A case study from Tŷ Aberdafen, illustrating short-term intensive neurorehabilitation at Tŷ Aberdafen

Tom* was admitted to Tŷ Aberdafen on 12th November 2015 from a general hospital for a period of intensive neurorehabilitation. Tom had suffered a right Middle Cerebral Artery stroke in March 2015 which left him with left sided weakness, increased muscle tone (causing stiffness and spasms in his limbs), thalamic pain, hypersensitivity and perceptual impairments.

Tom was assessed by the clinical therapists at Tŷ Aberdafen and it was identified that he experienced lowered mood, fluctuating motivation and cognitive impairments, including difficulties with initiation and processing. He was disinhibited and had marked problems with mobility and balance, needing a wheelchair and unable to stand unaided. Tom also displayed a lack of insight into his brain injury or rehabilitation needs.

On admission the team at Tŷ Aberdafen assessed Tom and set rehabilitation goals which would:

  • reduce long-term health risks to Tom (including his diabetes management)
  • enable behaviour changes and improve Tom’s understanding of his brain injury
  • develop Tom’s levels of independence and mobility so that he could be more independent
  • increase his independence with personal care
  • investigate discharge options for Tom

Below is a summary of the outcomes and the rehabilitation delivered by the team at Tŷ Aberdafen.

*name changed to protect identity

Outcome

  • Increase levels of independence around personal care. Although he still needs some support, this has been significantly reduced and Tom is now more confident and independent with preparing food and hot drinks, dressing and showering.

Rehabilitation delivered

  • Tom was housed in an internal flat within Tŷ Aberdafen where he was supported in engaging with practicing daily living tasks such as improving personal care, food preparation and making hot drinks.
  • Improved bilateral limb function (using both hands) and reduced left sided inattention, particularly when standing.
  • Tom’s brain injury had led to him had adapting his movements to compensate for limited function in this arms – his left side was particularly affected.
  • Task repetition, physiotherapy and consistent support and encouragement from staff enabled Tom to gain confidence, skills and strength needed to be able to use both hands for tasks.
  • IImproved mobility – Tom is no longer entirely reliant on a wheelchair and can stand and walk with the aid a tripod stick.
  • Physiotherapy input combined with work on motivation – which has included graded home visits for Tom to spend time with his family: a big driver in his rehabilitation.
  • Risks to Tom around his diabetes reduced
  • Tŷ Aberdafen’s Head of Care oversaw work by local nurses in blood sugar monitoring. The team also drew up a food plan for Tom and worked with Tom and his family around nutrition and reducing sugar intake.
  • Home visits - Tom was able to spend time at home with his family on Christmas Day to see his children open gifts.

  • Graded home visits carried out to problem-solve barriers to Tom achieving his goal of being able to be spend time at home and – ultimately – be discharged.