Innovative Therapies for Complex Conditions: A Deep Dive into Neuro Alliance

In this interview, we speak with Daniel Buck, Neurological Physiotherapist and General Manager, and Tim Mogg, Facilities Manager at Neuro Alliance, based in Thornton, Australia. Neuro Alliance is dedicated to providing state-of-the-art rehabilitation services for individuals with complex conditions. They emphasize goaldirected, intensive therapy programs designed to maximize client outcomes. We discuss how innovative technology, like the THERA-Trainer lyra, supports therapists in enhancing the effectiveness of treatments by increasing the volume of evidence-based task practice and repetitions.

Lars Timm:Hi Daniel, thanks for joining us. Could you start by sharing some background on the history and mission of your clinic?

Daniel Buck: Hi Lars, absolutely. Neuro Alliance was established to provide gold standard neurorehabilitation to a range of clients. Using the principles of high volume, tasks specific training our therapy team is positioned to maximise the functional gains for clients with various neurological conditions.

Lars Tim: Can you tell us more about the mission that drives Neuro Alliance?

Daniel Buck: At Neuro Alliance, the mission is to build a strong therapeutic partnership with each client, guided by core values. Accountability is key, as the team takes responsibility for their actions and promptly addresses any issues. Compassion ensures that every client’s unique needs and journey are understood and respected. Collaboration involves forming honest, trusting relationships, transparently aligning services with each client’s goals and referring them to other resources if needed. Respect for each client’s choices is central, prioritizing their preferences in all aspects of care. Finally, a commitment to evidence-based practice means that all methods are grounded in the latest research, providing effective and reliable interventions. Together, these values drive the provision of exceptional, personalized care that supports meaningful participation and progress in life.

Lars Timm: What distinguishes your clinic from other neurorehabilitation centres in Australia?

Daniel Buck: Neuro Alliance along with a number of clinics around Australia provide high quality rehabilitation. In Australia the training standard of therapists if high and this is reflected across the many great services available.

Lars Timm: Are there any special therapy concepts or innovative approaches that you use?

Daniel Buck: Neuro Alliance are focusing on goal directed, intense therapy programs to maximise client outcomes. Technology like the Thera-Trainer Lyra help our therapists maximise the number of repetitions and volume of task practice. Technology like this can help reduce therapy staff costs and maximise value for money when clients are engaging in neurorehabilitation therapy.

Lars Timm: How do you integrate evidence-based practice into the day-to-day running of your neurorehabilitation clinic?

Daniel Buck:Staff have an intimate understanding of the evidence base for many of the conditions we see at Neuro Alliance. Whilst there is variability between conditions in terms of what is best practice, the key principles of neurorehabilitation and neuroplasticity do apply across conditions. At Neuro Alliance we are trying very hard to implement options for clients that allow them to increase their rehabilitation and exercise dosage to place them in the best position to maximise their functional gains.

Lars Timm: Can you give specific examples of how you incorporate evidence-based research findings into your treatment plans and therapies?

Daniel Buck: The Neuro Alliance Intensive Gait Lab is a great example of integrating evidence-based practice into our clinic. Client goals are clearly identified, then an intense therapy plan is implemented for a 5-week block at a time. With this higher level of dosage, it aligns with what the research has been telling us for many years, that being therapy needs to be goal directed, task focused, specific to the individual and have a high enough level of intensity to promote positive plastic change.

Lars Timm: Are there specific processes or com­mittees within your clinic that are responsible for regularly reviewing and adapting treatment protocols?

Daniel Buck: Within our team we have several high-caliber clinical leaders who develop and review our various programs. Those programs are modified to adapt to the needs of clients. Therapy programs need to be cost effective, practical and approved by our senior clinical leaders at Neuro Alliance.

Lars Timm: Can you share success stories or patient stories that illustrate the effectiveness of your programmes?

Daniel Buck: In Australia we are legally unable to provide patient testimonials. Currently when writing this article, we are at the end of our current 5-week Intensive Gait Lab. For example, just one client is now able to transfer out of her new car and walk with an aid into a public place. Another client is now standing from their wheelchair without physical assistance, another client has just started walking with Canadian crutches and another is now walking with a forearm support frame for the first time.

Lars Timm: How have the needs and requirements of your patients changed over the years?

Daniel Buck: Clients’ needs have always been the same. That is, they want to maximise their functional gains after a neurological disease or injury onset. The approach to rehabilitation has now evolved to the point whereby clients’ needs are more effectively met.

Lars Timm: What future developments and innovations do you see in the field of neurorehabilitation?

Daniel Buck: We see technology playing a part in helping clinical staff maximise therapy dosage for clients. There will always be a need for a sharp clinical mind when working with a client, but the appropriately skilled therapist can certainly use a range of innovative technologies now that help explore new possibilities within neurorehabilitation that were not there 5-10 year ago, even 3 years ago.

Lars Timm: How are you preparing your clinic for future challenges and opportunities?

Daniel Buck:We are investing heavily in new technology like THERA-Trainer lyra, which is an end-effective gait trainer. Programs are heading in the direction of being more intense, for shorter periods of time with a heavy focus on goal direction. With the combination of this therapy approach, the skill of the clinician and the new technology now available to us, patients should see themselves in a better position to make functional gains.

Lars Timm: In your opinion, how does neurorehabilitation in Australia differ from that in other countries?

Daniel Buck: Australia do lead a lot of the research in relation to various neurological conditions worldwide. Australia has a strong presence especially in the stroke cohort which is helping us develop our clinical approach to managing stroke rehabilitation and management.

Australia is slowly adopting technology however due to our geographical location this does provide somewhat of a barrier to integrating this into practice.

Whilst we cannot comment on the training standards in other countries, the training standard of allied health professionals in Australia is very high. This does make our country positively positioned to lead the way in promoting and showing how to integrate gold therapy standard treatment into reality.

Lars Timm: What role do technological innovations, such as robotic assistance or virtual reality, play in modern neurorehabilitation?

Daniel Buck: Currently the evidence based on both technology groups is limited. As some of this technology is adopted it will assist researchers in being able to implement robust study designs to assess effectiveness. Currently, robotic assistance we see as the most promising component in terms of being able to assist clinicians in delivering therapy with a higher level of repetitions and intensity.

Lars Timm: Are there certain technologies that have proven to be particularly effective in your clinic?

Daniel Buck: Biofeedback technologies are useful, and these can be basic in nature to complex. The more a patient understands their movement patterns, the better positioned they are to make adjustments and improve.

In addition to this any technology that allows a clinicians to help a client spend more time in standing and stepping, this may in some instances place them in a better position to improve their functional capacity.

Lars Timm:How does healthcare and insurance funding affect access and quality of neurorehabilitation services?

Daniel Buck: Healthcare and disability funding in Australia is complex in nature. Overall, clients with their unique needs are in a good position to receive quality healthcare in Australia. As to what service, be that public or private, delivers this service essentially depends on that clients’ access to funding.

Lars Timm: How do therapist education and training programs differ in Australia compared to other countries?

Daniel Buck: Australia has a high level of compliance in relation to the initial tertiary education of a Physiotherapist for example and also the ongoing education they require to undertake to remain registered. Tertiary education programs in Australia are world standard.

Lars Timm:Hi Tim, thank you for joining us as well to answer some questions. First of all a personal question to you. What made you decide to work in the field of neurorehabilitation?

Tim Mogg: Many thanks for having me. I’m happy to discuss my decision to work in neurorehabilitation and answer your questions. After graduating as a physiotherapist in 2009, I’ve worked in many areas of Physiotherapy and rehabilitation and I feel that neurorehabilitation is the place where I can make the biggest difference. I enjoy mixing evidence based practice, interpersonal relationships, hard work and technical “know-how” to maximise outcomes. I love helping people to get moving and I love finding solutions to difficult problems. I enjoy it so much that I have been completing a masters Degree in Neurorehabilitation, which should hopefully be completed by the end of next year!

Lars Timm: How do the different specialisms and therapists in your clinic work together to ensure holistic care?

Tim Mogg:We are very fortunate to have a multidisciplinary team at Neuro Alliance. Having occupational therapists, speech pathologists, exercise physiologists and physiotherapists all under the same roof means that we have easy access to a breadth of specialist knowledge and great working relationships with each other. We may be fortunate and have multiple Neuro Alliance clinicians all working with the same client, which makes for easy communication amongst the treating team, and awareness of how we operate due to the close working relationships we all have. We can arrange formal case conferences or informal discussions about situations very easily. If we aren’t so lucky and the client does not have access to the full multi-disciplinary team at Neuro Alliance we can still use each other as a resource and keep things moving forward.

Lars Timm: What role do interdisciplinary teams play in your daily work?

Tim Mogg: If, as a physiotherapist, I am able to identify an issue that is best suited to be explored and looked after by another discipline I have the option of completing an internal referral, which can speed up the process for a client to gain access to the health professional most suited to their particular issue. If I have a small question that is outside of my scope the answer is normally a brief conversation or email exchange away. There may be times where we are able to arrange a joint intervention, where two or more disciplines can provide input with a client at the same time. This can be a really efficient meeting of the minds, where big problems get solved really quickly!

Lars Timm: What are the biggest challenges you face in your daily work and how do you overcome them?

Tim Mogg: The biggest challenge in the field of neurorehabilitation is maximising use of time. There is always more work that could be done, but only so much time. We do everything we can to make our processes as efficient as possible by having a large resource library on our company intranet to reduce the time it takes to get the right plans in place. We also put a lot of effort into working with our clients’ support network to involve them in the rehabilitation process. Having a well-trained support network can maximise the volume of practice that our clients are able to complete, which can make a world of difference.

Lars Timm: How do you motivate patients who have difficulties engaging with rehabilitation?

Tim Mogg: The environment and atmosphere at the Neuro Alliance clinics really help people to engage. When people come into clinic they see that there are lots of other people working hard and enjoying the process. Once our clients see how hard everyone else is working it is much easier to convince them that they are capable to do so as well. We also have a wide range of therapy equipment that keeps rehabilitation interesting and challenging. We have devices that help people to stand and walk that are pretty unique to our part of the world. We also have lots of interactive therapy devices that can feel more like games than therapy. We have pods that light up and react to being touched or stepped on that our clients love using. We have a therapy system that operates like a gaming console, that allows our clients to use their body as the controller. When clients use this system we find that they end up completing many repetitions with a smile on their face, all in the aim of achieving a high score! I also think we do an excellent job to “meet our clients where they are at.” I think that recognising that everyone is on an individual journey and by demonstrating that we have the necessary skills within our practice and the connections to professionals who provide services outside of our scope gives our clients confidence to work with us, knowing that they are receiving high quality care.