Rehabilitation after ICU: breaching the 4 walls

Kate Tantam

Specialist Intensive Care Sister, UK

Kate is a Specialist Sister in ICU in Plymouth.  Her role is to support patients, loved ones and staff pre and post ICU discharge.  She is a nurse researcher in rehabilitation after critical illness and the founder of the #Rehablegend campaign. The campaign shares patient stories to share best practice, improve patient experience, support quality improvement and clinical research and raise awareness of the importance of rehabilitation for all.  Her work was recognised with a Parliamentary Award for care and compassion in 2019, National Patient Experience Award in 2019.  Her work during 2020/2021 supporting patients with COVID saw her awarded with a British Empire Medal for services to improve patient experience.  She is the deputy chair of the National Rehabilitation Collaborative and is keen to develop national work to support recovery after ICU.

: @tantamkate

Aeron Ginnelly

Clinical Lead Speech and Language Therapist

Aeron is a clinical lead speech and language therapist (SLT) with 20 years’ experience of working in both neurosciences and critical care. She has a specialist interest in tracheostomy weaning, speaking valve use in line with ventilation and dysphagia. She has conducted research into swallow screening on patients with a tracheostomy and has been a contributing author to a chapter on communication in the ICU population. She is on the committee of the national SLT tracheostomy clinical excellence network and has contributed to the Royal College of Speech and Language Therapists critical care position paper and tracheostomy competency framework.

Joanna Medlicott

Clinical Lead Speech and Language Therapist

Clinical Lead SLT for Health Services for Elderly People & acute medicine, Royal Free Hospital since October 2023.

Previous to this, I was the Clinical Lead at Hillingdon Hospital since 2019, professionally and clinically leading the SLT team across the whole Trust, in addition to managing a district general hospital Intensive Care caseload. 

Graduated from Sheffield University in 2011 with First Class B (Med) Sci Honours in Speech Science. After graduating, worked at Frimley Park Hospital and Royal Surrey Hospital across medical wards as band 5 and 6. Spent five years working as a Highly Specialist SLT at Hillingdon Hospital managing a large acute medical caseload including critical care and patients with tracheostomy, and being Videofluoroscopy Lead for the team.   

Specialist interest in Frailty and Elderly medicine, as well as instrumental assessments of Videofluoroscopy and FEES.  

Sharon Barker

Lead Critical Care Occupational Therapist

I am the Lead Critical Care Occupational Therapist at James Cook University Hospital and one of the OT representatives on the ICS AHP Professional Advisory Group. 

I have worked in critical care since January 2020 where I have developed a passion for early physical and cognitive rehabilitation, non-pharmacological management of delirium and the humanisation of care. 

Prior to joining critical care, I worked in a senior role in Neurosciences from 2015, where I developed an interest in the assessment and care of patients with disorders of consciousness.

I have also completed several junior rotations with Newcastle upon Tyne Hospital trust and was part of a technology-based Stroke Rehabilitation Research Project with Newcastle University.

Zoe Van Willigen

Critical Care Physiotherapist

Zoe van Willigen is a Critical Care Physiotherapist with almost twenty years’ experience in the speciality. She has led the Early Mobilisation Project on intensive care (ICU) in Southampton since 2012, which is estimated to have saved her NHS trust over £2.5million. Zoe has conducted and published research into the family and patient experience of rehabilitation on ICU, leading to a number of pilot projects to address the provision of services throughout the ICU recovery pathway. Zoe is chair of the Thames Valley and Wessex Critical Care Network’s rehabilitation group and has also recently been employed by ICUSteps to lead national online rehabilitation classes for former ICU patients. Zoe holds one of only 10 physiotherapy professional advisory group seats for the Intensive Care Society and is also on the specialist advisory group for the current NCEPOD trial into rehabilitation after critical illness.

Nick Hart

Deputy Medical Director of the Heart, Lung and Critical Care Clinical Group at Guy’s and St Thomas’ Hospitals,

Professor Hart is currently Deputy Medical Director of the Heart, Lung and Critical Care Clinical Group at Guy’s and St Thomas’ Hospitals, including St Thomas’ Hospital, Guy’s Hospital, Royal Brompton Hospital and Harefield Hospital.

This follows his role, from 2020 to 2022 as Clinical Director of Sleep, Respiratory and Critical Care in which he directed the critical care response to the COVID-19 pandemic with over 1300 patients admitted from March 2nd 2020 with a survival of 76%.  Professor Hart was primary respiratory physician to the previous Prime Minister, Boris Johnson.  In October 2020, he was appointed as Joint Director of King’s Health Partners South East London (SEL) Long COVID Clinical-Academic Programme. 

From 2012 to 2020, he was Head of the Lane Fox Respiratory Service, which is an internationally recognised clinical-academic weaning, rehabilitation and home mechanical ventilation service, which currently houses the largest weaning and rehabilitation unit in the UK and supports 3000 patients with chronic respiratory failure. 

Professor Hart is currently on the trial steering committee of the UKRI funded PHOSP-COVID research collaborative and Chief Investigator for EPiC-HFT.  He is R&D Director of Delivery for one of the largest recruiting hospitals in the UK. 

From 2015 to 2022, he was Joint Editor-in-Chief of Thorax with the impact factor increasing to 10.8.  In 2021, he awarded Fellowship of the European Respiratory Society and in 2022 he was awarded the British Thoracic Society Meritorious Service Award. 

Professor Hart established the Lane Fox Clinical Respiratory Physiology Research Centre in 2007 with his own research group focused on enhancing outcome the outcome of patients with chronic respiratory disease, chronic respiratory failure and sleep disordered breathing. 

Imre Kouw

Assistant Professor in Clinical Nutrition and Metabolism at Wageningen University

Dr Imre Kouw an Assistant Professor in clinical nutrition and metabolism at Wageningen University and the Intensive Care Research Department at Hospital Gelderse Vallei, the Netherlands.

Imre obtained her PhD in 2018 at Maastricht University, the Netherlands on the topic of muscle metabolism in clinical populations where she conducted detailed mechanistic skeletal muscle amino acid metabolism studies in healthy volunteers and hospitalised patients (using stable isotope and imaging techniques). Immediately after completion of her PhD, she was awarded an ESPEN (European Society of Clinical Nutrition and Metabolism) Early Career Research Fellowship to investigate the effect of intermittent fasting on muscle protein metabolism at Australian Catholic University, Melbourne, Australia (2019-2020). Here, she implemented the use of deuterated water as a new technique to this application to capture the impact of fasting diets on muscle protein metabolism under free-living conditions.

In 2020, she received a Dutch Research Council (NWO) Rubicon Fellowship to further pursue her research ambitions and interest in conducting nutrition and gastrointestinal research in Intensive Care Unit (ICU) patients at the Royal Adelaide Hospital (RAH), Australia (2020-2022).

She led a large-scale, clinical intervention in 65 mechanically ventilated ICU patients, assessing the effect of feeding pattern on glucose control and gastrointestinal function (with research funding from the American Society of Parenteral and Enteral Nutrition (ASPEN) and Diabetes Australia) and provided integral expertise in the executing of a clinical trial applying stable isotope methodology in critically ill patients at the RAH (Chapple AJRCCM 2022).

In 2022, she joined the Intensive Care Research Department at Gelderse Vallei Hospital and Wageningen University & Research, the Netherlands, to further focus her research on reducing metabolic complications during critical illness and post-intensive care by optimizing nutritional strategies, thereby combining high-standard physiological research methodology with patient-centred outcomes to improve patient care at the bedside.

Imre is supported by a Dutch Research Council Veni Fellowship (2024-2028) and currently supervises 4 PhD students at Wageningen University and Gelderse Vallei Hospital. She is active in the clinical nutrition research community, contributing to key professional organisations (ESPEN, ASPEN, Dutch (NESPEN), and Australian (AuSPEN) Societies of Parenteral and Enteral Nutrition), including being a member of the ESPEN Early Career Faculty. She was awarded the Drummond Early Career Scientist Award from the British Nutrition Foundation in 2020 and Best PhD thesis in Clinical Nutrition and Metabolism in 2018.

Over the last years, Imre has published 42 peer-reviewed scientific articles (H-index: 20) in the field of nutrition and metabolism in clinical populations, reviews for several peer-review journals (including The Journal of Physiology, The Journal of Nutrition, American Journal of Physiology Endocrinology and Metabolism, Clinical Nutrition, Clinical Nutrition Experimental, Frontiers in Nutrition and Experimental Gerontology) and is associate-Editor for Frontiers in Nutrition, section Clinical and Clinical Nutrition ESPEN, and a reviewer for ESPEN (2021-2024) and AuSPEN (2019) Congress abstracts. 

James Bruce

Clinical Occupational Therapist

James is an Occupational Therapist employed by the ICU at the Bristol Royal Infirmary Hospital. He is an ICU clinical specialist and in a unique role promoting early rehabilitation, humanistic care and rehabilitation education to his ICU team. He has had the opportunity to engage patients in early rehabilitation, screening rehabilitation needs and delivering rehabilitation through the post ICU inpatient journey.

James is interested in upper limb dysfunction post critical illness,  long term functional outcomes, and learning from patients to improve acute care. 

He has had the privilege of co-authoring the Occupational Therapy chapter for GPICS V2 & V3; GPICS Rehabilitation chapter V3; a member of the steering group for the upcoming NCEPOD rehabilitation post critical illness study; he supported the development of the AHP critical care professional development framework; is a member of the ICS AHP professional advisory group and co-chairs the AHP Critical Care Network for the South West of England.

Ceri-Ann Lynch

Critical Care & Anaesthetics consultant

I’m a consultant in Anaesthetics and Intensive Care Medicine in Royal Glamorgan Hospital.

I am the health board critical care research lead and I’m passionate about improving the quality of life of survivors of critical illness, and their families.

Nia Humphry

Consultant Perioperative Geriatrician, UK

Dr Nia Humphry is a Consultant Perioperative Geriatrician, starting the POPS service in Cardiff and Vale University Health Board in 2020. She took on the position of Deputy Chair of the BGS POPS SIG in April 2023 and looks forward to contributing towards the development of POPS services nationally, as well as locally in South Wales.

Alongside clinical work, Nia is a Senior Clinical Lecturer at Cardiff University, delivering components of the MSc in Clinical Geriatrics and supervising students completing postgraduate studies. She has a research interest in the impacts of sarcopenia and nutritional status on older patients undergoing surgery and was awarded a BGS Specialist Registrar Start-Up Grant in 2016.

: @HumphryNia

Andrew Wheeler

GP

Dr Andrew Wheeler is a GP, community hospital doctor and the Clinical Director of Community Hospitals and Urgent Care for Gloucestershire Health and Care.

He is a trainer, an AP and PhD supervisor, and examines for the Diploma in Geriatric Medicine for the RCP/BGS. 

Ema Swingwood

Consultant Physiotherapist, UK

Ema is a Consultant Therapist (Physiotherapist by background) in Critical Care at University Hospitals Bristol and Weston NHS Foundation Trust. Her area of clinical expertise and interest is ventilation, weaning and complex airway clearance. 

Having completed the Advanced Cardiorespiratory Physiotherapy Msc programme at University College London (UCL) in 2012, Ema has continued her research focusing on the use of Mechanical Insufflation-Exsufflation (MI-E) and other cough augmentation strategies. Her current PhD work focuses on the use of MI-E in the intubated population which is funded through the NIHR Clinical Academic Research Fellowship pathway. 

Extra-curricular activities include contributions to the Undergraduate Physiotherapy programme at the University of the West of England, and post-graduate teachings at University College London and Brunel University. She sits on the Intensive Care Society Physiotherapy Professional Advisory Group and Education Committee, the Equity, Diversity and Belonging Committee of the CSP, and ICUsteps support group network. She has been part of the multi-professional authorship for BTS/ICS documents related to Respiratory Support Units and Weaning Centres. Most recently, she is part of the NHSElect working group for the development of a Critical Care Capability Framework.

: @emaroids1

Gareth Scholey

Critical Care Consultant

Dr Gareth Mark Scholey

MA BA BCh (Oxon) DICM(UK) FRCP FFICM

Gareth studied medicine at Oxford University graduating in 1998. He is dual accredited in Nephrology and Intensive Care Medicine. He has trained in hospitals in Oxford, London, Nottingham and Wales.

He was appointed as a Consultant in Intensive Care at the University Hospital of Wales in 2008 and held the position of Clinical Director between 2013-2017. 

Over the last few years, he has helped establish a more novel care model on intensive care for patients with prolonged critical care needs. This is a multi-disciplinary team cooperative approach to managing the rehabilitation needs of this complex cohort of patients.

Charlotte Buckley

Critical Care Physiotherapist

Charlotte has 10 yrs experience working in acute hospitals around the UK. She has been working in Critical Care since 2022 as part of a Cross-site Critical Care specialist rotation. She is normally based at Southmead Hospital in Bristol, part of the Severn Major Trauma Network.  Charlotte recently had the opportunity to rotate to the Bristol Royal Infirmary to broaden her experience working with a different critical care cohort including ECMO patients.

Charlotte has a special interest in early rehab, trache weaning and sharing great clinical practice. She is currently completing her accreditation for FUSIC lung USS.

She is working towards her masters in Advanced clinical practice, with a view to completing  service development projects,  improving the patient journey during and post critical care.

Jemma Smith

Occupational Therapist

Jemma is an Occupational Therapist working across the General and Cardiac Intensive Care Units at the Bristol Royal Infirmary. Jemma is particularly passionate improving the post-ICU experience for patients and their families, non-pharmalogical management of delirium, and the role of Occupational Therapy in palliative care.

Jemma is currently working toward her MSc in Advancing Practice, hoping to explore the impact of prolonged sedation and mechanical ventilation on sensory integrative and processing functions. She is also involved in a number of projects in the Trust, such as analysis of the impact of OT on patient outcomes at hospital discharge and gap in ward rehabilitation provision for post ICU patients.