Car accident resulting in a spinal cord injury

Angela was 27 years old when in January 2020 she was involved in a road traffic accident causing her to sustain an incomplete spinal cord injury (C2 ASIA D Tetraplegia). At the time of the accident, Angela was working as an accountant.

“Angela was a very social being, she had two jobs, one as an accounts manager and the other in a bar. She had a great social life and lots of friends.” – Michelle Bunyan, Case Manager, Spinal Injury Case Management

This case study, written in March 2023, shares Angela’s rehabilitation journey at STEPS Rehabilitation and her plans for the future.

Spinal Cord Injury Rehabilitation

Immediately after the accident, Angela was taken to the Queen Elizabeth Hospital in Birmingham, before being transferred to the North West Regional Spinal Injuries Centre, where she received treatment for 9 months. She was then discharged to a nursing home, where due to Covid Restrictions, she stayed for 13 months.

Nursing homes are generally designed to provide long-term care and assistance to individuals who require assistance with daily living activities, and while some may provide some rehabilitative services, they are typically not equipped to provide the intensive rehabilitation and specialist care required by individuals like Angela.

With the help of her Case Manager, Michelle Bunyan, Angela started researching rehabilitation facilities and as part of this search, visited STEPS Rehabilitation.

“Having looked at other places, Michelle and I chose to visit STEPS as it was closest to where I was living at the time. It had such a lovely feel from the minute we arrived, I liked everyone that I met, and we enjoyed a really lovely lunch. I was surprised by how big it was, and that it didn’t look like a hospital. STEPS is more like a hotel, and with the space, garden and café, there is always somewhere to just ‘be’ when you’re not having a therapy session.”

Michelle explains that although it was a good nursing home and was giving Angela some physio, it wasn’t pushing her, and she needed some more input.

“When I met Angela in the nursing home, it was apparent that she needed more rehabilitation. I contacted Katie Ryall at STEPS, to find out if they had a bed and got her moved to STEPS very quickly. When she arrived in December 2021, she could take a few steps with a Gutter Frame and some assistance, since being at STEPS she has made massive progress.”

Upon arriving at STEPS Rehabilitation in December 2021, Angela presented with:

  • Core and bilateral upper and lower limb weakness
  • Required assistance with all aspects of activities of daily living and needed assistance two with transfers such as moving from her bed to a wheelchair.
  • Spasms
  • Spasticity
  • Altered sensation and reduced proprioception
  • Fatigue
  • Low mood and frustration at current situation

Following initial assessments, short- and long-term goals were developed with Angela, these included goals such as:

  • Eating and brushing teeth independently
  • Applying make-up to a high standard
  • Transfer with minimal assistance

And in the longer term, goals such as returning to community living and work.

The STEPS team created a personalised rehabilitation plan, involving intensive input from across the disciplines in the STEPS rehabilitation team, including, physiotherapy, occupational therapy, hydrotherapy, neurologic music therapy, psychological therapies, Tai Chi groups and more.

The programme also included the use of robotic assistive devices such as the ArmMotus and the ArmMotus EMU, to target upper and lower limb strength along with balance groups, gait and transfer practice.

Additional complementary therapies were included, such as acupuncture for muscle tightness and pain, FES sessions for upper limb movement patterns, and massage therapy.

“When I first arrived at STEPS, I wanted to get better and achieve as much as possible. My main goals initially were to lift my arms and transfer independently.”

In the last 15 months, Angela’s goals have evolved and expanded as she realised her capabilities at STEPS Rehabilitation. With the unwavering support of the team, who consistently encouraged and recommended new approaches to therapy, she was able to surpass her initial recovery goals.

One of the greatest benefits of STEPS is that everything is conveniently located under one roof. This includes physiotherapy, occupational therapy, chair yoga, balance and upper limb groups, tai chi, Pilates, psychology, and neurologic music therapy, where she has started to play the piano again and crucially, practice her precise finger movements.

The variety of treatments available at STEPS has allowed us to create a unique combination of therapies and medical treatments best suited to Angela’s needs. Alongside the more traditional therapy sessions, Angela has enjoyed participating in group sessions with other clients, as well as the hydrotherapy sessions which allow for full-body movement in the pool.

Group sessions like Tai Chi, Pilates, and Chair Yoga have allowed Angela to connect with other clients and share the experience. These sessions provide a more social atmosphere where clients support and encourage one another, celebrating personal achievements along the way.

Angela has been a supportive and friendly member of the STEPS Community and is an active member of the peer support groups, spending time with other clients, chatting about life in general, their injuries and the progress they were making at STEPS.

“Whilst at STEPS, Angela accessed so many different therapies and treatments. She had a great group of other clients who were here at the time as well, who she really got along with.” – Michelle Bunyan

Angela particularly enjoys the aquatic-based physiotherapy sessions in the onsite hydrotherapy pool. Upon her initial arrival at STEPS, Angela struggled with walking unassisted. However, with the help of supervision, she is now able to enter the pool via the steps and work on her balance, walking, and a variety of gait exercises in a therapeutic and calming environment.

“Angela no longer uses a frame, she uses a stick at times, but can walk without anything at all and can stand independently. Her psychological mood has improved massively, at the beginning she couldn’t make any major decisions, now she is control of her life.

STEPS impresses me because of the vibe of the place, there’s a can-do attitude, there’s nothing that can’t be investigated and put in place if it’s possible for the client.” -Michelle Bunyan

Rehab Technology

Angela’s intensive rehabilitation timetable also included regular sessions in the RehabHub, using the ArmMotus, EMU, AnkleMotus  WristMotus and Exomotus, as well as using MindMaze VR and and FES technologies;MindMotionGO, MindPod and Intento.

The RehabHub offers a range of robotic assistive equipment that focuses on specific body segments. For example, the WristMotus aids wrist movement, while the ArmMotus M2 Pro and EMU are highly effective in improving upper limb strength.

Senior Physiotherapist, Kostas Falidas has worked closely with Angela since she arrived in December 2021 said, “Angela has found her sessions at the RehabHub very enjoyable. She can practice various activities such as balance, standing, and upper limb movements all while playing games either with the support of a physiotherapist or against other clients.

The robotic assistive technology enables us to record and monitor the clients' progress, thereby helping us create more challenging sessions tailored to their specific needs and goals.”


STEPS is an assessment centre for a range of exoskeletons, such as the ExoMotus, which are an important tool in the rehabilitation of clients, like Angela, who are seeking to improve their lower limb strength. By utilising the ExoMotus, Angela can 'walk' under the guidance of a physiotherapist in one of the exoskeleton's three modes: passive, active assistive, and active.

During these sessions, Angela is supported into the ExoMotus which is attached to the walking frame; this is then guided by the physiotherapist. The ExoMotus has played a vital role in improving Angela’s gait pattern and lower limb strength.  By lowering the device, Angela is able to achieve heel strike and ‘’feel’’ the floor instead of walking in the air, this is really important for improving sensory feedback and gait re-education.

STEPS Rehabilitation

Angela has had many milestone moments whilst at STEPS and reflects on one of the most memorable, “One of my favourite moments was when I went up the stairs for the first time, I was terrified the whole time, but really proud of myself.”

Thanks to the dedicated care and attention of the STEPS team, Angela's condition has significantly improved during her stay. While initially struggling with walking and balancing, she can now walk with the aid of a stick or supervision and is able to ascend and descend stairs. She has regained much of her independence with transfers, being able to roll from supine to prone position, sit up from supine, stand up, lower herself from plinth to floor, and transfer with minimal assistance from floor to her wheelchair. Clear improvements were made in Angela’s clinical outcome measures during her stay across upper limb, lower limb and functional activities. For example, her “3 Meter timed up and go” measure (time taken to stand from sitting, walk 3m and return 3m to sit in the chair) improved from 2mins 57 seconds on admission to 48 seconds in January 2023.


Admission to STEPSJan 2023
Sit to stand in 30 seconds​​6​​10.5​​
3 Meter timed up and go​​2 mins 57 secs​​48 secs​​
6 Minute walking test​​Unable to complete ​​51 Meters​​
Elbow flexion Left​​0​​20 degrees​​
Elbow flexion Right​​0​​120 degrees​​
9 Hole peg test left hand​​2.36.33 min​​ 1.57.36 min​​
Transfers​​Ax2​​Min initial hand hold x1​​
Lying to sitting over edge of bed​​Max assistance x1​​Independent from flat bed​​
Applying make up​​Unable to achieve to her own standards​​Able to apply to face, eyes, lips while looking in a mirror​​
Brushing teeth​​Ax1 to apply toothpaste, switch on, brush, switch off ​​Fully independent-applying toothpaste, switching on, brushing teeth, switching off and placing back on sink​​
A graph showing the Spinal Cord Independence Measures between 17/05/2023 - 20/02/23 for Angela, a client at STEPS Rehabilitation.

Transition Home

After spending 15 months as a residential client at STEPS Rehabilitation, Angela began preparing for her discharge from the facility. However, the process proved to be more challenging than expected. Angela faced numerous obstacles, including sourcing suitable and accessible accommodation, getting it ready for her needs, and recruiting a properly trained care team to provide essential support. Her experience highlights the complexity and time-consuming nature of the transition process, which is becoming increasingly clear for many people.

Now that an appropriate home has been found, Angela has been preparing for her transition home with the support of the entire team who have helped to develop a plan for her ongoing medical care and therapy and provide education and support ahead of her discharge.

A care team has been appointed with the help of Birmingham CCG, and Angela has been in the interviewing and selection process.  Angela’s care team have attended the STEPS training school for a theory day and have also had a meet and greet with Angela, where they were learnt about the individualised spinal care that she requires. During these sessions, the care team did ‘shadow shifts’ to spend time with Angela, take part in all aspects of her care and get to know her both clinically and personally – giving Angela the confidence and reassurance that they could best support her once home.

Angela is returning to an adapted apartment in Birmingham and is looking forward to reintegrating into the community, seeing her friends and family and getting back to life and get back to work. She would also like to do some peer support work with a spinal injuries charity.

“Angela has aspirations to travel, return to work and visit her family in Canada. She will achieve all of these things. She is such a warm and friendly person and her achievements at STEPS have been phenomenal.”
Darren Bracken – Clinical Nurse Educator

The Future

Angela is keen to continue with physiotherapy, particularly hydrotherapy, and practicing walking with her stick to maintain her mobility and minimise wheelchair use when at home. Additionally, after being unable to travel home to Canada due to her accident, she hopes to visit home and spend time with her nephews and do some travelling.

“What makes STEPS special is all of the group activities and the community spirit, the chefs and the food – I will miss that! Everyone is so willing to help the clients with any ideas they may have, and everybody is so positive.”

Not only has Angela benefited from her time at STEPS Rehabilitation, she has also offered guidance, support, and organised social events and outings for fellow clients, such as a trip to the cinema.

Angela's friendly, hardworking, and highly motivated personality is evident in the remarkable progress she has made, which serves as a testament to her dedication and persistence.

Nicola Golding, Associate Solicitor, Irwin Mitchell

“Angela is a truly remarkable young woman, and it has been wonderful to witness the progress she has made at STEPS Rehabilitation. When I first met Angela, she was desperately unwell, having sustained life changing injuries in a road traffic accident. As if that wasn’t enough to contend with, the world was about to go into lockdown which meant that she had limited access to early rehabilitation and a long wait in a nursing home. Despite that, Angela maintained a bright outlook and was determined that she could regain independence and a quality of life. 

Through her personal injury claim, we pushed for the funding to secure a place for Angela at a private rehabilitation unit. STEPS was actually an easy choice because both the Defendant Solicitors and I were aware of the unit’s excellent reputation, so when Angela went to visit with her case manager, we were delighted that she also felt it was the right place for her.  

It was immediately clear that Angela was going to make great progress and I liked that the goals Angela and her team set were ambitious but also achievable. Of course, it helped that Angela was willing to work hard and maintain her ‘game for anything’ attitude, but she was also surrounded by excellent therapists who knew how to get the best out of her. On visiting Angela at STEPS, it was clear to me that she had formed really strong connections with her therapy team, and with fellow patients. I was also amazed to hear about the wide range of therapies Angela was accessing at STEPS. Yes, I expected the conventional therapies to be available and to be of a high standard, but it was wonderful to hear how Angela was also achieving therapeutic goals through her alternative methods such as her love of music and playing the piano! When Angela first showed off to me how she could stand from her wheelchair, and then watching her take a few steps, I was blown away. She was a world away from the person I first met back at the QE Hospital. 

The success of Angela’s time at STEPS was that she was ready to be discharged to her own property, but as she had been in various institutions throughout the 3 years since her accident, this was a daunting prospect. Throughout this time, I felt that STEPS were there to support Angela, to ensure that her new care team were properly trained for her individual needs and to support recommendations for Angela to continue with therapies back in the community. STEPS have always worked closely with the Case Manager that we appointed through her claim, and this has helped to ensure good communications and a smooth transition from the rehab unit. As a result, I am delighted to say that Angela’s move home has gone extremely well, and she is starting to enjoy living independently. Being Angela, she still has a long list of things she wants to achieve, but I am confident that she is now in the best possible place to do so.”

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