Keeping Function at the Forefront Presented by: April ...
Keeping Function at the Forefront Presented by: April McChesky, MCD, CCC-SLP, CBIST Presentati on Goal To improve the learners knowledge of the rationale for function-based treatment and the ability to incorporate it into his/her treatment approach. Following this presentation, learners will be able to:
Learning Objectives 1. Understand the rationale for functionbased treatment after a brief literature review. 2. Select meaningful therapy activities that match the patients interest areas and occupations. 3. Develop a functional tool kit/repertoire to promote incorporation of functional activities into therapy. Lindas Story
What Does the Research Say? Throughout rehabilitation, it is important that a clinician incorporate functional goals unique to each patient. When customized treatments are utilized, patients engage in active, effortful processing of information and tasks, leading to improved outcomes. -Functional Evaluation and Treatment in Acquired Brain
Injury Acute Rehabilitation (Erin O. Mattingly, 2017) This (evidence-based) review highlights the need to use authentic occupations in the clinic as opposed to contrived cognitive activities and manipulations. -Effectiveness of Interventions to Improve Occupational Performance of People with Cognitive Impairments After Stroke: An Evidence-Based Review (Glen Gillen et al, 2015) Generalization of training from attention tasks to daily functional tasks is not automatic. Therapists should promote generalization by
also training in the use of strategies in functional tasks. -Evidence-Based Recommendations for Cognitive Rehabilitation (American Congress of Rehabilitation Medicine (ACRM), 2014) Cognitive Rehabilitation is a crucial component to brain injury rehab. Extensive reviews of literature have occurred and clinical practice guidelines have been established. It is essential that interventions must generalize to the real world outside of the clinical setting.
-The Essential Brain Injury Guide Edition 5.0, Ch 10(Brain Injury Association of America, 2017) Related Articles: Effectiveness of Occupation-and ActivityBased Interventions to Improve Everyday Activities and Social Participation for People With Brain Injury: A Systematic Review (American Journal of Occupational Therapy, April 2016, Vol.70) Revisiting the Neurofunctional Approach: Conceptualizing the Core Components for the Rehabilitation of Everyday Living Skills (ClarkWilson et al, 2014) Evidence-based Cognitive Rehabilitation After
Acquired Brain Injury: A Systematic Review of Content of Treatment (Neuropsychological Rehabilitation, 2012: 22:653-673) Other Resources Cognitive Rehab: A Retraining Model for Clients Post Brain Injury- Naomi Katz and Sarah Averbuch The Essential Brain Injury Guide Edition 5.0-Brain Injury Association of America, 2017 Neurofunctional Approach- Gordon Giles Home-Based Cognitive Stimulation Activities: University of Alabama at
Birmingham Traumatic Brain Injury Model System. https://www.uab.edu/medicine/tbi/uab-tbi-information-networ k/uab-tbims-home-based-cognitive-stimulation-activities (Booklet is free to print and disseminate for educational purposes.) Therapy can be functional at any language or cognitive level. Begin therapy with real-life experiences from the moment you meet your client/patient. Framework for Implementati
on It is ideal to involve family, friends and caregivers since information regarding interests, hobbies, their daily routine should be included during the development of the therapy program. When tasks are functional, opportunities present themselves for clients/patients to practice newly learned strategies. Functional activities do not usually focus on only one process. Be sure to not to make assumptions or place limitations based on your own bias. Outlining the
Framework Basic Skills Using the Environment-Cognitive Hierarchy Reading and Writing Executive Skills Higher Level, Complex Tasks Utilize familiar items relevant to personal or environmental needs when working with clients/patients at a basic language and/or cognitive level. Basic Skills
Integration of familiar items provides a more familiar and motivating experience versus addressing processes in isolation or limiting therapy to pen and paper tasks. Using a functional approach increases the likelihood of carryover while allowing the therapist to increase complexity as appropriate. Start with most basic skills first regardless of patients level to establish the strategy. Sorting (substitute for any items that are personally meaningful to your patient) Where to
Begin? Coupons-by food group, category, type of meal, associated items, stores, expiration dates, least/ most saved, food pyramid Patients favorite music (from their playlist, CD/record collection or by a list provided by family/friends)- alphabetical order, artist/group, year of release, type of music Photographs (brought in by family/friends, printed from their smart phone, of the hospital or clinic)- by family/friend, by location, black and white/color, male/female, chronological order Critical Listening-
allows opportunity for your client/patient to practice listening for specific information that is frequent in everyday life. People-tell them names of team member(s) they will encounter and then have them listen to a list and identify the name(s) Phone calls- call favorite restaurant or store to determine specific information such as business hours, daily specials, return policy, etc. Viewing a TV or YouTube show- names of characters, main idea/ message Viewing a news magazine or educational video related to their condition/diagnosis- name of news correspondent/host, key points from the discussion Checking personal voicemail- recall and/or record messages
Using Pictures (if personal photographs are unable to be obtained, use pictures from magazines) Assemble a scrapbook (sort, create a collage based on a theme of the patients choice such as vacation, hobbies, interests) Homemade sequencing cards (e.g., take pics of proper w/c transfer steps) Create a timeline- sequence pictures from childhood to present or of a special event or vacation Cut a photograph into pieces for a puzzle and have them assemble Create a postcard from a photo or picture, write
a note and mail Using the Environment- Cognitive Hierarchy Attention: Scan the environment to locate specific items (e.g., chair, clock, walker, call light, spoon, cup, water pitcher) Identify by function: Where are clothes kept?, What is used for communication?, What is used for cutting food? Categorization: Utilize the patients own itemsitems for bathing versus brushing teeth, laundrysort by dark vs. light, clothes needing to be ironed, meal- food items on a plate Sequencing: Have them demonstrate calling for help, making a bed, setting the table, preparing a cup of tea New Learning: Safe transfer into a wheelchair,
use of adaptive equipment during ADLs, state a diet recommendation/limitation, demonstrate swallowing compensatory strategy Reading and Writing It is important for patients to participate in age-appropriate activities to keep them from developing a perception of participating in a school-like atmosphere. Select activities which have relevance to the patients current situation. Important factors to consider when selecting materials include age of the client, relevance to his/her situation, interests and hobbies of
the patient and responsibilities of the patient. Functional Reading Activities Newspaper Recipe Food prep instructions Nutrition fact labels Educational website/article Clothing care labels Instruction manual Functional Writing Activities List of items needed from home Names of people or description of events related to photos
Shopping list Actual or desired therapy schedule Return address on an envelope Complete a job application Check writing/bill paying (using mail from home if possible) Write down questions to ask the MD at next visit Using a Cell/Smart Phone (some of these activities are more complex and require higher level reasoning/executive functioning) Read and respond to text messages from
therapist/family Locate/share contacts Set up/check voicemail Check the weather for different cities Social media- reading/creating posts, locating friends Locate calendar- search for upcoming events, create an event Set an alarm/timer Executive Skills As patients demonstrate new learning and carryover in various tasks, they enter a higher level of independence and move
toward community reintegration. Utilize activities that incorporate planning, sequencing, time management, organization, problem solving and reasoning with tasks that are directly related to their lifestyle. To develop executive skills, functional therapy is essential to promote carryover in the home and community environments. Alternative Modes of Transportation Executive Skill Training
Searching for information regarding local transportation options Bus, taxi, ride share, street car, paratransit (RTA), wheelchair van Questions regarding- transportation available for senior citizens and/or disabilities, ability to travel without assistance, equipment to assist persons with disabilities, cost, discounts After two transportation options are chosen, discuss advantages and disadvantages of each one Choose a primary option and have the patient call for more information and to possibly apply/set up first ride Brain Education
Understanding brain function is an important role of recovery to enhance insight and awareness into deficits, prognosis and comprehension. Executive Skill Training Have a model or picture of the brain present to enhance the discussion. Provide education regarding brain parts and function and deficits they may be experiencing as a result of their brain injury. Review risk factors and have the patient track their personal risk factors and separate them into controllable or uncontrollable factors.
Have the patient develop a personal plan to prevent future brain injury. Planning Meals Executive Skill Training Discuss patients typical eating habits and have them rate their eating habits on a scale from 1-10 Discuss specific food preferences and determine healthier eating options/substitutions Review labeled food products and determine if the food item would be advisable given their diet modifications or limitations.
Meal plan for a day/week Prepare a grocery shopping list If able, take the patient to the grocery to search for items or simulate at the therapy center by making a small grocery area Emergency Planning Discuss different types of potential emergencies (medical, disaster) Develop a plan to include all aspects of preparation including equipment, supplies and their locations, meds, involved family members, methods of communication, etc. Create a first aid kit Create an Emergency Safety Kit- matches, bottled water, blankets, radio, financial plan, etc.
These activities should be developed based on your patients previous or expected roles and responsibilities Simulation of the home, work and/or school environment should be considered Higher Level, Complex Tasks Activity suggestions include: Budget/checking account management Home file organization Map Work (Google maps, facility map, school/university map, etc.)
Planning a trip/vacation Scheduling classes Note taking/recall of educational material Simulated work environment Simulated home environment (caring for a child, following a recipe with multiple distractions, organizing family schedule, pet care, etc.) Party/Event/Holiday planning Medication management Getting Started Developing a Tool Kit Have a meeting with your team to determine
what kits can be created in your facility to meet the needs of your population. You can apply the same type of activities with each kit. Place an idea card in each kit with activities that can be addressed in PT, OT and ST. If your facility has a kitchen, laundry and/or grocery area, place laminated cards with activity ideas in those areas. Many of the items can be donated by staff members or found a local Goodwill/thrift stores. Create a donation request letter and send to local hardware store, grocery store, fabric store, etc. using company letterhead. Kit Ideas
Developing a Tool Kit
Sewing Kit Tool Box Kit Gardening Kit Sports Kit Everyday Kit Overnight bag Kit Gift Wrapping Kit Fishing Kit Hunting Kit Dressing/Adaptive Equipment Kit Medication Kit In addition to tool kits/boxes, utilize other items found in your treatment space Non-kit
Ideas Kitchen safety activity Other kitchen/mealtime activities Reading/ordering from a menu Reading/locating information in a magazine
Sweeping/mopping/vacuuming Dusting Ironing Washing/hanging/folding clothing Utilizing a remote control Moving to function-based treatment may seem overwhelming, but it can be done! Start slow and set achievable goals. Summary Designate a key person or team to organize and lead the initiative. Once everything is in place, little
maintenance is required. Be creative and think outside the box! Who will likely be more motivated to participate? What activity would be more motivating?
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