Darren - A Case Study

At the time of the accident Darren, a soldier, was a front seat passenger travelling back to base in a close friend\ís car. The friend died when he lost control and the car rolled down an embankment into a tree. At time of referral to reach Darren was 20 years old living alone in a bungalow with daily support from his mother. Darren had become isolated from family, friends and ex-army colleagues.

The route to progress

When reach carried out an assessment it identified various symptoms, both physical and neuro, which included:

  • Reduced power and movement in joints.
  • Fatigue, disturbed sleep and irritability.
  • Reduced short term memory.
  • Slurred speech.

reach believed that Darren\ís army experiences of discipline and physical fitness would make him an ideal candidate for a home-based rehabilitation programme.

Darren\ís aspirations and the aims of the rehabilitation were to reduce his level of dependence on external assistance and enable him to resume previous social and leisure activities, within his capabilities. In designing the programme reach decided to utilize Darren\ís interest in physical fitness and computer games as vehicles to address many of the objectives. The programme introduced Darren to swimming, bowling, golf and basketball as sports which could help him regain various skills.

Intervention

To increase physical stamina and establish an exercise routine, one of the activities utilised was the introduction of a regular walking programme. As well as contributing to strength it also helped him use planning and organisational skills. Darren was encouraged to carry out internet searches of local walks for specific lengths and difficulty, to then walk them and keep reference notes. The improvement he achieved was from being able to walk on the flat streets for a few minutes to hill climbing for an hour.

Other activities included swimming, where he achieved an improvement from one length with a floatation device to fifteen lengths without a float and gym work where Darren increased his grip strength from 29kg to 41.7kg.

In addition to these sports activities, Darren was encouraged to exercise at home using Wii Fit to further improve upper limb strength. This was socially acceptable, fun and increased his confidence and capability, which encouraged him to start attending a Gym. Through regular attendance at the gym and swimming with his family and friends, he began re-establishing his links and making new friends.

To improve Darren's memory and executive function management skills and promote recovery, he was given specific memory exercises. These were delivered on a one to one basis and took place in functional settings, for example, meal preparation. Cognitive rehabilitation used appropriate computer games as a baseline tool for the practice and rehearsal method and he was introduced to strategies to manage residual deficits. Amongst these were the use of lists, a diary and a mobile phone to provide prompts and a PDA for more detailed organisational needs.

Activity schedules were employed to establish structure and routine to the day/week. Schedules were initially written up with paper and pencil, but progressed to using a computerised calendar, helping to develop skills that would be essential for a return to work.

Outcome of rehabilitation

The programme was intended to improve Darren\ís physical abilities and his coping strategies. The aspiration was to reduce his dependence on external assistance, and increase the opportunity of resuming social and leisure activities. This was achieved. Darren has resumed some social activities and through his social networking, enhanced social skills and confidence he has the potential to engage in other activities if he so chooses.

The one to one support and encouragement provided on a regular basis by the Personal Programme Assistant was key to the progress and improvement throughout the duration of the programme. They supported and encouraged Darren as he undertook challenging cognitive activities which have contributed to his increased independence.

Darren completed an exit interview during which he was asked to describe the improvements made as a direct result of a reach home based brain injury rehabilitation programme. He said that he would like to use the skills to find a job but he felt that a period in a college with the potential to gain work placements would be most appropriate. Darren felt able to embrace this new challenge due to his acquisition of multiple skills within his home-based rehabilitation programme.

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