Below is an example of work with one of our clients, who was involved in a road traffic accident and as a consequence suffered a severe traumatic brain injury.
Input from the NAP team is outlined in terms of the rehabilitation support offered to the patient, as well as the support provided to the patient’s wife and family.
The patient was involved in a road traffic accident and was admitted to an acute hospital where he was in a coma for a month. After the acute period of medical treatment, he received rehabilitation in a hospital setting before being discharged home. CT and MRI confirmed that the patient had a severe traumatic brain injury.
On discharge from hospital the patient presented with the following difficulties:
- Severe mobility difficulties resulting from the brain injury
- Pain due to orthopaedic injuries sustained in the accident, including multiple fractures
- Significant speech difficulties, including expression of thoughts
- Severe memory difficulties
- Severe difficulties with mental health issues
- Executive problems (difficulties with planning and initiation, controlling of mood and impulsivity)
- Difficulties in caring for himself, including dressing and preparing food
Early challenges faced by the patient and his wife:
- The change of roles in their relationship and family life
- The patient’s wife had to take on responsibilities that were not a strength previously, including managing the family’s finances
- Difficulties with intimacy in their relationship
- The patient had anger outbursts that were having a negative impact on the relationship
- After being discharged from hospital, the patient would be at home 24 hours a day
- The patient's wife began suffering from depression, which resulted from the stress of the family situation and the patient's difficulties
NAP led the rehabilitation programme after a request from the brain injury case manager to become involved in the community neurorehabilitation programme.
The following professionals were appointed to the case:
Neuropsychologist (to provide neuropsychological support to the patient)
Clinical Psychologist (to provide psychological support to the patient’s wife and their daughter)
Personal Trainer in Rehabilitation
Neuro Occupational Therapist
Speech and Language Therapist
Rehabilitation priorities included:
- Good communication between the brain injury case manager and therapists and clinicians at Psicon
- Ensuring regular team meetings to consider strengths, weaknesses and goal priorities
- Regular feedback to the brain injury case manager and solicitor
- Pacing the journey of rehabilitation and inclusion of therapists over time as the patient progressed
- Focus on the rehabilitation priorities of the patient
- Feedback from the Clinical Psychologist working with the patient’s wife and daughter
- Support when moving from one property to another
- Training of support workers
- Neuropsychological rehabilitation and Clinical Psychology treatment
- Cognitive rehabilitation
- Psychological support to help the patient adjust to his new role
- Psychological support of the patient’s wife, and support in understanding of traumatic brain injury
- Couples therapy for the patient and his wife to work on their difficulties and the best management of the patient’s difficulties
- Training of support workers to allow them to contribute to the multi-disciplinary team decision making and goal priorities
- Ensuring good communication with all stakeholders
Clinical Psychology intervention (with daughter and wife)
- Cognitive Behaviour Therapy (CBT)
- Brain injury education with the daughter
- Couple and Family Therapy, and together with the neuropsychologist consideration of the systemic approach to the rehabilitation programme
Input from Neurophysiotherapy & Personal Trainer in Rehabilitation
Neurophysiotherapy intervention included focus on various aspects of mobility, which was supported by the Personal Trainer in Rehabilitation to further work on stamina, strength and balance.
Neuro Occupational Therapy input
The Occupational Therapist (together with the Neuropsychologist) assisted in work on the patient’s cognitive rehabilitation needs, including establishing external memory aids. The work focused on activities of daily living, including the patient’s ability to contribute to activities in and around the house within a framework of significant mobility problems.
Speech and Language Therapy support
Before the accident, the patient was very intelligent and high functioning. Due to the nature of the brain injury, he was left with significant difficulties in expressing thoughts, despite ability in considering various complex cognitive challenges.
Social Support Worker/ Rehabilitation Assistants
This group of staff played an important role in supporting their clinicians and therapists in the implementation of rehabilitation strategies in day-to-day life. NAP believes that all Support Workers and Rehabilitation Assistants should work closely together with the therapists and clinicians of NAP. We are often involved in the training, supervision and support of this group of staff.
The patient’s progress included:
- Improved mobility and being able to walk distances without support or aid of a walking stick
- Increase in independent activities, including going with a Rehabilitation Assistant on a public bus to visit other towns and places of interest
- Awareness of memory difficulties and ablity to use external memory aids
- Ability to contribute to discussion about ongoing difficulties, including improved behaviour when travelling as a passenger in a car (in the past, the patient often got angry when other drivers did not drive the way the patient thought they should)
- Improved ability to contribute to the upbringing of their daughter
- Improved ability to give support to his wife
- The patient’s wife’s mental health also improved, despite her husband’s ongoing neurological difficulties
- Their daughter is now attending school with less anxiety and fewer mental health difficulties