Lane Fox Respiratory Unit: our specialities

25 years of delivering chronic respiratory care

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.

  • Lane Fox services for patients with polio and post-polio syndrome

    Dr Simon Shaw, consultant in rehabilitation medicine leads the polio and post-polio syndrome (PPS) clinic and service working closely with the Lane Fox multidisciplinary team. The clinics provide a holistic approach with the aim of improving a patients’ quality of life and help patients to manage their PPS symptoms. The clinics facilitate the diagnosis, assessment and management of post-polio syndrome with the aim of addressing orthotic prescription, musculoskeletal pain management and offering falls prevention, exercise advice and fatigue management.

    There are:

    • Medical clinics (Dr Simon Shaw, Consultant in Rehabilitation Medicine)
    • Physiotherapy and occupational therapy clinics (Alexandra Curtis, clinical lead physiotherapist, and Jeong Su Lee, senior specialist occupational therapist)
    • Orthotic clinics (Chris Cody, clinical lead for orthotics and Lyndsay McNicol, senior orthotist)

    Post-polio syndrome self-management course

    This programme is multi-disciplinary and is led by Alexandra Curtis, clinical lead physiotherapist, and Jeong Su Lee, senior specialist occupational therapist and includes input from a psychologist, a psychiatrist, consultants from the Lane Fox respiratory service, a dietician, a representative from the British Polio Fellowship and a chairman of PPS expert panel. 

    The programme aims to promote self-management of the symptoms associated with PPS such as muscle fatigue, new muscle weakness and muscle pain leading to loss of endurance and function and helping to improve quality of life. After an initial assessment by medical and therapy staff, patients attend the course for three days each week for three consecutive weeks and accommodation is provided at the Simon Patient Hotel at St Thomas' Hospital. It is not possible to cure or resolve these symptoms completely, but we would hope some of the skills and information included in the course might help to improving lifestyle balance and reduce peaks and troughs of activity common to those with PPS, reducing fatigue and promoting function. The course helps participants understand their symptoms and reduce the impact on day to day life as well as improve coping strategies.

    Specialist orthotic service

    Orthotic prescriptions can play a really important role in the clinical care of patients with polio and PPS and can be employed to reduce pain, aid mobility, improve energy efficiency, stabilise and protect joints and help maintain levels of independence.

    The service is promoted by the close collaboration between Dr Shaw and the orthotic department led by clinical specialist orthotist Chris Cody.

    An orthotist is a qualified, state registered healthcare professional with extensive knowledge of anatomy, physiology, material and engineering science and biomechanics of the body. They are responsible for the prescription, manufacture and management of orthotic prescriptions.

    Within the service we can provide complex and clinically-reasoned bespoke orthotic solutions but for more standard prescriptions and where clinically appropriate patients can also be managed locally.

  • 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:

    1. * Chest infection requiring hospital admission
    2. * Chest infections treated at home with antibiotic therapy

    Please optimise saliva management

    Referral Process

    1. 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.
    2. 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.