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Adult with an acquired brain and spinal injury

History and Diagnosis:

Voyage Specialist Healthcare have over eight years experience in providing 24/7 nurse led complex care for adults and children who have an acquired brain and spinal injury.

Ms K wasinvolved in a road traffic collision at the age of 46. Following the collision, she was admitted to hospital and diagnosed with an acquired brain and spinal injury. During her admission, it was established that Ms K struggled to communicate, had reduced concentration levels, a ten minute memory recall problem, high fatigue levels, irritability, anger and limited executive skills (planning and organisation). The spinal injury had left her doubly incontinent, paralysed down one side and requiring the support of two members of staff and a hoist to facilitate any transfers. Additionally, the acquired brain injury had resulted in a delayed swallow, which required the insertion of a percutaneous gastrostomy (PEG) to maintain an adequate amount of nutrition and hydration,as well as to administer on-going medication. Ms K’s multi-disciplinary team arranged for her care to be transferred to a neurological rehabilitation centre where a behaviour plan wasdevised to support her needs.

The acquired brain and spinal injury home care plan:

Voyage Specialist Healthcare wasapproached by the local PCT to determine if we could provide 24/7 home care support on a 2:1 basis for Ms K. Our clinical manager and behavioural therapist arranged a meeting with Ms K and her family to fully understand her needs and to develop a person centred care plan.  Both Ms K and her family were involved in the recruitment process which sourced suitable healthcareassistants to support her needs. Once the healthcare assistants had been recruited, they received mandatory and clinical training sessions from our in house specialist trainers as well as on-going competency support from our clinical managers and behavioural therapists. The clinical skills of our healthcare assistants were further developed by allowing them to work with Mrs K in the neurological rehabilitation centre prior to her discharge.

Mrs K`s healthcare assistants were trained to provide her with the following support:

Clinical support:

Tissue Viability, Medications Administration, PEG and Enteral Feeding (and mandatory moving and handling with hoists)

Behavioural, Cognitive and Executive support

Behavioural and memory: Ms K`s irritability and anger could be exacerbated by unfamiliar routines and situations. She became involved in the recruitment of her healthcare assistants who were also allowed to provide her with support in the neurological rehabilitation centre prior to discharge.  Ms K was provided with a clear daily routine which helped her to recognise the care which each healthcare assistant would deliver, as well as to understand when her support would be provided. This routine was placed on her bedside table and ensured that it could be reached and referred to every day.  Large font and a simple language style also made her routine very easy to understand. These activities helped to facilitate the introduction of Ms K’s care team and provided her with an increasingly familiar routine to manage her behaviour and to support her memory.

Ms K was provided with a person centred communication support plan which encouraged her to use assistive technology to develop her communication skills. This plan also offered her dedicated time where she  could discuss any concerns, ensuring that her needs could be expressed and that she could seek assurance without having to resort to challenge.

Memory: A range of strategies were used to support Ms K`s memory,  including the use of lists, a diary and a mobile phone to provide prompts. Ms K also used the board game Sequence, as well as the online card games Rumicub and Kings in the Corner to improve her attention to detail and concentration.

Planning and organising: Ms K was encouraged to plan tasks and utilise schedules to support her organisation and planning skills. She was supported to pick a task which could be carried out during the week and plan when it would occur. Ms K used a diary to plan when a task needed to be carried out as well as a checklist to ensure that each activity was completed correctly. Our healthcare assistants also provided her with prompts which focused her attention on specific tasks and delivered praise to support positive actions.

Fatigue: With the support of a Wii fit, Ms K was encouraged to increase her energy levels and address fatigue by working on the goal of improving her fitness in a therapeutic and graded manner. Ms K was also provided with a fatigue support plan which scheduled time limited activities and managed rest breaks into her daily routines.


Physical and emotional:
Ms K still requires two healthcare assistants to support her with transfers, personal hygiene and dressing. Due to her delayed swallow, it is necessary to provide her with close supervision when eating and drinking and to administer medication. However, she is now able to benefit from the delivery of reliable care and can spend quality time with her family.

The delivery of Ms K`s support hasenabled her to maintain the behavioural gains she hasmade.  She uses her weekly planner as a prompt to organise her time and to support her memory. Improvements have been made with her concentration and she is learning to make choices on her own. The on-going familiarity of our healthcare assistants has also provided Ms K with a consistent routine and had a positive impact on her emotional wellbeing.

Client and family feedback:
The feedback received from Ms K and her family has been very positive. They are both happy and confident in our healthcare assistants and have frequently praised their reliability and level of clinical competency.

Commissioner feedback:
Very positive feedback has been received from the PCT regarding the speedy response to the commencement of the acquired brain and spinal injury home care plan. The Behavioural, Cognitive and Executive skill improvements seen by Ms K have also increased her independence and reduced the number of commissioned hours which are required to support her needs.

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Voyage Care Voyage Specialist Healthcare is part of Voyage Care.

Voyage Care supports thousands of people with learning and physical disabilities, brain injuries, autism and other needs across England, Scotland and Wales.

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