Sub-specialties
Specialist therapies
Physiotherapy
As well as conventional techniques we do negative pressure ventilation, oscillation therapy and cough assist technique. We also provide post critical illness rehabilitation and a specific programme for the post polio syndrome.
Occupational therapy
Our senior occupational therapist works with us to aid rehabilitation.
Post polio syndrome rehabilitation programme
The Lane Fox Unit runs a post polio syndrome rehabilitation course, unique within the UK.
The course is multi-professional and is run two to three times a year.
After an initial assessment by medical and therapy staff, patients attend the unit for three days each week for three consecutive weeks.
Accommodation is provided at the the Simon Patient Hotel at St Thomas'.
The programme aims to:
- advise on the management of post-polio syndrome, helping to improve quality of life
- help participants understand their symptoms and reduce the impact on day to day life
- improve coping strategies.
There is a strong educational focus in the delivery of the programme. Semi formal presentations to the group supplement individual assessments. Non-fatiguing exercise programmes are established for each participant.
Motor neurone disease (MND) Pathway for Respiratory Assessment
Referral criteria for motor neurone disease patients with a confirmed diagnosis (or strong suspicion) by neurology specialist. Find out how to make a motor neurone disease referral (Word 49Kb).
Symptoms
Breathlessness
Poor swallow
Orthopnoea
Recurrent chest infections
Disturbed sleep
Significant daytime fatigue
Morning headaches
Signs
Elevated respiratory rate
Weak cough
Abdominal inspiratory paradox
Use of accessory muscles of respiration
Reduced chest expansion
Dribbling
Low volume Voice
Criteria for urgent referral for NIV assessment (any of the below)
FVC <50% or <80% with symptoms/signs of respiratory impairment
PaCO2 or TcCO2 >6kPa
Orthopnoea
SNIP or MIP <40cmH2O
SNIP or MIP <65 cmH2O (men), <55 cmH2O (female) with symptoms/signs of chronic respiratory failure
Criteria for referral for cough assist device assessment
Peak cough flow <240L/min with:
- * Chest infection requiring hospital admission
- * Chest infections treated at home with antibiotic therapy
Please optimise saliva management
Referral Process
- Urgent referrals will be vetted by the LFU consultant team and triaged to an urgent assessment with Emily Ballard (specialist physiotherapist) for outpatient NIV set up in 2 weeks and review by a consultant in clinic in 6-8 weeks. These should be marked as URGENT and reason for URGENT referral.
- Routine referrals will be vetted by the LFU consultant team and triaged to Thursday am clinic review Dr Ramsay in 6-8 weeks.
All set ups will be outpatient based unless there are difficulties in managing NIV when an inpatient review will be arranged.
Following set up of NIV a further routine review in outpatients with the consultant will be arranged for every 6 months with 3 month follow up with Emily Ballard.
Patients not yet started NIV and with risk factors for respiratory decline e.g. falling FVC, SpO2 < 96% will be seen every 3 months.
We do offer a PEG insertion service for patients with respiratory symptoms and/or requiring NIV. If assessment is required this needs to be highlighted in the referral letter and details regarding discussion with the patient.
Please state if any discussions regarding escalation plans, advanced planning or advanced decision to refuse treatment (ADRT) have been made with the patient prior to review.
If the patient is known to palliative care services please state who has been involved in their care. If not, please refer to your local palliative care service alongside this referral.
Outreach reviews and set up of NIV for MND patients will only be requested by the LFU team and decision made on an individual basis.
Please ensure that discussions regarding NIV are had with all patients prior to referral and agreement to treatment in principal is accepted by the patient and their family.