The Challenge

Gemma came to us six months after sustaining a traumatic brain injury in a road traffic accident. While she had made encouraging cognitive progress during her recovery, the physical challenges resulting from her brain injury were significantly limiting her independence and confidence as a working mother.

When Rob first met Gemma at her home, the extent of her physical challenges became immediately apparent across multiple domains:

Postural Control Issues: Her brain injury had resulted in significant trunk weakness, particularly affecting her left side. She was unable to reach beyond arm’s length without losing her balance and experienced considerable difficulty with weight shifting when sitting or standing. When walking, she had developed a tendency to lean heavily to the right, compromising both her stability and confidence.

Functional Impact: The physical limitations were having a profound impact on Gemma’s daily life. She experienced fear and anxiety when moving around her own home, was unable to climb the stairs (resulting in her sleeping in the living room and using a commode in the utility area), and avoided walking outside due to her fear of falling. Even minimal activity left her feeling fatigued, further limiting her participation in daily activities.

Quality of Life: Perhaps most significantly, Gemma was experiencing a loss of confidence and self-identity. She had withdrawn from family activities, felt anxious about her potential to return to work, and was frustrated by her dependency on others for tasks she had previously managed independently.

Our Approach

Rob developed a comprehensive 12-month home-based programme specifically focused on rebuilding Gemma’s physical skills through progressive, functional exercises tailored to her home environment.

Months 1-4: Foundation Building The initial phase focused on establishing basic stability and strength. We used Gemma’s own dining chair for core strengthening exercises, implemented sitting balance training with reaching activities, and introduced visual and proprioceptive awareness exercises. Weight-bearing activities were specifically targeted to improve left-side strength.

Months 5-8: Dynamic Control As Gemma’s foundation skills improved, we progressed to more challenging activities. This included progressive balance challenges in both sitting and standing positions, functional reaching tasks using household items, weight-shifting exercises integrated into daily activities, and the introduction of dual-task training where Gemma learned to maintain balance while thinking about other tasks.

Months 9-12: Real-World Application The final phase focused on applying Gemma’s improved skills to real-world situations. We worked on kitchen-based activities requiring postural adjustments such as reaching into cupboards, stair climbing with improved trunk control, and outdoor walking on varying surfaces. We also began identifying return-to-work specific movements and located a local gym where Gemma could continue her rehabilitation independently.

The Outcomes

Gemma’s progress throughout the 12-month programme was both remarkable and measurable across all areas of concern:

Postural Control Improvements:

• Achieved confident, independent standing without support
• Developed the ability to reach 45 centimetres beyond arm’s length in all directions
• Demonstrated smooth weight shifting during transfers
• Maintained upright posture during complex tasks

Functional Gains:

• Became confident and independent in her home environment
• Successfully returned to sleeping and using the bathroom upstairs
• Regained the ability to walk her daughter to school each morning

Quality of Life Enhancement:

• Regained confidence in walking outside her home
• Started participating in family outings again
• Reported feeling “like myself again” – a powerful indicator of restored self-identity

Key Success Factors

Home Environment Advantage: Training in Gemma’s actual living space meant she could immediately apply new skills to daily activities. We used her own furniture, stairs, and kitchen to create safe spaces and develop relevant exercise programmes.

Family Involvement: Gemma’s family, including her young daughter, learned to support her exercises between sessions, which accelerated progress and built confidence for the whole family.

Functional Focus: Rather than using abstract exercises, we embedded postural control training into meaningful activities like braiding her daughter’s hair and preparing her lunch box.

Progressive Challenge: Starting with basic stability and gradually increasing complexity ensured Gemma never felt overwhelmed while consistently improving her abilities.

Key Outcomes

• Restored independent mobility within and outside the home
• Regained ability to use upstairs facilities and sleep in her own bedroom
• Rebuilt confidence and self-identity as an independent person
• Successfully reintegrated into family activities and routines
• Developed foundation for potential return to work
• Established pathway for continued independent rehabilitation
• Measurable improvements in postural control and functional reach
• Elimination of fear and anxiety around movement

The Value of Specialist Home-Based Care

Gemma’s case demonstrates that significant improvements are possible even months after brain injury with tailored, specialist physiotherapy intervention. The key to success was addressing the movement problems caused by her brain injury not as isolated issues, but by integrating rehabilitation into the activities that mattered most to Gemma.

By the end of treatment, she had not only improved her physical abilities but had rebuilt her identity as an independent, capable mother. The home-based approach allowed us to work within her real environment, involve her family in the recovery process, and ensure that improvements translated directly into better quality of life.

Testimony:

“I have worked with Susan and her fantastic team for well over 10 years and wouldn’t hesitate to recommend their skill and professionalism to others.”

Amanda Phillips, AP Rehabilitation

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