Kim Ryder is an experienced physiotherapist, with almost 25 years’ practice and 20 years as an amputee specialist.
Tell us a bit about your background and your work as a clinical lead in amputee rehabilitation.
I started my career in one of the biggest NHS prosthetic clinics in the UK, located within the West Midlands Rehabilitation Centre in Birmingham. My role as a clinical lead physiotherapist at Shrewsbury and Telford Hospitals involved assessing new amputees entering the service, from initial triage to working alongside consultants in the clinic and as part of the wider multidisciplinary team. I also managed a small team, including a band 6 physiotherapist and an apprentice physiotherapist, but my true passion lies in patient care.
I strongly believe in collaborative working, especially in the complex field of amputee rehabilitation. It’s essential to consider all aspects of a patient’s life, including home life, career, other elements such as driving, and home life, and to coordinate these elements effectively. Learning to walk again is just one part of the journey; caring for oneself, family, work, and things like driving are equally important.
Understanding the various prosthetics available is crucial. When the NHS introduced the microprocessor-controlled prosthetic knees (MPKs) policy in 2017, there was a significant learning curve to ensure we applied the policy correctly and achieved better patient outcomes. This has been one of the most exciting parts of my career because the patient outcomes on these devices were remarkable.
How did you come to specialise in amputee rehabilitation?
I’ve always been passionate about rehabilitation. I wanted to treat the whole person, not just a joint, and really get to know and work with the individuals, considering the psychosocial elements of care. It’s quite different from just spending 20 minutes as a physiotherapist treating an elbow.
I worked in a Band 6 position as a prosthetic physiotherapist in Birmingham, which meant working with amputees within a tertiary level service. Although I also have experience in neuro-specialist clinics, orthopaedic injuries, fractures, peripheral nerve injuries and other disciplines, I realised within weeks that supporting amputees was what I truly wanted to do.
Amputee rehabilitation is often more dynamic than neurological rehabilitation, and you can achieve results for patients more quickly. This aspect of the field really appealed to me. I also really enjoyed the multidisciplinary working that takes place between the prosthetist, the physiotherapist, the consultant, the counsellor, and, of course, the patient.
Tell us a bit more about your experience as a physiotherapy expert witness – what does this entail?
Expert witness is another arm of personal injury litigation. It involves gathering reports from various experts to outline in litigation what individuals need for their ongoing rehabilitation and how they should be supported in their future lives. This includes selecting appropriate services and presenting the associated costs, such as future physiotherapy, walking aids, gym memberships, and any other necessary resources that are required for reasonable restitution. The goal is to help individuals return to as close to their pre-injury state as possible. I’ve handled around 60 cases in this capacity, and these have been a mixture of Claimant instructed cases, Defendant instructed cases and single-joint instructions. This has given me an in-depth insight into how personal injury cases are handled by the legal teams.
Why the change from physiotherapy to case management?
I’ve moved to case management to focus on helping patients achieve better outcomes. In my previous role, I managed patients’ journeys, but I couldn’t always provide the level of support they needed, such as helping them fill out important forms for services that would help their recovery. Many of the patients I worked with in the NHS were undergoing amputations due to factors like vascular issues, smoking, and diabetes, which often affected their motivation.
They also tended to have knowledge that an amputation might be needed in the future, and some of them had attended a pre-amputee clinic in our service. However, with personal injury and trauma patients, an individual can be fine one day and then suddenly lose a limb due to an incident like a road traffic accident. This requires different psychological support and processing. Trauma patients tend to be younger, with more dynamic goals and aspirations such as caring for their families, returning to an active lifestyle and progressing their careers. Case management allows me to take patients through their recovery journey and help them identify and achieve their goals.
It’s rewarding to support them through their recovery journey and build a relationship which allows me to support them in a variety of ways – from accessing gym memberships to supporting their psychological needs – and help them get the best outcomes for their recovery.
How do you find working with NHS prostheses versus private prosthetics providers? What impact does it have on the clients?
Clients with private prosthetics can still access NHS services for physiotherapy. Professional network conferences have provided many training opportunities, and I’ve seen a lot of advancements in private prosthetics through the legal work that I do. Private services offer a much better provision of prosthetic components compared to the NHS, and it is not uncommon to see rehabilitation clients who have three or four different legs for various activities, such as day-to-day use and sports.
One significant advancement in private practice is the use of microprocessor-controlled knees. These are knees that are driven by computers, and they have features like the ability to switch from walking to running and can sense if you’ve stumbled, adjusting the knee’s function to prevent falls. This technology is fairly common in private practice and greatly reduces the risk of falls for clients. These knees also support a return to a more normal gait pattern especially on uneven ground and slopes.
Are there any specific innovations that you’ve seen have made/or could make a real difference to the rehab client’s life?
One significant innovation is the surgical treatment to manage phantom pain through Targeted Muscle Reinnervation (TMR) surgery. This procedure involves rerouting the affected nerve to nearby muscles. Although it is surgically more challenging than amputation and requires a longer time in surgery, it has shown great promise. Many amputees suffer from phantom pain, and there are many plastic surgeons who now perform this surgery privately. It is often done as a revision procedure, but it is sometimes performed at the time of the amputation. I believe we will continue to see more of this innovative treatment in the future.
What are the differences when it comes to working with adults versus children with severe and life-changing injuries?
In my physio and legal roles, I’ve encountered a few children with severe injuries, often resulting from sepsis, trauma, or cancer. While specialist children’s prosthetics services exist, they are few and far between.
One memorable case involved a 14-year-old girl with complex needs who was hit by a car. She already faced significant challenges in life, including family issues, and pre-existing mental health problems and the accident only added to her difficulties. Her recovery involved complex limb reconstruction and required a counsellor to address psychological issues. Working with her was challenging, as she had to be engaged on her own terms. It was essential to use various skills to keep her motivated and achieve the best possible recovery outcomes. This included providing positive reinforcement, making the process fun, and helping her to accept the bad days.
Understanding where physiotherapy fits into the bigger picture for her was crucial. Sometimes, she just wanted to come in and talk. Joint goal setting and focusing on what she wanted to achieve were key. Once her rehabilitation journey was complete, she even considered becoming a counsellor herself. Working with her family, despite the difficult circumstances, required maintaining professionalism while empathising with their situation.
How do you advocate for your clients?
Advocating for clients starts with recognising their needs through a comprehensive assessment. This involves acknowledging all the important aspects of their lives, such as activities of daily living, family life, and work, and helping them set and achieve their goals by breaking them down into manageable stages. Support can range from signposting and assisting with paperwork to accompanying them to appointments. This all depends on their individual needs.
It’s crucial to put clients at the centre of their journey. Some may want a lot of handholding, while others prefer to receive information and take a more independent approach. Understanding different personality types and what resonates with each client is key. This involves assessing their personality, what matters most to them, and their psychological state, allowing them to drive their rehabilitation.
Some clients may want the case manager to take on a lot of responsibilities, while others may prefer to guide what they want from us as case managers. Finding effective communication strategies, whether through phone calls, texts, face-to-face meetings, or attending employer meetings, is essential as people have different preferences.
Is there a particular case throughout your career that has really made an impact on you and why?
One case that stands out involved a patient with Complex Regional Pain Syndrome (CRPS), who experienced chronic severe pain. This patient came to us before their amputation at a pre-amputation clinic and already had psychological issues, so we had to take a cautious approach to her rehabilitation due to her pain history Despite these challenges, the patient was physically very capable.
Initially, the patient used a temporary prosthetic with a locked knee and then transitioned to a free knee, which she managed exceptionally well with. However, I strongly believed that the patient would benefit greatly from a microprocessor knee, even though one of our team members was hesitant to provide one. The patient was highly motivated with her rehabilitation, engaging in various activities, including skateboarding, but was falling regularly. This was because she was out-walking the capabilities of her mechanical knee joint.
Throughout the journey, I worked closely with a counsellor and prosthetist to advocate for the patient, as we could see how much a microprocessor knee would improve their quality of life. It was a battle against the team member’s reluctance, but we persisted because we knew the positive impact it would have.
Seeing the patient go from being a wheelchair user for three years to using a simple knee and eventually to skateboarding was incredibly rewarding. The support from counselling played a significant role in these outcomes. It was challenging to confront the judgmental attitude of the team member who had a misinformed view of the patient, but it was necessary to advocate for what was best for the patient. We were eventually successful, and gained consent from the manager of a prosthetics company to support the use of their microprocessor knee for skateboarding. They provided a guarantee that any damage to the knee would be repaired under the warranty. This reassured the reluctant member of our team.
Now, the patient has her own YouTube channel and is about to receive the microprocessor knee, which will further enhance her quality of life. This case truly made an impact on me, highlighting the importance of advocacy and the difference it can make in a patient’s journey.
Tell us something interesting about yourself.
I live in a rural part of the world and have a passion for the outdoors and gardening. I used to be a yoga teacher and still practise regularly, and I often incorporate yoga teaching skills into my rehabilitation work, including postures, stretches, breathing techniques and relaxation methods. I’m a passionate yogi and also an animal lover.
What attracted you to HCML?
While working as an expert witness, I assessed patients and wrote detailed analytical reports, as well as reviewing the records from case managers. This was my first introduction to case management. I felt I had achieved what I wanted to within the NHS and was ready for a change with new experiences.
I was impressed by the HCML case management reports and the outcomes they achieved for their clients. One notable case involved a client who had dismissed four case managers. They had difficulties in coping with their situation following their injury. However, they were very complimentary about their current case manager, who has helped them achieve many things in their rehabilitation journey, such as re-housing. This helped me understand the value of case managers to personal injury clients. The HCML records I saw were always well-organised and easy to follow, which led me to approach this company about employment.
I was attracted to HCML because of the potential for better patient outcomes, a more varied caseload, and the opportunity to learn new skills and broaden my horizons. In case management, you start early on in the rehab journey, which I find very rewarding.