The impact of an acquired brain injury on daily life can be monumental both for the individual and their family. Coping with the lasting effect of such a life-altering event requires the support of an expert therapy team and a rehabilitation programme to promote independence and help maintain quality of life.
Occupational Therapists (OTs) play an important role in rehabilitation and their expertise in the observation and analysis of how an individual can perform daily tasks is vital in the coordination of an appropriate rehab programme.
In this EveryExpert article we discuss how functional performance and assessment enables a holistic rehabilitation approach and helps ensure that the individuals we support receive expert care at every step of their rehab pathway.
Neuro rehabilitation at Badby Park
Set within 58 acres of rolling grounds within the Northamptonshire countryside, Badby Park is a specialist neurological rehabilitation and complex care centre. Providing inpatient rehab for people with neurological illnesses, acquired brain and spinal cord injuries, the dedicated clinical and therapeutic team work to help individuals regain independence in activities that are important and meaningful to them.
Central to the success of the neuro rehab programme is our experienced team of OTs. By observing and analysing an individual’s movement and cognition as they perform daily tasks, such as getting dressed or preparing food, OTs can obtain detailed insight into each person’s level of motor and cognitive skills, and identify where they might need additional support during their rehab and beyond.
This type of ‘functional assessment’ enables a holistic review of how an individual is performing whilst carrying out practical tasks, something that paper-based assessments might miss. Analysis of functional performance looks at the interplay of the various cognitive and physical elements and how they work together, rather than just looking at one particular skill in isolation.
With this knowledge, OTs work together with the other members of the MDT (multi-disciplinary team) such as Physiotherapists, Psychologists and Speech and Language Therapists to determine the most appropriate rehabilitation plan that meets each person’s individual needs.
Jane Diamond is an Occupational Therapist at Badby Park and particularly works with residents who have an acquired brain injury. Jane specialises in using functional assessment and rehabilitation to support recovery. She also prescribes equipment to maximise functional independence both at Badby Park and to support discharge home.
Jane explains the benefit of assessing functional performance both to the individual and the team supporting them.
“Functional performance assessments are completed by OTs through a process called task analysis. This can be through formalised assessments such as the AMPS (Assessment of Motor and Process Skills) or the MoHOST (Model of Human Occupation Screening Tool), but is most often the observations of the OT, trained to specifically breakdown an activity into its complex component parts whilst being performed by the individual.
Performance anxiety can have an impact on anyone and so the skill is in making the assessed feel relaxed about the process, and thereby able to demonstrate their true abilities and difficulties in real world situations.
When you work closely with individuals on practical tasks it also provides a much more complete understanding of their rehabilitation needs. It is easier to identify the areas that they can complete independently and where they need additional support. When this information is shared across the clinical team, we can agree joint goals and work together to achieve them – everyone benefits.
It’s also more enjoyable for the individual. When we complete practical tasks with a purpose, such as working through a recipe or perhaps some vocational skills, the experience is far more meaningful and motivating. If people enjoy tasks, they are more relaxed, they open up and our assessments are more accurate and insightful.”
Utilising a Therapy Kitchen
Badby Park extended its rehabilitation facilities in May this year with the completion of a therapy kitchen where residents could participate in cookery sessions, preparing food and practising basic cooking skills. The kitchen is fully wheelchair accessible, with a height adjustable hob and sink, an eye-level oven with retractable door, a variety of adapted equipment as well as the standard kitchen appliances and accessories.
The therapy kitchen has become an important resource in the rehabilitation programmes at Badby Park, enabling residents to spend more time practising activities of daily living (ADLs). As Jane explains, observing and analysing task performance provides a much more detailed understanding of someone’s capabilities and where they might be struggling.
“Sometimes residents know how to do something and can tell you how to do it, they’re able to explain it and demonstrate good understanding verbally, but when they come to perform the task you can see where any impairments are, which would otherwise have been masked. It is only in the ‘doing’ that you really understand the ‘hidden’ difficulties that can be the result of a brain injury.”
“The therapy kitchen provides a versatile space where we can offer a range of activities tailored to the different rehabilitation needs of individuals. If someone is preparing to move back into the community then we can ensure they can perform tasks independently. It also provides a variety of different engagement opportunities for those who aren’t quite ready to live independently.
The process of preparing food is also very adaptable – preparing a dish can be broken down into separate elements – reading recipes, preparing ingredients, the actual cooking and then eating or sharing the food. From a therapeutic point of view, we’ve got lots of scope to work with.
As well as one to one sessions, we have a regular baking group. In group sessions we can assign different roles to individuals depending on their abilities or rehab goals. For example, someone in need of practising speech might read out the recipe. Others may need to practice social skills, turn taking or allowing others time to process their task without interruptions, and it can be a safe place for someone to express their specific difficulty. Insight and acknowledgement can be vital for rehab, especially for those working towards a return to community living.”
For some residents at Badby Park, cooking was also socially significant for them and their involvement with food formed part of their identity. As Jane explains, enabling individuals who used to be avid chefs or enjoyed the social interaction of dining with others, to regain that social satisfaction gives them a huge wellbeing boost.
“Our identity is so often linked to what we do or what roles we’ve held within our families or social groups. When we’re suddenly unable to perform that activity it can be very detrimental to our self-worth. The new therapy kitchen has enabled us to help residents who formerly enjoyed cooking, they can practice the basic skills and with a few adjustments we’re seeing people who perhaps didn’t think they’d be able to cook again participate and enjoy doing so.
For example, one individual that we support used to really enjoy making food for other people. It was a rewarding social experience for him and part of his identity. We’ve tried to recreate that experience for him – even though now he doesn’t have a great appetite he can still prepare food for others (with support) and benefits a lot from the social affirmations of sharing that food.
If there are aspects of the food preparation that he cannot complete independently then we don’t just take over, we encourage him to guide and direct those supporting him – he’s in charge of the session.
Functional tasks, like cooking can support other rehab goals, such as bilateral co-ordination, using both hands together, and upper limb exercise, to safely and effectively complete a task. If that is not possible, we can introduce adaptive aids.”
Real work opportunity programme
Another area where functional performance assessment offers therapeutic benefits is within vocational rehab and preparing individuals for a return to the workplace. The team at Badby Park are currently preparing to re-launch their real work opportunity programme that provides volunteer work opportunities for individuals such as reception experience, a mobile library or working as part of the maintenance team. Volunteers would work in short shifts, a couple of times a week, arranged around their rehab programme, to give them a reminder of the workplace experience.
The programme, which was paused during the pandemic, will be restarted in the coming weeks, and Jane recalls some of the earlier success achieved.
“Enabling individuals to regain some workplace experience, whilst in a safe and supporting environment had huge benefits. It boosted wellbeing, and improved self-efficacy. Individuals gained confidence and it encouraged them to engage a little more widely than they previously would.
It was a comprehensive programme, complete with an application and interview process. Candidates needed to demonstrate that they wanted to gain work experience and show that they were committed to the responsibilities of the role. We found that this helped individuals with a sense of purpose and fulfilment.”
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