Welcome to the TBI-HELP Live Chat

Today's topic is: "Facilitating Independence in Activities of Daily Living after a Brain Injury"

Our Guest is: Ms. Patricia Gentile, Chief of Occupational Therapy, Jamaica Hospital Medical Center

[19:00:47] Mod: Good Evening and welcome to our chat session this evening. We are please to have as our guest speaker this evening Ms. Patricia Gentile, Chief of Occupational Therapy, Jamaica Hospital Medical Center. Welcome Ms. Gentile. Ms. Gentile will be discussing: Facilitating Independence in Activities of Daily Living after a Brain Injury.
[19:01:36] Ms.Gentile: Thank you for inviting here tonight
[19:03:12] Mod: What exactly does the term "Activities of Daily Living" mean?
[19:04:41] Ms.Gentile: Activities of Daily Living (ADL) is a general term used to describe all those tasks a person performs as part of their normal. ADL can include self-care, homemaking, work and leisure activities. In many rehab centers, however, the term ADL primarily refers to self care and sometimes home management. After a brain injury, because of physical, perceptual or cognitive impairments the ability to perform basic tasks can be impaired.
[19:06:20] Mod: Rail: Can most patients with TBI benefit from the use of assistive devices and adaptive equipment during self-care?
[19:07:26] Ms.Gentile: This is an excellent question. An OT would need to carefully assess the pt. to see if the use of a device would be appropriate. Whether or not an individual could benefit from a device varies. In my experience, clients with cognitive problems can find devices confusing to learn. Very often in these cases it may be easier to restructure the task. For those with physical problems, however, devices can be very helpful.
[19:09:25] Mod: What do you mean by restructuring the task?
[19:10:20] Ms.Gentile: Tasks can be restructured in many ways; for example, steps can be eliminated in cases where patients have trouble with sequencing.
[19:10:38] Mod: Louise: Since a friend has had a head injury I find that she continuously forgets what she was doing or said...is there anything I can do to help her?
[19:11:59] Ms.Gentile: Because many people have problems with memory, this can be a frequent problem. Some strategies that may be helpful may include redirecting her (tactfully) to the topic or writing things down.
[19:12:26] Mod: Rail: Is the OT always the advisor for ADL issues: Can't the PT also advise in many instances?
[19:14:08] Ms.Gentile: Very often the OT is the lead person in this, but there is some overlap with other disciplines. Occupational therapists, however, have the most training in ADL assessment and training and activity modification. Successful ADL training, is however, a team effort.
[19:14:33] Mod: Louise: The therapists always encouraged us to let her be independent but it just takes so long to get things done...any suggestions?
[19:16:06] Ms.Gentile: Louise, this is a good question. It can take individuals with brain injury extra time to do things, but I agree that this is time well spent. A suggestion might be to allow your friend time to plan in advance on her own.
[19:16:48] Mod: Eddie: Is there any way to improve the memory of a TBI patient that suffers from some form of cognitive impairment?
[19:18:10] Ms.Gentile: Eddie, there are some remedial techniques for memory loss but the literature is mixed on how successful these techniques are. Providing cues and then gradually extinguishing them would be an example of a remedial technique. As the person begins to remember on his own, they need less external reminders
[19:18:15] Mod: Eddie: What are some techniques for helping people remember of assisting them in coping with memory loss?
[19:19:40] Ms.Gentile: Regarding techniques for coping, aids that help memory loss includes such things as a daily planner, alarmed watch, checklists, etc.. It is important to find the one that works best for the individual
[19:19:56] Mod: Louise: How do we know how far to allow independence when safety is always a big concern?
[19:22:07] Ms.Gentile: This is a very good question and one that everyone struggles with. I like to look at safety in 3 steps: Can the person recognize potential unsafe situations, can they identify actions and then can they take action. Different individuals have problems along this continuum. The best thing to do would be to what the person can do safely and incorporate those activities into their daily routine
[19:22:48] Mod: Louise: Could the family play a role n fostering independence while the individual is still in the hospital...and how can this be done?
[19:23:07] Ms.Gentile: The family plays an essential role in fostering independence. Independence means different things to different families. It is important to identify what the family and pt want independence in. Cultural considerations also are key when looking at family involvement. For example what role did the pt have before the injury? What methods, rituals, etc ere used to perform ADL? Treatment should use the answers to these questions to guide treatment.
[19:25:46] Mod: Rail: Is it ok to "force" self care activities-even if there is NO interest, and an absence of focus during the task???
[19:27:35] Ms.Gentile: Forcing someone to do something is never a successful course of action. If an individual refuses to perform a particular self care activity I would try to find out why. Sometimes a person may be embarrassed that they need help with a taks so basic and personal, such as toileting or feeding. Sometimes, all too often, a therapist may be having a pt perform a activity that they didn't have an interest in prior to their injury so it has no meaning to them. Finally, one must consider if there is an initiation problem as a result of the brain injury that is preventing participation.
[19:29:28] Mod: Susan: How can you get "others" to treat the physically impaired as adults and not children and to give them a change to progress, any suggestions?
[19:30:16] Ms.Gentile: Susan, by "others" do you mean health care professionals or friends or family?
[19:32:27] Mod: Susan: All of those, especially health care professionals that have such negative attitudes when the physical is combined with a cognitive deficit.
[19:32:39] Ms.Gentile: Unfortunately I would agree that there some health care providers who lack skill in this area. I think that for some the physical is "easier" to address than the cognitive. If a caregiver is present and feels that their loved one is being patronized or left out, then that should be brought to the attention of the provider. When I have OT students I try to instill and model for them the importance of a client centered approach so they can develop these skills.
[19:36:09] Mod: Susan: I guess the best TBI rehab would be where a TBI unit is also present in the facility.
[19:36:19] Ms.Gentile: Susan, I would agree with this-- TBI units generally offer the special skills and services to meet the unique needs of the population.
[19:37:16] Mod: Louise: Is it important to encourage activities an individual may have been interested in prior to their injury or will the lack of skill be a problem?
[19:38:08] Ms.Gentile: Louise, another great question to which there is no easy answer! It really depends on the patient, if you have to modify a familiar activity some patients embrace this so they can resume the activity. Others feel sad that they can no longer perform the activity the way they did before. An occupational therapist might offer some easy ways to modify an activity so it may not look so different than it's original form.
[19:40:20] Mod: KiKi: Have you ever used music...if so how did you do it?
[19:40:43] Ms.Gentile: I have not used music in treatment but I know some other therapists who have.
[19:41:55] Mod: Susan: Since progress can be affected by the frame of mind a good working relationship is needed between patient and therapist. How can we assure this will happen as well as possible- What can family do?
[19:42:47] Ms.Gentile: Yes Susan, it is very important to have a good working relationship with the patient and the family. I think communication is the key. I would encourage the family to be involved early on and often. To ask questions, to observe treatment, to be involved with goal setting.
[19:44:41] Mod: Louise: I find that a big problem is utilizing time and finding a productive way to spend a day that was previously devoted to work...what can we do and are their any resources out there?
[19:46:49] Ms.Gentile: Louise, this is a difficult adjustment for the pts. In our society, work is so closely associated with our self image that when one cannot go back to work this is extremely difficult. Finding out what other interests a person has besides work can be a start. There are also some, although too few, resources in the community for this.
[19:48:11] Mod: Sometime when a person has a cognitive problem, they may get easily confused and frustrated when trying to perform a simple task, like getting dressed in the morning. Are there any strategies you can suggest to help?
[19:48:51] Ms.Gentile: If a person is motivated to do so, it is very important to have them participate in self-care as much as they can. Often the best and easiest thing to do is to develop a daily routine and tick to it. For example, when getting dressed in the morning, have the clothes laid out for person so this is one less decision for them to make. If necessary present the items one at a time in the order in which they are put in to reduce the need for sequencing. Keep the same style of clothing to make things easier. These basic strategies can help to organize a person and decrease confusion. The same principles can be applied to other self care tasks, such as grooming.
[19:51:21] Mod: How do you evaluate ADL skills?
[19:51:50] Ms.Gentile: An evaluation of ADL is important part of the rehab process. An evaluation of ADL should be designed so as to identify the problems a person is having with those tasks they need to perform in the normal course of a day. An ADL eval should include an interview to find out what the person's normal daily routine is, subjective information abut their satisfaction with their current performance, and a structured observation of them actually performing the activity in order to identify specific problems that may be impeding function. Whenever possible, the patient's primary caregiver should be involved in this process. This is especially important if a person is at home and the caregiver is providing help with ADL.
[19:55:16] Mod: If a patient has visual inattention after a head injury, what can be done to help him perform basic self-care?
[19:56:55] Ms.Gentile: Perceptual problems such as visual inattention are common after a brain injury. These types of problems can significantly impact on independence in ADL. I have seen for example, some patients with inattention eat only half of the food on their plat or literally comb only one side of their head. Compensatory strategies are often helpful. For example, during feeding, the entire tray should be placed within the intact visual field; grooming should be performed in front of a mirror for a visual cue. Providing an anchor to help prompt scanning may also be helpful. Often times these are very helpful and simple techniques that can increase independence.
[19:59:58] Mod: Well I see that our time is up. I want to personally thank Ms. Gentile for a very interesting and informative evening and I welcome her back to participate in our chat session in the future. Good night to all, have a great week and be safe! See you next week!
[20:00:41] Ms.Gentile: Thank you for having me. The questions were really great. I would welcome a return invitation!