A Case Study by Stephanie McDonald.
Coordinated Rehabilitation Support for a Young Person Following Traumatic Brain Injury
An Introduction to Stephanie.
Stephanie is a qualified Nurse and health visitor with extensive case management experience, including work with paediatrics, brain injuries, and multi-trauma patients. She effectively prioritises time critical needs and builds strong relationships with stakeholders to foster collaboration and improve wellbeing. Friendly and professional, Stephanie adapts quickly to fast-paced environments, is resourceful, and pays attention to detail. Passionate about supporting individuals through rehabilitation, she is creative, organized, and maintains a healthy work-life balance. Stephanie is part of the Unite Professionals Clinical Leadership Team, is an experience cased manager, and nurse.
Noah (name changed), a 17‑year‑old college student, sustained a traumatic brain injury (TBI) alongside multiple orthopaedic injuries after being involved in a serious school bus collision. Although his physical injuries healed within several months, the brain injury led to ongoing neurocognitive, emotional, and behavioural changes. The incident had a profound impact not only on Noah, but also on his family, friends, and wider peer community.
Before the accident, Noah had been thriving academically and socially. He lived between both parents’ homes and enjoyed strong relationships with his two older siblings, who were away at university. He was an exceptionally talented pianist and had been preparing for conservatoire auditions to pursue a performance career.
Presenting Challenges.
Around one year after the incident, Noah was referred for case management support. Despite recovering physically, he continued to experience significant and debilitating effects of the TBI. His NHS input had been limited to two physiotherapy appointments and a small number of GP visits related to low mood, fatigue and symptoms indicative of post‑traumatic stress.
In the initial assessment, Noah described:
- Severe fluctuations in mood, ranging from prolonged periods of high energy and minimal sleep, to extended phases of overwhelming fatigue.
- Auditory and visual hallucinations, which intensified during times of emotional distress or exhaustion.
- Cognitive difficulties, including poor concentration, memory lapses, and reduced problem‑solving capacity.
- Social challenges, including feeling disconnected from peers and struggling to interpret social cues.
- A sense of loss in relation to music, particularly a disturbing feeling of “disconnection” between his brain and hands when playing the piano. This impacted his performance and contributed to unsuccessful conservatoire interviews.
At the same time, Noah had recently transitioned to university, where he enrolled on a music technology course. Feeling vulnerable and overwhelmed, he began experimenting with substances roughly twice monthly in an attempt to calm or escape from the hallucinations. His educational engagement became inconsistent, and both family relationships and peer interactions were increasingly strained.
Noah’s parents also expressed concerns regarding episodes of impulsivity, irritability, and periods of low mood during which he made passive statements about not wanting to be alive. A coordinated, multi‑agency approach was essential to ensure his safety and stabilise his emotional wellbeing.
Case Management Approach.
Our case management role centred on coordinating care, advocating for Noah’s needs, and ensuring a trauma‑informed, holistic rehabilitation plan. Key elements included:
Multidisciplinary Coordination
- Arranging joint reviews with Neurology and Neuropsychiatry to understand the interplay between TBI, mood instability, and perceptual disturbances.
- Ensuring clear communication pathways between medical teams, therapists, family members, and educational staff.
Specialist Rehabilitation
- Facilitating access to Neuropsychology to support emotional regulation, coping strategies for hallucinations, and adjustment to identity changes post‑injury.
- Referring to Neuro‑Occupational Therapy to address attention, memory, executive functioning, and everyday problem‑solving skills. OT input also focused on strategies for managing impulsivity, irritability, and anxiety, thereby supporting greater confidence in social settings.
- Introducing support from a Cognitive Rehabilitation Assistant, working under clinical guidance to help transfer therapeutic strategies into Noah’s daily routines, community life, and academic tasks.
Family Support and Psychoeducation
- Helping Noah’s parents understand the neurological basis of his emotional and behavioural changes, reducing feelings of blame and improving family communication.
- Supporting the family in navigating risk concerns and maintaining a safe, structured environment at home.
Education and Participation
- Collaborating with his university to implement reasonable adjustments, such as flexible attendance, reduced timetabling, rest breaks, and modified academic expectations.
- Initiation of an education, health and care plan (EHCP) process to secure long-term educational support.
Risk Management and Crisis Planning
- Developing a clear, collaborative risk management plan involving the family, university, GP, and mental health services.
- Providing regular reviews and adapting the plan as Noah’s presentation evolved.
Outcomes and Reflections
This case highlights the complex interaction between neurological injury and mental health in adolescence. Noah’s journey demonstrates why young people with TBI require careful, sustained, and well‑coordinated support, particularly during major life transitions such as starting university.
From a case management perspective, three elements proved essential:
- Consistent coordination between services to prevent gaps in care.
- Trusting, supportive relationships with Noah and his family to maintain engagement and safety.
- A balanced approach that combined risk management with empowerment, recognising that many of Noah’s behaviours were injury‑related rather than intentional.
Ongoing rehabilitation will continue to play a crucial role as Noah moves into adult services, builds insight into his injury, and develops the skills needed to manage his symptoms and regain independence.