Acquired Brain Injury Case Studies

Client Background
Mr. Gerado M. is a Spanish national in his mid-40s who has resided in the United Kingdom for over two decades. A highly intelligent individual and a professional language interpreter fluent in five languages, Gerado lived with his wife in a modest two-bedroom bungalow. The couple had no children and led a close, independent life prior to the incident.

Incident and Initial Response
Gerado sustained a severe brain injury as a result of a road traffic accident. Following the injury, he experienced significant language regression, retaining only the ability to understand and communicate in his native Spanish. Baxter Life Care Ltd. was involved early in Gerado’s post-acute recovery phase, offering comprehensive physical and personal care, alongside support for daily living activities.

Presenting Needs and Initial Challenges
Upon initial assessment, Gerado demonstrated high levels of anxiety and physical aggression, particularly during personal care interventions. A notable behavioural trigger was identified: a strong adverse reaction to the colour black, especially in staff clothing. To safeguard Gerado and the care team, a Deprivation of Liberty Safeguards (DoLS) authorisation was obtained, ensuring that any restrictive practices used were the least restrictive and in line with legal and ethical frameworks.

Aggression required a three-to-one staffing ratio initially. However, the consistent deployment of a regular care team enabled relationship-building, a key element of trauma-informed rehabilitation as advised by BABICM. The team adapted clothing protocols and wore non-black attire, which resulted in a modest but positive behavioural shift.

Communication Barriers and Cultural Sensitivity
A major barrier to progress was the language divide. Staff noted that Gerado interacted positively with his wife, who spoke only Spanish to him, but remained suspicious and non-compliant with members of the multidisciplinary team (MDT), who could not communicate effectively in his language. To bridge this gap, the team leader sourced a real-time English-to-Spanish translation app. This simple yet innovative intervention significantly improved communication, reduced Gerado’s anxiety, and eliminated physical aggression, allowing the staffing ratio to be safely reduced to 2:1.

Person-Centred and Culturally-Informed Rehabilitation
Ongoing dialogue with Gerado’s wife revealed his pre-accident love for Italian opera. During a potential trigger episode, one staff member light-heartedly sang the jingle from the "Just One Cornetto" ice cream advert, which uses a popular Italian operatic tune. This spontaneous action had an immediate and profound effect—Gerado became animated and began to sing along. This intervention provided valuable insight into the power of music and reminiscence in calming and connecting with individuals living with cognitive and communication impairments.

Subsequently, the team adopted a more holistic and culturally sensitive care plan. They introduced musical therapy elements, integrated familiar media like Spanish TV programs, and, remarkably, all staff voluntarily enrolled in conversational Spanish classes to better engage with Gerado.

Functional Gains and Rehabilitation Outcomes
With consistent, tailored support, Gerado was encouraged to gradually regain independence in personal care tasks. Over a period of 3.5 years, he transitioned from full dependency to achieving near full independence in personal care. Although his written English comprehension remained impaired, he began using occasional English words in conversation. Enjoying shared TV time with staff and his wife became a meaningful social activity, enhancing his sense of belonging and emotional wellbeing.

Community Reintegration and Long-Term Progress
Community outings were introduced gradually. Initially, Gerado experienced anxiety in crowded environments. These trips were adjusted to include visits to quieter venues such as local parks and garden centres. Over 5.5 years, Gerado made significant functional and social gains. He became independently mobile, was able to engage in brief conversations in English, and could venture out alone for short periods.

Although he did not return to his previous professional role, Gerado expressed interest in pursuing volunteer opportunities—a key indicator of purposeful engagement and meaningful recovery. At this stage, his rehabilitation had reached a point where formal care needs were minimal. Support was reduced to respite sessions twice weekly, allowing his wife to resume personal interests and improving overall family wellbeing.

Reflection and Key Learnings
Gerado’s rehabilitation journey is a testament to the importance of personalised, relationship-centred care. The multidisciplinary team’s commitment to innovation, cultural competence, and psychological insight—aligned with BABICM guidelines—was critical in transforming a highly complex and challenging case into a success story. Key factors contributing to this outcome included:

• Consistent care team and structured routines

• Use of technology to support communication

• Cultural and emotional sensitivity

• Engagement with family and acknowledgment of pre-injury identity

• Staff training and language learning

• Creative use of music and reminiscence therapy

Conclusion
Mr. Gerado M.’s progress showcases the value of holistic, adaptive, and person-led rehabilitation. His case reinforces the importance of combining evidence-based practice with compassion, creativity, and respect for the individual’s cultural background and personal narrative.

​

Prepared by:
Bev Baxter
Director
Baxter Life Care Ltd.