Case study 1
Andrew suffered significant brain injury as a result of a road traffic accident aged 13 years old. He was referred for Occupational Therapy by his Case manager when aged 22 years old, to look at independence, daily routine and community skills. Andrew was living at home with his parents, getting up late in the afternoon and had no purpose to his day.
An initial OT assessment was carried with the client and family along with a review of previous rehabilitation.
The following issues appeared to be the main issues:
Poor sleep hygiene
Lack of exposure to tasks required for independent living
Difficulties with planning, organising and implementing tasks
Interventions were initially carried out at the home. The focus was on the following tasks – planning a meal, budget and shopping. These were new tasks for Andrew. After some work on likes and dislikes we worked out a few meals he might like to make. We used a meal plan sheet prepared using activity analysis to break down all task parts. A step by step list is produced which includes all steps in detail, a list of utensils and ingredients needed. This allows planning of a shopping list for the meal. The client needed a reminder to check the cupboards and fridge for items they may already have and estimate cost of items.
Andrew struggled to understand basic steps in traditional recipes such as ‘brown mince’. Therefore this was broken down into more steps: e.g. put pan on hob, turn on heat to number 4, add oil, open mince, add to pan, stir occasionally until all meat is brown. Using these sheets and after practicing several times, he was able to cook set food for himself and his family, without support.
Andrew wanted to live independently we therefore looked at an independent living trial. This involves helping the client find a property, organising furnishings and looking at utility suppliers, developing routines to maintain the property, meals, food shopping and budgeting.
For Andrew this was hard as he had never needed to be independent as his family had previously done everything for him. It was daunting for him to tackle everything at once. Initially he stayed at the flat two nights week, but he soon decided he wanted to live there full time.
We structured his environment and time to enable this to be successful and allow for learning. A simple timetable type structure was used to plan in meals he could cook and prepared a weekly schedule for washing his clothes and putting out the rubbish. Activities were gradually increased to include cleaning tasks.
We looking at his sleep hygiene and adjusted it slightly so he was getting up in the morning and going to bed earlier than previously, the added structure to his day supported this routine change.
Initially Andrew really struggled with budgeting and his takeaway intake was high. He requested help with this and we started using the banking app to review his spending every month. Looking at week by week spending under several categories chosen by the client, this enabled him to see fully what he was spending his money on. After a baseline he decided on set budget amounts for each category and we reviewed these monthly. Although initially this was time consuming the client now manages his budget independently.
We have worked with Andrew for a number of years and he now lives independently in his own home and he has recently begun voluntary work, attending for a short period of time twice per week.