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Case Study: Raymond

Raymond is a 70-year old gentleman who was referred to neuropsychiatric service, St Peters Hospital, in Newport following an Acquired Brain Injury.

His injury had resulted in significant impairment of his cognitive function associated with paranoia and disturbed behaviours which included impulsive and unpredictable outbursts of aggression towards others.

At the time of referral Mr B had spent 8 months in hospital where it was considered that due to high levels of agitation and aggression it was unsafe to engage him in active rehabilitation and therefore he was being nursed continuously in bed.


What did Raymond and his commissioners want to achieve?

  • A review of his medication, with a view to reducing his dependency long-term
  • To get him mobile again


What did we do to achieve these goals?

After a thorough initial assessment a personalised 16 Week Pathway was created for Raymond aimed at addressing his mobility, mood and behavioural presentation.

On arrival at St Peter’s Hospital the clinical team judged that Raymond was being over-medicated. Initially they optimised Raymond’s mental state with the use of psychotropic medication and then gradually reduced medication.

Importantly, a Positive Behaviour Support plan was designed and implemented by the staff team with an aim of recognising and reducing triggers for challenging behaviours. Additionally this plan was used to provide an education tool for his family so that they could also understand and help manage behaviours.

Finally, to address the mobility issues, Raymond received an intensive programme of physiotherapy that took the form of land-based therapies on-site at St Peter’s combined with swimming and hydrotherapy.


What were the outcomes for Raymond?

  • Raymond’s mental state has been optimised by the use of psychotropic medication.
  • With a reduction in his levels of agitation his level of disability and confusion significantly reduced.
  • A Positive Behavioural Management Plan was informed by functional analysis and implemented by the Staff Team, leading to a significant reduction in intensity and frequency of aggressive incidents.
  • Raymond regained strength in his legs and improved his balance by working with St Peter’s physiotherapy team.
  • Raymond was unable to walk on admission and is now mobilise with the use of a zimmer frame, and can even walk short distances without any walking aids.
  • Raymond has now started transitioned back to his family home through implementation of a structured transition plan, which included regular community access and home leave in preparation for his discharge.
  • A comprehensive assessment of his needs has been shared with locality teams and his Behavioural Management Plan has been reviewed and shared.
  • Occupational Therapist, Physiotherapist and Psychologist visited the family home to make recommendations for necessary adaptations to the environment, as well as training and mentoring his wife and family on how to implement the Positive Behavioural Management Plan at home and in the community.

The significant improvements made by Raymond over the period of his rehabilitation at the hospital, combined with the careful transition planning and management, meant Raymond was able to transition back to his home and enjoy a happy family life again with his wife.


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