CHRONIC BRAIN DAMAGE

A Primer Case Study of the Therapeutic Potential and Health Policies in the Context of Chronic Brain Damage

A Primer Case Study of the Therapeutic Potential and Health Policies in the Context of Chronic Brain Damage

Introduction

This retrospective single case study aims at demonstrating intervention of multi-professions providing enriched therapeutic environment according to the current policies in nursing home setting and how it enhances the patient's ADL and QoL. In addition, the neuroplasticity changes were quantified by standard outcome measures. A comprehensive literature search was used from Pubmed central, Embase, Medline, Ovid, Google and Science Direct electronic databases. The keywords that were used include “therapy”, “nursing homes”, “activities of daily living”, “rehabilitation”, “national policy” “neurological conditions” and “vestibular schwannoma”. The cores evidences are included since year 2002 and evidence particularly focused on neurological conditions (e.g. stroke) or related to other pathologies are excluded.

The discussion suggests that these interventions are in compliance with models of disability and rehabilitation practice. The most common diseases (motor neuron disease) or neurological disorder (stroke) have a care pathway or clinical guidelines and they are well designed to enable the health system. VS is peculiar neurological disorder and post-operative complications are rare, but consequences are sever (Nuseir, 2012). Therefore, this case is focused to communicate with other clinicians, the experiences encountered in clinical practice (Falcioni, 2004).

Patient Case Presentation

Ms. Emily is a fifty five years old lady who was presented to acute hospital in London in October 2009 with a 12-month history of slow progressive gait disturbance and right-sided hearing loss and diagnosed VS. Magnetic resonance imaging (MRI) brain scan showed a right cerebello-pontine angle VS with brain stem distortion and mild hydrocephalus and subsequently she underwent for excision (retro-sigmoid craniotomy). Post-operative clinical course was complicated by cerebrospinal fluid (CSF) leak, which was repaired. She subsequently developed progressive ventriculomegaly and this was managed with a ventricular catheter. She then had an enhancing lesion in the right cerebello-pontine angle and underwent exploration of retro-sigmoid craniotomy in November 2009. She subsequently underwent many VP shunt revisions as well as 3'd ventriculostomy and septum pallucidotomy. She also had treatment with a prolonged course of antibiotics. She had a further MRI brain scan in late 2010 and this showed a nodular enhancing lesion involving the right temporal region. In addition, MRI showed low attenuation within right frontal lobe and white matter of temporal lobe. She was found to have recurrent accumulation of pus over right upper thorax despite drainage in October 2010.

Role Played By Multidisciplinary Team

Ms. Emily received therapy from multidisciplinary team (MDT) following initial assessment. Royal College of Physicians (RCP) (2008) cites Physiotherapist, Occupational therapist, community Speech and language therapist, music therapist, Consultant in Neuro rehabilitation and the therapeutic activity team should be included in MDT to enhance the level of functional activity and socialisation following brain damage. Also, Ms.Emily's treatment plans were tailored according to her disability and achievable goals for three months time scale. Goals setting meetings were organised every month by MDT with patient and family ...