Queen Square Upper Limb Neurorehabilitation Programme

The Programme

The programme offers high dose, high intensity physiotherapy and occupational therapy focussed for those with upper limb dysfunction as a consequence of central nervous system disease, particularly stroke. In addition, participants have the opportunity to take part in cutting edge clinical research that will improve our understanding of upper limb recovery and help to further improve the treatment we provide.

In 2019, we published the results of the first 224 people with stroke to go through the programme. The scores on 3 different outcome measures are shown for all participants at admission and discharge as well as 6 weeks and 6 months after discharge. The group median scores are shown at each time point, illustrating both change over the 3 week programme but also continued improvement over 6 months of follow up.

Published work from the programme:

1. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme - download the full paper for free here
2. Pushing the limits of recovery in chronic stroke survivors: User perceptions of the Queen Square Upper Limb Neurorehabilitation Programme - download the full paper for free here
3. Relationship between intensity and recovery in post-stroke rehabilitation: a retrospective analysis - download the full paper for free here
4. Differences in outcomes following an intensive upper-limb rehabilitation program for patients with common central nervous system-acting drug prescriptions - download the full paper for free here

Who to refer:

• Current waiting time for clinic appointtment: 5-6 months
• Current waiting time to start programme: 4-5 months

Please help our waiting time by considering who could be managed locally and who might need specialist input

• The focus of the intensive 3 week upper limb programme is achieving individualised goals relating to functional tasks.
• The intense goal-directed nature of the programme is best suited for people with some forward reach and at least the beginnings of thumb and/or finger extension.
• The key is the ability to participate in goal-directed training and so those with stiff and painful shoulders and/or problematic spasticity in wrist and fingers will need these problems managing locally before considering admission to the programme.
• Please consider whether people will tolerate a 3 week intensive programme, considering conditioning, fatigue, cognition.
• It is a day-attender programme and so most people are relatively independent.

How to refer:

• GPs should refer via the NHS electronic referral system using the following information
  • Hospital: UCLH
  • Speciality - Rehabilitation
  • Service - Multidisciplinary Neurorehabilitation for the Upper Limb Clinic - NHNN - Queen Square- RRV
  • Clinic Type - Neuro-rehabilitation
• Consultant to consultant referrals should be sent to: Professor Nick Ward, Professor of Clinical Neurology and Neurorehabilitation, The National Hospital for Neurology and Neurosurgery, Box 146, Queen Square, London WC1N 3BG, or by email to nick.ward4@nhs.net
• For administrative matters relating to the Queen Square Upper Limb Rehabilitation Programme please email uclh.referrals.upper.limbadmin@nhs.net
• For queries about the waiting list, please contact uclh.referrals.nhnnchooseandbook@nhs.net

Referral

• The referral should include at least the following information to allow triage:
  • type of stroke or other injury
  • extent of previous rehabilitation 
  • level of independence and self care
  • ability to use affected hand in daily activities
  • extent of finger movement (especially extension)
  • is the immediate problem spasticity/joint range management? Please think about managing locally before referring to us
  • is the immediate problem painful restriction of shoulder range? Please think about managing locally before referring to us
• Referrals with insufficient clinical information will be returned

Our Research

The Programme offers a unique opportunity to investigate how we can further our understanding of recovery of the upper limb after focal brain injury through a range of studies using brain imaging, neurophysiology or behavioural (kinematic) measurements

Media

• Queen Square to run first trial of MindPod Dolphin in chronic stroke patients in the world Read here

• Nick speaking on the Know Stroke podcast on You Tube 

• BBC2 Horizon - My Amazing Brain - Richard's War - the story of Richard Gray and his remarkable recovery from a catastrophic stroke Watch here

• BBC Radio 4 - The Life in My Head: From Stroke to Brain Attack - Robert McCrum, who survived a severe stroke in 1995, goes on a journey into his own brain to understand more about what happened to him Listen here.

• The i newspaper reports on the Queen Square Upper Limb Neurorehabiliation programme Read here

The Annual Queen Square Upper Limb Neurorehabilitation course

Every year we run a two-day teaching course providing an up-to-date overview of current research in treatment and rehabilitation options for the neurological patient with upper limb deficit. The course looks at the practical, real-life translation of scientific evidence into clinical practice and discusses the ingredients that make an upper limb therapy effective. The 11th Annual Course will run on 27-28th June 2024. More details on speakers and registration soon!