Placing You at the Centre of Care

Case Study

EW | Brain Injury | Winchester

August 2, 2024

EW lives with her partner Dave in a 3 bedroom rented house. She is a mother to 5 children and grandmother to 11 grandchildren. EW used to work full time as a public relations officer. Elaine loves to see and socialise with her family and friends. She enjoys cooking, watching films and eating out.

Main Areas Affected

• Reduced balance and mobility resulting in walking with a stick and one other person
• Poor conversation and initiation talking to family and friends
• Significantly poor memory and memory recall
• Poor planning and organising skills with an inability to think flexibility
• Reduced vision and figure ground skills
• Significantly impaired orientation and recall of family and friends
• Involuntary global tremor at rest
• Increased levels of anxiety and poor confidence
• Reduced concentration and attention
• Assistance needed with all Activities of daily living

Functional Ability on Admission

• Assistance with all activities of daily living
• Verbal prompting and assistance with cooking and meal prep and orientation within
kitchen
• Assistance and constant verbal prompting with morning routine including washing,
dressing and self-organisation
• Full assistance to support communication and memory recall through the day
• Assistance of one when mobilising indoors and outdoors
• Significantly poor orientation to day, date, year and place
• Significant levels of fatigue

Hobbs Rehabilitation Input

Hobbs Rehabilitation provided EW with regular weekly therapy for 2 blocks of 40 hours over the past 8 months with transitional periods in between. Therapy took place in Hobbs Winchester clinic and at home and in her local community. A final 4 home visits were completed carrying out joint transitional work with EW’s new carer to continue her rehabilitation.

Occupational Therapy
• Focused on her functional goals, increasing her confidence,
participation in daily activities and orientating her within her own home
• Using cognitive strategies to practicing the use of her mobile phone
• Engaging in meal prep and cooking
• Accessing her local shops and community

Physiotherapy
• Focused on balance work, walking unaided indoors and outdoors
• Reduced overuse of shoulders and increasing strength in upper limbs

Speech and Language Therapy
• Focused on building up conversational skills, use of mobile phone to generate words, messages and initiate conversation with family and friends
• Looking at information processing through reading, writing down key information to support her cognitive communication difficulties and poor memory

Functional Ability on Discharge

• Independent choosing own clothes, dressing and following an independent morning routine
• Independently making self and partner a hot drink and breakfast
• EW is able to prepare and cook a main evening meal with the use of written instructions and verbal prompting only
• EW is able to write a shopping list with verbal prompts and walk to the local shop to buy items with supervision and verbal prompting only
• Independently use written prompts to orientate self to daily routine and weekly structure
• EW’s confidence has significantly improved when completing daily tasks without prompts to initiate
• Able to independently answer mobile phone, prompting needed to call on her phone with
on-going practice needed
• Able to independently mobilise indoors with use of stick and minimal supervision when
outdoors
• Increased engagement in conversation with family and friends and ability to read and
discuss information
• EW now has a full time carer in place at home to continue rehabilitation, as partner has returned to work full time

Outcomes

Berg Balance
60% Improvement
FIM/FAM
100% Improvement
Over all confidence significantly improved

Goals

To be able to make a phone call to Dave with scaffolding from the SLT and use of prompt cards
Achieved
Increase confidence walking without walking stick
Achieved
To be able to recall the key events of a short magazine article with scaffolding from the SLT
Achieved

Testimonial

Thank you for being so kind and helping me so much. You are so wonderful and because of all of you I have come so far on this journey, with all our love Elaine and Dave

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