Setting independent living skill goals

The following steps outline a useful method for helping people with TBI achieve greater independence by learning daily living skill activities:

1. Firstly decide which skill or activity to target. Choose something that the person with the brain injury considers important. Plan to upgrade independence in only one or two skills to start with.

2. Next, decide which part(s) of the activity the person needs help with, e.g.:

• To initiate the activity in the first place - to get started;
• To remember to do something in the first place, without being reminded every time;
• To physically manage the task;
• To concentrate and attend to the task without getting distracted and going off to do something else midway through the activity;

3. Think about whether the task could be modified or whether you could use some compensatory strategies to complete the task

Eg. If making a stir fry for dinner you can buy pre- cut vegetables and meat if the person doesn’t have the physical strength to prepare all the ingredients.

Identifying problems can often be a difficult process, and it may be necessary to consult an occupational therapist to determine what assistance a client needs. For example if a client stood in the kitchen but could not start the activity, this could be a
problem of “initiation”, ie. with a verbal prompt they may begin the task, or could it be a problem of memory, because they can’t recall where the items they need are located.

Case studies

Gemma

Gemma is a 35-year-old 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.

Think about how you might assist Gemma to manage to live independently. Use the following questions to assist you. Write down some key points.

Which cooking activities might Gemma have difficulty performing?

What strategies might assist her to work around that difficulty?

Case studies

Tom

Tom is 28 years old and 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.

Think about how you might assist Tom to manage to live independently. Use the following questions to assist you develop a plan. Write down some key points.

1. Identify the skills and tasks that Tom has difficulty with.

2. What are some of the strategies you might use to help Tom manage these difficulties?

Case studies

Pam

Pam is 22 years old and 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 other 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. same time each day/week. You have also noted that now she has more independent mobility, she 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.

Think about how you might assist Pam to manage to live independently. Use the following questions to assist you develop a plan. Write down some key points.

1. What are some of the issues that you may be able to start working on, with Pam?

2. What are some of the strategies you might use to help Pam manage her difficulties?

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