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Taking the rehab journey off-piste



Catastrophic injuries have an ugly habit
 of robbing survivors of their dreams and ambitions.

Bucket list items like dancing with tribal warriors or eyeballing sharks in the deep can suddenly seem unattainable.

Even less exotic desires, such as skiing or sur ng, may be lost in the looming shadow of the fateful event.

Yet reviving these written-o wishes can have a dramatic and long-lasting impact on the rehab journey, says case management expert Maggie Sargent.

Maggie is co-director of Community Case Management Services (CCMS) and runs her own expert witness reports business.

Among people with disabilities and challenges caused by severe injuries or other factors, however, she is perhaps better known as an instigator of global adventures.

Skiing, surfing and safaris are all part of her efforts to encourage clients and their families to do things they had either given up on – or never thought were possible.

A popular fixture is a regular children’s ski trip, with 50 to 70 people including parents, siblings, support staff and volunteers jetting o to the slopes every year.

“I insist they bring their siblings as it’s so important that the whole family are involved. Also, if they are in a wheelchair [and therefore ‘sit-skiing’] it’s the one thing that they are probably faster at than their brothers and sisters.”

Another recent trip was a group holiday to Africa which took clients from ocean depths loaded with tropical fish to the reside of a remote tribe; and many places in between.

But the trips offer much more to clients than merely a week or so of fun and escapism, says Maggie.

“It gives them something to work towards in their rehab; a tangible goal.”

This involves a planning process which may encourage the client to think about how

the holiday will be funded.

Money from the individual’s allocated care resources may be used, but often the client will need to take a lead on raising charitable funds or saving for the trip.

Wrapped up in the holiday are several vital elements of rehab, says Maggie.

“We are giving them physio, speech and occupational therapy. In terms of physio, we’re looking to get the best possible physical benefits from whatever activity they are going to do.

“In planning and organising the trip, you are using OT skills, trying to be as independent as possible. Are there communication needs ahead of the trip?

“Speech therapy could include new languages or just looking at how the client is going to communicate. Mobile phones, radios, bleep systems and assistive technology are all things we might use.

“Also there is a psychological element. How are they going to get on with other people? What are they going to be doing on the trip?

“Half the fun of going on holiday is imagining what it will be like. This can be quite difficult if you are [disabled] and your last holiday may have been when you were an able- bodied 18-year-old, for example.”

The lure of an upcoming overseas adventure can inspire dramatic change in the individual’s outlook and motivation.

Often, it also forces families and loved ones to think differently and break out of the safe house they have built around the client.

“It reminds them that this individual is the same person they were before their accident or incident.

“This can be quite hard for the family to accept because the individual has been living in the cocoon of being a patient, looked after and not getting out there.

“It’s easy to hide from reality and so these trips can be a big reality check for families as well as clients.”

Understandably if their son or daughter has suffered a catastrophic injury, some parents require reassurances if they are consenting to something potentially risky like skiing. Videos play an important role here.

“For example, you may have someone catastrophically injured with quadriplegia and communication problems but bags of awareness.

“You can immediately see the feedback on the client’s face and how they respond. We sometimes record this and send films to families to show them how things are going. We might also take them to a dry ski slope beforehand to show what we’re suggesting is possible.”

The trips are not designed to feel like a once-in-a-lifetime opportunity to the client. Instead they are organised with the aim of creating a new, more positive sense

of normal, with less limitations and more possibilities.

“Unfortunately, so many people with a
brain injury living with residential support just don’t have many people to go out with socially, to spend time with, go shopping with and so on. We are building up a tolerance to these activities.

“It’s also about getting back to normal experiences. A lot of young people have skied or surfed before and have been camping
and travelled.

“But after their injury their world becomes narrow. Our whole idea is to make the trip feel as normal as possible.

“We include people who want to volunteer and those who want to come on holiday
 as a professional, so everyone is part of
an interesting group of people. It’s about making sure the clients are given space to do an activity where they are supported but are not over-supervised and there is an element of normality about it.”

An important ingredient of the trips is the consistent stimulation they offer. This comes not only from flying down ski slopes or swimming with deadly predators, however.

It also thrives in the smaller things that make up a holiday. Fresh experiences can be found relaxing in the hotel pool, chatting with new-found friends over breakfast or marvelling at strange sights and sounds through a minibus window.

A common change in clients as a result, is greater engagement with others. Maggie recalls one brain injured 30-something who began initiating conversations after several group trips – having previously remained silent in social situations.

In another case, a young disabled man unable to communicate other than by making a few gestures, had a life-changing experience on a ski trip.

“He met another brain injured individual who’d been communicating with his own form of sign language for some years and was a real character.

“Within a week he had taught the young man hundreds of signs and he was able to communicate so much better than before. He was absolutely locked into this other man and the two spent hours after skiing communicating.

“He was desperate to start communicating after seeing someone else with a brain injury doing it. We took a physiotherapist with him and she was able to act as a conduit, helping him to work out how to make the signs.”

This case sums up what Maggie calls
“the greatest force” of the holidays; the willingness and capacity of clients to help each other out.

A common goal, examples of other people overcoming challenges 
and a situation which takes people out
of their comfort zone all encourage great camaraderie and teamwork, she says.

“What is surprising is the tolerance there
can be between clients in wheelchairs
 and those that aren’t. There is a mutual admiration between people facing different challenges.

“People with brain injuries that are able-bodied tend to help those that aren’t as physically able, and vice versa.

“There’s a respect between members of the group who are doing a certain activity together and enjoying each other’s company with an
 open mind.”

This open-mindedness extends to Maggie and her team. When a brain injured young man expressed an interest in going skiing – they had the vision to see past the ventilator keeping him alive.

It took six support staff and five ski instructors, but the fact that he was up at 4am in the hotel, the first one down for breakfast and “the last man
 on the mountain” at the end of the day, suggests it was well worth the effort.

“When he was in Canada on a gap year training to be a ski instructor he’d had meningitis. He was later paralysed and became totally dependent. I promised we could get him back on a ski slope but had to fight very hard for him.”

With around 30 years in case management under her belt, Maggie has experienced the field’s growth from a fledgling profession to a vast sector.

As it continues to evolve, she believes exciting group trips will play an ever-more important role in the case manager’s job in future.

“For some reason, as case managers, we are all very nervous about getting clients together. We tend to keep them boxed off from each other.

“But case management has grown
and become mainstream, which it
 wasn’t 25 years ago. We must move with the times and mustn’t get left behind.

“This includes increasing what we offer. Because of their own constraints, the 
client may not be able to plan these trips themselves. I think this is where case management needs to be looking in 
the future.”

Maggie advises anyone organising group or individual excursions with potential 
risk factors to use the valuable support
 of charities and organisations with 
special expertise.

With brain injured clients in particular, organisers should also consider how to pace itineraries accordingly.

“Travelling can be tiring. Sometimes you have to educate overseas organisers about brain injuries and the fact that, although clients may look able-bodied, you need to take things one at a time at the right pace.”

Ultimately, just about any challenge can
 be overcome in pursuit of a potentially life- changing trip, says Maggie.
 “Sometimes you just have to be big and brave and say ‘we’re doing it!’”

It’s an approach that’s certainly worked for Maggie and her clients.

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