i) Setting goals

The following steps outline a useful method for helping people with TBI set goals to achieve greater independence in daily living skills:
Identifying problems and areas for retraining can often be a difficult process, and it will be beneficial to consult with the multidisciplinary team to determine what assistance a client needs and areas to focus rehabilitation.
1. Decide which skills and/or activities to target. Choose something that the person considers important and meaningful. Rehabilitation should be restricted to one or two skills initially to assist the person to focus on the goals and encourage achievement .

2. Decide which part(s) of the activity the person needs to target, e.g.:

• To REMEMBER to do something in the first place;
• To INITIATE the activity- to get started;
• To KNOW THE STEPS of the task;
• To PHYSICALLY complete the task;
• To CONCENTRATE and ATTEND to the task for the whole time;
• To be SAFE completing the steps of the task.

3. Decide whether to MODIFY the TASK or the ENVIRONMENT. At times you may need to do both.

4. Decide whether to do RETRAINING or teach COMPENSATORY strategies.

Example:

Jim has problems completing shaving tasks, he has physical (upper limb hemiplegia on dominant side) deficits which impact on function.

1. TARGET: Shaving

2. Difficulty with PHYSICALLY completing shaving due to two handed activities.

3. MODIFY TASK: use electric razor rather than standard razor

4. TRAIN: to use electric razor

ii) Case study: Gemma

Gemma is a 35-year-old woman who sustained a severe brain injury in a motor vehicle accident. She also sustained fractures to both her feet and her right leg. Gemma now walks independently using two walking (quad) sticks. She has returned to live at home with her husband. Her husband has given up work and completes the majority of household maintenance tasks.

In your initial meeting with Gemma, she said that she has been living at home for nine months and has become frustrated that she can no longer complete the roles and tasks she used to. She says her major difficulties are her reduced physical abilities and her poor memory. The task she is most interested in returning to is preparing the evening meal.

iii) Case study: Tom

Tom is 28 years old man who sustained a traumatic brain injury following an assault. He participated in a 3-month inpatient rehabilitation program at the Liverpool Brain Injury Unit. As a result of his injury, Tom has weakness down his left side, making it difficult for him to walk long distances or carry heavy objects. Tom also has difficulty planning and organising his time and often on the ward became frustrated because he couldn’t seem to get to his appointments on time.

It is now three weeks since Tom’s discharge. He has returned to live in his two-bedroom unit. He is living alone and receiving carer support for main meal preparation and heavy household cleaning tasks. Tom has been finding that he is tired all the time and that he is not managing to get on top of all the household chores. He is finding this very frustrating and is often having aggressive outbursts due to this frustration.

 

 

iv) Case study: Pam

Pam is 22 years old women who sustained a severe brain injury in a car accident. She had a lengthy admission to the inpatient rehabilitation unit (nearly 12 months) before she was discharged home. Pam lives with her mother and sister in a two-storey house in the Fairfield area. Pam has carers every day who work from 8am to 8pm.

On discharge Pam was mobilising with carer assistance in a manual wheelchair. Over the past six months she has been assisted by carers and her occupational therapist to develop her ‘driving’ skills and is now able to ‘drive’ herself independently in a powered wheelchair. She can navigate in crowds and around shopping centres safely and effectively.

One of the major difficulties that currently impacts upon Pam’s life, is her poor memory. She is unable to recall what activities she completes during the week and she has difficulty remembering appointments she needs to attend. This often makes it difficult when Pam meets up with friends who inevitably ask, “what have you been doing lately?” It also means that she has to be extremely careful that she doesn’t double-book herself.

As a carer you have been working with Pam for six months and you feel she is ready to begin working on some new goals. You have noticed that Pam remembers things more readily if they happen regularly (ie. At the same time each day/week). You have also noted that now she has more independent mobility and wants to go out more frequently. You are happy to continue to explore different ‘outing’ opportunities with Pam but also realise that she sometimes doesn’t have enough money to do ‘everything’ and has difficulty accepting this.

v) Useful tools

For more help with identifying goals and strategies and monitoring progressuse the

Worksheets in Toolkit B Promoting Independenc.

3. Identifying issues
4 . Setting goals
5 . Making goals happen
6 . Monitoring progress