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Mary with one of her horses illustrating Mary's story of tailored rehabilitation with case management services

There is a place and time for everything and this is so true of neurorehabilitation.

When someone first has a neurological event it is the misconception that they must have the most therapy possible in the shortest timeframe. Being bombarded with therapies and having a very full timetable of activities is not always the best for the client. However, clinically there needs to be therapy input to prevent deterioration and to enable the best outcomes for the client in the future.

Some clients take a long time to process what has happened to them and to adjust to the difficulties that they are experiencing. They are not able to take on board all the information that they are being given to make informed decisions.

If clients do not make significant progress within a certain time frame (usually weeks) they are thought to not be engaging in the rehab process and will often be discharged from hospital with very little community therapy set up.

Caroline Lewis is a case manager with Brain Injury Group member firm, Circle Case Management, she spoke to us about her client, Mary.

Mary’s story

As a Case Manager, I have been supporting client Mary since May 2019. When I was first instructed Mary was living in a small cottage in a remote setting with 24-hour support via an agency. Her neurological event had occurred in late 2016 and Mary was on an independent living trial. The cottage had been chosen as it was within a 15min drive to a livery where Mary’s horses were being kept.

However, the cottage was very cold, dark and provided no space for Mary to have any privacy or for the support workers to be able to distance themselves from her. This led to Mary becoming very dependent on the support workers and very anxious if they were not with her all the time.

No engagement, no participation

When I was instructed Mary was not engaging with any therapy or wanting to participate in the running of the home. All she wanted to do was visit her horses as she felt they were not being cared for properly. When she was not able to visit her anxiety increased.

Prior to her accident, Mary had worked extensively with horses and she missed this interaction. Mary was unable to visit the horses twice a day as she would have liked which led to her spending up to 6 hours sat in a field with her support worker with no food, drink or access to amenities. She was very low in mood which had a massive impact on her fatigue, which just got worse. She desperately wanted to move house so she could have her horses in a field nearby.

A small cottage, land and her horses

Fast forward to June 2020 (during Lockdown), after a 9-month search a small cottage with 4 acres of land was found and Mary moved in with her horses. She had 4 days of 24-hour support to enable her to settle into the property. CCTV was also installed due to Mary’s fatigue, which impacted on her being able to see her horses and also to decrease her anxiety about living alone.

Support was decreased further with direct recruitment for two personal assistants in October 2020. Mary now looks after her horses with minimal support, she has 5.5 hours of assistance Monday – Saturday to assist with running her home due to cognitive issues and a cognitive communication disorder. Mary’s mood has improved, she is engaging with her team and her anxiety has decreased. She is living life as a ‘normal human’ (Mary’s words).

About Circle Case Management

Circle Case Management work with individuals and families across England and Wales who have suffered life-changing injuries including acquired brain injury, cerebral palsy, spinal cord injury, multiple orthopaedic injury, amputation and complex disability.

How can Brain Injury Group help?

Brain Injury Group is a network of approved personal injury solicitors with brain injury expertise. Moreover, our member firms have the complex injury experience to get the best possible rehabilitation and compensation for brain injuries.

Brain injury rehabilitation is important; to us, to our members, to you and towards getting the best outcome. We can help get you that best outcome. Get in touch to find out more from our brain injury experts.

Contact us – to get in touch you can either:

  1. Call us on 0800 612 9660 or 03303 112541
  2. Email us at
  3. Complete this short enquiry form and we’ll get back to you
  4. Find a specialist brain injury solicitor near to you
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