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.

Psychology services for adults with complex needs

The psychology team at The Richardson Partnership for Care plays a crucial role in the care and support of our service users, who have complex needs and acquired brain injuries or learning disabilities. Dr Pedro Areias Grilo, Consultant Clinical Neuropsychologist, heads up the team and is supported by three Assistant Psychologists: Julita Frackowska, Olivia Ferrie and Joseph Szablowski. The Assistant Psychologists are assigned to specific service users according to their needs and the homes in which they live.

Person-centred care
The ethos of the psychology team is the one that runs through the organisation as a whole: the service user is at the centre of everything we do. We are committed to providing individualised care to effectively support the nuanced needs of each service user. We take a person-centred approach and offer interventions to service users based on cognitive behavioural models, dialectical behaviour skills and operant conditioning. All of the interventions offered are evidence-based and follow NICE guidelines.

Psychological reviews
All service users receive an initial psychological review, which includes neuropsychological assessments, a review of clinical presentation, assessment of stability of mood and suggestions for future interventions. This review is then repeated on a regular basis to assess the effectiveness of the therapies and interventions delivered. In addition, we have an ‘open door’ policy at The Richardson Partnership for Care, so all members of the psychology team, and the Assistant Psychologists in particular, can develop close working relationships with the service users. This means that their well-being can be monitored closely on an informal basis and we have found that this helps to maintain their mental health, so any problems can be addressed early, preventing the need for crisis care.

Positive Behaviour Support
Positive Behaviour Support (PBS) is a key part of the psychological support that we provide and an emphasis on positivity is one of our main philosophies. PBS Plans are person-centred and designed with input from the service user to promote positive behaviour. They are supported to set their own goals and to achieve them.

In addition, Pedro and the team are working on an innovative Positive Behaviour Tool to more effectively monitor and encourage positive behaviour. This runs alongside the traditional techniques of reducing negative behaviour.

Multi-Disciplinary Team
The psychology team works closely with the other members of the multi-disciplinary team. (This comprises a consultant neuropsychiatrist, homes managers, service manager, physiotherapist, speech & language therapist and occupational therapist.) Pedro and Consultant Neuropsychiatrist, Dr Seth Mensah, work closely together to balance the use of drug therapies and psychosocial therapies. Where possible, we aim to focus on psychosocial approaches and gradually reduce the reliance on drug therapy to achieve better outcomes for service users over the longer term.

A diagram explaining the psychology services at The Richardson Partnership for Care
A summary of the psychology services offered at The Richardson Partnership for Care

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

New Acquired Brain Injury Care Home Opening

We’re pleased to announce the launch of The Coach House – our new residential care and rehabilitation service for 11 adults with acquired brain injuries. And to celebrate, we’re holding an Open Day on Thursday 24th January, 2019.

The Coach House is a self-contained home in the grounds of The Mews, another of our specialist residential care homes in Kingsthorpe, Northampton. We’ve spent a lot of time, thought and effort in creating the best environment we can to help people recover from brain injuries and rebuild their lives. We believe that designing a home that is accessible, practical and safe does not mean that it can’t also be cosy, comfortable and feel like home. In fact, we believe this is crucial to service users’ well-being and their engagement in their own rehabilitation plan.

We have some fantastic speakers involved in the event, so please come along to celebrate the opening of the Coach House, meet the team at The Richardson Partnership for Care and find out more about brain injury rehabilitation.

Open Day Programme

9.30am – arrival and coffee
10.00am – 1.00pm – presentations and discussions

Dr Seth A. Mensah, MB ChB, MSc, DPM, MRCPsych – Consultant Neuropsychiatrist
“The Brain and Human Behaviour – What has Phineas Gage taught us?”

Pedro Areias Grilo, HCPC, MSc – Consultant Clinical Psychologist
“Positive Behavioural Tool – capturing positive behaviours in neurorehabilitation”

Jo Throp – Neurological Occupational Therapist and Clinical Director at Krysalis Consultancy
“The Brain and its Function from the Perspective of a Neuro-Occupational Therapist”

1.00pm ribbon cutting, lunch and tour of facilities
2.00pm close

Please reply to Sian.Richardson@careresidential.co.uk or call her on 01604 791071 for more information.

The Coach House residential home for adults with acquired brain injuries

The Coach House, Kingsthorpe, Northampton NN2 7PW

Activities for adults with acquired brain injuries

Building confidence and self-esteem
As well as specific therapeutic inputs, such as occupational therapy, physiotherapy and psychology sessions, service users in our care can also choose to take part in a range of activities each week, depending on their needs and abilities. These activities include music sessions, arts and crafts, ASDAN learning sessions, swimming, visiting local cafes, shops, etc. Not only are they fun and enjoyable activities in their own right, but they are also important in providing a ‘normal’ lifestyle and they support the therapeutic regime provided by the Multi-Disciplinary Team.

One popular activity for several of our service users with acquired brain injuries is Rock Club. It brings together people using different brain injury services in Northamptonshire to take part in a wide range of different activities: Anything from a disco and karaoke night to a bake-off competition, film night or quiz.

Halloween is a big event and the fancy dress disco is eagerly anticipated. Sallie Maris, the Arts and Crafts Co-ordinator at The Richardson Partnership for Care helped some of the service users prepare their Halloween costumes, which was all part of the fun.

Dressing up for HalloweenPreparing for the Halloween party

The Rock Club summer fun day was also a big occasion, with a barbecue, side shows and a visit from ‘Party Animals’ – an organisation that enables people to have close encounters with reptiles, rodents and mammals so they can learn more about them, overcome their fears and build confidence. Terry, one of our service users with an acquired brain injury was inspired to create this poster after the Rock Club summer fun day because he enjoyed it so much.

Terry's Rock Club poster

Rock Club events are held in Northamptonshire every other month, but the benefits extend to both before and after each occasion, and they are just part of the programme of activities included in the care plans for our service users.

As well as being very enjoyable, a varied activity schedule is important to service users in many ways: It helps them to build relationships with other people in a safe, supportive and good-humoured environment. This improves their well-being, self-esteem and confidence. In addition, the activities themselves help to improve motor skills, dexterity, co-ordination, concentration, memory skills, communication and vocal skills.

Brain injury rehabilitation – Kay’s story

Kay - brain injury survivor

Kay has transformed her life with the help of the MDT and support staff at The Richardson Partnership for Care

When she was only 18 months old, Kay contracted Encephalitis and consequently experienced severe epilepsy. At the age of 13, she underwent surgery on her frontal lobe, which further exacerbated the brain damage. Kay also has a diagnosis of moderate learning disability.

Kay lived at home with her mother and grandmother before moving to specialist residential schools and other settings. At the age of 27, Kay moved to The Mews at The Richardson Partnership for Care. She had previously resided in a private hospital, but the placement broke down due to her risk behaviours and the inability to manage Kay in that environment.

Behaviour on Admission to The Richardson Partnership for Care
Kay’s challenging behaviour was thought to be underpinned by poor impulsivity control and a reactive approach to challenging situations due to her brain injury.

On admission, Kay presented with severe verbal and physical aggression towards herself and others. She also would make false allegations towards staff and other residents, disregarding staff prompts and instructions compromising her and others’ overall safety.

Kay was offered a holistic approach to help her to manage her challenging behaviour and become more self-aware. With the support of the multi-disciplinary team at The Richardson Partnership for Care and her care support workers, Kay has transformed her quality of life.

Read Kay’s brain injury rehabilitation case study in full here

Our new residential care home – update

The excitement is building as our new residential care home and rehabilitation centre gets closer to completion. The Coach House is a listed building in the grounds of one of our existing care homes, and it hadn’t been used for many years. It is being renovated and extended and will soon become a new residential care home and rehabilitation centre for 11 adults with acquired brain injuries.

The scaffolding is down and a large team of trades people are busily working away inside. Doors are being hung, skirting boards and architraves fitted; The underfloor heating is in and floors are being tiled, and wet-rooms fitted out.

The terrace has been laid outside the bedrooms and the fine weather has meant that we’ve made good progress on the groundworks, so we’ll soon be in a position to show round visitors – we’ll keep you posted!

The Coach House - exterior

The Coach House – exterior

The Coach House - terraces

The Coach House – terraces

Sad news and tribute to Brian Richardson

Brian Richardson

Brian Richardson

This month we pay tribute to my dad, Brian Richardson, who has died after a short illness: He was diagnosed with Lymphoma in his brain in April this year. Brian was the driving force behind The Richardson Partnership for Care, which he founded with my mum, Jackie, in 1989.

Brian was an amazing man who touched the lives and hearts of so many people. He was born on Christmas Eve 1949 and grew up in humble surroundings in Northampton with his parents and two brothers. His entrepreneurial spirit was evident from a young age when he would devise enterprising schemes, which included repairing motorbikes on the lawn in front of the family home.

After leaving school Brian attended the newly opened Nene College in Northampton and qualified as a teacher, however he didn’t quite fit into the teaching world. Instead he came home with a teenage student who desperately needed short-term foster care and that was the beginning of his career as a carer.

Brian and Jackie started The Richardson Partnership for Care in their own home, caring for people with learning disabilities. In fact, two of the people that they looked after then are still residents in our care homes now, almost thirty years later. They built up the business with love, sheer hard work, determination and dedication; qualities that Brian also displayed in his personal and social life.

Brian and Jackie grew the business by buying up properties in Northampton to enable them to care for more people. They also recognised there was a need for specialist residential care and rehabilitation for people with acquired brain injuries, so extended the services to care for them too. I grew up in the business and have worked full time for The Richardson Partnership for Care since leaving school. Around 15-20 years ago, I was appointed a Director, and Brian and Jackie gradually stepped down from the day to day running of the business, handing over to me and my husband Greg.

The Richardson Partnership for Care is very much Brian’s legacy. He and Jackie established it to feel more like a family than a business. Brian was more than a boss to his employees – he was a true friend and a gentleman. He was known for his generosity, often helping people out when they didn’t expect it and investing in their personal development. He gave them the skills and the freedom to move on, but many of the staff chose to stay. This is still the case today.

Part of Brian’s legacy is also the ethos of The Richardson Partnership for Care and its commitment to providing a warm, friendly and positive environment for people with learning disabilities and acquired brain injuries. They are treated with dignity and respect and we aim to support them to realise their potential and live a fulfilling life.
Brian was a man who lived life to the full. He had many friends and a wide range of interests. As a youngster he would go to the Salon ballroom with his parents where he achieved gold medals for Ballroom and Latin American Dancing, and in later years he would love to Rock and Roll and Salsa with Jackie and Laura. He also loved the outdoors: he enjoyed walking and fishing, but his great passion was stalking and shooting. He was also a confident and extremely competent diver, as well as fast and enthusiastic skier. He was a risk-taker and had a reputation for a having a dare-devil attitude, which is perhaps why he was so much fun.

Brian was a warm and generous host and loved cooking for friends and family. He has been described as kind, caring, friendly, funny, a life-long friend, supportive, great company, interesting, intelligent, daring, obstinate and even, eccentric. We will miss him dearly, but we endeavour to maintain the ethos and vision for The Richardson Partnership for Care that Brian and Jackie established.

Summer holidays and activities

The excitement has been building as the holiday season is now well underway and we’ve had weeks of glorious sunshine. Holidays are planned months in advance and our service users, who have acquired brain injuries, or learning disabilities and complex needs, are supported in choosing where they would like to go.

Wherever possible, we try to accommodate specific requests for holiday destinations and they are financed by accruing a certain amount each month then topped up if someone needs something extra. Service users go away in small groups or individually, depending on their needs and preferences. They are supported by their care workers and they are involved in the decisions on who accompanies them.

Our service users enjoy the activities, atmosphere and the change in environment that a holiday brings. Some people need familiarity and routine so we balance this with the opportunity for enjoying new experiences. This year, some of our service users have been on a boat or seen the sea for the first time. Going on holiday is paramount to their health and well-being and is instrumental in their social inclusion and positive feelings of self-worth. There are also physical benefits of being outside and taking part in new activities.

This year popular holiday destinations include the Isle of Wight, Hemsby in Norfolk and Skegness in Lincolnshire – which is also close enough for a day trip. Billing Aquadrome is a local holiday park with good facilities, which is popular as it combines a change of scene and a relaxed holiday environment with a very convenient location. In addition, one service user has enjoyed a weekend trip to Blackpool, and others have visited their respective families in Malta and Serbia. We’ve also enjoyed day trips to London, the coast, zoos and country parks. Summer activities have also included trampolining and swimming, and one of our service users went to a David Byrne concert in London. We support our service users to lead a fulfilling and active life as possible.

A boat moored off the Norfolk Coast

Our new residential care home is taking shape

The Coach House will soon become a new residential care home and rehabilitation centre for 11 adults with acquired brain injuries. It is a two-storey building situated in the grounds of The Mews (one of our existing residential care homes) in Northampton, and after extensive renovation work it is now taking shape.

As it’s a listed building, we’ve been working alongside planners and conservation officers to ensure that we retain the integrity and character of the original building, while making it a modern, comfortable place to live. We are extending and renovating it to bring a run-down building back into use, which will provide much-needed accommodation and rehabilitation facilities for people with acquired brain injuries and complex needs.

Maintenance Manager, Dexter Griffin, is managing the project and the team of builders, contractors and specialist trades to ensure that everything runs smoothly and it up to the required specifications and standards.

We are including as many environmentally-friendly and energy-efficient features as possible within the care home. These include rainwater harvesting, and installing the system was a big project. Much of the work happened below ground as we had to dig a hole 5m deep and install a tank capable of holding 42,000 litres of water. The tank then had to be filled and settled before the rest of the hole was filled in. This was one occasion when we were grateful for some torrential rain! The system will collect water from the whole of The Mews’ roof as well as the Coach House, which will be used to flush toilets in both buildings as well as supplying the laundry rooms. In addition to being environmentally-friendly, we will achieve a return on our investment from reduced water and sewerage costs over time.

The roof and external structures are almost complete and we’re looking forward to the scaffolding coming down so we can have a better impression of what the finished care home will look like.

Dexter and the team are now working on the interior framework and services. The care home will have light, spacious bedrooms and communal areas with wide corridors to give a practical, relaxed and comfortable environment. We’ll keep you updated as the building progresses.

The extension of the new care home

Three new bedrooms in the extension, which will have their own individual terraces

Corridor in the Coach House

Corridors will be wide and light

Stonework

The stonework on the new part of the building will age to match the original