i) Teaching strategies

There are five common strategies you can use to help a person with a TBI to be more independent at home and in the community:

1. Demonstration

• Demonstrate/ model how you would perform the activity
• You may need to demonstrate a number of times so that the person understands
• Get the person to practice the actions or repeat the steps verbally to you

2. Instruction

• Try to use as many methods of instruction as possible (e.g. written checklists, photos/pictures, physical demonstration, voice recorded on ipad/phone)
• Instructions should be:

• Timely (given at the time the activity is being performed)
• Short (minimse extra words, gestures or ideas)
• Clear (simple language, pictures)
• Consistent (the same each time)

3. Routine

• Maintaining a set routine makes it easier to learn; Try to do tasks:

• At the same time each day/week (i.e. grocery shopping every Wednesday)
• In the same way (i.e. write shopping list on ipad  every Tuesday evening)  

4. Feedback

• To help someone stay motivated when working on a goal you need to provide feedback about their performance. Feedback should be:

• Honest and positive: Feedback needs to be accurate but should be phrased positively to encourage the person to keep trying.
• Specific: Examples of good/poor performance should be provided to assist the person to learn.
• Timely: Feedback should be provided as soon after the session as possible.

5. Environment

• Enviroment is a vital part of any teaching. There are a number of things to consider:

  • Appropriate environment: Activities should be performed in a suitable environment (i.e. self care activities in the bathroom)
  • Quiet environment: Try to teach in a quiet environment with limited distractions (e.g. turn off radio/TV)
  • Environmental Cues: Think about using the environment to cue behaviours (i.e. use alarm clock to wake someone up or a whiteboard to list “jobs for today”)

Example: Making a cup of tea:

1. See the person in their own kitchen with items needed for making a cup of tea on the bench (Environment)
2. Discuss with the person the steps required to make a cup of tea and write a list (Instructions) provide assistance to make list if required
3. Run through the task using the list with the person present (Demonstration)
4. Have the person complete the task following the same instructions (Routine)
5. Provide guidance and prompting during the task and discuss any issues after completion (Feedback)

Remember learning a new skill takes time, so don’t give up after only 1-2 weeks, everyone will benefit if the person increases their independence.

 

ii) Managing fatigue

Plan activity levels

• Try to spread “heavy” activities over the day/week (i.e. physically demanding tasks such as vacuuming, over the day/week). This could mean that the person vacuums the house on one day and does the washing on another.
• Alternate between physical tasks and cognitive tasks. (i.e. mow the lawn then sit and watch TV).
• Take regular rest breaks and include in daily planning if necessary

Simplify the task

• Can the task be performed while sitting?
• Can parts of the task be completed at different times in the day?  (eg make a pasta sauce in the morning and then cook pasta in the evening)
• Is there a different way of performing the task? (e.g. hanging clothes inside on a drying rack rather than on the line in the back yard)
• Can certain steps within a task be changed? (e.g. buying pre-cut vegetables rather than chopping up all the vegetables)

 

iii) Memory tips

Here are some suggestions you could make to clients to help them with memory difficulties:

Diaries - keep a written diary or electronic organiser for day to day activities (eg attend gym, meet friend for lunch, pay phone bill). Encourage the person to check their diary at least every morning or evening

Calendar - keep a big calendar in a place where it can be seen clearly (eg on a kitchen wall or near a phone). Write information next to the date and cross the days off as they pass. Make sure all the people in the household use the same calendar

Whiteboard - write important notes on a white board (use white board markers so it can be wiped clean). Make sure the board is in a position where it can be seen and used easily. Keep information tidy and organised

Checklists - make checklists of things to remember or do. Tick the items off so that you know you have done them.

Rehearsal - repeat silently or out loud the information to be remembered. If you don't remember or don't understand something, always ask questions.

Electronic devices - set an alarm clock or wrist watch to remind you to do a regular activity (eg to take medication or feed a pet).

Telephone note pad -write all phone messages on the same pad. Keep the pad next to the phone so messages can be written down immediately. Get into the habit of checking for messages when you come home. Cross off the messages when you have called them

Post-it notes - write yourself notes and put them in placed you can see them. Throw them away when you have completed the task.

Special places - designate a special place where you keep things like your handbag, wallet, keys, mobile, glasses and bills to pay. This may be a tray next to the phone, a cupboard or shelf in your room.

Telstra wake-up and reminder call service - This can be used if you are worried about forgetting important things

Dosette box - a box with compartments for different times of the day to help you to remember when and how much medication to take

Try to stay calm - sometimes worrying or becoming upset about being forgetful can make it more difficult to remember things

iv) Useful tools

There are lots of specific strategies in Toolkit B Promoting Independence, e.g.

11. Remembering information and messages
13. Managing time
15. Food and meals