The Brainability Programme
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​Key population groups
Generalisations about “people with long term conditions” are of course fraught with problems because people with long term health problems, even in the one age group or with the one condition differ from one another in more ways than they resemble one another.  Nevertheless, it is important to describe the various sub populations because different approaches will be needed for different groups.  The following groups are proposed for the first phase of the service
Children
children with long term conditions do receive a multi-disciplinary service often including play therapy and other measures designed to ensure that they do not miss out on the normal activities of childhood.  Of course, a related issue is the fact that the general activity levels in childhood are decreasing, contributing to the increased prevalence of obesity.  It is recommended that a children’s workstream be set up in the first phase of the service.
 
Teenagers and people in transition
The health problems of teenagers with long term conditions, and the transition to adult services is now well recognised as a need that has not been dealt with well by the Health Service.  For this group, for example teenagers with type I diabetes or juvenile rheumatoid arthritis or long term psychological problems the psychological benefits of activity are as important consideration as the physical benefits.  During the phase of adapting to disease feelings of anger are common and vigorous activity can help people cope with such feelings.  High priority will be given to the problems of teenagers and ensuring that the transition to adult services does not interrupt the activity therapy.
 
People in mid life
The incidence of long term conditions arises with age but most people in midlife are able to leave their home and participate in group activities outside the home.  The principal problems faced by this group include pressure from other sources for example care from children or elderly parents but it is recommended ed that a major focus for this group is to develop a common single approach activity therapy with modifications for each of the common long-term conditions rather than having completely separate workstreams for each long-term condition.
 
There is however a need to ensure that people with learning disability and sever mental health problems are not overlooked
 
Older people with multiple conditions
The various subgroups of this large population group will be discussed below and the incidence and prevalence of long term conditions increases with age. 
Firstly there is the problem of what is sometimes called multiple morbidity but is more actively described as a multi-specialty problem namely the person who sees three different specialist teams each of which prescribes without full understanding of the impact that their prescription they have on the prescriptions of other specialists, leaving the person, family and their GP trying to cope.  The benefit of having a single approach to activity therapy, as stated in the previous section would be of great importance for this particular group although their own particular combination of conditions would need to be taken into account.  Many of these people of course are active, some of them looking after older people with frailty near them so it is assumed that they should receive the therapy not only by taking action daily in their homes, a core theme of activity therapy, but also by joining events in their local community.
Although attention has been given to people in old peoples’ homes there is now good evidence that care homes and sheltered housing appreciate the benefits of activity particularly because some of the actions that require people living in their own homes to struggle, but which in itself can help them keep fit, are removed.  Charities such as Oomph are playing a very important part in developing work in old peoples’ homes and the work of Age UK for the past decade has made a big difference to people in these communities.
A much bigger challenge is with the person who is house bound.  Obviously the priority would be to get this person out of their home to a group facility and the aim should be to do this at least once a week.  In addition by encouraging groups such as faith groups, old peoples’ clubs, bingo clubs and bridge clubs to add physical activity to their core activity the people who are able to get out once or twice a week to such activities and have their daily home activity therapy reinforced and supported by group activity.  The role and contribution of digital means of supporting, encouraging and stimulating people, including digital television and virtual reality will be explored during the first year of the National Activity Therapy Service based on the excellent work already been done by Age UK.
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