19 - Adam: extending the therapeutic milieu into the community in the rehabilitation of a client with severe aphasia and apraxia

Summary

Introduction

This chapter describes the significant gains that can still be made by clients in rehabilitation several years post-injury through thorough assessment and tailored intervention. An in-depth interdisciplinary assessment and formulation of the client's difficulties was carried out at the Oliver Zangwill Centre (OZC) for Neuropsychological Rehabilitation prior to intervention that, as with Malcolm (Chapter 20) and Kate (Chapter 21), did not entail attending the OZC intensive programme. Instead, once Adam had completed the assessments in Ely, including a two-week period of work testing out specific rehabilitation approaches, two team members, an occupational therapist and clinical psychologist, provided appointments in Adam's home. The therapists provided eight individual day sessions targeting specific daily living goals through the use of errorless learning methods. We have included a description of this case to also emphasize our view that the core components of rehabilitation described in Chapter 4 can be recreated, in a less intensive way, through active involvement of family and carers in the community.

History of injury

Adam was involved in a road traffic accident in 1999. He was the driver of a car that was struck on the driver's side by another vehicle and subsequently admitted to Intensive Care. On admission, his Glasgow Coma Scale was measured at 3/15, indicating severe brain injury. A CT scan showed a left frontal haemorrhage and right-sided contusion. He had also suffered additional multiple orthopaedic injuries. He was transferred to a Neurosurgical Unit where he underwent a craniotomy and evacuation of a left frontal haematoma.