Service detail

We are an integrated stroke early supported discharge (ESD) and community neuro rehabilitation team (CNRS).

We also have MS nurses that sit within the team for Huntingdonshire. 

We provide county wide specialist neurological rehabilitation services which are available to all patients/clients who are aged 18 years old and over who have a complex neurological condition. This may include people with neurological conditions that have a sudden onset such as stroke or acquired brain injury, as well as those that have chronic, long-term and progressive conditions such as multiple sclerosis or motor neurons disease. ESD only sees mild to moderate stroke survivors for intense rehabilitation at home or in a community ward for up to 6 weeks after they have left hospital.

We work as a multidisciplinary service with physiotherapists, occupational therapists, rehabilitation assistants. Some conditions also have to psychology support, speech and language therapy and specialist nursing, where these are not present for the condition the team works very closely with the wider MDT.

The aims of the integrated team include the following:

• Promoting independence and self management, enabling patients to live at home through the provision of a range of support and therapeutic services.
• Improving outcomes and experience for patients.
• Improving quality of life including support for returning to work.
• Creating access to better, more integrated care outside of hospital.
• Developing ways of coping with problems arising from their condition.
• Enabling patients to understand their condition.
• Enabling patients to be discharged from hospital or avoid a hospital admission through the provision of support in the home setting.
• Providing specialist education and training to generalist therapy staff on neuro-rehabilitation.