Addressing the Needs of Clients & Carers

As part of the integrated support provided by INS, the team works inter- professionally to promote independence and self-management. This incorporates education, advice and motivational support in addressing the physical, practical, social and emotional needs of clients and carers. This ongoing professional support can be offered on both a 1:1 basis and in a group, dependent on need, client choice and capacity.

Home Visits

Home visits are carried out by all therapy staff and are provided in response to the assessed need of the individual. Visits may take place to:

  • Continue the rehabilitation process
  • Address a particular problem, such as falls or exercise tolerance, in preparation for a group
  • Offer therapy to people who are not able to join a group
  • Provide help and advice on the use of equipment and other aspects of daily living
  • Provide individual support and advice to a client and/or their family carer
  • Provide individual advice to domiciliary care workers on supporting and maintaining self-help and independence for a client
  • Offer palliative care support

Regular Groups for Clients

Therapy groups

The overall aim of the long term groups is to improve and maintain physical, functional and cognitive abilities. The social discussions held in the group promote integration and social support. The skills learned can then be transferred into the clients’ own lives to maximise and maintain independence for as long as possible.

These groups are condition-specific and include exercises and activities designed and graded for the particular needs of the clients attending.

Parkinson’s disease

  • Exercise to improve physical strength, range of movement, posture and stamina
  • Gross motor, fine motor and coordination tasks to maintain upper limb and hand function
  • Facial exercises to retain facial expressivity
  • Breathing and voice projection exercises to help volume control, articulation and intonation of speech
  • Symptom management strategies to retain independence, such as cueing for movement initiation and maintenance
  • Relaxation practice using a variety of techniques
  • Technique training to assist with everyday activities, such as handling money and bed mobility
  • Social discussion, including PD issues

Multiple Sclerosis (MS)

  • Exercise to improve physical strength, range of movement, posture and stamina specifically addressing issues with spasticity, spasm and core stability
  • Gross motor, fine motor and coordination tasks to maintain upper limb and hand function
  • Fatigue management strategies (with individual programmes provided if a need is identified)
  • Sensory stimulation to assess and monitor changes and provide compensatory techniques/equipment
  • Relaxation practice using a variety of techniques
  • Social discussion, including MS issues


  • Exercise to improve posture and balance, strength, range of movement and stamina specifically addressing issues with spasticity and upper and lower limb function
  • Functional practice of everyday activities such as dressing, outdoor mobility and money management
  • Cognitive stimulation to assist with memory, attention, perception and executive function
  • Sensory stimulation to assess and monitor changes and provide compensatory techniques/equipment
  • Social discussion, including stroke issues, with supportive assistance for people with communication difficulties such as expressive or receptive dysphasia, dysarthria

Creative Therapies

This group is designed in blocks of creative activities such as arts & crafts, creative writing, reminiscence, cooking and music, with clients signing up to any block of particular interest. Each activity block is aimed at providing a variety of areas for engagement to assist with:

  • Stimulating physical and cognitive abilities through activity
  • Promoting executive functioning through planning work, sequencing tasks and thinking laterally
  • Enhancing psychological well-being from gaining a sense of achievement in activity participation and completion, and by experiencing flow, that sense of full involvement in the process of an activity.
  • Encouraging social engagement with new people in a supported environment

Communication Groups

These groups are designed specifically for people with communication difficulties from a variety of conditions including stroke and Parkinson’s disease. The communication difficulties may include expressive or receptive dysphasia, dysarthria, and reading and writing difficulties. The groups provide the resources and opportunity for people to express themselves in a variety of ways. The groups are facilitated by a speech therapist, providing specialist skills in enabling communication to allow all members of the group to participate in the activities.

Fit Club

This provides a supportive environment in which clients and carers are assisted to follow their individual programmes, using specialist fitness equipment at an INS therapy gym. Each programme involves elements of resistance training and aerobic activity to promote physical strength and stamina. All participants are supervised by a therapist to ensure safety and to motivate and adapt programmes so as to maintain a continuing challenge. The aim is for clients to move on to local community gyms with the support of our therapist and the local gym instructor to feel confident and able to maintain their fitness independently.


By using the water as a supportive environment, hydrotherapy can:

  • Improve range of movement and muscle strength
  • Reduce pain and spasticity
  • Improve endurance, weight bearing and confidence in standing, walking and using stairs
  • Improve well-being by the enjoyment of swimming, floating and being in a new environment

There are two sessions at the local hydrotherapy pool. One is a more supportive session focusing on developing a suitable individual programme for each client. The other session runs for 12 consecutive weeks and allows people time to gain more confidence in the water so that they can then access public sessions.

Short Term Groups for Clients & Carers

Living Well with Parkinson’s disease (PD)

This 12-week programme is for people with Parkinson’s to provide education, advice and coping strategies to enable people to live well with the condition. The course covers the main difficulties experienced by people with Parkinson’s and each session includes a physical, functional and social aspect. Sessions include: symptoms & posture, cueing strategies, falls management, bed mobility, reaching & grasping, fitness training and relaxation. There are also guest speakers such as the local PD specialist nurse, Parkinson’s UK local representative and INS social worker. At the end of the course clients will be encouraged to continue to be more physically active – maybe attending a community gym or starting Nordic walking – whatever suits them.

Living Well Stroke Group

This 12-week programme is for people who have had a stroke and want to improve their general fitness and also to gain a better understanding of ways to reduce the risk of having another stroke. Each weekly session lasts for an hour and a half.

Each client is assessed individually for the group and, if they are suitable, will have a personal exercise programme developed for them by a physiotherapist to help improve strength, balance, flexibilty and aerobic fitness. As well as exercises and advice on stroke at each session, the client is also encouraged to set a new aim for the coming week – maybe walking further or continuing a particular exercise at home. The 12 weeks may be consecutive or in blocks to allow time for ideas to be practised and consolidated.

At the end of the programme each client is encouraged to continue to be more physically active in a way that is enjoyable for them – this might be going to a community gym, walking more, bowls – whatever suits that individual.

Living Well with Multiple Sclerosis (MS)

This 12-week programme is for people who have MS, aiming to help improve their understanding of their MS.
Each client is assessed individually for the group and helped to set their own goals. The exercise component of the sessions focuses on improving strength, balance, flexibility and aerobic fitness. The education component includes understanding tone, spasms, weakness, fatigue and continence issues.
At the end of the programme each client is encouraged to continue to be more physically active in a way that is enjoyable for them – this might be going to a community gym or joining in with a seated exercise class – whatever suits that individual.

Taking Back Control

This 8-week programme focuses on the emotional impact of living with a long term neurological condition. The programme aims to develop self-management strategies to enable participants to manage anxiety, stress and depression to regain and/or maintain general psychological health and enhance overall well-being. Sessions will assist with:

  • Understanding the links between neurological conditions and emotional issues
  • Recognising the effects of depression, anxiety and stress and learning coping strategies
  • Practising a variety of relaxation techniques

Taking Back Control for Carers

This 3-week programme focuses on the emotional needs of carers who are supporting people with long term conditions and explores strategies in coping with the changes that this brings.

Occupational Therapy Groups

A 12-week group run by INS occupational therapists and focusing on enhancing health and wellbeing. This includes the opportunity to join in different activities of interest, perhaps gardening, art or cooking, as well as some exercise and also information on issues such as memory and managing sleep and fatigue problems.

Fatigue & Sleep Management

This 4-week group teaches strategies to cope with fatigue and sleep issues caused by neurological conditions. This is a very practical course helping to increase understanding of what causes fatigue and teaching strategies to manage it.

Memory Group

This 4-week group helps people understand their memory issues caused by having a long term neurological condition and teaches coping strategies to help manage them.

Other Services

Carer Support Groups

The aim of the carer support groups is to enable carers to discuss their concerns and share experience and solutions to problems. Coordinated and supported by INS social workers, the groups aim to provide:

  • Information and advice on specific difficulties encountered by the person with the condition
  • Information and help on issues such as benefits entitlements and transport
  • Access to a Carers Assessment from the local authority and registration as a carer with your GP
  • Information on and referral to other services for carers, including respite opportunities. We work with other organisations to provide support to carers. In Richmond this is through the Richmond Carers Hub and in Hounslow through INS Partnership
  • Emotional support and counselling
  • Advice and practical solutions for carers to enable them to remain healthy and well and to minimise the stress of caring
  • Identification of and referral to INS therapists for carer training in moving and handling the person with the condition to reduce the risk of injury and encourage independence.

Individual support and advice is also provided. INS continues to offer support to carers for as long as needed, even after bereavement.

Befriending Service

This service aims to provide regular practical and social support to clients who may feel isolated by their condition. It also provides a period of respite for their carers.

This service is managed by INS social workers who coordinate, supervise and support the trained volunteers who provide this invaluable service.

Exploring Spiritual Wellbeing

This monthly group meets on a Wednesday afternoon, usually at Hampton Road. The aim of the group is to nurture the spirit and promote emotional wellbeing to help cope with difficulties as they arise and enjoy life more fully.

It is open to our service users, carers and volunteers, from any faith or none. We welcome contributions from group members; reflections on inspirational teachings, readings or something that has given personal encouragement, the group starts and end with a time of quiet meditation.

Expanding Horizons

Expanding Horizons gives clients and carers the opportunity to try something new and different in a supported, fun environment. Over the summer period there is a wide range of activities from archery, cup cake decorating, massage, reminiscence to Wii fit and walks. A programme is published and clients and carers can book onto activities that interest them. There is a charge for some of the activities.
Comments from clients in summer 2012:
Following a boat trip: “A really good day + organised very well. Thank you for today’s treat!”
Following a circuit training session: “This is brilliant for those with Parkinson’s. Great fun.”
Following glass painting: “Very enjoyable – lovely experience.”