16 - Interdisciplinary vocational rehabilitation addressing pain, fatigue, anxiety and impulsivity: Yusuf and his ‘new rules for business and life’

Summary

In order to illustrate our developing approach to interdisciplinary rehabilitation, we describe our work with Yusuf. He was one of the first clients with whom teamwork was organized across a range of impairments, activities and contexts, which in turn fed into increased social participation in one key goal area. The work also provides a good example of formulation-based rehabilitation, which provides a means of integrating assessment results, and developing a ‘shared understanding’ across the team and with the client. Since our work with this client we have sought to develop these principles further to become formalized aspects of the rehabilitation programme, as described in the ‘core components’ (Chapter 4), and in more detail in our work with Judith (Chapter 17). The case also highlights specific successful interdisciplinary interventions for pain and fatigue delivered as part of the integrated rehabilitation programme.

History of injury

Yusuf was involved in a car accident in May 1998. He was in coma for a week, and post-traumatic amnesia was reported to last for about a month, indicating a very severe head injury. Computerized tomography (CT) scans at the time of injury identified a left fronto-temporo-parietal subdural haematoma, which was causing some mass effect on the left cerebral hemisphere and left lateral ventricle.

Social history

Yusuf was a 35-year-old man (32 at time of injury) who lived with his wife and three young children.