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.
1. Background
Keith was an active, sociable young man with a promising future. He played the drums, loved being outdoors and was about to start a new job when, tragically in his mid-twenties he sustained a traumatic brain injury.
Following the accident, he was treated in various hospitals and made a significant physical recovery. He was then admitted to various mental health facilities and care homes before moving to The Richardson Mews nine years after his injury.
2. Admission to Richardson Care
Prior to his arrival at Richardson Care, Keith was prescribed PRN medications as he was said to be ‘hard to handle’ without them. His parents were shocked at this. They noticed that his speech was slurred and that it was often difficult to connect with him. He could, at times appear quite drowsy and vacant.
His mood was often low and his ability to manage his emotions would fluctuate, particularly when he became frustrated. He was quite withdrawn and would only occasionally take part in social events or group activities. He also needed encouragement and prompting to carry out daily tasks.
On his admission to The Richardson Mews staff provided Keith with frequent reassurance to help support him with regulating his emotions and prompting and encouraging him with daily tasks.
Taking a more holistic approach incorporating more psychological interventions helped Keith to manage his low moods and challenging behaviour. This was soon effective in enabling a shift away from PRN medications.
3. Person-centred Approach
At Richardson Care, service users benefit from the support and guidance of an onsite multi-disciplinary team as well as 24/7 activity support staff. This enables each individual to receive person-centred care and rehabilitation, working with the team towards their personal goals. Keith receives regular reviews and assessments that inform his care plans and ongoing intervention guidance.
Within 18 months, Keith was a changed person: He had become more positive and confident, keen to engage with staff and other service users, and always polite and friendly.
4. Therapeutic Interventions
A Positive Behavioural Support (PBS) approach is taken with all service users at Richardson Care. This involves care plans, risk assessments and intervention guidance created in collaboration with Keith to recognise and reinforce positive and adaptive behaviour, thus increasing independence.
The psychology team at Richardson Care work with Keith both in one-to-one and in group settings. These sessions are aimed at improving his cognitive skills and mental wellbeing. They support him with coping skills to use when he is feeling low or frustrated as well as providing a safe space for him to discuss any worries or issues.
These therapies include Cognitive Stimulation Therapy, Cognitive Behavioural Therapy, psychoeducation, goal setting and computer-based cognitive rehabilitation.
One of the psychology team reports: “Keith responds well to emotional regulation techniques such as grounding exercises, breathing strategies and the use of structured coping tools, which support him to manage his emotions more effectively during periods of distress. He particularly benefits from regular psychology check-in sessions, as these provide him with a safe and consistent space to explore his thoughts and feelings, reflect on challenges and receive reassurance.”
This support has contributed to improved management of his mood and behaviour, with Keith demonstrating increased emotional awareness and a greater ability to respond to situations in a calmer and more regulated manner. Overall, Keith’s engagement in therapy has had a positive impact on his emotional wellbeing and day-to-day functioning.
5. Milestone Achieved
An important milestone for Keith, was to go back to his family home, which is outside the UK. He is now supported to visit his parents and siblings on a regular basis. Remaining close to his family, he has a Zoom call with his parents each week.
Six years after arriving at Richardson Care (and 15 years post-injury) Keith lives an active life. He goes out for a walk most days, goes shopping and cooks meals for himself a couple of times of week with minimal help. He goes to the gym, volunteers at a local historic garden and still enjoys music – he has a 1:1 music session each week as well as engaging in group music enrichment sessions. He sometimes joins in with bowling sessions as well as the many activities taking place within the home. He still needs to manage his fatigue, and enjoys watching films in his room. He is also able to remove himself from noisy or over-stimulating environments when he needs to.
*We have changed the name of the service user to retain his anonymity
