Cleveland Clinic London’s three Rs for recovery from brain and spinal cord injury

The Cleveland Clinic London, which opened in 2021, is one of the few but growing number of private hospitals with facilities to provide intensive care and complex operations.
Doctors and therapists from various specialties work together as a team to offer the three Rs – reconstruction, recovery and rehabilitation – to patients who have suffered devastating injuries.
Consultants say the approach is unusual in London hospitals, where specialist departments – from surgery to imaging and occupational therapy – are often siloed and sometimes even in different buildings.
“Having everything in one building, I would say, is fairly unique,” said Dr Arvind Chandratheva, a consultant neurologist at the Cleveland Clinic.
“We’ve held complex case discussions with orthopaedic surgeons, plastic surgeons, intensive care unit teams, neurologists, neurosurgeons,” he told The National.
This helps to speed up treatment and support the patient better. “The ability to rapidly involve highly skilled specialists in a really timely manner makes a huge impact to patients,” he added.
One case from the Arabian Gulf, he said, involved traumatic brain injury and severe bodily injuries that required an amputation.
The patient’s neuro and orthopaedic surgeons got together to decide which surgery would be done first. “How does one approach reconstructive brain surgery while they’ve got an amputation. [We] operate as a team of specialists to try and achieve that,” he said.
The hospital expanded its services in October to include a unit for patients who have lost limbs and require amputation and prosthetics.
UK patients facing weeks of waiting on the NHS are attracted to the private hospital’s services.
Eli Lew, 35, who works in property development in London, told The National of his recovery at the Cleveland Clinic, after a skiing accident almost left him paralysed.
In March last year Mr Lew landed head first on rocks while skiing in France, causing a haemorrhage to the front left of his brain.
Two British women doctors who were skiing near by witnessed the accident and rushed to help him. He was then flown to a French hospital.
“They manipulated my body so that I could get oxygen to my brain. They saved my life, they’re my guardian angels. I’m still in touch with them,” he said of the two women doctors.
His family flew over to France and were prepared for the worst as he spent 10 days in a coma. The chances of him waking up were low, and doctors feared that he would be paralysed when he did.
Mr Lew spent two weeks at the French hospital learning how to walk again after waking up from the coma – a time he does not remember well. He also found he could not move his left arm – but he eventually trained himself to use it again.
The biggest challenge would be recovering his memory and speech – which he would do back in the UK.
When he was well enough to travel back, he was transferred to the Royal London Hospital.
The contrast to the round-the-clock care he received in France was stark. “I was under constant supervision and care in France. The NHS hospital knew that I was high risk, and yet I just felt like any other person,” he said.
He spent his first night in the Accident and Emergency ward, because no beds were available in the hospital itself.
He rolled over and fell out of bed on his first night, and rang his sister for help. “I was so all over the place at the time. I thought someone had come into my room and pushed me on the floor, so I called my little sister,” he said.
The experience left him feeling discouraged about his prospect for recovery. “I could feel myself getting depressed,” he said of the three days at the hospital.
His family made the decision to send him to the private Cleveland Clinic London after learning that there would be an 11-week wait before he could continue his rehabilitation.
“Treatment within the first three months is the most critical,” Mr Lew said, whose treatment was covered by his health insurance.
Dr Chandratheva, Mr Lew’s neurologist at Cleveland Clinic, confirms the need to begin treating the patient as soon as possible.
“In all forms of neurological injury, the sooner you start stimulating the nervous system with positive rehabilitation techniques, the greater the chance of recovery,” he said.
When Mr Lew arrived at the private London hospital, he was immediately seen by Dr Chandratheva and put on a rehabilitation programme with a physiotherapist and language therapist.
The road to recovery would be long, he was told. “I refused to accept that anything was wrong with me,” he said.
“The doctor asked me to say the months of the year backwards. I just looked at him blankly. Then he said, OK, what if you count backwards from 20. I said 20, and couldn’t do anything else,” Mr Lew recalled.
Dr Chandratheva said his aim is not simply to get the patient walking or moving again, but to live a life as close to the one they had before the injury.
“You really want to get them to the level where they can go to work – they have a vision of having relationships, going out – and all the things that young people want to do,” he said.
“Eli was incredibly fit. He was well, super active, and thriving at work,” he said of Mr Lew prior to the accident.
There were more subtle injuries to the brain which, if left untreated, can affect one’s ability to return to work, one’s interactions with friends, and leave the patient struggling to sleep or being really irritable.
Mr Lew also had to learn how to go about performing normal day-to-day tasks, like making a cup of tea.
“Eli lacked complete insight into what his injuries were,” Dr Chandratheva said. “You reflect this to them in a way that doesn’t totally dent their confidence, showing them a pathway to recovery,” he said.
Mr Lew was determined to be well enough to deliver the speech at his best friend’s wedding, which was five months away.
He spent five weeks at the hospital, working with his therapists every day, and spending hours on the tasks and exercises assigned to him.
“I just can’t explain the satisfaction you get from seeing improvement every single day. It was the best feeling in the world,” Mr Lew said.
Brain and spinal cord injuries can also be caused by strokes, infections, and other disorders. Although patients in the Middle East are often able to access care for these at home, UK doctors offer sub-specialties that are not available in the region.
Another patient from the Gulf came suffering more than 90 epileptic seizures a day, with low levels of consciousness as a result.
“We’ve managed to drop the number of epilepsy medication she has. She’s now able to sit up independently, [and suffers] not as many seizures a day,” Dr Chandratheva said.
There are plans for the patient to return home, which, “at the start would not have been possible in the family’s mind”, he said.
Caring for the families was an important part of the process, Dr Chandratheva said. “Often injuries have ripples beyond the patient, and the family as well. It’s hugely traumatic [for them].”
Families must be kept informed regularly and clearly. “Continuous medical oversight give[s] continuity to the family. Because when there’s so many specialties involved, there is a risk that the family just gets lost in the mix,” he said.
Cleveland Clinic London is part of an international network of hospitals under the Cleveland Clinic brand, which also has a hospital in Abu Dhabi.
When a patient returns home, they receive a summary of the care and virtual consultations to follow up on their recovery. The hospital will often speak to the patient’s clinician back home and supply a copy of the summary.
The hospital offers treatments approved in the UK but not yet widely available on the NHS.
“We have used advanced lipid therapies, which are not yet regularly commonplace in day-to-day NHS practice, and we have access to the full range of multiple sclerosis treatments, without restrictions,” he said.
When Mr Lew returned home, he spent his first days on the sofa, watching TV, relieved to have some time to himself again after spending more than two months in hospitals.
He was back at work within three months. “I was told to live my life as normally as possible,” he said.
As his best friend’s wedding day drew closer, Mr Lew began to draft his speech. “Obviously the first draft was terrible, I showed it to my brother,” he said.
But he was able to deliver a speech that he felt proud of.
The experience has changed his life for ever, and he has booked his next skiing trip, at the same spot where he had the accident.
“I’m really doing everything I can to go this year, because I currently hold no fear. The longer I leave it, the more of a chance [fear] will creep up on me, which I just don’t want,” he said.