Videos: Occupational Therapy for Adults With Brain Damage
Occupational therapy for adults is heavily focused on redeveloping skills that may have been lost due to injury and prevention of further loss. Since adults have completed their physical development and have already learned many skills, the emphasis of treatment is not keeping them on track with development like with children, but in assessing where their functioning once was and on working with them to make goals for where they want their functioning level to be. The three videos below focus on adults recovering from damage to the brain either by trauma or stroke. Each therapeutic interaction addresses a unique need and goal for the client.
The Client's Perspective
This video shows the progress of a woman who sustained a traumatic brain injury while mountain climbing. Though her injury is not fully explained, it appears to affect her motor control as she is shown struggling to walk and to write. Furthermore, it may have damaged the connection between the two sides of her brain as she is shown struggling to coordinate writing with her right hand. The video is not a treatment session but is instead an overview of the type of care she received and is told from her perspective. In the video, she is shown doing several occupational therapy activities of different levels of difficulty. These are not elaborated on, but it is possible to tell the types of things she is doing and the purpose for the interventions.
Since the video covers her entire recovery process from the time she was injured to the time she can run a half marathon, many interventions and approaches are shown. The main method of intervention focused on is the occupation and activities she engages in. These include activities designed to restore abilities she once had before her brain injury. This is the approach of remediation and specifically addresses her gross motor skills and problem solving such as when she is shown working on spacial reasoning by stacking blocks. The modifying approach is also used, such as when she is practicing using a pen and paper while looking in a mirror. This has been shown to aid people with brain injuries in learning how to write again (McIntosh & Sala, 2012). Most of the interventions shown are low technology ones, though there are parts that show her with preparatory interventions being done to her such as being placed in a wheelchair or hooked up to machines that assist her in eating of breathing
The client appears to have a serious traumatic brain injury accompanied by physical injuries. The setting of the therapeutic sessions varies as she progresses. She starts in a hospital setting and eventually is able to do work in her own home. Her therapist interactions are very positive, especially considering that she agreed to make this video to show what occupational therapy had done to help her. Her therapists uses modelling of the task for things like stacking blocks, but will also help guide her hand if necessary in the earlier stages of her recovery. While this is a kind of activity, it can also be viewed as a preparatory task helping her regain function in her hand for use doing other things such as using utensils.
OT Session for Left Leg Neglect
This video shows an elderly man who is recovering from a stroke and who has left side neglect. Though he can move the left side of his body and is not blind on his left side, his brain has trouble recognizing things that are to his left. The setting appears to be his home environment. As with the other videos, the exact cause of his condition is not apparent. It is made clear that he had a stroke, but other than that it can only be inferred that the stroke occurred in a part of his brain that affects his spacial reasoning more so than his ability to move or sense his surroundings. However, he is shown to have a tremor in his hand and seems to have trouble gripping things.
This activity involves some preparatory intervention, though very simple technology, the pegboard used is important for helping the client recognize items situated to his left. Though the activity does not have meaning outside of itself, it is very goal oriented and the client responds well to it. Once clever thing the board is used for is the perimeter. The therapists encourages the client to run his hand along the perimeter of the board. This gives him a multisensory experience which is often important for recovery (Lape, 2009). Since his hand is forced to follow along the edges of the board, even into his left side which he has trouble recognizing, this causes his brain to realize that there is more in front of him than what he can see, and allows him to locate all the pegs.
Though there is no clear goal present such as turning on a sink or feeding himself, the activity still seems to be within the realm of restoration and remediation as it is helping him regain the understanding of his left visual field which he lost from his stroke. This method can also be viewed as implementing the approach of prevention. The longer he goes without practicing the use of his left side, the worse his condition may become, since time matters in the treatment and recovery process following strokes (Skidmore, n.d.).
Summary and Integration of Learning
One of the key concepts shown in all three videos is that of applying meaning and goals as an effective method of treatment such as described in the Skidmore (n.d) article. Adult physical therapy often deals with clients who once had full functioning but then lost it to disease or injury. Because of this, measures are taken to help them regain the functioning they once had as best as possible and the use of familiar stimuli seems to be important to this.
The concept of goal oriented therapy is especially important in individuals with brain damage and the majority of the interventions are active participation rather than modifications of routines. This seems to be due to the nature of brain damage. The loss of a limb, for example, is a very definite thing that would require modifications of activities to regain function. But since it is unclear how much function can be regained in an individual with brain damage, it seems that therapists keep in mind that there is no definite end goal, instead using small day to day goals.
While I was aware of many of the concepts demonstrated in these videos and explained in the readings, I did not have as clear an idea about how they worked. The use of eating as a tool to help re-learn movement in the arms is an example. Of course, I had been aware that therapists use a number of different techniques to encourage and motivate their clients, I did not know how powerful a tool even pretending to eat could be. That is something that I would be interested in learning more about.
One thing that was unclear to me in the video was on the women practicing eating a bowl of oatmeal. It appears that she is only pretending to eat, and yet she seems to have severe cognitive deficits. She mentions being hungry throughout the video and she is shown to be confused much of the time. I am wondering why then she so readily plays along with eating pretend food. It is possible that she is only an actress, however the video does not say so, nor does any of the production information below it on the page. If it is not a acted out situation, I would like to understand the benefits of not having her use real oatmeal, especially since that is what is described in the Capasso, Gorman, and Blick (2010) article.
Capasso, Nettie, Gorman, Amie, & Blick, Christina (2010, May 10). Breakfast group in an acute rehabilitation setting. OT Practice, 14-18.
Lape, Jennifer E. (2009, May 25). Using a multisensory environment to decrease negative behaviors in clients with dementia. OT Practice, 9-13.
Skidmore, Elizabeth R. (n.d.) Cognitive impairments after acute stroke: guiding principles for occupational therapy practice.
McIntosh, Robert D., Sala, Sergio Della (2012). Mirror-writing. The Psychologist, 25. Retrieved from https://thepsychologist.bps.org.uk/volume-25/edition-10/mirror-writing