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So Teo Intinusa The Physio Show, As this is before Copley. It's a pleasure to invite Rebecca to come to talk to you. Eyes a lead visit therapist. She's going to be talking to rehabilitation. Also the risperidone position on Also on Jim Whole Speak that paper, I noted. Get up the name. So I guess I'm coming to this talk with two hats on a little bit like Mel was earlier on. Has clinical your physio at me, See LH in the post covered service, but also has a region of special adviser, and it just turned on Long Coppola's well on. My experience is not particularly in pots. Talk to you about my experience. Is another covitz A. So you've seen this man many times before. It's something that's gonna stick in a little minds when we're back. Rocker is. But we opened up a scale good service in May 2020. So really no, the beginning. And we've seen a lot of patients through our clinic s. So I'm going to be bringing to this talk my experience of having seen people through that clinics and seen over 4000 patients through the door so far, I'm bringing my expertise in breathing training as well. I got some answers to the questions about resources that can add in that the end of well on ball. So my experience setting up on now coach airing a long hope it network help with therapy conditions, which is regional but gets national attendance as well. And we have about 500 people or distribution list. So you don't also bringing the experience that I have known from all of them as well. To this on blast years, My, with my sort of regional left, advise a hat on doing here unusual services on feeding into and toe work that's been coming out. So here is a disclaimer. Intense conflicts. Have them set into the commissioner guidance. It's gonna be coming out soon on the wh show. That guidance is also coming up within the next month, say, 15 minutes to talk about rehabilitation in non cave. It's just a home. It down to three G messages, which you have already heard at this afternoon. So the first is about assessment on that. You're good on that being extension to your rehab rehabilitation plan, it being personalized to the person that is in front of you and it being multifaceted, and we're just gonna talk a little bit about each of those things. So again, I don't know whether to be shared this night this morning because I'm completely still, then it from him. But when we started our assessment clinic, we really thought that we see lots of people. We do lots of tests and they fit nice and neatly into boxes, and they would send them to different services, depending on what they need it. The reality of that was for for different. So assessment is really important because, as well as ruling out your red flags on the world physiotherapy briefing paper that came out identifies kind of four kg red flags for you to be looking for for rehabilitation. So cardiac impairments, exertionally saturation, coast exertion or symptom exacerbation. And this sort of pneumonia has four things that we want to really look for in your assessments. I'm you also want to understand the patient in front of you. What is there that most important problem? We'll talk about personalized care in a minute. But then, once you have done your assessment and you can understand those problems, then you can choose what your rehabilitation approach is gonna be on. I'm just going to quit. He mentioned post exertion of sense to me exacerbation because it was a term that was fairly new to me when I came to work in people with post dated syndrome or not coated. And it's really important for how we frame out rehabilitation. So this is a symptom or cluster of symptoms that will develop after exertion on that's know exertion. As you might have thought. You know your pre cope itself. That's not like going for a run for somebody Post dated that could actually be having a shower making a meal, and it can cause a flare of symptoms on. But that could be anything from feeling fatigue or headache or palpitations on it. So understanding about speech of your patient is really important in terms of your rehabilitation approach. On, there are different types of exertion as well. It's not just physical effort that could cause that, but it's also cognitive efforts having to concentrate for another period of time, or it can also be emotional efforts. If you're a very stressful situation, that's also gonna during your body battery could be leading to a post exertional symptoms activation. So assessment for your rehabilitation is key and then that brings don't personalization. So personalized care is really important. There are patterns and how people present on there are different genotypes. We thank you so that lovely side from el before with circles on s So you know, there are different genotypes. However, there's so much to get through when you're assessing the patient will be January Habilitating that the most important thing you can ask them is about what matters to them on what's important to them. What is the thing that that is most problematic for you that we can help with on That's the starting point and so I wouldn't need to think about the whole person on. We need to entertain that we have offer to fit them rather than trying to get them to the rehab because that we have you want to be thinking about him a stick. We have so helping a lot of Mainz so physical, financial, social, environmental, spirituals, psychological health, on using goals as well. To help from your cough way on your rehab for the needs to be multi faceted. So initially when we were seeing people with lots of different symptoms, we pretended to different experts in two different services to get the input that they need on as you heard earlier. Partially for Mel, what you end up with is a patient is getting conflict going. Information on it's not coordinated At the same time, we know your work for short two years and it got massive waiting lists on. So one of our roles as we have imitation connections is to be up Skilling to be able to provide kind of versatile interventions for our patients. So in an ideal world would be offering a multifaceted. We have approach for your patients, so picking the things that they need on delivering those together. And it may be that once you delivered kind of you tier one basic treatment, then you need to seek help from an expert. But that's where your duties and really valuable you don't need to add in to somebody else's waiting. This necessarily. You can coordinate that care and it's sometimes people will need to go and see a separate specialist for for something. But we should be trying asthma as possible to be providing kind of a one stop, multifaceted approach. So exercise or not to exercise with non covitz Really controversial question on. So for me, this really depends on whether they have exercise and tolerance on. But what you're trying to achieve by doing the exercise, because exercise is a really broad term, encompasses a whole lot of things on what we hear from patients is if they have exercise intolerance. They have this place, international sense of investigation. Cardiovascular exercise causes a massive crash of blurred symptoms, and they struggle on. The thing That's really tricky for us at the moment is that we don't have enough research kind of explain these mechanisms and tell us what's helpful. There's some really helpful work that's come out come out of Leicester. That's well, it's at the positive impact of exercise post coated on. We also see because that talked about exercise and tolerance on deconditioning know, explaining that well. So I think the question is firstly, what's important to the patient is exercise something that they care about doing on. But the next thing is about the stability of the symptoms. So if I have somebody in front of me. He's got very unstable since, and lots of boom and bust exercise that is not the right thing for them at that moment. If you've got somebody who has achieved a bit more stability has broken that being a bus cycle, you can begin to think about adding some exercise into the rehabilitation. But it needs to be titrated, so it needs to be targeted in the right way since, um was monitored and also choosing that something that they can tolerate so often. People will talk about things that supine exercise or swimming if they can tolerate to begin with so on blast. It needs to be supported. Okay? Telling people to just exercise their way out of their exercise. Intolerance is not going to end well. So again, you've seen some of you seen some of this data. Then Carmelo slides earlier. But just to share some my expertise is really personally training on. We are running a routine pattern. Retraining virtual group for postcode patients on on just to share. Actually, graph the top was a virtual breathing training 1 to 1, so we were able to demonstrate improvement in the distant 12 reckless the score on down there being packed so right in the middle of that first way when we weren't seeing that many people face face. That was quite reassuring for us conditions that what we're doing is actually making you feel better. But we have now also rolled out was agree on That's a six week program. Has breathing happen? We training some fatigue, Management's and psychological health advice on Dmard, just importantly, has the peer support. So it's 8 to 10 people on a group. They do six sessions in 12 weeks on, but again able to demonstrate improvement in their big pats in their dyspnea 12 on never TV assessment scale. On in a place where with long coat it, it's really quite hard to prove outcomes and toe kind of show. What's working? What's what isn't It is actually really reassuring to show that what we've been doing with our patients is helping them on just on this, so in terms of kind of resources. So we're just about to know which they might have said they might already be on YouTube or about to do in order fancy breathing pattern training videos you choose, and you can find Pace your patients to those on on. Uh, you know, I think as you know, Child said, if you've got some, he's really dysfunction breathing, you know, self directed, um, approach, like my full short. But it's definitely a good place to start getting going with some initial breathing at work so and invitations two conditions in the room. So our London allied health therapy is non coated network and meats for 90 or Tuesday morning on. We set this up last year when we have lots of conditions working and services, really loads of clinical uncertainty. We don't really know what works we need some here supports on on our aims. Here in this group are sharing. Imagine clinical experience and innovation, insuring we're up to date on policy on system updates on be able to contribute to the evidence based on the guidance. So if you would like to join us, you distribution extent, please do that. The other thing that this space has been really lovely. Four has been hearing from people about on the ground what the problems are, what we need to try and support. But we've also been able to hold together a consensus document again, we're hoping to release in the next few weeks on that going principles of rehabilitation. So it's not just about the what's, but it's the how so the key things that this document is going to talk about S O. But as you can see upon the slicer kind of engaging with people, how we treat eczema set properly, how we treat and manage what we need to do is to support our staff in terms of their competence is care coordination, which has been kind of a recurring thing that you've heard the software is being really important on. Then how we support discharge from services because again, that's a really tricky area in a condition that might turn out to be a long term condition. That's certainly not fluctuating, fluctuating nature. So just a couple of minutes on the case study whistlestop of rehab. So I'm just bringing it back to the case. Is that new that we that you kind of had running throughout the day? So for this individual key looking assessment will be to be ruling out those red flags that we've talked about. I don't want to take your aspirin control because we're definitely seeing some people have had coded Who's asking control flares. So being able to do 15 and 10 is really helpful. Tells you what they're controlled is like I would absolutely be looking at their breathing pattern on. For those people who are not kind of experts and assessing breathing pattern, the be packed would be a nice screening tool on. I'm glad you disclose the conflict of interest there as well, because I'm biased, the value being helpful on do. Also, psychological risk is something we really had to think about in this great. You know, these people who's kind of function on things have been able to do, like have basically been taken away at night on. For a lot of people, that's traumatic. So assessing for psychological risk, just a check that people are not kind of nearing that breaking point, it's really important. And so for this Navy, what matters to her? You know, in the case that you could see her role as a child I had was a mother, her rollers, a nurse. You know she's got a child's needs to judge them a swell on you, it could be have financial security, and it could also be being believed. It's really hard when people can't see anything wrong with you for them to understand that we're struggling and then in terms of her rehab offer. So again, it being not so fast. It'd so in NCL, which started to use personal health budgets to support people s o for this lady, you know, that's something that will be worth exploring. Is there a personal health budget that confronts and childcare commune that she can activity, marriage and pace properly and then turn around after child, which could then have a positive impact on her on her rehab? Thinking of activity management? So whether that's using diaries, whether that's working, it's pacing, teaching her how to identify triggers. It's not to push herself psychological support. Clearly, there's a lot of trouble going on here is well, and how can we support has psychological health alongside, have physical health thinking about vocational rehab, can be engaged with her employer and make that return to work when it's the right time happened successfully rather than failing, as we often see on, we'd offer her some breathing pattern retraining if her breathing pattern was disordered on trying to get some peer support because a lot of people don't know anybody else with the coated on Go, Can we? Can we get some of that? That was Mr Stop. Every medication coming that you call us within it. Say, how did they have a They don't know what? Yeah, what we've seen and actually, we need to be able to report it. Got that? What is the chance of another one? Is that the Web site that was being talked about before that Bleeding disorders interesting. So I don't know, but I can find out. Uh, yeah, I think that a *** No, child, you have any thoughts? But I feel like if I was teaching the basics of breathing pattern training would probably starting in a Some of the place in terms of exercise is on. So maybe that's a good starting point. I don't know about specifically written literature. And so for Children. Yeah, Charlotte. Well, it might be developing something. There was a last question asking about the criteria for the red flags. So just to say, I have a little world physical briefing paper. Lovely. Thank you very much. Fantastic.