Physiotherapy doesn’t have to be all about pain, repetitive tasks and intense exercise. At Orchard Manor, we create a fun, functional and action-packed environment for our young people to enjoy, whilst continuing to promote physical health and wellbeing. The young adults at Orchard Manor have profound and multiple learning difficulties and disabilities with a wide range of co-existing physical and health requirements. It takes all of my physiotherapy knowledge to ensure person-centred, individual therapy for each resident through a range of exciting and challenging activities.
Orchard Manor is a residential transition care home run by the disability charity Scope for 31 young people with severe physical, sensory and learning difficulties and disabilities. Our overall aim is to promote skills and put in place programmes to enable these individuals to live as independently as possible in later adult life. Placements last 3 years and within this time we provide a vibrant, supportive and challenging timetable of development and therapy sessions. This encourages people to develop existing and new skills that they can retain and continue to use when they move on in the future. Physiotherapy is a key area in the lives of our residents and my role is to ensure each individual has the vital equipment, individual programmes and input to enable our high level of physiotherapy care and to put in the ground work so that this continues within the wider community when our residents move on. Orchard Manor practices a multi-disciplinary method of working and therefore I work within an extensive team of professionals, sharing knowledge and expertise to ensure that each young person is supported to maintain and extend their abilities. Orchard Manor has an onsite Skills Development Centre which delivers sessions in art, drama, music, media, ICT, cookery, occupational therapy, speech and language therapy and physiotherapy. We aim to ensure that an individual’s time at Orchard Manor is full of functional experiences as well as fun and satisfaction.
I take a ‘hands on’ approach to my role and I see each of our residents between 2-4 times per week depending on their level of physical disability and need. I provide physiotherapy intervention within a group setting or on an individual basis depending on the task or activity being provided. Each of our groups are carefully created to combine residents with similar cognitive and communicative skills in order for us to customise activities to suit their level of understanding and ability. I work in many different environments to ensure physiotherapy is a functional and daily aspect of our resident’s lives e.g. I spend lot of time within the residential flats ensuring equipment and physical management programmes are being correctly carried out by support staff. I also support residents in the community whether that is the local public swimming pool, gym or accessing local horse riding facilities. My plan is to combine social integration and physical wellbeing into the day to day lives of the young people.
Physiotherapy sessions at Orchard Manor are always full of laughter, games and opportunity. I work on the trampoline four mornings a week providing Rebound Therapy for all residents. This acts as an ideal platform to complete alternative positioning, stretching programmes and functional tasks such as bridging and rolling. Each individual completes a specific programme working on their level of mobility and physical aims. Some of our residents are able to bounce with support. However some require adaptive equipment to support their physical position and trained staff to assist them in passively moving their limbs in order to complete stretches and activities such as throwing and catching. Every resident works towards personal goals appropriate to their level of cognition and physical ability. This may be through a sensory experience, increased body awareness, independent sitting or rolling, standing or bouncing. Any physical activity completed on the trampoline during Rebound Therapy also enhances the respiratory system, circulatory systems and bladder and bowel function. This therapy is accessible to most of the young people who live at Orchard Manor and is very popular. As I mentioned at the beginning, my aim is to ensure that physiotherapy intervention is not painful or boring but fun and enjoyable.
Another facility we have at Orchard Manor is a hydrotherapy pool. I run hydrotherapy sessions four afternoons a week for residents who are unable to access the local community swimming pools, either due to accessibility or the temperature of these pools. Our pool is specially adapted with excellent changing facilities and a hoisting system straight into the water. I especially enjoy working with our profoundly physically disabled residents in the water as they are able to achieve so much more mobility and function due to the weightlessness this environment provides. I am able to effectively support the residents to achieve certain positions which would not be possible on land. For example, some young people use wheelchairs at all times throughout the day, but they are able to stand and take steps in the water with suitable support from myself and adaptive hydrotherapy equipment. The 34°- 36° temperature in our hydrotherapy pool also allows muscle relaxation and hence further stretching potential for those with contracted limbs. The young people may help actively with their stretching programmes or we may support them passively to achieve as much additional range of movement as possible. Within this controlled, relaxing and sensory water environment, the residents don’t perceive physiotherapy as painful or intense, but pleasurable, comfortable and safe.
Another very important aspect of the young people’s physiotherapy intervention focuses on mobility and physical activity through active exercise. We have a range of adaptive pieces of equipment to support individuals to achieve this. Our focus during the 3 years people are at Orchard Manor, is to ensure that everyone has their own equipment for long term future use. We support individuals and their families to proceed with the funding for these pieces of highly specialised equipment via private funding or applications through the health or social authorities. I work closely with the Occupational Therapist to ensure the equipment is individually assessed so that it is suitable and physically beneficial for the person who will use it. We have very close links to representatives from large equipment companies and they visit Orchard Manor on a regular basis to demonstrate new equipment and maintain and reassess our existing equipment. This means that our residents remain safe, supported and comfortable and benefit from advances as they become available.
Our young people have an array of standing frames, walking frames, side lying boards, tricycles, comfortable seating and sleeping systems all individually adapted for their use. The extensive grounds at Orchard Manor include a private road that orbits the entire site and can safely be used for tricycle riding and walking. This provides a change of scenery and a stimulating environment in which to complete these activities. Mobility for residents comes in a range of different forms depending on the physical needs of each person’s body. We use the most adaptable walking frames to achieve walking/stepping with the most unlikely to mobilise residents. As you can imagine, this creates a satisfying and rewarding personal achievement along with the health and physical benefits gained from moving and being in an upright position.
Postural care is a major aspect of each individual’s physiotherapy regime. Our staff ensure that positive postural positioning, for each young person, is applied 24 hours a day and individual photographic and written programmes are composed by myself for the support staff, families and the residents themselves to follow. Alternative positions are implemented within the day, whether that is in a music session, whilst watching a film, when eating or drinking, or in an individual’s free time. I work with residents and liaise with our care and skills development staff to identify the most beneficial and appropriate positions for each person when using adaptive equipment. Each resident also completes weekly small group physiotherapy sessions that focus on positioning. During this time individuals are supported 1:1 by a member of staff and, following my directions, achieve a suitable position, whether that be in standing, sitting, lying on their back, front or side. When each resident is positioned correctly and comfortably we complete a range of activities such as bowling, puzzles, sensory object manipulation, exercise tape recordings, drawing, looking at books or using table-top games. This again incorporates function, fun and positive positioning for our young people.
Another session we complete weekly within physiotherapy is integrating postural care with passive movements. Each resident is positioned in a relaxed neutral position and supported 1:1 by a member of staff. We complete a full body passive movement stretch routine to assist the young people to maintain their current range of movement and muscle flexibility. I lead this session and my aim is to educate staff so that these activities are completed as part of an individual’s daily stretching routine within the residential flats. With practice, advice, demonstration and observation during these sessions, the confidence and competence of our support staff greatly increases and we ensure each member of staff works with different residents with different physical presentations to enable further progression.
I am committed to the role I play in staff training which greatly benefits the residents. I lead formal training on Postural Care and Passive Movements, indicating the aims, benefits and safety precautions within these topics. I include a practical demonstration of full body passive stretches and a sleep system demonstration. Support staff use sleep systems with residents on a nightly basis, without immediate physiotherapist assistance and so this training is vital to ensure that sleep systems are used effectively and safely. This training has been extremely successful and popular. It has helped support staff to further their knowledge and understanding of these important aspects of care. I also train staff to assist our residents in the hydrotherapy pool so that they can make the most of this facility in the evenings and at weekends.
I have mentioned just some of the activities I complete with the residents at Orchard Manor, however every day is different and we adapt, change and explore alternative ideas all the time to achieve exciting and beneficial results. The young people I support are extremely important to me. Their care, independence and enjoyment are always at the forefront of all my physiotherapy intervention and I strive to ensure that their health, happiness and physical wellbeing is well maintained and monitored. Orchard Manor Transition Service is a fantastic place to work and the attitudes of the staff combined with the facilities and high standard of care ensure that each person’s needs are met and that they are happy, motivated and ready for the challenges the future is sure to bring.
Gemma Smith, Physiotherapist HPC