Nigel Skates has been one of the patients to use EvolvRehab and the RehabKit as part of the Hobbs & Winchester University Telerehabilitation project for stroke survivors which was funded by the NIHR Brain MIC.
Nigel, who worked in IT before his stroke, is a big fan of using technology at home to help augment the amount of traditional therapy he is receiving, especially during the the current Covid crisis which has limited his access to such therapy.
In the 5 months that he has used EvolvRehab, Nigel has performed over 8864 reps and near 12 hours of exercise activities in the 71 exergame sessions he has completed. His therapist, Hannah Woods-Hier, remotely supervises Nigel’s therapy programme, and personalises it to his particular needs.
We spoke to Nigel and his wife Lynda to discuss their experience of his using EvolvRehab at home and the improvements they have both seen in Nigel’s overall quality of life since he first began using the system.
Please give us a little information about yourself Nigel.
Nigel: My name is Nigel Skates. I’m 59 and an ex R&D and NOC Manager. My hobbies are photography & home DIY projects.
Can you tell us about when you had your stroke and how it has changed your life?
Nigel: My first stroke was in February 2020. It turned my life upside down. There are lots of things I can no longer do that I was able to do easily before my stroke.
How has COVID-19 affected your life and your rehabilitation?
Nigel: I haven’t been able to join local Stroke Club due to national restrictions. Some therapies have been delivered remotely. Therapists have had to wear PPE which made it more difficult for me to read their body language.
Have you used a technology solution before as part of your rehabilitation?
Nigel: No software, but I have used some therapy equipment like squeezy balls, putty, walking frame, etc.
What do you think about receiving telerehabilitation as a means of augmenting the amount of therapy you receive?
Nigel: Brilliant idea, all in favour of it!
What do you find be the biggest differences between telerehabilitation vs traditional therapy?
Nigel: Telerehab is more demanding because you can’t talk to someone, but telerehab can push you to your limits, with assistance of therapist programming the exercises.
Do you think the NHS should implement telerehabilitation as part of the stroke and brain injury care pathway, even after the Covid-19 crisis is over?
Nigel: Yes I do wholeheartedly.
Has using EvolvRehab helped you? If so, in what way? For example, has EvolvRehab helped you in any everyday functional activities or tasks?
Nigel: Yes, my life has improved no end! I can bend down now. I can use my right arm more. I am more confident in stepping sideways. I can stand independently for longer.
Outside of your physical wellbeing, has using EvolvRehab helped you in any other way?
Nigel: EvolvRehab has improved my self-confidence. It has increased my stamina. It can be a daily challenge which I enjoy.
How do you like using the RehabKit hardware? Do you find it easy to use? Was the initial set up challenging in any way?
Nigel: Yes, I like using the Rehabkit hardware and have found it easy to use.
Would you recommend EvolvRehab and its use for telerehabilitation to other stroke and brain injury survivors?
Nigel: Yes, but the earnest is on the user to make use of it to gain full benefit.
Do you have a favourite virtual activity?
Nigel: Balloon popping – It’s the easiest and the hardest.
Goal setting is important in the process of rehabilitation. What are some of your goals? Has EvolvRehab been able to help you with any of your goals? If so, how?
Nigel: My main goal is to mow my lawn. EvolvRehab is helping me by improving my balance, walking and stamina.
Do you have anything else you would like to share about using EvolvRehab and the RehabKit?
Nigel: It is a wonderful idea and has loads of functional benefits.
Thanks to Lynda Wilson for the photos
We also spoke to Nigel’s wife Lynda who is a nurse and takes a very active role in his post-stroke care, including his use of EvolvRehab. Lynda’s experience as a care giver mirrors that of most spouses of stroke survivors and is an important reminder that stroke doesn’t just affect one person. Our experience here at Evolv is that caregivers like Lynda also need to see a clear benefit of incorporating technologies like EvolvRehab into the home. Her insights both as a nurse and the spouse of a stroke survivor are ivaluable to us and our aim of improving EvolvRehab for people like her.
What are some of the challenges for you as a spouse/partner/family member/caregiver of a stroke or brain injury survivor?
Lynda: As a couple, our goals, current priorities and lifestyle changed totally overnight. The shock and uncertainty for the future became dominant focus of everyday life. Socialising/hobbies/home décor/holidays/careers became irrelevant. 18months later, the most significant change for me individually is the near total loss of my personal lifestyle due to being full-time carer and having to do nearly all the tasks that were previously shared. I can no longer “just” go out/chill out/chat on phone/etc
The major impact for us has been less than for many following major stroke as Nige has retained his intellectual abilities and I was experienced in working with people with disabilities and negotiating the care systems due to my nursing career. However, supporting a Loved One is of course very different emotionally to supporting patients.
Nige however has an added disadvantage of most of his disabilities not being obvious. His strokes caused most devastation in cerebellum brain stem and pons affecting all 7 senses e.g. balance, sight, hearing, tactile, force/strength/distance. So, whilst medical professionals in this field of work understand the implications, other care services often do not. It can also be difficult for Nige to be aware of some aspects e.g. temperature of an object, strength of his grip, his proximity to objects, if he is upright or leaning over, visual focusing. Therefore, I need to support in more ways than just his mobility e.g. predicting risks to his balance from gradients, not reacting to tone of voice, advising on temperatures, alternatives to calling for my attention
Do you think technology can help with these challenges?
Lynda: Absolutely. Telerehabilitation can be used more regularly and for longer than any employed person could ever provide. ‘Playing a game’ can be more engaging to start and more interesting to continue than exercises performed alone.
For some people who find basic technology difficult, they may take longer to become confident operators and need more support from others. However, ‘playing the game’ can be enjoyed by I would think nearly everyone who has some control over some aspects of their physical movement and understands basic cause and effect.
I would also suggest this system may be useful for people with physical and/or learning disabilities who need regular motor skills exercises for their continued physical movement e.g. cerebral palsy, global developmental delay,
What you do you think of your loved one using EvolvRehab at home as part of their therapy?
Lynda: EvolvRehab has been ideal for Nigel, predominantly due to his continuing struggle with excessive fatigue. Nigel can juggle the timing of when to do the rehab physical exercise with his current level of energy and with other commitments e.g. appointments, personal care, social contacts.
Additionally his motivation to use EvolvRehab totally surpassed any interest in doing any of his self-exercises or self-activities recommended by any of the therapists. The encouragement of a game target far outweighs a verbal “well done”
I believe telerehabilitation is more suited to his feelings of self-worth. E.g. doing a ‘computer game’ challenge vs being physically supported to exercise because he’s ‘crippled’
Have you seen any improvements in them since they started using EvolvRehab?
Lynda: Nigel started using EvolvRehab after his second debilitating issues. Nigel’s improved stamina, motor skills and balance are significant, particularly when comparing staff hours required now vs the improvements he made with intense therapy interventions by team of therapists after his first debilitating strokes.