Andrew's story

David's* story of recovery - Highbank's adult services

David, a 22-year-old man, was admitted to Priory Highbank Centre for neurorehabilitation following hypoxic brain injury, caused by an overdose. He was admitted to Highbank from a major trauma centre, with the following presentations and needs:

• Prolonged disorder of consciousness (MCS+)
• Profound cognitive impairment Emotionally labile
• Paroxysmal sympathetic hyperactivity (PSH)
• Percutaneous endoscopic gastrostomy (PEG) tube
• Continence management programme
• No established method of communication
• Established fixed contractures
• Lacked capacity for admission, care and treatment

On admission to Priory Highbank, which includes a neurorehabilitation consultant, physician, occupational therapy team and physiotherapy, all work collaboratively and, David presented with complex physical and psychological needs.

It was clear that he needed the skills and expertise of an experienced neurorehabilitation team to assess and establish an appropriate slow stream rehabilitation programme for him. The specialist interdisciplinary team at Highbank Centre reviewed David’s prolonged disorder of consciousness using formalised assessment tools. He fulfilled the criteria for emergence, and was deemed to no longer be in a prolonged disorder of consciousness.

Episodes of PSH, which included hypertension, tachycardia, profuse sweating and physiological distress, were managed through appropriate pharmacologic management, a sensory programme and suitable pain management. This significantly reduced David’s distress. David’s fixed contractures made his positioning, seating and general posture very difficult and painful, and he needed two or three people to mobilise and re-position him safely.

Our consultant ensured that David received the correct medication , and our occupational therapy team made bespoke splints, casts and seating, to ensure that David suffered no further deterioration. Our physiotherapy team also developed a bespoke 24-hour posture management programme for David, which helped his positioning, chest management and skin integrity.

Emotional support and psychological strategies helped to promote David’s wellbeing during his rehabilitation programme. David was able to access the community regularly, and was able to engage in social activities of his choice, which also involved his own family. With regular reviews and input from dietetics, the nursing team, and speech and language therapy, David achieved a normal diet and fluid intake, along with being able to take his medications orally. This meant that David’s PEG tube could be removed.

Our team also supported David to achieve his communication goals, and he gained the ability to verbally communicate all of his needs. This allowed him to make decisions about his care and treatment, and ultimately become the decision maker in all aspects of his discharge planning.