Case Studies
Living Life to the Full

Jemma has had case management for all her adult life and has been working with Ben Holden Ltd for over 10 years. She has cerebral palsy from hypoxia at birth and is a full-time wheelchair user. Ben Holden Ltd proudly provide Jemma with Case Management from Christine Waites and Occupational Therapy Services from Ellie Harvey, two of our clinicians. She has a 24/7 team of support workers which enables her to live independently in her own home.

Jemma has many equipment needs owing to her disability but overall is stable and settled from a therapy point of view, and therefore has a ‘light touch’ Occupational Therapy package from Ben Holden Ltd. We have built a team of reliable and responsive professionals who can pull together to see her needs are met as they arise, and furthermore support her to resolve any equipment issues without need for re-referral, which can cost time.

Recently, Jemma’s much loved Permobil wheelchair gave up the ghost! We knew its days were numbered given its age and had pro-actively booked in a quote visit for a new wheelchair but while waiting for this appointment, her Permobil broke down. We compared the cost of repair versus cost of a new chair whilst bearing in mind the level of demand on the wheelchair, as well as how long we could realistically extend the life of the current Permobil.  Following assessment and consideration along with agreement from her COP team, Jemma decided to put an order in for a new Permobil F5.

Successfully the whole process only took 8 weeks end to end from the original Permobil breaking to the new one being delivered. This would not have been possible without the swift and collaborative teamwork along with Clinical Mobility Solutions. They took the time to get to know Jemma and understand, as we do, how having the right equipment is essential to positively enhancing her wellbeing and quality of life.

This is one example of our commitment and professional approach to successfully meeting our clients’ needs.  We believe the key to success with Jemma and all our clients, is the stability of professionals, excellent inter-disciplinary relationships, and the longevity of intervention with them. Ben Holden Ltd effectively provides a team who thoroughly understands the client, and in return the client can trust and rely upon them.

Jemma: “This is my 2nd Permobil chair.  I can honestly say I wouldn’t be without it now.  Best adaptable chair and helps me stay as independent as possible.  I just absolutely love it!  I would highly recommend the Permobil to anybody in my position, I think it is the best chair I have ever owned!”

The outcome:

Jemma is now back out in the world enjoying experiences such as those in the video, made possible by her Permobil F5 (a standing wheelchair). Jemma does not do life in half measures; she will give new experiences a go and is repaid in the joy she finds through meaningful activities. By being in this amazing chair, in the crowd, she even got to dance with the lead singer of Bastille!!! What an experience!

Making Work Sustainable

Injury:

This client had a serious injury at work and the hospital did not diagnose his mild brain injury. Due to the effects of his brain injury his ability to perform effectively in his role at work was compromised. His coping abilities at home were also problematic as his relationship with his wife was under immense strain.

When we first met him, nearly two years after the injury, his relationship with his employer was breaking down; he had cognitive (thinking) problems that were worsened when he faced pressure and rapid changes at work. He had been sent home from work and was on leave. His situation was compounded with other mild neurological problems, pain, insomnia, low mood, anger, irritability, fatigue and severe anxiety. It was likely that without any help, his employment and marriage were on course to fail.

Our Interventions:

  • A referral was made to a consultant neurologist to assist with confirming a missed diagnosis of mild brain injury and to provide some guidance with rehabilitation and useful medications;
  • The client was referred to a clinical psychologist to assist with the cognitive issues, anxiety and low mood;
  • The client had some residual painful soft tissue injuries and the case manager referred him to a musculo-skeletal physiotherapist;
  • The client experienced dizziness and vertigo and was referred to a vestibular physiotherapist;
  • The case manager coordinated all of these clinicians, and also regularly communicated with the GP, the client’s solicitor and other relevant parties;
  • In this situation, the case manager was an occupational therapist experienced with vocational rehabilitation and had unique skills to support the client with maintaining his employment;
  • A workplace assessment was completed;
  • Education and training about brain injury was provided to the client, his family, the employer and key management/supervisors in the work place;
  • The case manager worked closely with the clinical psychologist and client to ensure that a comprehensive return to work plan was established;
  • The case manager completed several visits to the work place and supported the client with successful implementation of the various recommendations from the multidisciplinary team.

The Outcome:

This gentleman was able to successfully implement many strategies that allowed him to have more energy, make better decisions and cope much better in the workplace. He was able to return to work and gradually build up his hours back to full time. His mood improved significantly, as did his relationship with his wife.

This gentleman reported a dramatic improvement in the quality of his life and after he demonstrated that he was able to maintain his employment over a period of about nine months our involvement was gradually brought to a close.

Living Independently in the Community

Injury:

Mr A sustained an injury aged 51 that resulted in both of his legs being amputated. He also sustained a right brachial plexus injury meaning that he has minimal use of his right arm. When we first met Mr A, he was living in a residential care facility, leading a less than fulfilled lifestyle.

The equipment he needed included:

  • An electric hi lo bed;
  • A ultra light manual wheelchair;
  • A power indoor wheelchair;
  • A power all terrain chair;
  • A hoist;
  • Specialised bedroom and bathroom furniture and fixings;
  • Stair lift;
  • Kitchen equipment;
  • Closomat- electric power toilet;
  • An electric bath;
  • A power shower commode;
  • Portable ramps;
  • Environmental control equipment – power windows, doors etc.

Our Interventions:

An initial needs assessment was undertaken to establish the client’s abilities, strengths, limitations, problems, priorities and goals. This information was incorporated in a report containing a plan of how to address identified problems and goals;

A priority was to assist the client with deciding upon where to live following discharge from the residential care facility, as his former home was no longer appropriate or adaptable to meet his needs.;

Guidance was given with property searches and suitability to Mr A’s interests and lifestyle, making some predictions about his physical abilities in the future and the many types of specialised equipment he might need;

Upon convening a suitable property, assistance and advice was provided with adapting the property specific to the clients needs. This involved extensive liaison with the architect, quantity surveyor, environmental control provider and main contractor;

Arrangements were made for the client to have a neuropsychological screening assessment for any cognitive impairment (thinking problems) or psychological problems after his injury;

The Outcome:

Mr A now lives in a fully accessible and adapted home that has environmental control technology to maximise his level of independence. He has a team of support workers to assist him with everyday domestic tasks.

He is independent with his personal care tasks using the equipment in his modified bathroom.

Mr A is able to drive his power chair right into his car, and drive and operate the car using only his left hand and a joystick and small control panel. He enjoys the freedom of being able to go out independently without relying on taxis or support workers to assist him.

Mr A is now able to mobilise short distances indoors on his prosthetic limbs, and continues to receive regular physiotherapy; with the aim of using a wheelchair for outdoor mobility only.

Mr S and His Baby - Independent in the Community

Focus on Doulas: A Case Study by Ellie Harvey

As part of our role as case managers and in the breadth of our job, we take on tasks which sometimes may be novel. Knowing when to seek additional support or the knowledge and expertise of others I consider very important – we simply cannot know it all and collaborative working is something I really love about my job.

Exploring the world of doulas has indeed been novel. My client, Mr S, and his wife were expecting their first baby in 2023, and when looking at nanny support versus agency support to help in the days and weeks before and after baby’s birth, neither could really cater for the family’s needs. A nanny was there for the baby, and a support worker there for the client.

I began to think outside of the box and explore experts in the field of client-centred ante- and post-natal care and discovered doulas, an unknown to me at the time. A doula is an independent practitioner who supports in pregnancy, birth and in the ante- and post-natal periods by providing information, advocacy, and offering practical and emotional support to the whole family. This summed up exactly what we were looking for!

Having developed a clear picture of the ante and post-natal needs and goals of my client, I found a local doula. I broached the idea of supporting a ‘dad to be’, with a brain injury – she listened, we talked it through, and she felt she could help. She worked collaboratively with me, with her links and knowledge of the NHS services and professionals, to provide face to face c-section training to my client and his wife with bespoke sessions to cater for his cognitive deficits, arranged preparatory ward/theatre visits, and most importantly she informed the many hospital staff of Mr S’s brain injury, triggers, likely behaviours and how to best support him and understand him/those behaviours. This would have taken hours of case management time, but our doula handled it expertly. And it worked – baby was brought into the world, with dad by mum’s side and all was calm and co-ordinated! Their ante-natal doula stayed around for the initial days, on hand for text support any time of day.

On discharge home, a post-natal doula (who the family had got to know prior to birth) commenced her work to support my client to learn the ropes of hands on fatherhood, tailoring support to his needs, strengths and deficits and working alongside him to build his confidence in ‘dad duties’ such as feeding, sling wearing, shopping with a baby, understanding the baby’s needs/cries, and even how to co-ordinate walking the dog and taking the baby out at the same time – whatever was important to Mr S, was important to her. She spent several weeks with the family, with Mr S reaching the goal of full independence with his baby out in the community.

My client’s post-natal doula Bonnie says: “The joy of us being completely independent is that it gives us flexibility to be really responsive to the client’s needs, for them to choose the right person and the right type of support for their own unique needs. When it’s someone who becomes really involved in your home and family life, especially with a newborn, there has to be a real degree of trust and comfort both ways.”

He has flourished as a dad, and it’s so wonderful to watch. Both doulas have been key in the family’s journey into parenthood and in mine as a case manager – an extra layer of bespoke help and support for parents-to-be and new parents that I would never have known about before this experience, and one I am sure to explore again for others.

And now, in 2024 we prepare to welcome baby number two… with an A-team of doulas at the ready, and new challenges to conquer as three becomes four!

Please click here for a detailed diagram showing how Ellie jointly mind-mapped birth plans with Mr & Mrs S.

IRCM

We are proud to be an official supporter of the Institute of Registered Case Managers

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What do our clients & referrers say?

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When Jo started supporting me it was also the start of the Covid Pandemic. She took the time to explain physical anatomy which helped me understand the immediate and longer term impact of my injuries. We set attainable goals for me to rebuild all aspects of my life.

With professional understanding of procedures and expectations she liaised with my legal representative for insurance funding and others, securing the further support I needed, for example; intensive physio, counseling, driving confidence lessons, further surgery, occupational health equipment, a PA to support me and relieve the pressure on my family. I would always be happy to recommend Jo as a Case manager to others.

Before I was supported by Jo Forrest at Ben Holden Ltd, I was struggling with EVERYTHING caused by the RTA. I was incapacitated in a hospital bed in my dining room worried about the traumatic impact on my husband and family, not just following the accident, but the reality of my lack of independence, my ongoing care and my own physical rehabilitation.

Please pass on my thanks to all at Ben Holden for their help and patience with me over the past few years. Things are so much better for me now compared to when I came to you and you have all played a part in that, no matter how small, and I greatly appreciate it. Credit where it’s due in my eyes, and everyone at Ben Holden have been kind, courteous but perhaps more importantly understanding of my difficulties if/when I’ve been confused or remiss in remembering an invoice or some such. It is much appreciated.

Christa came to visit me numerous times in the Royal Free Hospital. Having assessed my needs, she organised repair of my wheelchair, hospital bed on my return home. Organised private physiotherapy and stay in care home. Once home, she came with me to private therapist in Harley Street.

Very kind, understanding and caring.

Before I started working with Ben I was struggling with the everyday tasks e.g. getting myself dressed, walking any distance, lifting, getting in and out of bed, bending. Within six months, Ben and his team enabled me to do all these things and return to work gradually, which resulted in me being able to do my pre-injury job.

My life began to significantly change. Ben treated me with the upmost dignity and respect. He coordinated a team of professionals experienced in working with neurological disorders, especially with people who had experienced an accidental severe traumatic brain injury or through illness. I felt confident that Ben would and did manage to select professionals who he somehow knew would manage my challenging eccentric behaviour and complex needs.

It was very reassuring to know that Ben was always at the end of the phone.  He was there when I needed him most. He always responded quickly and kept everybody involved well-informed of what was happening with Progress Reports.

I could trust Ben and felt reassured by his knowledge and patience.  He has a great and appropriate sense of humour. I would highly recommend Ben to others who would surely benefit from his expertise.

Ben was very helpful and promptly organised a good local physiotherapist for me. There I was given exercises specific to my problem, along with acupuncture and massage. This was invaluable, as nothing had been offered to id my recovery by my local hospital. In addition, Ben organised a six-month gym membership at my local leisure centre.

I always found Ben easy to talk to and he regularly called to check on my progress. I would not hesitate to recommend Ben Holden td, who gave me a very friendly and professional service.

My experience working with Ben was excellent. I felt very at ease, relaxed and confident with him. If I had any queries or needed extra support, he was always on the end of the telephone. Nothing was ever too much trouble.

I highly recommend Ben Holden, for his professionalism, friendliness and for the individual support I got. I would like to take this opportunity to thank Ben and his team for all their work getting me where I am today, leading a normal life again, and being able to put my accident behind me.

Before Ben Holden started working with me on my injuries, I was struggling daily and unable to progress with my rehabilitation back into normal life. Since Ben Holden Ltd took on my case I have been able to focus on getting my life back together following my accident.

Working with Ben made me feel confident and in control again, his relaxed and easy style made me feel I could talk to him freely about my concerns. I wouldn’t hesitate in recommending Ben Holden Ltd to anyone facing the prospect of life following a life changing accident.

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