Susan had sustained a traumatic brain injury fourteen years prior to her referral to Kemsley which she had sustained as a result of a road traffic accident. For the last ten years she had been residing in a nursing home, although two years before her referral her physical and mental health had deteriorated. Susan had been a teacher prior to the brain injury and she had been continuing to tutor young people even when living in the nursing home, however, when her health began to deteriorate she no longer felt able to continue with this. Susan was referred to Kemsley because of the changes in her physical condition and due to ‘non co-operation’, apathy and ‘stubbornness’. When Susan was referred she was dependant for all activities of daily living. She was able to carry out many tasks for herself but chose not to and up until recently she had been mobilising independently. Susan had developed anaemia, a vitamin deficiency and was dehydrated and naso-gastric feeding had been necessary because of this. She had developed oedema of her lower limbs and had bed sores from spending long periods of time without moving. Susan was accepted and came to Kemsley for assessment, leading onto treatment. When she first arrived she presented with quite similar challenges to those experienced in the nursing home over the previous two years.
On admission, Susan was refusing to walk. She was very slow in all activities in all actions, including eating and there was also high levels of perseveration noted in motor and verbal behaviour. Susan was reluctant to engage in conversation or physical activity and would often sit for long periods of time with her head on her knees. She required a high degree of physical assistance to complete most activities of daily living and experienced a unilateral hemi-paresis. There was some physical and verbal aggression, although this was only usually noted when she was being asked to complete an activity which she did not want to. The predominant barrier to Susan’s rehabilitation was her apathy, rigidity and non co-operation.
Following a period of a thorough assessment of Susan’s needs a number of goals were highlighted. Some of these goals were aimed at improving co-operation, decreasing perseveration and improving monitoring skills in order to increase functional independence. Increasing walking tolerance and then speed and gait and also to decrease incontinence. Each of these goals was clearly identified and planned by different members of the multi disciplinary team, however, every member of staff working with Susan was able to utilise aspects and work towards all of the goals. For example a physiotherapist, psychologist and nurse were often involved in aspects of Susan’s self care with the primary goal of Susan becoming more functionally independent with washing and dressing, yet during this self care programme aspects of mobility and self monitoring were also able to be approached.
There were numerous goals for Susan to work towards to enable her to be more functionally independent and to improve her quality of life. Each of these was broken down into small manageable goals to ensure she was able to gain a feeling of achievement. After two years of hard work Susan was walking again with an aid and this helped to reduce the oedema in her legs and helped to ensure that the bed sores that had developed previously did not return. Her continence had improved greatly also helping in the prevention of skin disorders. Susan was taking part in a range of activities again and took a keen interest in news items, regularly reading news papers. As her monitoring had improved she was able to be more functionally independent, meaning that she was able to do more for herself and also taking less time.
Susan reported that she felt enjoyment in activities again, something she had not experienced for some time prior to her admission and for many months as she was working so hard. With the improvements she had been able to make she was able to move to a group home closer to her parents and family, an aspect of her life which was most important to her.