Neuro Case Management’s adult case team has evolved through the years to bring holistic support to patients, carers and families across the UK. Founder and CEO, Martin Gascoigne, discusses the importance of highly specialised teams for both paediatric and adult case management.
Founded in 2010 Neuro Case Management, which specialises in brain and spinal injury cases, started out working in paediatrics – supporting families with an holistic approach to case management.
Gascoigne explains that this involved collaborating with various therapists, who were all dedicated paediatric specialists, and that, while he could work with both adults and children as a case manager, the therapists Gascoigne worked alongside were exclusively paediatric practitioners.
“Case management is a small, specialised field, with only around 105 case managers across England, Ireland, Scotland, and Wales,” said Gascoigne. “Within that, different professionals focus on specific areas. Neuro case management specialises in brain and spinal injuries, but our client group has always spanned all ages, from early childhood to later life.
“My background in social services and hospital work initially centred on supporting children and families, so I never saw a reason to limit myself to paediatrics or adults – I chose to do both.
“When I started, we had just three paediatric clients, all in special needs schools. This introduced me to the world of paediatric care, therapies, and specialised equipment, which was a steep learning curve. Unlike working in a hospital, where patients come to you, paediatric case management meant conducting home visits and working closely with families.
By 2012, adult referrals began coming in, Gascoigne said, and the company recognised the need to establish a dedicated adult case management team.
“Although we had built significant experience in paediatrics, transitioning to adult care required a complete shift in approach,” Gascoigne said.
“Adults had different needs, required different equipment, and lacked access to the same funding streams as children. For instance, children could benefit from school-based resources, while adults faced a different set of challenges in securing support.
“Launching the adult team meant learning on the go and adapting quickly. It was a significant adjustment, but it allowed us to expand our expertise and ensure we could support clients of all ages effectively.”
Gascoigne explains that, when working with paediatric clients, the case management teams would typically ask parents whether they thought their child needed an assessment for mobility aids or other specialist equipment.
“In contrast, adults make their own decisions, which required a shift in approach,” said Gascoigne.
“Instead of discussing with parents what their child might need, we had to directly engage with the adults and ask what they wanted to do. Their goals were often very different from those of children. Some wanted to return to university, while others aimed to re-enter the workforce.
“A particularly interesting aspect of brain injury is that no two cases are alike. You could have identical twins with the same brain injury, yet they would present entirely different symptoms and recovery trajectories.”
When Neuro Case Management officially launched its adult case management team in 2012, it was important to establish strong links with private rehabilitation services across the country.
“Brain injury rehabilitation differs significantly between children and adults,” said Gascoigne.
“In children, the brain is still developing, so intensive rehabilitation is often delayed until brain maturity, typically around age 23. In contrast, adults have a much smaller window for recovery. Following a road traffic collision (RTC) or similar injury, there is generally only a two-year period during which rehabilitation is most effective. After this, the brain is considered “static”, meaning its potential for further recovery is significantly reduced.
“Many adults with brain injuries are unaware of the full extent of their condition, often attributing their struggles to physical symptoms rather than cognitive impairment. For example, someone might frequently complain about back pain while overlooking their neurological symptoms.
“One lesser-known but common issue among brain injury survivors is hyperacusis, or extreme sensitivity to noise. For instance, they may struggle in crowded places like swimming pools, where background noise becomes overwhelming, making it difficult to focus on a single conversation. These sensory processing difficulties are poorly understood by the general public, which can make independent living challenging for many brain injury survivors.”
Gascoigne said that one of the first steps in adult brain injury case management is establishing when the injury occurred to help determine what rehabilitation options are still available, as timing is crucial.
“NHS rehabilitation typically lasts only eight weeks, known as the acute stage, after which many patients are discharged,” said Gascoigne. “Those with access to compensation claims may be able to afford private rehabilitation, but specialist private centres in the UK are limited.
“Each case requires matching the individual to their injury, future goals, and available services. Unlike children, whose needs may evolve more slowly, adults with brain injuries often have immediate and noticeable impairments, making it easier to identify their struggles. However, securing the right support can be challenging due to limited service provision.”
Gascoigne said that, for many adults with brain injuries, pursuing a civil litigation claim is often necessary to secure long-term support.
“This typically involves seeking compensation from an insurance company, rather than directly suing a hospital,” said Gascoigne. “In cases of medical negligence, such as a child being deprived of oxygen at birth, the claim process can be more straightforward, as the lifelong impact is clear and measurable.
“In contrast, adult brain injury claims are far more complex. There are numerous factors to consider, such as pre-existing conditions, previous injuries, and individual developmental differences.
“Establishing a clear link between the injury and the impact on daily life requires detailed assessments from a team of specialist therapists and legal experts. This process is a complex puzzle, requiring expertise in multiple disciplines to build a strong case and ensure the individual receives the necessary support.
“In both paediatric and adult brain injury cases, a specialised legal team is typically involved, with barristers or lawyers responsible for moving the case forward. However, when a case reaches court, the focus shifts from legal arguments to practical solutions.
“Rather than fostering a blame culture, the court appoints a case manager to conduct an initial needs assessment. This assessment determines the individual’s abilities, limitations, and required support, such as specialist medication, rehabilitation, or dietary modifications.”
Gascoigne explains that, at this point, paediatric and adult cases diverge, as paediatric cases involve therapists specialised in working with children, while adult cases require professionals trained in supporting independent living and long-term rehabilitation.
“The key challenge is finding experts who can accurately assess the person’s needs, project how those needs may evolve over five, ten, or even fifty years, and provide a detailed roadmap for future care,” said Gascoigne.
“Historically, brain injury assessments focused on what an individual could no longer do.
“However, modern case management takes the opposite approach, prioritising what the person can do and then addressing specific challenges caused by their condition. Factors such as medication side effects, chronic fatigue, cognitive impairments, and rehabilitation requirements are all incorporated into a personalised care plan.
“This requires a highly specialised team, often comprising three to four expert case managers. Case managers typically come from occupational therapy, physiotherapy, social work, or nursing, and must be degree-qualified to work in this field. Their expertise allows them to build tailored, bespoke rehabilitation plans, ensuring that each patient receives the support they need to maximise their quality of life and independence.
“This highlights the importance of individualised case management, ensuring that each patient receives a care plan tailored to their specific needs, abilities, and long-term goals.”
