Penny and George

A Unique Journey

Penny’s husband, George, sustained a brain injury after a fall in his bathroom. In this case study she talks openly about George before the accident, the impact of his injuries, the challenges they have faced together and the role of the Neurological Occupational Therapist

This unique journey helps us to reflect on the consequence of brain injury, many of which are far reaching and go beyond the challenges experienced by an individual. Penny helps us to reflect on the fact that whilst brain injury can have a significant impact on an individual’s independence, often the impact on loved ones and families, as a whole, are just as important. Penny talks about the response of other people and the impact this has had on social interactions and engagements.

Penny’s occupational therapy journey started with a strong desire to understand George’s challenges. She needed support to help him relearn lost skills. The occupational therapy assessment highlighted a need to create a home environment that encouraged independence and purpose and strategies to help him manage his anxiety.

Facilitating change with George and optimising independence was a complex process given the symptoms he was experiencing. He needed to be considered holistically, taking into account his current and previous lifestyle, his personality, values, beliefs, activities, environment and routines. Penny needed support to understand where she could help, as well as to identify where making small changes herself would make a big difference.

…his peers are not good, particularly the pushier ones; they don’t know what to do and probably fire a stream of questions, which is hopeless…. empathy is not their thing, I think…

Our view of the world is unique to us as individuals. Occupational Therapists talk about the concept of ‘doing’ in the context of activity and, for all of us without a disability, the experience of living and doing is fluid and effortless. This is something we take for granted. When we are doing activities, our bodies disappear to us

For George, his brain injury significantly impaired his cognitive abilities, impacting largely on his memory which, being a core cognitive skill, also impacted on many aspects of everyday life. George is unable to organise, plan ahead or remember new information. He struggles to organise his thoughts and express himself in a way that is easily understood by others. As a consequence, he experiences anxiety and this has a negative impact on his abilities.

As a starting point, it was important to establish carefully what is important to George, what drives him to action, how he views himself in different situations, what he expected from activities and interactions, and what roles he valued for himself and the roles of others.

We needed to look at how George actually functioned within everyday activities; his abilities and limitations relating to specific skills. Equally, we needed to consider his previous and new routines and habits, as well as the structure, value and role of these routines in his day-to-day life.

Finally, assessment of George’s environment was essential to identify physical barriers and opportunities, to look at social experiences and the feedback these experiences provided, to make assumptions based on how interactions affected George and how they might impact on him in the future.

Occupational Therapy Plans in Focus

Using a dynamic approach to occupational therapy rehabilitation, we assisted George and Penny with a number of areas.

  • Treatment plans and rehabilitation goals were discussed together with Penny and George.
  • Time was spent on education to help them both understand the day-to-day functional challenges, including approaches that helped and hindered progress.
  • We advised on the implementation of practical self-help strategies that George could use every day.
  • We completed activities together to explore George’s strengths and reflect on challenges.
  • Activities were related to George’s past and to his valued roles and skills.
  • Activities were introduced that challenged physical and cognitive abilities.
  • Voluntary work placements were explored to help with introducing a structure and purpose to the week.
  • We provided education and support for carers and family regarding expectations, pacing of activities, importance of routine and consistency and a need to provide a safe and familiar base from which George could explore his potential.

Once you are pushing the boundaries, when you are dealing with something that is so difficult to deal with, you need the best…we need help, everyone needs help and from someone who has seen it before…


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