University student Oliver was just 22 years old when he was involved in a road traffic accident that left him with life-changing head injuries and in a state of Prolonged Disorder of Consciousness (PDOC). In October 2019, nine months after the accident, Oliver was admitted to Badby Park Neurological Centre, where the multidisciplinary team (MDT) embarked on a specialist neurorehabilitation programme to improve his quality of life and achieve personalised rehabilitation goals.
Over the past six years, supported by his devoted family, Oliver has made meaningful progress in areas including communication, range of movement and head and neck control, as well as eating and drinking. His treatment has included a combination of structured therapy sessions, round-the-clock person-centred care, and regular sensory stimulation.
In this EveryExpert case study, Badby Park’s Service Lead, Noreen Baldwin, Physiotherapist, Sneha Joshi, and Speech and Language Therapist (SLT), Candida Ellis, share how the MDT has worked with Oliver to achieve these positive outcomes through neurorehabilitation.
When Oliver was admitted to Badby Park in October 2019 for neurorehabilitation, he was in a state of PDOC and had a traumatic brain injury (TBI). The road traffic accident he’d been involved in the previous January had required surgeons to perform a right-sided decompressive craniectomy to release pressure on his brain. On admission, the team conducted a neurobehavioral assessment of Oliver to establish where he was on the Coma Recovery Scale – Revised (CRS-R).
Service Lead Noreen Baldwin explains: “We found that Oliver scored a 9 on the CRS-R scale, which indicates a moderate TBI. However, while he was able to track with his eyes, there was no other purposeful engagement at this point.
At that time, Oliver had poor head and neck control, so he couldn’t correct his head position independently, which presented a risk of him blocking his airways. We started using a collar to support him, and nursing staff were on hand to regularly reposition his head. Oliver was receiving all nutrition and hydration via a percutaneous endoscopic gastrostomy (PEG) feeding tube, except for some ‘tastes for pleasure’ sessions that his mum led in collaboration with the SLT.”
“Oliver’s family, especially his mum Joanne and dad Harry, are deeply involved in his care, and since the time he arrived, they’ve been consistently by his side. Through them, we learned about Oliver’s life pre-accident, a music-loving boy who was doing well at uni and enjoyed sports. We wanted to incorporate the things that Oliver liked, such as his favourite music, sports and TV shows, into his care plan to improve his quality of life and meet his care needs.”
The Speech and Language Therapy (SLT) team’s work with Oliver began with efforts to stimulate him and identify any communication he was making through verbal or physical responses.
SLT Candida Ellis explains: “We used a variety of different stimuli with Oliver, things that would be meaningful for him, so we could track his awareness as well as any attempts to communicate.
“Progress began when we noticed he was holding eye contact with his care team, and later, he started smiling to communicate. The SLT assessment in 2021 showed he was now scoring 9 on the CRS-R scale, which increased to 13 by 2023. This was a significant improvement, given that the highest score on the scale is 15.
“Oliver is starting to communicate verbally, and if you say ‘hi’ to him and then put your hand to your ear, he tries to voice ‘hi’ back. He’s gaining better control over his voice production and attempting to vocalise more.
“Music has been a valuable stimulus for Oliver, and he regularly attends music therapy groups. He expresses his happiness when people sing with him, both during these sessions and in his daily life.”
On admission, Oliver was moved using hoists, with two care staff members using the hoist and one supporting Oliver’s neck. He also had splints on his ankles, hands and wrists to ensure that his joints didn’t contract and to mitigate the shortening of the tendons and muscles. Physiotherapist Sneha Joshi describes how Oliver has gradually achieved movement and mobility in some areas.
Snehi shares: “There’s been valuable progress in Oliver’s physiotherapy sessions over the years, and through a combination of passive stretching and plinth-based exercise, he’s gained the ability to pull himself up. There was a special moment in one session where he pulled himself up and was able to hug his mum, which was incredibly poignant for everyone.”
“We’ve done a lot of work in the gym on reaching for things to expand his range of movement, and with support, Oliver is now using the static bike for lower limb movement. Oliver, who has active movement in his lower limbs, can kick a ball after verbal prompting. In one session, he kicked a ball around 30 times, which is a significant achievement.
“Oliver is responding really well to rolling therapy. This involves him rolling left to right, and we’re seeing encouraging signs of movement on his right side. He’s started to ‘high five’ when prompted, and we’ve noticed improvement in his posture and balance.
“There’s been a focus on building his strength in the head and neck area to reduce the amount of time he wears the collar. Oliver is able to maintain the position of his head more independently now, and the head drops have been reduced significantly. The improvement has been so significant in this area that we’re now trying to phase out the collar entirely.”
“Another exercise we’re doing involves working with Oliver as he attempts to reach for and grab a ball. He responds well to these exercises and has progressed to a point where he can get a ball from a board and then place it back onto the board if given a verbal command. Every time he achieves another positive outcome, it’s great to see.”
The SLT and care teams have also been working with Oliver on eating and drinking techniques to achieve more independence. The PEG feed remains his primary source of nutrition and hydration, but as Service Lead, Noreen Baldwin, shares, Oliver is making gains in this area.
Noreen explains: “Now Oliver can sit so well, and he’s able to maintain his head position, we’ve started to introduce pureed food into his diet.
“With gentle support, he can use a cup and bring a spoon up to his mouth, which is excellent and really encourages us to keep supporting his progress. It used to be that only his mum or the SLT could give him drinks, but now he’s also comfortable with care staff doing this.
“From the beginning, his mum Joanne has led ‘tastes for pleasure’ sessions with Oliver, and these have been impactful and positive. As he progresses onto the next stage of eating and drinking, modified items are used to expand his palate and bring joy as part of the work on his wellbeing.
“It’s my personal dream to get Oliver to the point where he no longer requires PEG feeding, and he’s able to eat food normally again. It’s something we continue to look at as he carries on adapting to pureed food.”
Boosting the wellbeing of a patient who was in PDOC and is now living with a TBI and limited movement can involve reintroducing their interests and hobbies back into their lives in new ways.
With Oliver, music was a key part of this, and his care team and family have explored using different types of sensory stimulation activities with positive results.
Noreen added: “Oliver’s family created a sensory garden for him on the patio outside his room, which has been a fantastic resource for him – he loves being out there.
“He really enjoys the various group sessions which involve music, reading, relaxation and sensory stimulations. He particularly loves it when you applaud him or clap for him; both types of validation inspire big smiles and expressions of happiness. He loves being in group therapy and engages well with the other patients, which has a positive impact on everyone involved.
“He’s got a Rea Azalea tilt-in-space wheelchair so he can go out with his family, and the Occupational Therapy team is now assessing him for more independent travel. Sometimes, the transport he needs is not available when the family wants to have Oliver at home with them, so the OTs are assessing whether he can travel via taxi and spend those important occasions at home with his loved ones.”
After six years at Badby Park, Oliver continues to make meaningful progress.
Noreen says: “Oliver has gone from strength to strength, and he’s so much more alert to the world around him. He’s a joy to have here with us.
“It’s been lovely to see his sense of humour on display with a button-pressing game that is Halloween-themed and makes this terrible noise. He loves to press it to surprise you and get the ‘OMG!’ response. It really tickles him.
“As far as future goals for Oliver, we just want to continue finding ways to work with him towards gaining more independence and doing things for himself.”
For Oliver’s family, the experience at Badby Park has been overwhelmingly positive.
Oliver’s mum, Joanne, says:“The therapy that Oliver has received has been exceptional, and we’re so pleased with how far he’s come. The dedication and warmth of his care team means a lot to us; they’ve been supportive and kind to us, as well as to Oliver. It feels like a team effort between us all, and every time Oliver has another win, everyone at Badby Park is as pleased as we are. We’re so grateful for everything they have done and continue to do for him.”
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