About the Spinal Unit

In-Patient Occupational Therapy

The Spinal unit has a team of Occupational Therapists covering the ward. The Occupational Therapists work closely with the  doctors, nursing staff and other allied health professionals in order to maximise the functional independence of our patients both during their admission and at the point of discharge. Occupational therapy is concerned with enabling engagement in activities of daily living through facilitating recovery of function and offering strategies and/or equipment to promote safety and maximise independent living.

Role of the Occupational Therapist

Within the acute, ward setting the main role of the Occupational Therapist is to assess patients functional ability and make recommendations to improve safety, independence and ,subsequently, quality of life.

Routinely the Occupational Therapists will assess and advise patients on the following:

• How to transfer on and off furniture e.g. bed, chair, toilet including recommendations and provision of equipment to assist
• Ability to wash and dress independently
• Upper limb function i.e. Eating and drinking, use of everyday objects
• Managing domestic tasks such as cooking in the home environment
• Requirement for care or additional community based services such as adult social care or community based rehabilitation
• Fatigue management
• Postural and seating assessments including provision of wheelchairs
• Advice on resuming work and social activity including signposting on to supporting services
• Education on managing disability for both patients, carers and/or family
• Management of altered sensation and strategies to enable recovery
• Splinting of affected upper and lower limbs
• Advice and referral on for longer term adaptation of the home environment

Occasionally patients on the unit may require a longer or more intensive period of rehabilitation prior to returning home. In this instance the assessments completed by the Occupational Therapists will support decision making around where that rehabilitation is best delivered. This may be within a local rehabilitation unit or within a more specialist, regional rehabilitation setting.

 

Ward D8 Occupational Therapy Team

Fiona Mcloughlin - Spinal Occupational Therapy Team Leader

Helen Bunker- Senior Occupational Therapist

Sophie Laker- Senior Occupational Therapist

Annette Seedhouse – Occupational Therapy Assistant

Spinal and Neurosurgery Pre-Op and Anaesthetic Assessment Unit

You may be asked to have the following tests done:

 

Lung Function Tests

You will be asked to perform some breathing test into a machine which will measure the size of your lungs and how efficiency they work.

4 hours before the test

Please do not drink alcohol or caffeinated drinks (e.g. coffee, tea, chocolate, cola within 4 hours of your appointment)

2 hours before tests

Please do not smoke or eat a heavy meal for 2 hours prior to your appointment time.

 

What is an ECHO?

An echo or Heart Scan is a procedure looks at the structure of your Heart using sound waves to produce an image. The test is not painful and are no side effects.

You will be asked to undress down the waist and lie on the bed. 3 electrodes will then be placed on your chest in order to monitor the heart beat.

Ultrasound Gel is also put onto your chest (this ensures a good contact between skin and probe). The technician will move the probe around the chest to various positions to obtain specific images. The test takes up to 30 minutes to perform.

 

Why Perform Blood Test?

To ensure fit to undergo surgery and to get a set of baseline results

 

What is an Ultrasound examination?

An ultrasound examination allows pictures to produce by using sound waves. Gel is put on the body and a small probe is moved over the skin. Ultrasound is used to examine many parts of the body such as liver, kidneys, bladder, veins and arteries, tests, muscles and ligaments.

Ultrasound is extremely safe with no known side effects.

After the examination, you will be free to go home and resume your normal diet.

 

What is MRI?

MRI stands for Magnetic Resonance Imaging. This is a scanning procedure that uses a combination of a strong magnet, harmless radio waves and a computer to produce very detailed picture of your body.

How long will I be there?

The scan time varies from 30 to 45 minutes depending on the information requested by your doctor.

After you have been scanned, you can carry on with your normal activities immediately.

 

What is an Electrocardiogram (ECG)?

An ECG is a recording of your heartbeat. It is straightforward test that is painless and has no side effects.

The heart beats by producing small electrical signals. It is from the surface of the skin that we are able to detect theses signals, and by using an ECG  machine, record them onto paper.

The technician will ask you to undress down to the waist and lie down on a couch. Stick on electrodes will be placed on your arms, legs and chest. Wires from the ECG machine will then be connected to the electrodes. You will be then asked to relax while the recording is being taken.

The test takes approximately 5-10 minutes to perform.

 

What are X-rays?

An X-ray is a widely used diagnostic test to examine the inside of the body. X-rays are a very effective of detecting problems with bones, such as fractures.

X-rays are a type of radiation. Radiation is a general term that refers to any sort of energy that can travel through space as with a wave or a particle. Examples of other types of radiation include:

• Light
• Radio waves
• Microwaves

Due to their high frequency, X-rays can pass through the human body. This makes X-rays ideal for looking inside the body.

 

What is CT?

CT stands for Computed Tomography. This is a scanning procedure that uses a combination of x-radiation and a computer to produce detailed images of your body in several sections.

What does CT scan show?

A CT scan provides images of thin section through your head and body. Images data can be manipulated to enhance the tissue and bone details dependent on the area of interest.

 

You may also be seen by the following Specialists

Consultant and registrar: To discuss your current health problems, to go through consent form and answer any outstanding questions.

SHO (Senior House Officer): Assessing general health before you get admitted onto the ward.

Nurse Practitioner: Carries out all your observation including you height and weight and gives out leaflets containing information about surgery, general anaesthetic, risks of blood clots and MRSA screening.

Psysiotherapists: See some patients and talk about your general health, carry our spirometre tests and listen to your chest.

Anaesthtist: ​Takes into account your results of any tests which have been carried out to decide your fitness for anaesthesia.

 

For inquiries, please contact Ms. Teresa Hill-Daykin at 01159249924 ext 64341

We have three theatres that are dedicated to this complex matrix of care, and we offer our surgeons a dedicated team of Operating Room Personnel appertaining to spinal surgery. 

Spine surgery undertaken ranges from microsurgical procedures, minimally invasive techniques to major reconstructive and deformity pathology. 

We work closely with many members of the multidisciplinary teams across the trust ensuring our patients receive the highest standard of care during their unconscious state. 

The team is always looking to expand its workforce and the team are educated to a high level in this field of surgery and strive to deliver safe and quality patient care within the operating suite.

The team is lead by Jo Gilding, and supported by deputy team leaders Steph Nathanson, Charlotte Hartley, Kathy Malaya, Daisy Moone and Mhel Cestona.

Our daily vision is to enhance our practice by:

• Forward thinking in our preparation and planning prior to delivery of care.
• Formulate systems for maintaining high quality and safe standards of practice.
• Use professional networks to share wisdom in helping each other to address the many challenges unique to each spine patient when they come to our clinical area. 

Akshay Gadiya

Spinal Fellow

 

Olakunle Badmus

Associate Spinal Specialist

 

Darko Stipic

Associate Spinal Specialist

 

Sultan AlKalbani

Spinal Fellow

 

Nirmal Patil

Spinal Fellow

 

Kubilay Ece

Spinal Fellow

 

Timothy Hammett

Spinal Fellow

 

Naveen Pandita

Spinal Fellow

 

Siddharth Shah

Locum Spinal Consultant

 

Saurabh Kapoor

Associate Consultant

 

John Lester Firth

Honourary Consultant

 

John Webb

Honourary Consultant

Patients may be referred to a physiotherapist via their own doctor, by their spinal consultant or by another health professional.

 

Physiotherapy in the Spinal Outpatient Clinic

Physiotherapists work closely with the doctors and nurses within the spinal outpatient clinic at QMC.  Senior physiotherapists with specialist training in managing back and neck pain are on hand within the clinic to see patients referred direct from a doctor or nurse. The physiotherapist assesses the patient, gives advice, and arranges follow-up physiotherapy in a physiotherapy clinic convenient for the patient.  This may be at Queens Medical Centre or Nottingham City Hospital, but can also be at an NHS physiotherapy clinic closer to their home, either within the Nottingham area or further afield. If appropriate, patients can also be referred on to the Nottingham Pain Team who offer a range of group programmes across Nottingham, including intensive education, advice and problem solving on how to manage pain in the long-term. 

 

Physiotherapist Extended Scope Practitioners

NUH also has four Spinal Extended Scope Physiotherapists (ESPs) working within the QMC spinal clinic. ESPs see selected patients on behalf of the spinal consultants.  These ESPs have extensive experience treating spinal patients.  They have received advanced training in assessing spinal conditions and deciding how they should be managed.  They work closely with spinal consultants in deciding the appropriate treatment for individual patients.  This may be physiotherapy, or referral to the Nottingham Back and Pain Team, or it may be referral for further tests e.g. MRI, for injection or for surgery.These ESPs also train the senior physiotherapy staff who work in the spinal clinic, and who treat spinal patients in the QMC and Nottingham City Hospital physiotherapy departments, to ensure that all NUH physiotherapists are familiar with the latest research and treatment approaches, and provide the highest standard of treatment for spinal patients.

Eleanor Dunstan, Physiotherapist Extended Scope Practitioner, Spinal Clinic - eleanor.dunstan@nuh.nhs.uk

 

Physiotherapy via a GP

Physiotherapy is often one of the first avenues of treatment for people with back or neck pain.  Alongside appropriate painkillers, and advice to keep gently active, this is often successful in settling a back or neck problem, so that there is no need for referral on to a Spinal Consultant.  GPs will therefore usually refer patients to physiotherapy before they refer them on to the Spinal Unit.  Some GPs will encourage patients to refer themselves through the self-referral system running in some parts of Nottingham.There are physiotherapy clinics across Nottingham.  Some are run by the City and County Primary Care Trusts (PCTs) and are held within GP practices or health centres.  There are also large physiotherapy departments within QMC and Nottingham City Hospital.  Patients are offered the choice of where they would like to be treated.

 

Out-patient Physiotherapy Contacts:

Louise Neale - Team Leader for Spinal Physiotherapy Outpatients - Louise.Neale@nuh.nhs.uk

Rhianan Hutchings - Spinal Physiotherapist Outpatients  -  Rhianan.Hutchings@nuh.nhs.uk

In-Patient Physiotherapy

The Spinal unit has a team of physiotherapist working on the ward. The team consists of a team leader which specialises in spinal conditions their assessment and treatment, and a team of rotating staff with varying experience within the musculoskeletal division.The physiotherapists work closely alongside the consultants, doctors, nursing staff and other allied health professionals in or to help facilitate and maximise care to the patients on the ward.  Working in partnership with other health professionals enables the unit to provide a holistic approach to your in patient stay and management. Physiotherapy is concerned with providing services to people with the aim to develop, maintain and restore movement and functional ability for a variety of spinal conditions (elective procedures such as spinal decompressions/fusions to spinal fractures and spinal cord injuries). The physiotherapists in NUH are a dedicated and dynamic team of professionals who are passionate in delivering high quality healthcare.

 

Role of the physiotherapist

The main role of the physiotherapist is to assess patients post operatively looking at their neurology, respiratory function, functional ability, movement and mobility. A physiotherapy rehabilitation plan is then devised based on the patients previous level of mobility/function and/or any post operative problems. These are set on an individual basis dependent on the needs and problems of the patient.

Routinely the physiotherapists will assess and advise patients on the following:

• Log rolling
• How to get in/out of bed
• Transfer bed to chair
• Posture advice/re-education
• Early exercises and advice
• Mobility assessment and practice (In some cases a walking aid may need to be supplied to help with mobility)
• Stairs practice (as required).
• Home-talk advised booklet with relevant information/advice and exercises on their post operative management for when they go home.
• Discussions of home/work/leisure situations

The physiotherapists will facilitate patients under going routine spinal procedures to return back to their previous level of function/mobility and a safe discharge home.

For the more complex conditions in particular spinal cord injuries a more structured and patient centred rehabilitation approach is required. Physiotherapy is based on facilitation of neurological deficits, posture and positioning, range of movement exercises, and functional activities.When appropriate, patients will be referred to out-patient physiotherapy for continuing treatment and rehabilitation for their condition. In some cases patients may be referred onto rehabilitation units/hospitals for ongoing rehabilitation.

 

Ward D8 Physiotherapy Team

Kamal Manek - Spinal Physiotherapy Team Leader

Alistair Murray - Senior Physiotherapist

Kim Woodcock - Assistant Physiotherapy Practitioner

Dawn Brooks - Therapy Assistant

Scoliosis Nurse Practitioner

This is a highly clinical role, maintaining and assisting in the development of an established hospital-based nursing service for patients with Scoliosis. Based in the Musculoskeletal and Neuroscience Directorate and having the responsibility to promote clinical excellence, providing advice and support for nurses and other health professionals.

 

Roles and Responsibilities

• Act as principal liaison for the effective admission planning and eventual discharge of children with spinal disorders including trauma and adult patients with spinal deformity.
• Develop and implement care pathways regarding pre operative preparation and management of inpatients.
• Provide written and verbal advice for patients/families.
• Run nurse-led clinics for children and adult patients with scoliosis in conjunction with nominated consultants.
• Participate in out-patients consultations.
• Provide specialist education and training for ward/dept nurses, other health professionals and students within the NUH.
• Providing Telephone advice service for patients/families and ward/dept nurses.
• Undertake/participate in clinical audit in the field of scoliosis

If you are affected by Scoliosis visit www.sauk.org.uk for further information.

If you have any questions about our scoliosis service, you can contact our Scoliosis Nurse Practitioner at: Ann.Marriott@nuh.nhs.uk

 

Osteoporosis Nurse Practitioner

The spinal unit has an Osteoporosis Nurse to enhance the care and service delivery of patients presenting with osteoporotic vertebral fractures. Osteoporosis is a major public health concern which affects a large number of people. Vertebral fractures can be painful and debilitating for many sufferers. The aim of our service is to optimise bone health, prevent patients from having the misfortune of further fractures and to manage existing ones appropriately. The Osteoporosis Nurse practitioner, working closely with the Spinal Consultants, will be developing holistic management plans to achieve the best possible outcome for our patients.

 

Roles and Responsibilities

• Identify patients presenting with vertebral fractures and assess their risk of osteoporosis
• Assess patients, identify possible causes for low bone mineral density and manage accordingly
• Health promotion
• Multidisciplinary team involvement
• Liaise with general practitioners to agree management plans
• Supply advice and support for patients
• Provide teaching and education for staff, students and patients
• Run nurse-led clinics
• Participate in outpatient consultations
• Be an advocate for patients

If you are affected by Osteoporosis visit www.nos.org.uk for further information.

If you have any questions about our osteoporosis service, you can contact our Osteoporosis Nurse Practitioner at: Nicola.Marsh@nuh.nhs.uk