What is the challenge your project is going to address and how does it connect to your chosen theme?

Currently, there is no standardised CIMT programme available in the Occupational Therapy Neurology Service. In a recent upper limb audit only 31.3% used this treatment modality.

This model is not available in Northern Ireland although is implemented in other parts of the UK.

At this time, the NHSCT does have adequate staffing levels, i.e. rehab and professional staff to carry out this form of therapy.  Additionally, investment would need to be put in place to provide adequate training to increase knowledge and skills in this specific treatment modality.  This increase would allow staff to maintain protected time to deliver this new programme.

Additionally, the lack of equipment means that even with training and staffing in place, the Trust would not be in a position to provide this therapy model.

Studies have shown that the demands and frustrations of CIMT, and the necessity to consent to treatment, and potentially comply with a behavioural contract are challenging.

What does your project aim to achieve?

The aim of this project is to bridge this gap in service delivery and offer the neurology patient the CIMT Programme, an evidence based approach, which will be delivered in a group setting, and ultimately reduce the waiting times for patients accessing this service.  This project will also aim to improve the seamless transfer of patients from the Community Stroke teams.

This service will also assist in maximizing the functional/ motor potential of the clients Upper limb through increasing intensity and repetition for task based practice. ( The Excite Randomized Clinical Trial).

The objectives of this project will be as follows:

-Standardise a modified CIMT protocol for the Neurology service

-Develop a clear list of criteria to identify patients suitable for CIMT

-Agree a set of accessible and useable outcome measures

-Devise a behavioural contract for patients and carers

-Devise written daily schedules of activities.

How will the project be delivered?

This project will be trialled  for 1 year initially within the Neurology OT service, and will follow a standardised structured approach as per protocols.

The Modified CIMT Approach will include

– A 3 week delivery programme delivered at clinic/ place of residence
– 60 minute group outpatient training
– Use of Standardised Outcome measures to assess impact
– Transfer package and patient and carer behavioural contract.
– Home skills assignments and home diary templates (reviewed at regular intervals)
– A Client satisfaction form

Once the protocol has been devised a Schedule for the CMIT programme can be drawn up and paperwork around the other aspects of the programme developed.

This model will be developed and refined through service user feedback, with patients involved from the outset of the project in the design of the service. Service users will be engaged and involved also through 10,000 voices and as part of the project team. Service users will also provide further feedback as part of the evaluation process. Other stakeholders will include the neurology OT service, the community stroke teams, community and voluntary sectors, local Innovation and Quality Improvement teams etc.  Internal Q members will also have the opportunity to provide additional input.

What and how is your project going to share learning throughout?

Given that this model is currently not available in Northern Ireland, the potential learning is significant on a number of levels.  For instance, if successful it would evidence:

Patient level – improve compliance and overall functional use of upper limb, flexibility of treatment delivered through a home programme, and the support of a group setting.
Service level – improve access, and interfaces with community stroke teams

As this model is not available regionally, it could be offered adopted by other Trusts or as a regional programme.  Learning would be shared  through regional Neuro networks already in place, as  is the current position in other parts of the UK.

Within the Trust, all learning will be shared through poster presentations, annual events, through training events etc.  There would also be opportunity to share the learning with other AHP colleagues, with the potential to develop and grow this service beyond the 1 year timeframe.