Rehab - a road best travelled with help.

Posted 15/08/2018 : By: Emma Mcclean

Bridge Case Management was asked to carry out an initial needs assessment of Mr D, four months after he received his injuries. On assessment we were able to ascertain that Mr D is a 58-year-old male, who was involved in an incident whilst riding his motorcycle. He suffered extensive injuries including;

· fractured right femur

· fractured right acetabulum

· fractured left tibia and fibula

· fracture dislocation of right thumb

· fractured right radius and ulna

Mr D required surgery to stabilise the fractures in his right femur and right thumb. All other fractures were managed conservatively, with casts and rest. At the time of the assessment Mr D had commenced NHS physiotherapy for some of his injuries, the others were not ready for physiotherapy.

Mr D is a Chartered Environmentalist, he was working as a woodland manager for a national charity at the time of the incident. His employers had remained in contact with him since the incident and were sympathetic to his current predicament.

Mr D lived with his wife and youngest daughter, who was completing school. His eldest daughter was away at university. Mr D’s home had a downstairs toilet that he could manage to use, but he struggled with the stairs to get up to bed, and access washing facilities. At the time of assessment, he was sleeping on a sofa bed in the dining room and was reliant on his family for help with washing, dressing and domestic tasks.

When asked how he was coping psychologically Mr D initially claimed he was fine. On careful further questioning he did admit to feeling low in mood and experiencing anxiety around moving traffic. Mr D’s family commented that he was very disengaged from family life, and prone to angry outbursts. Not at all his normal positive self.

Bridge Case Management recommended additional physiotherapy to supplement the NHS input he was already receiving as the sessions were sporadic with long intervals in between sessions. We recommended liaison with his treating surgeons, to enable Mr D to better understand his treatment options. We also suggested psychological support for Mr D, but he did not wish to undertake psychological therapy initially. To enable Mr D around the home Bridge Case Management recommended hiring a stair lift for a four-month period to allow Mr D to access upstairs safely and easily. Simple aids were also recommended to make activities of daily living more easy for him to with a greater level of independence.

Following agreement to proceed, Bridge Case Management arranged the hire of the stair lift to enable Mr D to sleep in his own bed, and simple aids to make everyday tasks more easy. Liaison with his treating doctors and physiotherapists was established, and agreement received to supplement the current physiotherapy with more regular funded physiotherapy.

As things progressed Mr D experienced several setbacks with the healing of his femoral fracture. Interventions included further surgery by his NHS treating consultant to try and resolve issues that could prevent healing. The recommended treatment of Exogen to aid healing of non-union of fractures, was not freely available through Mr D’s Primary Care Commissioning Group, so Bridge Case Management worked to secure the funding, and referred him to a local provider for this additional input. During his extended recovery time Mr D became increasingly despondent. After much discussion he agreed to undertake EMDR therapy (Eye Movement Desensitisation and Reprocessing therapy). Here in his own inimitable words he describes his experience of psychological therapy;

“Now prior to the accident I was a typical bloke - always sporty. When I was younger I played Rugby, did a bit of boxing and Martial Arts. I was always trying my hardest to keep fit with cycling, canoeing and just doing stuff.

Prior to my accident I had always had a very effective “crap filter” and had never experienced a situation I could not deal with. However now it was different. I was getting angry for the sake of getting angry. I was turning into a complete pillock in front of my very eyes. I felt like there was no way out of this. I found I just could not work anything out, my thinking became jumbled. I would sit and think about my work, "how are you going to go back to work, you’re finished" the little voice on my shoulder would say. “Anyway you will never work again, you can't ride a motorbike, even if you get a car to go to work what colour would it be, what colour seats do you want, why are thinking about cars - you will never work".

Every day the same thing would happen - jumbled thoughts, angry moods, swearing at my poor old dog.

It was at this stage that Bridge Case Management donned their Wonder Woman cossies and swooped in. I was put in touch with a local therapist and undertook a course in EMDR therapy. Well what a revelation! I went from a pillock back to making myself laugh. EMDR is not hypnosis or the like; you remain conscious and in control. It's a marvellous way of unblocking negative thoughts and re-balancing your mind.

Instead of negative ‘you can’t, you won’t’ thoughts I’m now looking forward and putting this accident behind me. I now realise that my preferred career of being Miss January may be beyond reach as people can be so shallow. I still will not apologise to my crutches for the many attempts to launch them. I need new excuses to swear at my poor old dog.

I realise how lucky I am to have access to the brilliant surgeons of the NHS and the numerous other health professionals I have encountered.

My advice to other blokes who may be reticent about therapy is “Don't be a wally just go and get it done you owe it to yourself and family”.

Anyway must go got a pole dancing lesson booked…”

Mr D made a good recovery from his physical injuries, and with the EMDR input made an excellent psychological recovery. He maintained

contact with his employers throughout his rehabilitation. With input from Bridge Case Management a return to work programme was devised to enable Mr D to return to work and undertake some of his former job roles. Mr D continued with his physical rehabilitation, and with a graded exposure programme began to undertake the more physical aspects of his job role.