In May 2014, following a (grade 5) spontaneous subarachnoid haemorrhage, with bilateral frontal delayed cerebral ischaemia, and aneurysms in the anterior communicating and middle cerebral arteries, Bex was left with neurological impairments affecting both her physical and cognitive functioning.
Bex completed an initial neuropsychological assessment at Frenchay hospital. The outcome was to focus on ways to work on, and compensating for, the cognitive and physical difficulties Bex was now experiencing in day to day life. Bex was initially admitted to Glenside’s hospital neurorehabilitation unit in January 2015, and was later transferred to the Horizon simulated supported living bungalows.
Whilst at Glenside, Bex received an intensive multi-disciplinary rehabilitation program, working with a Clinical Psychologist and Speech & Language Therapist, around cognitive communication rather than language ability, as well as with the Occupational and Physio therapists to improve independence and mobility. Bex found it difficult to plan and organise her day and could get “stuck” when she needed to solve problems. She also had some difficulties with memory.
As Bex is a skilled florist, she worked with the Psychologist and Speech & Language therapist to organise a floristry demonstration. This meant she could be supported to develop compensatory strategies and to practice using them in a complex project that was meaningful to her. Strategies included things like a diary, to do lists, breaking tasks down and keeping visual records during a conversation to help when making important decisions. It also helped the team to identify the best way to support Bex to reach her full potential in other areas.
Part of the cognitive difficulties Bex experienced meant she had less “get up and go” than before her stroke. This meant she often needed prompts from staff and family to get started on activities and to attend sessions.
She was committed to pushing herself and was open with the team about when she needed them to encourage her to do things independently and when she needed support. Having a structured routine, using strategies and an errorless learning approach meant Bex was able to rely less on prompts and initiate more herself. This combined approach allowed Bex to also improve her physical progression into a functional context, enabling her to become more independent with functional tasks, for example, self-propelling in a wheelchair, which was a significant milestone. At the end of her stay Bex was able to attend her sessions independently, was independent in taking her medications and was doing a lot of everyday tasks with minimal support.
After her transition into the Horizon bungalows, because of the emphasis on independence, Bex initially found it hard both physically and cognitively. However this enabled Bex to naturally become independent at problem solving and doing more for herself, which was a progression from the reliance she initially had on staff to assist her. During her time in the bungalow, Bex continued to receive input from the Psychologist, Occupational Therapist and Physiotherapist. Therapy was focused on Bex’s main aim, discharge home.
Bex progressed to being independent with making drinks, breakfast and cooking from her wheelchair, and completing her own laundry. Joint Occupational therapy and Physio sessions worked on her standing and stepping for kitchen tasks, which she then continued to practise with the Rehab Assistants. To further assist her mobility Bex commenced use of functional electrical stimulation (FES) and was able to learn to use the device independently, which is a complex task and required utilising strategies previously learned to assist with this.
During Bex’s time at the Horizon bungalows she was part of the Service User Set Up Committee for a collaborative project with the Trussell Trust which aims to provide vocational rehabilitation opportunities for service users whilst also raising money for a local charity. She helped develop policies and make decisions about how the project would be run whilst working on her own rehabilitation goals.
To enable a smooth discharge home, Bex’s Glenside therapy team referred to the local neuro therapy service and social services. Joint home visits were completed with Bex and both Glenside and community therapists, to try equipment at home and review how she was managing. Bex spent increased time at home before her discharge to ensure she felt confident in her abilities and to prepare her for living at home.
Bex participated in repeat neuropsychological assessment at the end of her stay at Glenside. These assessments showed her improvement in her ability to deal with everyday tasks. At the end of her stay, Bex was supported to reflect on the cognitive strategies she found most helpful and these were written down in her own words to explain how she would like people to support her in the future. She now has this document to share with those she spends time with and can update it as she develops new strategies and continues to progress at home.
Bex has always been positive about the support she receives from family, especially from her husband, and this has been a significant motivation for her, as she was determined to return home as soon as she was able to.
Bex said of her time at Glenside “I found the staff at Glenside very helpful. My physio Clare, whilst I was in the Horizon bungalows was fantastic. Going home every weekend prior to discharge was very helpful and I have my husband to thank for that. Also my family and friends. I don’t think I would be where I am today without all their support and love. For that I truly thank them.”