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Physio Fiona

On 1st December 2015, Fiona remembers driving home from a shopping trip, when she started feeling a bit weird, so she pulled over to the side of the road and put her hazard lights on.

Next, she remembers the ambulance turning up and then has no memory of the next few weeks. Fiona was initially admitted to Salisbury District Hospital (SDH) where she was diagnosed with an intracranial bleed, and was transferred the same day to Southampton Hospital for a craniotomy to evacuate the clot and on 24th December underwent a reopening of the craniotomy with excision of Atriovenous Malformation, before returning to SDH on 1st January 2016 for a period of rehabilitation.

Fiona was then admitted to Glenside in January 2016 for a period of further rehabilitation, to work with the multi-disciplinary team to review and build goals to target her impaired language skills, moderate cognitive communication difficulties and reduced sensation on her right hand side.

Fiona participated in joint physio and psychology sessions to have the opportunity to ask questions and learn more about how physical rehabilitation works. Physical rehabilitation after a brain injury can be a difficult and strange experience due to changes in sensation. This can impact on how comfortable and confident someone feels as they improve physically. Changes can be subtle and, at first, improvement isn’t always obvious. Fiona worked with her care team to identify her key goals and to reflect on her progress.

Fiona participated in neuropsychological assessment to further her understanding of cognitive strengths and weaknesses following her brain injury. Assessment highlighted several areas of cognitive strength, but also suggested some difficulties with memory and attention as well as slowed processing speed. In Psychology sessions, Fiona was supported to identify and set up strategies such as a diary and “to do” list. She has also taken on more responsibility with booking her sessions and independently attending her sessions in preparation for discharge.

Fiona worked with the speech and language therapy team to gradually improve her clarity of speech. As Fiona has reduced mobility and sensation on her right side upper and lower limb, the OT team implemented the GRASP programme to promote movement of her right upper limb, particularly to stretch her fingers and thumb and twist her wrist.

The Occupational Therapy team also supported Fiona with active assisted facilitation again particularly focusing on her right upper limb. This included identifying pieces of equipment to support Fiona to be as independent as possible, with activities of daily living around self-care, dressing, kitchen aids to support with food preparation, etc.

Fiona has worked hard with the physiotherapy team to improve her walking, range of movement, muscle strength, sensation and midline perception. This has incorporated joint working with the podiatry team to improve her functional foot posture and lower limb biomechanics. Fiona’s mobility has progressed significantly, she is now able to independently mobilise, for short distances, with a wheeled zimmer frame. Fiona continues to improve and is working towards independently walking with a walking stick.

With family living locally, Fiona has had various home visits with OT and a joint visit with physio, to make an assessment for specialist equipment and recommendations for home leave. Thankfully Fiona’s home didn’t need much adaptation as it was already all on one level. Fiona has since been able to return home each weekend staying overnight.

Fiona said “As far as I am concerned, my problems are mainly physical and that is my priority. I find that progress is incredibly slow and each movement, even the twitching of my thumb, is a hugely positive step.”

Fiona’s long term goals are to return to living independently at home and to be able to walk again.