Case Studies
A neuro-rehabilitation case study
Simon’s Story
Simon* was 29 years old when he suffered a fall and sustained a very severe head injury with fractures at the base of his skull, pelvis and ribs. He was initially ventilated via a tracheostomy and a ventriculo-peritoneal shunt was inserted to manage his hydrocephalus. After six months on an acute ward, medical stability was achieved. Unfortunately secondary complications had developed including severe lower limb deformities. At this stage it was felt that he was in a low awareness or “vegetative” state and his vision was severely impaired. The treating team were unable to progress further because of inadequate resources and skills in areas such as posture management and assessment of awareness.
Fifteen months following the accident Simon was transferred to the Priory Highbank Centre in Bury, Lancashire. Simon was assessed using SMART®, a nationally recognised measure of awareness in severely brain damaged people. The results showed reaction to visual stimulus in lower visual fields and inconsistent meaningful reactions to other stimulus. An appropriate sensory programme was set up as a result.
Another key intervention at this stage was the development of his posture management. This resulted in a full 24 hour programme of position changes including the acquisition of a supportive seating system which both prevented damaging joint deformities from developing and maximised his visual abilities. Following this intensive treatment period on the Priory Highbank Walmersley Unit (which lasted approximately three months) there followed a period of slow stream rehabilitation at the Priory Highbank Elton Continuing Care Unit. A programme was set up in which high quality care and an appropriate sensory environment was made a priority. He was extremely well supported by his family network and opportunities were made available for him to have experiences outside of the unit.
During this period in the Priory Highbank Elton Continuing Care Unit (which lasted approximately two years) Simon’s programme was overseen by a specialist brain injury team. The intensity of face to face therapy intervention was significantly reduced and the emphasis was placed instead on the care team giving Simon the space and time to recover at his own pace. Our experiences of providing long term care have taught us that providing a less challenging therapeutic environment can be beneficial in allowing a natural rate of recovery. Over stimulation can be detrimental in this minimally responsive client group and can inhibit natural recovery.
Simon showed good improvement whilst on this continuing care placement. He became more interactive with people. At the end of his time in rehabilitation he was able to eat a fork mashable diet, drink normal fluids and vocalise some words although he was unable to initiate speech or conversation. In addition he was able to make simple choices (although inconsistently).
Simon had an excellent support system in his family and 42 months after his initial accident, he was discharged into his own home, close to his family, with 24 hour carer support in place. Our experiences have shown that cognitive and physical improvements can continue for several years following severe traumatic brain injury. Moreover these improvements can take place in a less intensive specialist continuing care unit once the initial improvements have been achieved.
Contact us…
The Priory Highbank Centre on tel. 01706 829 540 Email: highbank@priorygroup.com
* Real names have been disguised to protect patient confidentiality.