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The effects of brain injury are complex and varied, causing a range of physical, psychological and mental health difficulties. A brain injury can affect someone’s personality and behaviour as well as their cognitive abilities and mental health – and all of these aspects can be inter-related, creating additional challenges.

Consultant Neuropsychiatrist, Dr Seth Mensah, is a key member of our team, supporting service users by treating and managing a range of mental health conditions. Here he gives his view on acquired brain injury rehabilitation.

“It has been widely established that acquired brain injury can result in significant and lifelong psychiatric and neuropsychiatric complications, which are responsible for at least as much disability as the associated physical symptoms.

These psychiatric effects of ABI: (i) interfere with rehabilitative interventions, (ii) are often associated with risks such as family disintegration, loss of accommodation, reduced access to rehabilitation or community facilities and conflict with the law, and (iii) more importantly, affect the survivor’s ability to function autonomously following their discharge from structured medical rehabilitative settings and place untold limitations upon their attempt to reintegrate into family and community life.

Neuropsychiatric disability, as sequelae of acquired brain injury, often limits participation in post-acute neurorehabilitation, which consequently leads to failure to exploit and attain the full potential for recovery for the survivor of brain injury. For families, this poses difficulties in terms of acceptance and adjustment.

Hospital-based and community-based rehabilitation, the goal of which is to help the survivor of brain injury achieve the maximum degree of return to their previous level of functioning, is therefore particularly crucial for those who develop neuropsychiatric disability.

Richardson Care blends an enabling and safe environment together with a very highly skilled and experienced specialist multidisciplinary clinical and care team where the service user, the survivor of acquired brain injury, is at the centre of all care, treatment and rehabilitation. This sets Richardson Care apart from many other community-based acquired brain injury health and care providers across the United Kingdom.”

Dr Seth Mensah MB ChB, MSc, DPM, MRCPsych
Consultant Neuropsychiatrist


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Activities of daily living require a huge range of cognitive skills, which we develop from childhood as we grow. However, someone who has an acquired brain injury has to re-learn many of these skills. At Richardson Care we take an holistic approach, where members of our clinical team work with each service user to develop the skills they have lost. These include communication and cognitive skills, physical abilities and mental well-being.

In addition to the therapeutic interventions from the clinical team, our service users take part in a wide range of daily activities, depending on their personal preferences. We aim for these activities to be fun and inclusive, catering for a wide range of skill levels and tastes so the service users enjoy the activities and engage in them. These activities support the work of the therapists, without actually feeling like therapy, and can have a positive and lasting effect.

During the coronavirus pandemic, we have had to be more resourceful and creative as our service users have not been able to access the local community for their usual range of activities. This has meant providing a varied schedule within the home, and these ‘science experiments’ were an imaginative way to support cognitive skills in a group setting.

Experiment 1: Travelling Rainbow Water
This simple experiment shows colours travelling through kitchen roll and mixing together to make new colours. We started with three cups of water, one red, one blue and one yellow. We separated the cups of coloured water with empty cups and connected them all with kitchen roll. It takes a bit of time for the magic to happen, but the group were very patient with the experiment and the results were definitely worth the wait.

Experiment 2: Storm in a Cup
With water, shaving foam and food colouring, we recreated the science of the rain clouds! We half-filled our cups with water and added a layer of shaving foam, ensuring it floated flat above the water. We then added coloured water, drop by drop to the shaving foam. When the water became too heavy for the foam, the sudden swirling clouds of colour sparked plenty of gasps and giggles.

Experiment 3: DIY Lava Lamps
We made our own lava lamp reactions using vegetable oil, water, food colouring and an Alka-Seltzer tablet – the contents of the cup bubble around together mimicking the reaction of a lava lamp.

This activity lasted for over an hour and all service users who took part were engaged for the entirety of the session and helped to clean up afterwards. This activity promoted cognitive skills such as reading and following instructions, patience, coordination, listening to direction, creativity and curiosity. Members of the group were also encouraged to think about how the reactions worked. A number of them commented on the difference weights of the materials in the Storm in a Cup activity, how the materials separated in the DIY Lava Lamps and how the tissue paper absorbed the colour to make the Travelling Rainbow Water.


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Each service user at our specialist residential care homes has their own individual care plan, which is designed to provide therapies and activities to meet their needs and help them to reach their personal goals. These therapies may include psychological support, psychiatry, speech & language therapy, occupational therapy, physiotherapy as well as exercise and activities of daily living. Our aim is for these activities to be enjoyable and stimulating; not to necessarily feel like ‘therapy’ but to be part of the individual’s weekly routine.

One of the psychological therapies we provide is Cognitive Stimulation Therapy. It’s a weekly group activity and each session has a different focus, for example current affairs or creativity. Cognitive Stimulation Therapy aims to promote and reinforce growth in areas such as memory, concentration and communication. It also stimulates social interaction, increases confidence and well-being. The Cognitive Stimulation Therapy sessions are designed to be fun, and are person-centred, tailored to meet each individual’s needs and preferences.

In this blog post, we take a look at a recent Cognitive Stimulation Therapy session for some of our service users who have an acquired brain injury; what the session involves and how it benefits the individuals taking part. The session starts with orientation: reinforcing the time, date, place, season, etc. Then moves on to the activity of the week.

This time it’s creativity: making personal globes.

Each service user started by making their own personal paper mâché ‘globe’. This involved lots of PVA glue and tissue paper, stuck onto an inflated balloon. The service users chose the colours they wanted and got stuck in with the creative mess. This particular session was attended by several residents who don’t often engage in group activity, so this was amazing progress.

Once the paper mâché was dry, we popped the balloons and asked the guys to illustrate the globe with pictures that represented them as people. The results were quite amazing! On this occasion, Assistant Psychologist, Olivia, ran the session and was supported by Admissions Co-ordinator, Ebony. They had spent some time sourcing lots of images that may resonate with the service users, such as images to convey emotion, relationships, hobbies, family, careers and their brain injuries.

They jumbled all of the images around and, without much direction, the individuals started to pick out the images that spoke to them. This was such a great activity: it enabled the service users to express elements of their lives before their injuries and who they are as a person. As you’d expect, there were huge variations – one resident looked for an image of a diamond ring to represent his engagement, while another illustrated his many years as a taxi driver and love of chicken!

Ebony worked on a 1:1 basis with Andy*. He picked out the images and Ebony prompted him to think about why he chose them and how they resonate with him as an individual. This is what he said.

Smiling face: “I like this because he’s laughing. He represents my humour”

Water: “Because I love to swim.”

Glasses: “I wear glasses: they represent me physically.”

Watering can and growing plants: “Because I really like gardening – it could represent personal growth too”.

Couple in love: “This one represents my need to love and be loved. I would really like to get married one day.”

Hard hat: “This represents my former job as a labourer and how I really want to get back to work. I’d like to be a plumber or a bricklayer.”

Dog: “This represents my family dog and my love for animals.

Two men hugging: “This reminds me of my Dad. I have a very close relationship with him and it’s important to include this – he has grey hair too!”

Knife and fork: “I’m a typical man, always thinking about food!”

Yin and Yang: “I associate this with Thai Chi martial arts – my Dad teaches Thai Chi.” After a bit of research Andy decided to include it in his project as he felt it represented ‘life’.

A hospital: “This is a big part of my identity, I spent a lot of time in hospital, but that wasn’t necessarily a bad thing.”

Ebony expressed how proud she was of Andy, as this was the first activity that he had fully engaged in enough to complete. He said he thought it was because it had really got him thinking and had been fun to do.

No two brain injuries are the same and person-centred care is all about treating the person, not the injury. Individuals are shaped by the lives that they had before their injury and we respect that person, aiming to restore as much of them as we can.

*We have changed the name of the service user to protect his identity

 


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The Coach House is our newest specialist residential care home and our third dedicated to adults with acquired brain injury. It is adjacent to The Richardson Mews and under a joint CQC Registration. It is a self-contained home and run by Registered Homes Manager, Jo Wilkins.

We launched The Coach House on 24th January 2019 and the CQC registration process was completed last summer. The first service users arrived in August and after just six months, we’re pleased to report that one of them was able to be discharged earlier this month.

Goal setting and care plan

Andrew* had sustained an hypoxic brain injury following a cardiac arrest 14 months prior to his arrival at Richardson Care, and came to us from a hospital neurological rehab setting. Members of our multi-disciplinary team (MDT) assessed Andrew and prepared a care plan for him. Goals were set for Andrew at the point of admission, with the aim of enabling him to move to a location closer to his family.

Andrew’s goals included:

  • Increasing his independence with personal care
  • Maximising his engagement in community access
  • Reducing his frustration in relation to his limitations
  • Reducing his wandering at night
  • Participation in elements of meal preparation

A small consistent care team supported Andrew on a daily basis, reinforcing the therapies implemented by the MDT. He built a good rapport with some of the members of the team, which was instrumental in his support and rehabilitation.

Gains achieved

Andrew made good gains in personal care and in mobility. He has been receptive to daily walking practice and he has been supported to access the community every day, which he does using a wheelchair due to stability and fatigue issues. He can also transfer more independently. Although The Coach House is located in private grounds, it has a wide range of shops, cafes, etc. in the immediate vicinity. Richardson Care has a good relationship with local businesses, which enhances the experience of service users when accessing the local community.

Although Andrew still presents with challenging behaviour, he has been able to reduce his frustrations and manage his behaviour more effectively. He engaged well with his care team, who found that distraction and diversion techniques were effective in reducing Andrew’s agitation due to his cognitive deficits.

Regarding elements of meal preparation, Andrew now actively participates in selecting menu choices every day with the support of staff. He will also initiate helping himself to a drink left on the table beside him without prompts from staff. These make important contributions to his overall well-being.

Positive outcome

Within six months, Andrew had made sufficient gains in all of his goals to enable him to be discharged to a residential setting closer to his family. It is hoped that with continued close supervision and increased family contact, he will be able to continue his rehabilitation from his brain injury.

*We have changed the name of the service user to protect his identity.


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