A rough sleeper and IV drug user with an extensive mental health history suffered a Traumatic Brain Injury due to an unwitnessed fall from a full flight of steps. After a period of treatment on acute wards, Ryan was admitted to Nottingham Brain Injury and Neurological Care unit.
The following injuries were recorded in his medical records:
- Traumatic encephalomalacia (softening or loss of brain tissue) in right temporal lobe.
- Subdural Haematoma
- Ingested foreign body in abdomen
- Extensive facial and scull fractures
On admission Ryan presented with extreme head and neck flexion (Ryan was unable to lift his head) and as a direct result Ryan had poor control over his saliva.
Ryan also had impaired balance, strength and stamina and was only able to mobilise very short distances (<3 meters) and was reliant on an attendant propelled wheelchair.
Ryan was nil by mouth with a PEG tube in for all nutrition and hydration.
Ryan was unable to complete simple day-to-day activities without verbal prompting and physical assistance due to cognitive and physical deficits as a result of his brain injury.
Ryan was discharged in time to return to his childhood home for Christmas. This placement was not only in a different area but a different country, however Occupational Therapy liaised with support services in Ryan’s hometown. They organised support service input to be in place for his previous IV drug use, but Ryan did not require a care package.
Ryan had agreed to regular drug and alcohol testing and had remained clear throughout his admission to Millwood.
Despite being in a different country, Occupational Therapy supported Ryan in a graded discharge programme to ensure safe and successful discharge, beginning with several hours at home, then overnight stays, building to weekend stays and longer.
On Discharge Ryan was able to intake all food and fluid orally, independently mobilise within a community setting, complete all day-to-day activities independently and manage his own finances.
Ryan has expressed a desire to return to work – a programme of vocational rehabilitation was introduced into his regular therapy programme. This included sitting on interview panels for all new staff for the service, and voluntary positions at the Angling Trust (a previous leisure activity) were set up by Occupational Therapy.
Prior to his injury and his history of IV drug use, Ryan was a keen rock climber. Initially his goal was to be able to set foot onto the wall and then to climb. Ryan was able to return to this leisure activity without support 2 months before being discharged back home.
