Managing fatigue and brain injury

It’s Action for Brain Injury Week from 20th – 26th May, and the theme for Headway’s campaign this year is Brain Drain: Wake up to Fatigue. Fatigue is one of the most common effects of brain injury, but it’s experienced differently by everyone. People may feel exhausted, lacking in energy and motivation, and feel weak or sleepy. Fatigue may also worsen existing difficulties associated with brain injury, such as memory problems, speech and language difficulties, frustration, irritability or low mood.

Pathological fatigue may be present most of the time and this excessive tiredness may not necessarily be alleviated by rest. As fatigue is different for everyone, and caused by a range of factors, there is no single cure or treatment. However, it can be managed and gradually alleviated by focusing on each individual’s specific needs.

Below are some of the factors that affect fatigue and some of the ways that we help our service users with acquired brain injury to manage their fatigue.

  1. Cognitive Behaviour Therapy (CBT) – Regular CBT sessions with members of our psychology team help our service users to increase their understanding of their brain injury, including the fatigue that they experience, what the triggers are and how they can respond.

  2. Relaxation Therapy – weekly group relaxation sessions aim to teach relaxation methods, including progressive muscle relaxation exercises and guided imagery, which can help to reduce fatigue. In addition, our service users enjoy regular hand and foot massages from our massage therapist, which helps to reduce tension and aid relaxation.

  3. Mental well-being – low mood, anxiety and depression are all factors that can make people with acquired brain injuries more vulnerable to experiencing fatigue. These are addressed by a combination of therapies and activities in each individual’s rehabilitation plan. For example, our Consultant Neuropsychiatrist prescribes medication and monitors how an individual is affected by it, and the psychology team help them to deal with the psychological aspects of their brain injury. Our holistic approach to medication and psychology support aims to reduce the reliance on drug therapy over time, when possible, which also reduces side effects – another potential contributory factor in fatigue. In addition, our focus on providing opportunities for social inclusion and community participation also help to improve mental well-being and motivation.

  4. Neurological Physiotherapy – regular physiotherapy sessions help individuals to gradually increase their muscle strength and mobility, which helps them to manage their fatigue. These sessions are carefully controlled to ensure sufficient rest breaks.

  5. Neurological Speech & Language Therapy – enabling service users with acquired brain injuries to improve their communication skills helps to reduce frustration and building strength and co-ordination in their facial and vocal muscles also contributes to alleviating fatigue.

  6. Environment – the home environment that we provide is calm and relaxed, with a choice of social and quiet spaces so that each service user can decide when they spend time with others and when they have some time out. Also, the decoration within the homes is attractive, but not over-stimulating, and everyone has access to the garden and outdoor spaces, which is also important.

  7. Diet – we support all service users to have a healthy diet and maintain good hydration. As well as being important for their general health and well-being, it can also help to alleviate fatigue.

As with all aspects of brain injury rehabilitation, everyone is different and there is no single solution. Neurobehavioural factors are often interlinked, so our dedicated person-centred interventions, delivered by our experienced multi-disciplinary team, work together to deliver effective rehabilitation and positive outcomes for our service users.

Watch our video

Click on the link below to watch the video that was filmed at the opening of The Coach House, our new residential care and rehabilitation home for adults with long-term brain injuries and complex needs. It encapsulates the essence of our organisation and the homes that we provide for our service users.

The Coach House video

Liam cutting the ribbon to open The Coach House
Liam, a brain injury survivor and former service user, cut the ribbon to formally open The Coach House

Community participation and well-being

Activities for service users with learning disabilities and acquired brain injuries

With Spring in the air, we are looking forward to longer days and better weather. However, even in the winter, we have a varied range of activities for our service users. Community participation and presence are two of the key principles that underpin our organisation. We take positive steps to enable service users to integrate into the local community and build culturally-valued relationships, and we do this in a number of ways.

Our care home at 23 Duston Road, Northampton, accommodates ten adults with learning disabilities, acquired brain injuries or a dual diagnosis. In addition, service users have complex needs and may present with behaviour that challenges. Here is a brief list of some of the activities that they did, supported by their care workers, in January and February this year.

  • Walk into the village centre, visit local shops
  • Drive out and walk around garden centre
  • Visit local park, café and mini zoo
  • Singing in the music room, karaoke at Care with a Difference
  • In-house board games and movies
  • Trip to the cinema
  • Trampolining, swimming, working out at the gym
  • Ten-pin bowling, short-mat bowling
  • Card making at Headway
  • Dancing at the Rock Club disco
  • Shopping for clothes and toiletries
  • Visiting the library, visiting the museum
  • Meals out, pub lunches
  • Supported visit to see family in London

Many of these activities anyone would do at a weekend or part of their daily life: they are not particularly unusual. However, for someone who has previously been living in a hospital or institutional setting, they are a big step forward in their quality of life and an important part of their care plan.

For someone with learning disabilities and complex needs, managing their anxiety sufficiently for them go on a shopping trip and enjoy other people’s company has a very positive impact on their well-being. And for someone with an acquired brain injury, just being able to do some of the things that they did before their injury can be an important step. It is part of our focus on ‘normalisation’, enabling our service users to live as close to a normal life as possible and to improve their emotional well-being.

In addition, these activities benefit service users in several different ways:

  • Physical activity improves fitness as well as having a positive impact on mental health
  • Decision making – we respect each person’s individuality and support them in making their own choices
  • Skills development – craft activities improve dexterity and creativity, while developing skills in any area increases confidence
  • Reducing anxiety – gradually increasing the range of activities an individual undertakes, while helping them to develop their own awareness and coping strategies, reduces anxiety and improves their quality of life.

For more information about how our services improve the lives of service users with learning disabilities, acquired brain injuries and complex needs, see our case studies

Service users’ families’ survey results 2018

At The Richardson Partnership for Care we have an open-door policy so the family members and friends of the service users in our care can visit at any time. As this is not practical for everyone we also include supported home visits in individuals’ care plans. As well as contributing to the service users’ well-being and family relationships, it also helps to encourage feedback from family members about the care that their loved one is receiving. In addition, we send out an annual questionnaire so that we can formalise the feedback process and identify any changes that are needed. Our service users have acquired brain injuries, learning disabilities and/or complex needs, so everyone’s requirements are different, but this process helps us to see the overall picture, identify trends and flag up any issues.

The questionnaires can be anonymous and they are optional, so we may only receive a relatively small number of responses. However, we are very grateful to the family members who complete them. Once again, we have received some very positive feedback and some lovely comments, but we are never complacent. We regularly step back and review our services and are always looking to improve.

The same questionnaire is sent to the families of service users who have learning disabilities and those who have an acquired brain injury. We ask all families whether they strongly agree, agree, don’t know or disagree with the following statements:

1. I am happy with the care provided for my relative
2. The home has a warm, non-institutional feeling
3. The home provides an inclusive or family environment
4. Staff are friendly and approachable
5. I am regularly updated with information
6. I feel that my relative is treated with dignity and respect
7. I feel that their quality of life has improved since they arrived at The Richardson Partnership for Care
8. I feel that my relative takes part in meaningful and/or enjoyable activities
9. Would you recommend The Richardson Partnership for Care?

We are pleased that:
100% of those who answered said that they would recommend the Richardson Partnership for Care to others.

100% of those who answered said that they strongly agreed or agreed with the statements:
“The home has a warm, non-institutional feeling”
“Staff are friendly and approachable”
“I feel that my relative is treated with dignity and respect”

94% of those who answered said that they strongly agreed or agreed with the statements:
“I am happy with the care provided for my relative”
“The home provides an inclusive or family environment”

All of the 2018 families’ questionnaire results are shown in the graph below.

2018 Survey Results

Some of the comments that we received are shown below with the names removed to protect the identity of the service users.

Comments from families of service users with an acquired brain injury:
“My sister has very good care and kindness at all times, which I know is not easy to achieve…Everyone works together to make it feel like a real family home.”

“The staff do appear to genuinely care about my brother.”

Comments from families of service users with learning disabilities:

“The home is superior to most other homes visited.”

“The staff have always been very supportive to our family.”

“He is very happy at Kingsthorpe Grove, we wouldn’t wish for him to be anywhere else.”

“He is more alert because of the time and effort the Manager and staff have worked to cut down on the amount of unnecessary drugs he was taking, which enables him to live his life in an enjoyable and contented way of his choosing.”

“He has a full and happy life. Everyone seems pleased to work with him. He could not receive better care.”

We would like to thank all of the family members who took the time to complete our annual survey.

Learning Disabilities and Autism Awards 2017

We believe it’s very important to celebrate the excellent work that goes on day in and day out in caring for people with learning disabilities. We are therefore pleased to be part of the National Learning Disabilities and Autism Awards, which pay tribute to the hardworking and inspirational people who work in this sector, as well as the people they care for.

We are dedicated to providing a positive, supportive and homely environment for the service users with learning disabilities who live in our homes. We support people with complex needs and behaviour that challenges and getting the physical environment right is relatively easy. It’s the staff within the homes who make the difference.

We have decided to sponsor the Manager Award this year as we are fortunate to have some excellent managers who have worked in our homes for many years and we appreciate just how much of an impact they have on the success of a home. They lead by example and are crucial in developing and inspiring the managers of the future.

More information about the awards

National Learning Disabilities and Autism Awards logo

Welcome back to Helen Petrie!

It’s hard to believe that Helen Petrie has now been Home Manager at The Mews for over a year.

Helen first joined The Richardson Partnership for Care in 2002, starting as a Senior Support Worker and then gaining NVQ qualifications in Health & Social Care and Management & Leadership. She left to widen her experience and worked as a Manager in a care home for the elderly, which was owned by a large national organisation. In the five years that Helen was Manager, she turned the home around from having CQC notifications and being non-compliant in all areas to being fully compliant.

Helen returned to The Richardson Partnership for Care as Registered Manager at The Mews in March 2016 and is pleased to be back. She said: “It felt as though I’d come back home. It’s a very supportive environment and I feel part of a big family. I’ve loved my first year back and it’s gone very quickly. It’s good to come back with a new perspective and wider experience. My role has many aspects but I most enjoy helping people develop to the best of their abilities.”

You can view Helen’s profile and find out more about our management and multi-disciplinary team

Helen Petrie

Helen Petrie, Registered Home Manager at The Mews

Person-centred care: What does it mean?

In the fields of brain injury rehabilitation, caring for adults with challenging behaviour and caring for adults with learning disabilities, a ‘one size fits all’ approach would consistently fail. In all walks of life we are all individuals with different personalities, characteristics and preferences. When an acquired brain injury or learning disability is added to the mix, then catering for individual needs is more important than ever. But what does that mean in practice?

At The Richardson Partnership for Care we have a multi-disciplinary team of therapists who are all involved with each individual’s care to a greater or lesser extent, depending on their needs. This multi-disciplinary team comprises a consultant neuropsychiatrist, psychologist, assistant psychologists, home manager, service manager, physiotherapist, speech & language therapist and occupational therapist. The multi-disciplinary team meets regularly to review and discuss the care package that is put together for each individual. We aim to deliver the most effective care while reducing the administrative burden by providing an inclusive care package. This means that funding is agreed at the outset and we don’t have to put in extra requests for additional ad hoc support.

Each service user also has a dedicated key worker who gets to know them and who provides valuable continuity in their care. This key worker, along with other activity support workers, helps to deliver some of the therapy advised by the multi-disciplinary team.

Person-centred care can also mean thinking outside the box to deliver the right type of therapy and activities to encourage confidence building, for example, or physical dexterity. These activities may include arts and crafts, music, drama, sport, computer games, board games, cooking, shopping or gardening.

We have found that ongoing clinical psychology provision is crucial for the well-being and progress of service users, whether they have an acquired brain injury or learning disabilities. It helps to maintain their mental health and any problems can be addressed early, helping to prevent the need for crisis care. We have also found that reducing drug therapy and focussing on psychosocial approaches can result in better outcomes for service users in the longer term.

Below is a testimonial from the carers of one of our service users about how our person-centred approach has helped their nephew. It was written after they visited him in December 2016.

“Pat and I visited John yesterday and we were greeted by a very calm and cheerful young man. We both know how much work this takes and we are very grateful for this. We are so grateful for your tremendous work and commitment over the years to him, and we also know how much you care for him. More importantly he knows how much you all care and love him in spite of his incessant verbalising. We are very proud of our nephew and we are extremely grateful for your expert work in moving away from drug therapy to modifying his behaviour through psychosocial approaches. John is a much healthier man because of your imaginative and professional strategies you use to manage his behaviour and we thank you for this.”

This diagram shows the support team that delivers the care plan for each individual service user.

Record number of ASDAN certificates awarded in 2016

Congratulations to all service users at The Richardson Partnership for Care who gained ASDAN certificates in 2016. There was a grand total of 41 certificates awarded.

ASDAN is the Awards Scheme Development Accreditation Network, which provides courses to thousands of training providers. The courses offer flexible learning opportunities and enable skills to be recognised with accredited and independently verified qualifications. The Richardson Partnership for Care became an officially recognised ASDAN accreditation centre in May 2012.

All service users, whether they have an acquired brain injury or learning disabilities, can benefit from the ASDAN courses. As well as recognising and increasing skills, they provide a sense of achievement and fulfilment. They can also increase motivation and provide encouragement for further learning.

Five certificates in ‘Independent Living’ and ten certificates in ‘Myself and Others’ were awarded to service users with learning difficulties. Twenty six certificates were awarded to service users with acquired brain injuries. The subjects were: Independent Living (7), Myself and Others (15), Numeracy Skills – Introduction (2) and Numeracy Skills – Progression (2).

Everyone worked very hard and most pass levels were either ‘no help’ or ‘spoken help’, with two being experience recorded.

Annual survey of service users’ families

Earlier this year we conducted our annual survey amongst the families of service users in our care. While we try to encourage feedback throughout the year, the survey enables a more structured approach to gathering the views of family members on the care and support received by their loved ones. The survey includes all of the residents in our homes with learning difficulties and/or an acquired brain injury.

As the survey is optional, the number of responses can be quite small. However, below is a summary of the feedback that we have received. All of the names have been removed to protect the anonymity of the service users.

100% of respondents strongly agreed or agreed with the statement: 
“I am happy with the care provided”

95% of respondents strongly agreed or agreed with the statement:
“The home has a warm, non-institutional feeling.”

95% of respondents strongly agreed or agreed with the statement:
“The home has an inclusive or family environment.”

100% of respondents strongly agreed or agreed with the statement:
“Staff are friendly and approachable”

94% of respondents strongly agreed or agreed with the statement:
“I feel that my relative is treated with dignity and respect”

89% of respondents strongly agreed or agreed with the statement:
“I feel that their quality of life has improved since they arrived at The Richardson Partnership for Care”

100% of respondents said that they would recommend The Richardson Partnership for Care.

We are continuing to focus on keeping families informed and we are trying to improve our performance in this area. 78% of respondents strongly agreed or agreed with the statement: “I am regularly updated with information.” Although this is an improvement on last year’s survey results, we recognise that more needs to be done.

We were pleased to receive the following comments:

“Our son has made remarkable progress since living there. Staff are friendly and knowledgeable. Particular thanks to Darren Kendall, his keyworker, our son considers him his ‘big brother’.”

“Your team always strive to meet our son’s needs. I mean all his needs both physical and psychological. He is treated in a very empowering way, his achievements are always celebrated. He has never been happier than this, you have enabled him to achieve so much. We want you to know that we really appreciate your professional and person-centred approach to meeting our son’s needs and enabling him to become contented and happy. We thank you from the bottom of our hearts for this.”

“I always come unannounced. That is never a problem: I always get a warm welcome.”

“[We think] that all staff at The Mews should have a pat on the back. They have been great, caring and attentive and look after our daughter so well. When they bring her home to our house, the care does not stop. We feel that she is in the best place.”

We would like to thank all of the family members who took the time to complete our annual survey. If you would like any further information about our services, please contact us.

The Mews is praised by independent Quality Checker

The Mews, our residential care home providing short-term intensive rehabilitation for adults with acquired brain injuries, was recently assessed by Northamptonshire Quality Checkers. They are ‘experts by experience’ and perform quality assessments from a service user’s perspective.

This was the third time that Northamptonshire Quality Checkers had assessed the home so expectations were high. Our Quality Checker this time was Paul, supported by a Co-ordinator, Karen. There were no recommendations to follow-up from the previous visit and one of the service users interviewed last time has since moved out. Paul spoke to a young lady “L” whom he’d met last time but not interviewed. They discussed various aspects of life at The Mews and these were some of his findings:

About the home – Very Good:  “L said she felt safe in her home and she said it’s very important to feel safe…She likes her home and she is very independent”

Food and drink – Very Good:  “L makes all her own food and drinks herself… L does all her own shopping.”

Friends and people in the resident’s life – Very Good: “L is happy with the people in her life and she feels safe”

Health – Very Good: “L goes to the doctor, dentist and to have her eyes tested and wears glasses. Staff do talk to her about her health needs and she has had an annual health check. L knows what her medication is for.”

Staff and support – Good: “L said staff still talked to her nicely and they do really listen to her… L said she has not been asked to help on staff interviews but she said she would like to do this”

Activities – Good: “L told us she likes going bowling, shopping and to the cinema. L said she went to Wales on holiday last year and is going to Great Yarmouth this year, she doesn’t really go on day trips but she said ‘I would like to go on day trips’.”

About the resident making changes in their life and how they feel – Very Good: “L said she is still happy at the home, she said ‘I know I need to move but I like it here’. L thinks she will move out in the coming year and has been working towards this… We asked if she would tell people the home was a good place to live, she said ‘I do all the time’.”

Paul also asked the staff and manager questions about how they ensure the safety of residents, how they deal with misconduct, managing risk and staff training. He made the following conclusions:
• “The staff know what they need to do, they are nice, they are friendly, I didn’t see no problems”
• “The house is beautiful and has a lot of space – I really like it”
• “ I think this is a good home and L said she wanted to stay”

He also recommended that:
• L should be invited to help with staff interviews
• Staff should discuss with L the types of additional activities and day trips that she’s like to take part in.

These recommendations were addressed by the manager and no issues remained outstanding.

One of our communal lounge areas at The Mews