Acknowledgement: to Mrs Jillian Pawlyn from The Open University for her support of this example scenario
Terminology:
In the United Kingdom, the term ‘Learning Disabilities’ is formally recognised (Department of Health, 2001). Outside the UK, the term Intellectual Disabilities is generally used. More recently, the term Disorders of Intellectual Development (mild, moderate, severe, profound, provisional, and unspecified) has been used by the World Health Organisation (WHO, 2019). This term has not been adopted by the UK government. In this case study, the term Profound Multiple Learning Disabilities (PMLD) is used. Equivalent terms include Profound Intellectual and Multiple Disabilities (PIMD) and Profound Learning and Multiple Disabilities (PLMD).
Solomon's Story
Alex is a second-year learning disability nursing student undertaking a 12-week placement with a community learning disability nursing team. Early in the placement, Alex is introduced to Solomon, a 20-year-old man with profound and multiple learning disabilities (PMLD), cerebral palsy, epilepsy and dysphagia (Mansell, 2010; WHO, 2019). Solomon lives in a bungalow with three other young adults who also have PMLD. He requires support with all aspects of daily living and receives his nutrition, hydration and medication through a Percutaneous Endoscopic Gastrostomy (PEG) tube (Bischoff et al., 2020).
As Alex spends time with Solomon, the support staff and members of the multidisciplinary team, he begins to learn about Solomon's life journey. Solomon was born following an uncomplicated pregnancy and birth. During infancy, his parents became concerned about his development, noticing difficulties with movement, feeding and communication. Following a series of assessments, Solomon was diagnosed with cerebral palsy, dysphagia and a profound intellectual disability (NICE, 2017; NHS, 2023a; NHS, 2023b). The diagnosis had a significant impact on his family, who faced uncertainty about what the future would hold and how best to support their son.
Throughout childhood, Solomon benefited from specialist education and support from a range of health and social care professionals. Teachers, learning disability nurses, therapists and his family worked together to support his communication, health and wellbeing. Intensive Interaction approaches enabled Solomon to develop meaningful relationships and communicate in ways that reflected his preferences, choices and personality (Nind, 2009). Physiotherapists, occupational therapists and speech and language therapists supported his posture, mobility, communication and swallowing needs (Hill and Goldsmith, 2009; Crawford, 2009).
Due to dysphagia, Solomon receives nutrition and fluids through a PEG tube. Alex learns that careful management of PEG feeding, positioning and postural care are essential in reducing the risk of aspiration and maintaining Solomon's health (Stayner et al., 2012; HSSIB, 2020; NHS England, 2022). He also learns about the increased risk of respiratory infections, epilepsy-related complications and other health inequalities commonly experienced by people with PMLD.
As Solomon approached adulthood, planning for his transition from children's to adult services became an important part of his care. Nurses, therapists, social workers, his GP and family worked together to develop a person-centred transition plan (Mansell, 2010; LeDeR, 2025). However, shortly after leaving school, Solomon experienced significant changes in his family circumstances when his parents separated and the family home was sold. Health and social care services worked together to ensure that Solomon's needs continued to be met during this challenging period.
Today, Solomon enjoys living in supported accommodation with his friends and is supported by a multidisciplinary team committed to promoting his health, wellbeing and quality of life. Through working alongside Solomon and those who support him, Alex develops an understanding of person-centred care, health inequalities, multidisciplinary working and the vital role learning disability nurses play in advocating for people with complex needs across the lifespan (Mansell, 2010; LeDeR, 2025).
During the placement, Alex spends time getting to know Solomon through observing his daily routines, reviewing his communication passport and health records, attending multidisciplinary meetings, and working alongside support staff, learning disability nurses and therapists. Alex learns how Solomon communicates his preferences and choices, observes the management of his PEG feeding and epilepsy care, and develops an understanding of the adjustments required to support people with PMLD to live healthy and meaningful lives.
