Case study: Keith’s story

Keith’s story illustrates that recovery from brain injury is rarely a linear path. It is a complex combination of physical, emotional and psychological recovery, requiring ongoing support and commitment.

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1. Background

Keith was a popular young man with a supportive family, friends, hobbies and a promising career. Tragically, he sustained a traumatic brain injury and was initially treated in various hospitals whereby he made a significant physical recovery. However, he still suffered from the mental and cognitive effects of his brain injury and was subsequently admitted to various mental health and residential care settings before moving to Richardson Care.

2. Admission to Richardson Care

Keith arrived at Richardson Care nine years after sustaining his brain injury. He presented as low in mood, was quite withdrawn and would only occasionally participate in social or group activities.

He had been prescribed a range of PRN medications due to his behaviour being ‘hard to manage’. This made him appear quite drowsy and vacant, his speech was slurred and it was difficult to connect with him, which upset and shocked his family.

In addition, Keith found it difficult to manage his emotions, especially if he was feeling frustrated.

3. Current Presentation

After three years at Richardson Care, Keith is a changed man. He has been back home for the first time since his accident, and thoroughly enjoyed meeting up with his family and old friends. He has a paid role at Richardson Care and does voluntary work as part of a community project. He has an active life, going swimming and to the gym, and is well-liked and respected among the other residents and staff. He is keen to engage with other people, always greeting you with a smile and is polite and friendly in his interactions.

He has made good progress with his daily living skills and regularly cooks his own meals, only requiring minor prompting.

4. Therapeutic Interventions

Keith receives regular reviews and psychological assessments, which inform his ongoing care plan. Working in conjunction with his family and social worker, the multi-disciplinary team at Richardson Care put a care plan in place with more emphasis on psychological therapies, aiming to reduce reliance on pharmaceuticals and a move away from PRN medication.

The psychology team at Richardson Care is headed up by Consultant Clinical Psychologist Dr Pedro Areias Grilo, who is supported by three Assistant Psychologists. The Assistant Psychologists are available onsite every week day to support service users in both one-to-one and group sessions.

5. Cognitive Development & Managing Mood

Keith’s low mood had become a barrier to him achieving his rehabilitation goals, so the Psychology team worked with him to help him initiate coping strategies around his low mood. He also receives consistent support from the activity support workers, which help him to manage his mood and engage in other therapies and activities.

Keith practices his cognitive skills with the support of the psychology team. For example, using Rehacom®  – an adaptive computer-based cognitive rehab programme, which he enjoys, plus a range of other applications.

Keith also engages in group Cognitive Behaviour Therapy, where he discusses topical issues with other service users and experiences real moments of clarity.

He still experiences low mood, but is better able to reflect on his anxieties and frustrations, developing ways to counteract these feelings and knowing who to go to for support.

Keith fully engages in his goal-setting sessions and strives for more independence.

*We have changed the name of the service user to retain his anonymity

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