Presentation

Following a brain injury, children and families are often provided with many activities, exercises, and programmes from a range of different health professionals. As a result, families often find it challenging to complete all their recommended tasks, particularly when they return home and have other competing demands. Therefore, it is very important to work with families to help them incorporate therapy tasks and activities into their normal routines of daily living. This allows for plenty of practice in naturalistic tasks.

The most effective rehabilitation interventions in ABI occur when the intervention happens in a meaningful context (i.e. helps maintain and generalise skills). Therapy tasks that are embedded into functional and meaningful routines promote engagement and motivation for the child and family. Also, families feel less burdened and stressed by trying to “make time” for therapy which can be viewed by the child and family as another chore.

Considerations for intervention

When working with families to embed rehabilitation into routines it will first be important to understand what the family’s normal routines are. The goal setting fact sheet and resources such as routines based assessment can help with this. It is also important to understand what therapy tasks have been suggested by other therapists as a single routine may allow for several therapy tasks to be practiced. Or, therapy tasks (e.g. feeding) may work toward achieving another goal (e.g. going to a restaurant).

Being aware of other goals and therapy tasks will also help prevent overwhelming the family, and instead help you work with them to prioritize the goals that are important for them.

When embedding therapy into routines it will be important to remember the following.

• Aim for goals to improve participation or decrease dependence/ burden of care.
• Prevent learned helplessness (i.e. ensure the task is achievable with the child’s current skill levels, gradually building up complexity commensurate with the child’s skill improvement).
• Ensure that the tasks/goals are realistic and take into account the family’s resources and skills. For instance, time and financial burdens that impact on a family.
• Where possible, be integrative with other therapists.
• Prevent everyday routines from turning into opportunities for ‘testing’ the child.
• Coach carers, respite workers, and other stakeholders to help facilitate generalisation and practice of new skills and abilities.

Examples of routine learning opportunities

Examples of therapy goals that could be embedded into routines include:

Mealtimes and cooking

• Gross motor skills (e.g. positioning, standing, walking, carrying)
• Fine motor skills (e.g. holding/working with cutlery, manipulating objects, opening packets/ jars)
• Sensory needs/aversions (e.g. taste, textures, smells)
• Swallowing
• Thinking skills (e.g. following a sequence, attention, staying on task, remembering)
• Communication (e.g. following instructions, vocabulary, answering questions)
• Literacy and numeracy (e.g. reading a recipe)
• Independence (e.g. responsibility, chores, health and safety)
• Social (e.g. baking with friends/family, conversational skills)
• Equipment trials
• Emotions (e.g. keeping calm)

Bath time

• Gross and fine motor (e.g. dressing, washing, drying, teeth/hair brushing, safe transitions)
• Thinking skills (e.g. sequencing, following instructions, following routines, remembering, staying on tasks).
• Communication (e.g. vocabulary, following instructions, conversations)
• Independence (e.g. self-care, responsibility, health and safety, cleaning, hygiene).

Contact us

Queensland Paediatric Rehabilitation Service
Queensland Children’s Hospital
Level 6, 501 Stanley Street, South Brisbane 4101
t: 07 3068 2950
t: 07 3068 1111 (general enquiries)
f: 07 3068 3909
e: qprs@health.qld.gov.au