While various treatment approaches are incorporated in the treatment of TBI it does not guarantee or predict success. This is particularly so when faced

with an individual who has sustained a severe TBI.

Occupational Therapy focuses on improving a patient's ability to perform everyday tasks to be able to, not only, be independent in fundamental skills, but to be a building block for future improvement. These skills include but is not limited to dressing, feeding and toileting.

In an article by Giles et al.(1 997),a systematic, highly structured approach to improving these basic skills is discussed. This study tracks the improvement of four patients with both physical and cognitive deficits, and the apparent

general applicability of the technique.

The behavioral approach utilized in this study involves systematic repetition of the activity with no deviation of the verbal cues which are used to trigger the sequence of the task.

All patients in the study were dependent in these areas. At the conclusion of the research three of the four patients had gained independence. The fourth patient had shown increased learning and a reduction in the cues required

to perform the tasks, however no significant change in functional status.

This study highlights the effectiveness of structured approaches to enhance learning with severe TBI.

Giles, G. M.; Ridley, J. E.; Dill.A.; Frye. S. (1997).A Consecutive Series of Adults With Brain Injury Treated With a Washing and Dressing Retraining

Program. The American Journal of Occupational Therapy, 51,256-266.