Advancing Neuro Rehab: Dr Revin Thomas

November 21, 2023

Dr Revin Thomas is a consultant stroke and neurorehabilitation physician at County Durham and Darlington NHS Foundation Trust

Q1. What does your day-to-day work involve?

I work across trusts/hospitals in the Northeast of England, covering neurorehabilitation clinics at Walkergate Park in Newcastle, acute stroke work at University Hospital North Durham, and stroke rehabilitation ward rounds at Bishop Auckland Hospital. Because of this, my day-to-day work is incredibly varied. One day I might be running the hyper-acute stroke unit and dealing with the adrenaline rush of stroke thrombolysis calls, another day might be spent doing routine botulinum toxin clinics for patients with neurological conditions.

I lead the stroke rehabilitation unit, with weekly ward rounds and multidisciplinary meetings. The team comprises of therapists, assistants, and nurses with varying skills, focused on enhancing patient care and helping recovery post-stroke. I am also an assistant-associate medical director at Walkergate Park, managing neurological and specialist services.

Q2. Can you tell us about your research.

I believe research is an integral part of clinical work, and often drives innovation and change. At County Durham and Darlington NHS Foundation Trust, I’ve been appointed as the stroke research lead, helping identify studies the team can participate in, encouraging recruitment within ongoing studies, and managing workforce engagement. I also hold Principal Investigator (PI) status for national stroke studies. I particularly like to encourage junior doctors and allied health professionals to engage with research. This may be through supporting publication of journal articles, right the way through to appointing ‘associate-PI’ roles.

At Walkergate Park, I’m presently the project lead for a service evaluation on the use of incobotulinum toxin A for clozapine induced hyper-salivation (ItCH). This took approximately 1.5 years, from an idea on paper to recruitment!  Though the journey has only begun, I’ve been able to learn a lot through the process and hopefully the project will benefit my patients.

Q3. How does your approach to stroke management differ from your approach to neurorehabilitation?

My approach to both isn’t hugely different, apart from the clinical intensity of hyper-acute stroke versus rehabilitation. Essentially both specialties have patients (and their families) affected by a devastating neurological condition at its core, with a strong multidisciplinary ethos.

Hyper-acute stroke care requires a strong acute medical background with the mental stamina to manage a high-intensity high-risk environment. Stroke rehabilitation and neurorehabilitation requires a balanced and patient approach where the objective is to work with the team to help the patient through their journey towards recovery.

An evolved understanding of the neuroplasticity model has led to a focus on more intense community therapy.

Q4. What are the major advances in acute stroke treatment and neurorehabilitation in the past five years?

Within acute stroke care, there have been major advances in our understanding of the hyper-acute phase and the damage a stroke causes. This has meant, especially in acute ischaemic stroke patients, there is a greater push towards reperfusion therapy with intravenous thrombolysis or mechanical endovascular therapy using advanced imaging over traditional time-bound treatment.

Within neurorehabilitation and stroke rehabilitation, there is an evolved understanding of the neuroplasticity model of recovery, especially early-versus-late recovery. This has led to a focus on early therapy with plans for more intense community therapy to facilitate care closer to home. This can be with adjuvant therapy support like virtual therapy using telemedicine, or robotic therapy.

Q5. How can Rewire improve rehabilitation?

Rewire offers an exciting and promising prospect to increase the intensity of therapy provision to stroke patients. It allows customisation of therapy plans for individual patients based on their needs and requirements, with self-driven and monitored goals. Its simplicity and ease of use is its greatest appeal.

The hope is that this may serve as an adjuvant to existing therapy offerings, especially for patients who are able to engage or those for whom geographically it may not be easy to facilitate frequent community sessions with a therapist.