Saddling up for a once-in-a-lifetime career ride with neuro occupational therapy.
It was the first time in the history of ever that I’ve cried at work. It was amazing to watch her, not needing any help. 
Krysalis Neuro OT, Roberta Leyshon
By her own admission, Krysalis neuro occupational therapist Roberta Leyshon normally takes a no-nonsense approach in her role.
So, there was no one more surprised than her when she teared up at the sight of her 23-year-old client, Rebecca, literally getting back on the horse after months of no horse riding due to covid lockdowns.
Brain injury survivor Rebecca battles with physical disabilities affecting her balance, communication, executive and decision-making skills due to birth-related brain trauma and resulting meningitis and hydrocephalus.
She’s also had to cope with the deaths of both of her parents.
Rebecca and Roberta have been working on aspects that impact Rebecca’s participation in and performance of daily living activities since she was referred to Krysalis in July 2017.
However, the last time Roberta supported her with horse-riding at The Fortune Centre for Riding Therapy in the New Forest, Rebecca struggled with her physical strength and balance.
And she had needed the help of eight hands to support her in mounting her 15-plus hands' high horse.
So, as Roberta watched Rebecca confidently mount, entirely unaided, on her return to the sport, it was a particularly poignant moment in her 11 years as an occupational therapist (OT)
“I cried,” she states frankly. “It was the first time in the history of ever that I’ve cried at work. It was amazing to watch her, not needing any help.
“I think it was when she was walking around on the horse and then trotting around without any help, without needing me.
“And she got on without needing any help, whereas, before lockdown, it would take four of us.”
A startling transformation, indeed, after months when almost all therapy support services were being provided virtually, and activity centres were closed due to the pandemic.
So how did Rebecca do it?
Amazing pace
“She’s done all the physical therapy that she needs to do,” Roberta explains. “I set her up with a personal trainer, so she’s been doing that, one to one, twice a week during the lockdown.
“She also took up other online fitness classes to ensure her physical training continued throughout the week.”
But as any Krysalis neuro OT will tell you, there’s always a bigger picture to take in when supporting an individual to realise their full potential.
“Since lockdown, we’ve done a lot of work with Rebecca’s confidence,” Roberta said.
“She’s had psychology, and I did quite a lot of work with her around modelling what it’s going to be like for her in the community to help reduce her anxiety.
We asked her after her horse-riding how she felt about it and whether she’d expected to be that good, and she said she felt amazed.
Happily, Roberta added, “She’d been worrying that she wouldn’t remember anything, but she did!”
And Rebecca was especially motivated last November by another neuro occupational therapy goal to prove more productive than anyone imagined.
The Race at Your Pace Challenge [1] inspires people to stay active by running, walking, cycling or swimming, and rewards them with bespoke medals.
“So, Rebecca walked 85 miles in April,” Roberta reveals. “It started as a joke in that she wanted the medals, but now she’s become very focused on it.
“She’s also used her walking goal to achieve another goal of walking her dog, Teddy, regularly!”
And bike riding has also made it on to the goals agenda despite a wobbly start.
“We looked at bike riding before the 2nd lockdown, and Rebecca didn’t think she’d be able to do it,” Roberta said.
“So, we incorporated it into her personal training sessions so we could carry out a bicycle assessment, and now she’s going to take up biking.
“I did some research, and there is a charity in the New Forest where she can try different adaptive bikes with other adults and then decide if she really wants to carry on doing it.”
All part of the job for a neuro OT whose work can be as fluid as their client’s changing needs, some of which swirl around life’s biggest decisions. Like moving house.
Moving up
As if all of her lockdown level-ups weren’t enough, Rebecca also took the time to source, secure and relocate to her very own first home, with support from Roberta and other members of her multi-disciplinary team (MDT).
“This is something Rebecca had never done before or had to worry about, and she really demonstrated she could make big decisions,” Roberta said.
“She’s had to think about what things costs and do a lot of research surrounding that. It’s been really good. She’s learned a lot from it.”
But what are Rebecca’s thoughts about her progress?
It's hard for anyone to realize their own achievements…but there are some bits that I look back on and, yeah, I think, that is pretty big...
Krysalis client, Rebecca.
Life during lockdown has been “up and down” physically and emotionally, Rebecca concedes during a video meeting.
“There have obviously been good days when I’ve been keeping myself busy, but other days have been really difficult and really out of sync,” she added.
“I'm just trying to get there slowly.”
As well as horse-riding, Rebecca’s other interests - amateur dramatics and helping her miniature Shih Tzu, Teddy with school visits in his role as a Pets as Therapy dog [2] - were all shelved due to the pandemic.
“It all, more or less, had to stop, unfortunately,” Rebecca said. “Teddy does miss the children. He’s not used to having to stop seeing them.
“Whenever I was walking him out in the park, he'd just been wandering up to a kid because he just loves kids. He’s really good with them, and he really misses them.”
And Rebecca really missed horse-riding. “It’s a shame,” she said. “It was helping with my balance and my core muscles, and really helping with my posture.
“So, Roberta introduced me to a personal trainer, and he’s been really good.
“I’ve been doing my personal sessions for nearly a year now, and it's really helped me build up strength in my muscles.
“It’s also given me more confidence when I’m doing exercise now, even like walking Teddy.
“Before, I was wearing a knee support and an ankle support because my muscles were very weak and, now and again, I'd fall over.
“But, so far, I haven't fallen over.
I haven't really been wearing my knee or ankle supports because of the exercises. They’ve really improved my walking, which is good. And it is good that’s Ted's puffed out!
Rebecca’s Race at Your Pace passion is also prevailing, with her total number of medals earned now standing at five.
“The medals that you get are really nice,” she said.
“It makes you feel really motivated to get them. It also makes you feel proud that you’ve done the miles.”
“When I first did it, I got ahead of myself. I had seven days left, and people were asking me, how can you be finished already? You've got seven days left. It was crazy.
“But I really wanted that medal!” she added, laughing. “It’s so nice. It’s so shiny! I think I’m going to be addicted to wanting medals now.”
It’s as well, then, that Rebecca has her new home to house them all in. “This was my first time actually deciding where I’ m going to live and what house I want, so it's a really big thing,” she said.
I was just really excited that I could choose the place that I really wanted and actually say it's mine because I chose it.
She added,“I chose the area, I did the research for it, and yeah, I just feel really proud of myself to be able to have that.”
Aware that her late parents did a lot of DIY themselves, Rebecca has also played a big part in decorating her home her way and choosing the few adaptations that she needs, such as an exterior grab rail.
“I like to try and do things myself so that I can save a little bit of money. And, again, it’s new skills to have,” she said.
“I've been doing a bit of DIY like decorating and a lot of painting. We’ve been cracking on, and it’s been really good.
“My new place has got more or less everything I need: good bus services; a train station; and a local shop as well.
“It was basically what I was asking for, to be in an area like that, so I’m really pleased.”
Rebecca is also delighted by how she’s progressed with support from Roberta and all the other MDT members.
“It's amazing and surprising how much I've done. I don't realize it, but other people do,” she said.
“It's hard for anyone to realize their own achievements and what they've accomplished and what they've done.
“But there are some bits that I look back on and, yeah, I think, that is pretty big, and it does make me feel good about myself.”
Rebecca even had a message of support for others trying to cope with impairments that affect their daily lives.
“I feel like I want to be able to share my experience with other people who are going through a similar situation,” she said.
“I just want people to know that there is help and support and make them realise it’s not just them.”
When Rebecca began working with Krysalis in 2017, she revealed her prognosis as a baby was that she would never walk or talk.
Not long after, she landed the starring role of Dorothy in the Wizard of Oz while tentatively trying to find her confidence through amateur dramatics. [3]
Perhaps then, like Dorothy, with her pooch and wise guides by her side, all she needed, in the end, was a generous dash of non-nonsense magic to help her find her way home…
Working as a Krysalis neuro OT…
Roberta qualified from Oxford Brookes University in 2009 and went on to work in several brain injury and mental health settings before joining the Krysalis team.
Here are her thoughts on working in neuro occupational therapy as a private practitioner with us.
“I like the reward of it, the challenge of it and the problem solving,” she said. “You can't get that anywhere else.”
“Because of covid, I think the challenges in neuro occupational therapy have become harder and, therefore, the impact of what we do can appear smaller.
“But just look at Rebecca throughout lockdown. Making changes got harder, but, actually, when we did make those changes, the reward was greater.
“I think you have to develop a better understanding and a close therapeutic relationship with clients to achieve that; otherwise, it just doesn't work.”
Roberta's close relationship with the Krysalis head office team is also an aspect of her job that she values.
For me, it’s hugely important that I’ve got the support of the admin team, particularly when issues become tricky. Just being able to phone up the office and talk things over is really nice.
She added, “I never feel like I’m on my own, and if there’s something I need to ask, I can put it out on the Krysalis OT forum if I really need to and get the support that way.”
And she reassured anyone considering coming on board with Krysalis, “Don’t feel scared!”
She added, “My confidence is a lot bigger than before I started working here and specializing in neuro OT has helped that massively.
“I would say, however, that brain injury is not just brain injury; it is everything else as well. You need to know a lot, but you learn a lot too.
“You need to be open to thinking outside the box.”
Further reading
Passion and potential: from the NHS to independent practice (krysalisconsultancy.co.uk)
Me, Myself, The OT (krysalisconsultancy.co.uk)
Equine therapy Q and A (krysalisconsultancy.co.uk)
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References
1. Race At Your Pace | Running, Walking, Cycling & Swimming Virtual Challenges