Mark was a 38-year-old man, married with two children aged 2 and 6. He was employed as a Project Manager in the oil and gas industry.  His job involved regular travel across the UK and into Europe.  He was a qualified Engineer and held an MSc qualification. 

He was involved in a road traffic accident on his way home from work one evening, when his car was hit by another car as he turned right at a junction.

The London Air Ambulance Service attended the accident and administered emergency medical aid and immobilised his spine. 

Mark was taken to John Radcliffe Hospital, near Oxford, by ambulance instead of air ambulance, as there were concerns regarding neck and back injury. The doctor from the air ambulance team travelled with Mark and administered a blood transfusion in the ambulance. He remained an inpatient at John Radcliffe Hospital for six weeks.

On arrival at the resuscitation department, Mark was breathing spontaneously, although with an increased respiratory rate, and he was hypotensive. He had a Glasgow Coma Score (GCS) of 9/15. Mark was reported to be repetitive when speaking and making very little sense, he was not orientated to time, place or person. 

During Mark’s admission to John Radcliffe Hospital, 2 magnetic resonance imaging (MRI) scans revealed extended areas of haemorrhage within the brain. Mark had also fractured bones in is his ribs and spine, and had multiple soft tissue injuries.

Mark was discharged home six weeks after the accident, with his wife reporting that the hospital would have preferred to keep him in for longer, but that Mark was keen to return home.

NeuroHealth were contacted by Mark’s personal injury solicitor and proposed a skilled clinical Case Manager with experience in brain injury and orthopaedic injuries that matched with Mark’s injuries and situation. Mark’s solicitor confirmed that Mark was happy to proceed with the proposed Case Manager, and then instructed the Case Manager to carry out an in-depth Immediate Needs Assessment (INA) and report.

The Case Manager visited Mark at his home to carry out the assessment, and noted the following during the assessment and also in their report:

• Difficulty mobilising indoors and outdoors, due to issues with muscle control, balance and pain.
• Localised and general pain, despite taking pain medication. 
• Changes in his taste and smell, changing his preference in food.
• Physical and cognitive fatigue after short periods of time.
• Difficulty with his memory, both remembering past events and retaining information provided to him.
• Difficulty maintaining concentration during conversation, causing discussions to be confused.
• Difficulties with his speech and finding the right words to express himself.
• Feeling anxious and low in mood. He became tearful at times, such as when discussing the negative impact the accident has had on his relationship with his wife and children.
• He reported that his sleep was poor due to pain and nightmares.
• Mark’s wife noted that Mark had become less tolerant of situations following the accident and would be easily angered and frustrated by situations. 

Using information gathered at the assessment and from related medical records, the Case Manager created an Immediate Needs Assessment report, which included the following recommendations:

• Neurologist / Neuro Rehabilitation Consultant Assessment

To assess the extent of Mark’s brain injury, carry out further tests and investigations, and if needed refer to other specialists for ongoing treatment and rehabilitation. 

• Pain Consultant Assessment

To assess the localised and general pain symptoms that Mark was experiencing and advise on how best these could be effectively managed, to reduce Mark’s discomfort. 

• Audio-Vestibular Physician Assessment 

To assess the problems Mark is experiencing relating to balance and dizziness following his injury, and make recommendations in relation to treatment. 

• Neuropsychological Assessment 

To assess the cognitive and psychological impact of Mark’s injuries and resulting symptoms, and develop a treatment plan to guide and support Mark’s rehabilitation.

• Neuro Occupational Therapy Assessment

To assess how Mark’s functioning in relation to meaningful day-to-day activities has been impacted by his brain injury, and develop a treatment plan to help his rehabilitation, including future vocational opportunities.

• Neuro Physiotherapy Assessment

To assess how Mark’s physical performance and mobility has been impacted by his brain injury, and develop a treatment plan to help Mark’s physical rehabilitation.

• Neuro Speech and Language Therapy Assessment

To assess how Mark’s communication skills have been impacted by his brain injury, and develop a treatment plan to help Mark’s rehabilitation.

• Support Worker

To provide support to Mark for day-to-day tasks that he cannot complete independently due to his injuries, including help with personal care tasks and rehabilitation activities. 

• Domestic support

To provide support to Mark and his family for domestic tasks such as cleaning.

• Brain Injury education and counselling for Mark’s wife

To help Mark’s wife understand and accept the impact of Mark’s injuries and what this will mean for the family.

 

The INA report was then sent to Mark’s personal injury solicitor who was able to obtain funding to pay for all of the recommendations made by the Case Manager.  The Case Manager then began to implement the recommendations, making referrals to private specialist medical professionals and therapists, as well as liaising with statutory services, as appropriate, assembling an experienced team with the aim of rehabilitating Mark as close to his pre-injury condition as possible. 

The Case Manager managed and coordinated Mark’s rehabilitation team over the next three years, and Mark made great progress in all areas of his rehabilitation. His personal injury claim settled three and a half years after first meeting the Case Manager.