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Brain injury

Case Study: Lynda’s Story

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Lynda’s story provides an uplifting insight into how neurorehabilitation following a brain injury can have positive, long-lasting effects on an individual’s physical and mental wellbeing. This is even when there is a significant time period between the brain injury occurring and starting rehabilitation.

Lynda was an independent woman who had a job, family and friends. However, she had a history of battling with substance misuse and was at risk to the influence of others. The exposure to these negative influences resulted in her suffering a hypoxic brain injury following an overdose in 2010, from which she remained in a coma for three months.

Lynda’s story highlights her dedication and the commitment of the specialist care team at Richardson Care in her rehabilitation journey.

Unique and Supportive Environment

Lynda was admitted to The Richardson Mews in December 2014, more than four years after sustaining her brain injury. The home is run by Richardson Care, a specialist residential care provider in Northampton. What makes it unique is the family atmosphere that is created and the uncompromising commitment to putting the service user at the heart of every decision that is made about their care. Richardson Care is an independent family business with a 30-year track record. Their expertise and experience in creating a homely and supportive environment encourages people with acquired brain injury to engage in their therapies. Combined with a person-centred and innovative approach to care delivered by a multi-disciplinary team, enables Lynda and others, to transform their lives.

Goal-Orientated Rehabilitation

When Lynda arrived at Richardson Care she was wheelchair-bound and she had been told that it would be very unlikely for her to walk again. Her ability to mobilise was minimal: she was only able to mobilise for extremely short distances and required a walking aid. She expressed her wishes to be as independent as possible and to walk again. However, she had little insight into her own physical limitations. Lynda also needed frequent prompting and encouragement with all aspects of daily living (such as personal care).

“The day Lynda arrived she was withdrawn, unable to walk and had limited speech. Lynda has shown great determination throughout her rehabilitation. Today, she has a voice. It is a pleasure to be part of Lynda’s journey.” – Jane Payne, Operational & Clinical Officer

Lynda’s personal care and treatment plan

In addition to her physical disabilities, Lynda presented with behaviours that could be described as challenging. The multi-disciplinary team at Richardson Care worked with her to devise a care and treatment plan that would address her physical, behavioural and emotional needs.

The following gives us an insight into some of the different elements of her care plan, that when consistently applied, lead to lasting benefits. They are helping Lynda towards her goal of independence.

  • Psychology input – Cognitive Stimulation Therapy, Relaxation Group and 1:1 sessions that focus on improving and maintaining her emotional well-being. She is encouraged to use her coping mechanisms when facing challenges, and staff are aware of her early warning signs. These sessions also provide Lynda with the opportunity to discuss any issues or anxieties and receive reassurance and positive feedback on her behaviour.
  • Physiotherapy input – weekly physiotherapy sessions to work on balance, strength and stamina and to help maintain flexibility. They focus on improving Lynda’s physical well-being and strength, working collaboratively to reach her goal of independence.
  • Positive Behaviour Support (PBS) Approach – care plans, risk assessments and intervention guidance; working with Lynda to recognise and reinforce positive behaviours and increase her independence.
  • Consistent support from care workers enables Lynda to develop and maintain a good therapeutic rapport with staff, helping her to manage her surroundings and behaviour.
  • Social and environmental influences offered at Richardson Care allow Lynda to utilise her independence and build confidence. These include: meaningful activities, consistent structure and routine, trips to the community with staff support, opportunities to socialise and build positive relationships with other residents and staff.

Progress and Current Presentation:

Throughout her time at Richardson Care, Lynda’s strive for independence has been a prominent motivating factor for her. This is reflected in the significant progress she has made at every stage of her rehabilitation.

In 2019 (after being at Richardson Care for around four years) Lynda reached the stage where her strength, balance and confidence had been built to a level where she could walk independently with no aids. Throughout her physiotherapy sessions, staff adopted a person-centred approach to maintain engagement and compliance and to work with and around her cognitive difficulties. This approach has proved extremely effective with Lynda and has increased both her physical and mental well-being.

Timed Up & Go Test

“Lynda is the prime example of how a person living with a brain injury can still make considerable physical improvements given the right environment and therapy approach. Lynda was not in the early stages of her rehab and her injury was more than 12 months prior to coming to The Richardson Mews.” – Guy Stewart, Physiotherapist

The graph below provides a visual representation of Lynda’s substantial progress whilst at Richardson Care. The ‘Timed Up and Go Test’ is used to monitor Lynda’s improvements in walking 12 metres unaided, where the average time is taken from three attempts.

On admission in 2014, it took around 60 seconds for Lynda to complete the test. There was then a significant improvement in the following year and her average time decreased to 28 seconds. The years following have continued to see small improvements.

The most recent test, completed in January 2021, reported an average time of 14.90 seconds. Despite Lynda’s average time only being 0.35 seconds quicker than the previous year, it highlights how she is maintaining her mobility status and not showing decline. This is a vast achievement considering the restrictions in place due to the pandemic that has ensued between these two time points. Even with the limited access to physiotherapy and a reduced opportunity to go outside for walks, Lynda has remained consistent and motivated in her recovery with the support of her care team.

Emotional Well-being

In addition to her physical progress, Lynda has been supported by care staff and the psychology team to ensure the quality of her emotional well-being and improve her resilience. Lynda still requires support to build a healthy resilience to stress by using effective management techniques, particularly regarding her experience of health anxiety, and this is less frequent.

Through psychology sessions, such as relaxation and 1:1 coping skills sessions, Lynda has developed a good inventory of skills to use when experiencing frustration or anxiety. She appears to have developed more insight into her emotions, knowing when to seek out staff support. This has aided in the development of self-esteem, confidence and resilience.

“Lynda has become a part of The Richardson Mews family and I have witnessed her growth since her admission. When Lynda first came, she was told she would not be able to walk and would be wheelchair bound. Now she can walk without any support. Lynda is very bubbly and always welcomes new residents with open arms. The day she leaves will be a sad day for The Richardson Mews, but it will be good to see her progress and she deserves to live the life she wants.” – Gill Ayris, Admissions & Referrals Manager

Daily Living Skills

Lynda continues to make significant improvements in her daily living skills; these include cooking her own meals with little support, and under normal circumstance, attending the local swimming pool, visiting the local shops to complete her shopping, going to cafes for coffee, going to bingo and socialising with staff and residents. She often encourages other residents during group activities.

Lynda secured a part-time paid job at Richardson Mews, where she completes office tasks. This is in line with her ASDAN (Awards Scheme Development Accreditation Network) courses, which she thoroughly enjoys and shows dedication to.
Challenging and Risk Behaviours

Lynda is a caring and empathic lady. She is usually calm and pleasant but at times presents with behaviours that can be described as challenging. These behaviours highlight her vulnerability and her impulsivity. However, the positive interventions and consistent staff support offered at The Richardson Mews is contributing to a reduction in such behaviours.

Lynda could be viewed as a model resident at The Richardson Mews where she continues to progress in her rehabilitation journey. The continued staff support she receives, coupled with her own determination means it is reasonable to say that her goal of moving on to supported living in the future is well within her reach.

Lynda’s Comments:

“I love it here and I have grown as a person, but I am ready to move on all because of the decent services I have received here.”

“I love having physio, the food is lovely, and the staff are very friendly and I have achieved a lot with Sallie (ASDAN coordinator) and gotten loads of certificates.”

To find out more about the unique and specialist residential services provided by Richardson Care, call 01604 791266 or visit www.richardsoncares.co.uk

Brain injury

‘I’m sorry for handling the steering wheel with buttered fingers’

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As he continues to come to terms with the loss of his ‘ex life’ and learns to celebrate the 21st birthday of his new self, The Brain Damaged Baron reflects on the comfort blanket of support from those close to him, while struggling with the loss of vanishing friends

 

Let’s get straight down to business.  The salient truth is that one day, the life I once knew came to an end. Yep, gone, cheerio, toodle pip.

It is an ex-life. It has ceased to be, I trotted off this mortal coil in order to push up some buttercups. Is it buttercups? I forget. 

It was so very difficult, sometimes impossible, to comprehend that all I knew had gone. That sentiment only increased over the years and there have been 21 of them. Twenty-one long years.  My new life has matured and is now old enough…

To vote – when it remembers to.

To drive – it can’t, partial blindness caused by the brain injury would make driving an absolute lottery.  That and the complete lack of spatial awareness. After all, I can’t walk down the street without colliding with lampposts. I wouldn’t be safe in a bubble wrapped bumper car. I’m not sure the roads of the UK are ready for me just yet.

To drink alcohol – it can’t, epilepsy denied that pleasure. Due to medication, I feel half-drunk most of the time anyway. Without alcohol, I have the memory of a goldfish with Alzheimer’s disease. I hardly need the odd libation to wipe what recall I do have. 

To have sex – if I can stay awake long enough. I’ll say no more. It was all I could do to prevent myself typing ‘stay up’ long enough. Ooh-er, Mrs!

And it’s now old enough to know what the hell happened to me.  And is still happening right up to this very day.

That’s the nature of a bang on the bonce; confusion.  

Massive disorder in my mind, incomprehension shadows me like the gloomiest raincloud preparing to unleash a deluge of perplexity. I know it’s there, it’s always there. The monkey on my back, the albatross overhead, the angry weasel with a chip on its shoulder.   learnt to live with it. 

That and the ability to invent nonsensical idioms. It’s a gift.

However.

Back in the day, long before I became 21 again, it began.  The curtains were closed, slammed shut. Well, to be fair, they were curtains, not so much ‘slammed’, but more ‘flopped’.  They needed opening, I had to let the day begin.  And commence it did, as the flaccid curtains were swept aside and the hard graft started.

While I was hurting, while I was struggling, while I was learning, there were other people around. There still are, every day. It’s just a question of tenses really.  

Watching, witnessing, feeling my pain. Either on the side-lines or directly involved, family, friends, all observing the effects. Mostly it was no spectator sport, it was grim viewing, if I am honest. And still they remained, standing by with a collective arm outstretched.  

Twenty-one years later and it’s still there. A comfort blanket, a safety net cushioning the unavoidable falls.

It’s a whole new world out there, and that world has a habit of biting back. Sometimes it is just a nip, although occasionally, it’s like a bite from a hungry shark. And those nibbles come thick and fast. Each bite eroded away my former self and ate away, no pun intended, at the life that had sadly departed.  All the while…

Watching, witnessing, feeling my pain…

There are so many bites that they all seem to merge into one. Remembering can be exhausting beyond belief. I had never thought it possible to get so drained, so shattered simply from attempting to recall what the day is.  

Another aspect of my life that my previous self had taken for granted. There was never any reason not to. I was a 25-year-old man and it didn’t seem a lot to ask to remember where I kept my keys. It was never a conundrum.  

However, after the injury, I could then forget where I kept my pants and socks, let alone my keys. Not when I was wearing them, obviously; my pants and socks that is, not my keys.  

And with the exertion of something as basic to a human being as ‘thought’ came the inevitable headaches. The first to strike shook me to my very core. It smarted, just a tad.  They continue to this day, bless ‘em. 

Almost a year after the old brain took its battering and continued to fight the good fight, epilepsy was thrust into my life. The unwanted gate crasher causing havoc with every appearance. A lightning bolt from the deepest blue. Body spasms, unconsciousness, confusion, memory lapses, post seizure headaches that make the usual head pains seem like old friends.  Well, it keeps me on my toes.  And still…

Watching, witnessing, still feeling my pain. The outstretched arm remained, absorbing the anger and feeling my frustration. 

Fatigue and apathy soon entered the fray. More undesirable visitors cluttering an already overloaded brain. They pushed aside my old friends ‘eagerness’ and ‘concentration’ as ‘alertness’ looked on with all the subtlety of a slightly annoyed bricklayer wielding a sledgehammer. Oh, he had anger issues too.

The passage of time was a cruel mistress. Particularly when my addled brain was struggling to establish some form of normality… whatever that may be.  

My life in its entirety had altered beyond recognition. Epilepsy could now strike without warning at any given moment, throwing the day into chaos. Fatigue that plagued almost every aspect of my life began to throw up barricades.  

It was hard to live with what I had become.  To live in the present and not rely on the past.

And still they watched, witnessed, felt my pain. And for some, it was too much, too difficult, too much like hard work. 

Relationships ended and friendships broke down. Ultimately, people vanished. They had their reasons, I was never told what they were, but I’m sure they had them. Occasionally I had the courtesy of an invented tissue of lies that possibly salved their own conscience, but only served to batter my own into submission.

Relationships with everyone in my life, friends, new acquaintances, and even the odd member of my family, seem to be based on the flip of a coin. 

Should a ‘Head’ land on terra firma and whatever my brain throws into the mix, they’ll hang around. Should a ‘Tail’ drop gracefully to the ground and they’ll turn that tail and run for the hills.  And that’s how it’s been since the day I landed on my cranium with one hell of a thud.  But wait a moment here…

I like to think I’m not a stupid man, I pride myself on it in fact. I’m 46-years-old now, time is marching on relentlessly like a runaway train with only one destination.  

I’m married to my best friend, a couple of children have their place in my life and I’m still learning more about my own limitations and abilities. Only one thing has remained constant throughout the journey that became my second shot at this rollercoaster we call ‘Life’. That damn scar on my brain still throws its weight around whenever it fancies a bit of a giggle. And thus…

I still forget things with frightening regularity.

I can’t control my emotions like I should.

Background noise irritates me to the point of exasperation.

I still invent idioms like a ferocious aardvark with a knuckleduster.

I may have a seizure with varying degrees of severity at any given moment.

Fatigue is a pest that simply won’t leave me be. And sleep is my panacea.

I can’t socialise like I once could.

I can’t drink, I can’t drive.

I am no longer the ‘me’ I once was. And do you know what? I no longer care. I wouldn’t change one God damned thing.

I throw out these statements with gay abandon, almost on a whim.  The fact remains that while I was coming to terms with the throwaway facts, those people close to me WERE watching, they WERE witnessing and they WERE feeling my pain.  

For instance, let’s start at the very beginning. I was in a coma in hospital. Essentially, I was asleep, just for a smidgeon longer than usual. I always was a lazy sod. While I slept, my family and friends sat at my hospital bedside wondering whether I would live or die. I had it easy, I really did. I still do.

The first epileptic seizure and every single one since sees my good self disappear into another world for however long, while whoever is there can only watch, wait, and worry.  Again, I repeat, I have it easy.

I have a wife I adore. The lady who came along and turned out to be the missing piece in my jigsaw. Who knew? The rock to my roll, the milk on my cornflakes. Much like my friends and family who were there long before that missing piece arrived, she tolerates the moods and the headaches.  She lives with the forgetfulness, the now thankfully muted anger, the annoyances, etc. They’re all part of just another day.

Twenty years of watching and worry. Good grief, I’m so sorry for putting you all through this journey, none of you asked to be passengers, you really didn’t. You still don’t, you never so much as complain. I certainly didn’t want to be the driver and I’m sorry for handling the steering wheel with buttered fingers…

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Brain injury

Sleep problems ‘can be worse with mild TBI’

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Sleep disorders are more prevalent among people with mild traumatic brain injuries (TBI) in comparison to those with more a severe diagnosis, new research has revealed. 

In the study, the links between TBI and sleep problems were strengthened further, with people with TBI shown to be up to 50 per cent more likely to develop insomnia, sleep apnea and other sleep disorders than people who have not been injured. 

And in a significant outcome, the association with sleep disorders was stronger amongst those with mild TBI than in the case of serious injury. 

The research also showed that the risk for sleep disorders increased for up to 14 years after a brain injury – showing the need for the impact of TBI to be assessed in the long-term, said the research team from the University of California. 

“Clinicians should ask TBI patients about their sleep and they should follow that up,” says study investigator Yue Leng, assistant professor in the university’s Department of Psychiatry and Behavioral Sciences.

Data was analysed from 98,709 Veterans Health Administration patients diagnosed with TBI, alongside an age-matched group of the same number of veterans who had not received such a diagnosis. The mean age of the participants was 49 years at baseline, and 11.7 per cent were women. Of the TBI cases, 49.6 per cent were mild.

Researchers assessed a number of sleep disorders, including insomnia, hypersomnia disorders, narcolepsy, sleep-related breathing disorders, and sleep-related movement disorders.

During a follow-up period that averaged five years but ranged as high as 14 years, 23.4 per cent of veterans with TBI and 15.8 per cent of those without TBI developed a sleep disorder.

After adjusting for age, sex, race, education and income, those who had suffered a TBI were 50 per cent more likely to develop any sleep disorder compared to those who had not had a TBI. 

The association with sleep disorders was also found to be stronger for mild TBI than for moderate to severe TBI which, say the research time, might be due to differences in the brain injury mechanism.

While the study was conducted with veterans, the research team expected to find an increase in probability of sleep problems in those with PTSD. 

“But actually we found the association was pretty similar in those with, and without, PTSD, so that was contrary to our hypothesis,” says Leng.

The researchers could not examine the trajectory of sleep problems, so it could not be concluded whether sleep problems worsen or get better over time, she adds.

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Brain injury

Women ‘more likely to have long-term issues after concussion’

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Women may be at increased risk of long-term physical and mental issues after a concussion, a new study has revealed. 

In analysis of 2,000 people who sustained a head injury, women were found to be more likely than men to still have some symptoms a year later. 

These included memory and concentration problems, alongside headaches, dizziness or fatigue. 

Women between the ages of 35 and 49 typically had worse symptoms than both younger and older women, the research found. 

The study revealed that in other traumatic injuries, men and women’s recovery times were similar – the main area of disparity was in brain injuries.

While this research cannot answer the question as to why this happens, says lead researcher Professor Harvey Levin, from Baylor College of Medicine in Houston – it is possible, he says, that chronic inflammation in the brain tissue or hormonal influences play a role.

The brain has receptors for oestrogen, and previous research has indicated that women who sustain concussion at certain times in the menstrual cycle tend to have a slower recovery.

It also builds on previous research which has also pointed to sex differences in concussion recovery. 

Writing an accompanying piece to the study, which was published in JAMA Network Open, Martina Anto-Ocrah, an assistant professor of emergency medicine and neurology at the University of Rochester Medical Center, says it strengthens the case that women’s slower recovery is related to concussion. 

“We expect most patients to recover within weeks,” Anto-Ocrah says, adding that about 90 per cent have largely recovered within three months.

But in the study, women did have higher rates of depression and anxiety diagnoses before the concussion, compared to men. And those are risk factors for prolonged concussion symptoms, Anto-Ocrah adds.

However, the researchers accounted for depression and anxiety, and those diagnoses did not seem to explain women’s more persistent symptoms.

Some women, Anto-Ocrah says, encounter scepticism when they tell their doctor they are still having concussion symptoms many months after the injury.

“This is additional proof that it’s not all in your head,” she adds.

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