In this episode of ACNR’s Neurovoices podcast, Co-Editor-in-Chief Dr Ann Donnelly speaks to consultant neurologist and author Dr Orlando Swayne about his book, How to Use a Fork: Stories of Mending the Broken Brain.
Drawing on the experiences of people recovering from stroke and other acquired brain injuries, the book combines patient stories with the science of neuroplasticity and the practical realities of neurorehabilitation. Orlando explains why recovery does not necessarily stop after six months, how intensive multidisciplinary rehabilitation can help people rebuild skills and independence, and why access to appropriate services remains so uneven.
The conversation also explores the importance of skilled therapists alongside new technology, the neurologist’s role within the rehabilitation team, and the value of understanding complex cognitive problems such as neglect, inattention and apraxia. Orlando discusses the ethical challenges of writing about patients, his transition from clinical to more lyrical writing, and why neurologists often make such compelling storytellers.
This episode offers a thoughtful and hopeful exploration of what neurorehabilitation can make possible - and why the “neuro” should remain at its heart.
Guest Information:Dr Orlando Swayne, MA (Cantab), MB BS, MRCP (Neurol), PhD
Orlando Swayne is a consultant neurologist who works primarily in the neurorehabilitation of acquired brain injury, including stroke, but who also has a wide general neurology practice. He is a consultant neurologist at the National Hospital for Neurology and Neurosurgery (NHNN), where he is lead neurologist for the Neurorehabilitation Unit, and is a member of the Department of Brain Repair and Rehabilitation at the UCL Institute of Neurology. He also works at Northwick Park Hospital and the Wellington Hospital.
He has published widely on the control of movement by the brain and the role of brain plasticity in recovery following stroke.
His book, How to Use a Fork, brings together the science of brain plasticity with deeply human stories of survival, adaptation and recovery.
Key Discussion Points / Timestamps:
00:00 – Introduction: Ann Donnelly introduces Orlando Swayne and How to Use a Fork.
01:55 – Why write this book? The privilege of getting to know patients during prolonged inpatient rehabilitation and following their recovery journeys.
04:30 – The rehabilitation gap: Increasing scientific understanding of recovery contrasted with patchy and declining access to rehabilitation, particularly in the community.
07:30 – Technology versus the fundamentals of rehabilitation: Why robotics and other innovations can be valuable but cannot replace skilled therapists and multidisciplinary care.
10:00 – Explaining a complex specialty: Using patient stories to communicate the medical, cognitive, psychological, family and social dimensions of neurological recovery.
11:26 – Writing about patients ethically: Consent, confidentiality and the use of composite characters based on several clinical experiences.
12:56 – Reconnecting with former patients: What Orlando learnt from meeting people years later—and why recovery does not simply stop at six months.
15:31 – From clinical letters to lyrical writing: What can be lost when patients’ stories are reduced to bullet points, and the influence of neurologist-writers such as Oliver Sacks.
17:48 – Why neurologists make good writers: The importance of close observation and noticing movement, speech, behaviour and the whole person.
19:40 – Writing How to Use a Fork: Orlando’s six-month break from clinical work, his disciplined writing routine and the benefits of stepping off the medical treadmill.
21:51 – Teaching through stories and metaphors: Making complicated neuroscience understandable, accessible and memorable.
23:13 – Neurorehabilitation in medical training: Why every neurologist needs to understand chronic neurodisability, regardless of subspecialty.
26:35 – Keeping the “neuro” in neurorehabilitation: The essential contribution of neurology, rehabilitation medicine, neuropsychiatry and the wider multidisciplinary team.
28:22 – The art and science of recovery: Supporting diagnosis, prognosis and clinical coordination while recognising the central contribution of therapists.
30:52 – Why choose neurorehabilitation? The fulfilment that comes from working closely with patients, families and an expert multidisciplinary team.
31:39 – Closing thoughts.
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