to support care givers.

What we do

Occupational Therapy provides practical support to help increase peoples independence, enabling people to do the activities (occupations) that matter to them. This could be essential everyday tasks such as looking after yourself, work or social activities.

For example, we help people manage:

Personal care tasks (e.g. washing and dressing)
Household tasks (e.g. cooking and cleaning)
Vocational rehabilitation (i.e. returning to work)
Leisure and social activities
Arm and hand function
Functional mobility and transfers
Fatigue management
Adapting to changes in vision or visual perceptual difficulties (e.g.hemianopia)
Cognitive rehabilitation (e.g. memory, attention)
Equipment to aid independence

Who we see

People whose primary presenting need is related to a neurological condition. This service is for people who live in Richmond and have a Richmond GP.

Who we don't see

People whose primary presenting condition is:

Learning disability
Mental health problem
Substance misuse
Dementia
Traumatic injury or new medical condition unrelated to their neurological condition. E.g. a fracture or pneumonia
Multiple active unresolved medical needs taking priority over their underlying neurological condition
Non-organic conditions and M.E
People whose needs are for equipment or environment adaptation only- please contact Richmond Social Services Adult Access team on 020 8891 7971.

Who we are

We are a team of specialist Speech and Language Therapists (SLT) trained to treat communication and swallowing disorders.

What we do

We assess, diagnose and, where appropriate, provide goal-led therapy programmes to support aquired communication difficulties relating to their neurological condition.

For example:

Dysarthria (unclear speech): difficulty achieving clear or loud speech secondary to a neurological condition, eg, Parkinson's
Aphasia (language impairments): difficulties understanding and expressing spoken or written language
Cognitive Communication Disorder: communication disorder primarily associated with cognitive impairment

We provide direct therapy as well as education, advice and support to family and carers, includig referrals to local support groups.

We assess, diagnose and provide safe swallowing recommendations for people with swallowing difficulties relating to the mouth and throat (oral-pharyngeal dysphagia). Please note: oesophageal stage difficulties should be referred to gastroenterology.

Who we see

We see people with a neurological diagnoses and whose primary presenting need is related to that condition. This service is for people who live in Richmond and have a Richmond GP.

We also see people with Dementia, COPD and other non-neurological conditions for swallow assesment and advice (dysphagia).

Who we don't see

People with a voice disorder. Please refer to Specialist Voice Therapy SLT Team via SPA.
People with a developmental or acquired stammer: please refer to City Lit https://www.citylit.ac.uk/about-stammering or see the British Stammering Association website www.stammering.org.
People with difficulty swallowing secondary to an oesophageal diagnosis. Please refer direct to gastroenterology.
People with communication difficulties secondary to dementia.
People with communication difficulties relating to a Learning disabilty or mental health problems.
People with a non-organic condition, including functional disorders.

What we do

To integrate patient’s nutritional treatment into their overall CNRT care
Provide impartial and evidence based advice about nutrition and health for a range of neurological conditions.
Advise on food related problems, treatments and disease.
Advise on dietary management to limit future neurological events e.g. stroke
Ensure dietary advice is person specific and meets nutritional needs
Raising awareness of importance of good nutrition with patients, carers, health and social services, family and friends.
Work jointly with other team members and other professionals e.g. Speech and Language Therapists for patients with dysphagia (swallowing problems)
To support and counsel patients throughout their decision regarding artificial nutritional support e.g. Percutaneous Endoscopic Gastrostomy (PEG)

Who we do not see

Kingston Hospital Dietetic Department has the funding for enteral tube feeding e.g. PEG for patient’s registered with a Richmond GP.

Who we are

Janice Newbery - Multiple Sclerosis Nurse Specialist
Wioletta Kironde - MS Administrator

What we do

Support,advice and information for patients who have recently been diagnosed with MS
Ongoing support for patients with MS and their carers via telephone or direct contact
Specialist nursing assessment and advice on the management of MS, working closely with therapy colleagues within the Community Neuro-Rehab Team
Links between community and hospital services
Case management for patients with complex needs
Links to other services supporting people with MS, making referrals when required
Education and training for health and social care professionals involved in MS

Find more information on our webpage

MS Nurse Specialists - Richmond

Who we are

Neda Rahmani-Khezri - Parkinson's Nurse Specialist (Monday to Wednesday)

What we do

The Parkinson’s Nurse Specialist provides patients with information and advice to support and help self-manage condition.

This local service in Richmond is aimed at helping maintain a good quality of life for patients and their family/carer through:

Advocacy
Support for patients, families and carers
Facilitating medication management
Management of symptom control
Providing co-ordination of care with other professionals that are involved
Education about condition and how to self-manage
Information and advice
Telephone advice line

We provide a 6-week PD exercise class and also run a weekly newly diagnosed PD clinic alongside a physiotherapist. In addition, we also offer a newly diagnosed PD education group which is run twice a year.

Who do we see

The service is available for patients who:

Are registered with GP in Richmond
Have a confirmed diagnosis of Parkinson’s
Are already known to the service so self-referrals are accepted
Are experiencing problems associated with Parkinson’s

The Parkinson’s Nurse Specialist can provide advice over the phone, at clinic or at home for house bound patients.

Find more information on our webpage:

Parkinson’s Nurse Specialist - Richmond

What we do

The stroke early supported discharge team provides an early, intensive rehabilitation service for stroke patients.

The team helps patients to leave hospital more quickly and return to their own homes so that patients can maximise independence as quickly as possible after their stroke.

Patients are referred directly from stroke units or rehab units and are assessed within one working day (Monday to Friday).

Treatment is intensive in the home for the first two weeks. After this time treatment will gradually reduce in intensity over the next four weeks.

Patients may also be supported by a care package or district nurse if needed and must be organised prior to discharge. Any equipment must also be organised prior to discharge.

Who we are

Memory Musamadya
MSC – Specialist Neuro Mental Health Practitioner (Psychological Patient Support Service)

What we do

This service supports patients with a neurological diagnosis who experience psychological symptoms, including anxiety, low mood and feeling overwhelmed which is impacting their rehabilitation and general wellbeing.

Every patient is supported with tools that work for them, to let the patient take control of their life and not let the symptoms control them.

In cases where some patients experience advanced symptoms which are a high risk to their life or others, we can refer to secondary mental health services, emergency services, GP or Kingston and Richmond Assessment Team for an advanced mental health assessment.

Patients can be referred from within the CNRT Team, from other teams within HRCH, from external services or from patients/carers themselves.

Once known to Neuro Wellbeing services within HRCH, patients can be re-referred to our team via Single Point of Access (SPA).

Please find information on common neurological conditions listed below.

Pressure ulcers (also known as pressure sores or bedsores) are injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin.

They can happen to anyone, but usually affect people confined to bed or who sit in a chair or wheelchair for long periods of time

(source: www.nhs.uk/conditions/pressure-sores)

For more information, please visit page below:

www.hrch.nhs.uk/patients/patient-safety/pressure-ulcers

Sepsis

Anyone with an infection can get sepsis. It can be life threatening and difficult to spot. Please see link below for more information on symptoms and advice.

www.nhs.uk/conditions/sepsis