Andrew's story

Providing specialist neurorehabilitation for people with an acquired brain injury (ABI), Priory Elm Park, in Essex, aims to reduce challenging behaviour and optimise functional skills, including increasing social engagement through the provision of a graded independence programme.

We provide a full discharge pathway including inpatient rehabilitation, transitional rehabilitation, community rehabilitation, as well as inreach and outreach services.

Presentation on admission

Andrew*, aged 65, was first admitted to Priory Elm Park, in 2017 with an ABI caused by a ruptured brain aneurysm which resulted in a subarachnoid brain haemorrhage. Following his ABI and initial treatment in a general hospital, Andrew had become frustrated, angry and confused by people and things around him. He found himself unable to remember how to carry out simple tasks and failed to remember his own children and grandchildren. Andrew had become aggressive
and emotional in the family home.

Andrew was in need of a rehabilitation programme to address his memory deficits, and increase his cognitive and processing abilities. He needed support to carry out activities of daily living so that he could be discharged home to his family in a safe, sustainable and timely manner.

Care pathway

After his 12-week transdisciplinary team assessment at Elm Park, followed by an initial rehabilitation and treatment programme, Andrew quickly moved through the discharge pathway to Elm House. There, he was able to continue his specialist rehabilitation programme. Elm House is one of the specialist community rehabilitation houses in Essex and a step-down service linked to, and supported by, Elm Park.

Specialist rehabilitation programme

Andrew was immediately supported to develop his daily living skills, processing skills and socialisation. With staff prompts, he quickly established a routine and began to do his own laundry, cleaning and shopping.

Andrew’s rehabilitation programme also focused on his cognitive functioning. A programme of errorless learning was implemented to establish a baseline of information, to support Andrew to remember
his family.

The team worked with Andrew on a daily basis to reiterate essential information. Each day they would:

• Talk to him about his family
• Write the names of his children and grandchildren
  on his memory board)
• Talk about the things he had liked to do with them
  before his accident.

Initially, Andrew was shocked every day to learn that he had children and grandchildren. However, over time and with the persistence of the programme, Andrew began to remember and engage with his family.

Family support

Andrew’s wife Jane*, who worked full time, lacked confidence in her abilities and was very concerned that she would not be able to cope with Andrew’s needs at home.

The team also acknowledged that Jane was grieving for the husband that she once knew, and for their life and relationship which had changed dramatically as a result of Andrew’s injury. To support Jane, the team worked with her to understand more about ABI and the changes that this made to Andrew’s personality and abilities.

• A routine of regular telephone communication was established
• The team supported Jane and her family with 1:1 support. At the beginning, Andrew spent short periods of time with his wife and family
• Home visits lasted for 2 hours (duration increased over time); staff were present and observed Andrew’s interaction with his family and grandchildren.

Initially, Andrew found it very overwhelming to visit his family and he became aggravated, confused and tired. However, by increasing the visits slowly over time and decreasing staff presence, Andrew was able to engage with his family alone and in a meaningful and safe way. Jane, in turn, built up her confidence in being able to support Andrew and keep him safe.

Returning home

Andrew’s transition to his family home took place over six months. It was a long transition to enable Andrew to re-engage with his family including his grandchildren, and for his family to build up the confidence they needed to support him at home.

Andrew now enjoys retirement at home with his family. He enjoys looking after the many household pets, going for walks with his family, carrying out DIY projects around the house, gardening, and taking his grandchildren to nursery on the bus.

*Patient’s name has been changed to protect their identity