Therapy Programme

When a patient is first admitted to the Brain Injury Unit, assessments are carried out by the therapists to determine what problems the patient has as a result of his injury. An appropriate therapy programme is then drawn up. Problems which are common after a head injury are:

• behavioural e.g. irritability, impulsiveness, behaving in an inappropriate way, emotional lability (inability to control crying/laughing)
• cognitive e.g. memory problems, slowed thinking, difficulty solving problems, unable to reason in a logical manner
• physical e.g. a person may be unable to sit up without support or be unable to walk
• speech/language e.g. a person might have slurred speech or they may have difficulties finding the correct words to express what they want to say

If the patient is not in post-traumatic amnesia (P.T.A.) assessments will be carried out as soon as possible after admission, however, if the patient is in P.T.A. when he/she* is admitted to the unit, formal assessments will be delayed until the person emerges from P.T.A. See separate information on P.T.A.

The assessments are as follows:

• Neuropsychological assessment : this looks at the cognitive (thinking) skills of the person such as memory, problem solving, reasoning etc.
• Speech and language assessment : this assesses such things as reading and writing skills, the ability to understand what the person hears and reads and their communication skills.
• Occupational therapy assessment : this is to see whether the person is able to do such things as shower and dress themselves and more complex cognitive (thinking) tasks such as filling in bank forms or reading train timetables.
• Physiotherapy assessment : a detailed assessment of the person's motor skills is carried out to look at whether, for example, the patient can stand without support or can do more difficult tasks such as walking up and down stairs.

After these assessments are completed a therapy programme is drawn up for the patient to work on his problems. Each patient is different so some people will need more therapy than others. The therapy programme is designed to address cognitive, behavioural and language problems as well as physical problems. The patient will do some therapy individually, that is, the therapist will work with him alone. For other therapy the patient will work in a group with other patients. There are several reasons why group therapy is important:

• Most people spend a good deal of their lives interacting with groups of people (both at work and in social situations) rather than just dealing with one person at a time. After a brain injury some people lose their social skills and it is necessary to teach them how to relate in a group.
• Some problems only become obvious in a group setting, for example, a patient may be able to have a conversation with one person but may have difficulty following the conversation with a group of people.
• Some patients have trouble concentrating when there are other people around but it is important for them to learn to do this again because in real life situations we have to carry out tasks when there are other people around us, both at home and at work.
• Participating in groups also provides patients with support and encouragement from the others in the group and gives them some comfort knowing that others are experiencing some of the same problems.

  Relatives and friends are not allowed to sit in on group therapy. This is to respect the privacy of the other patients. Moreover, patients with behaviour problems sometimes "show off" in front of relatives/friends.

  Each person receives a copy of the group programme with a brief description of each activity. Also, the patient will be given a timetable of his individual and group therapy times and this will be changed from time to time as his therapy needs change. Individual counselling is also provided, if appropriate, to assist the patient to adjust to the changes in their lives which have arisen as a result of the injury.

  Q. Why does the patient practise cooking and shopping?

  Patients attend the cooking and shopping groups, as well as individual cooking sessions for the assessment of cognitive (i.e. thinking) and physical abilities whilst performing a functional task. These activities are used to assess such things as being able to follow a set of written instructions, social behaviour in the community, attention and concentration, fatigue, strength and co-ordination of the arms, memory and problem solving.

  Anne Pfaff Programme Co-ordinator

Last modified: Thursday, 20 April 2006