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‘DIY’ breakfast program to improve rehab after brain injury Michelle Quick, Jacqui Wheatcroft, Danielle Sansonetti, Natasha Lannin and Laura Jolliffe
Increasing participation in acquired brain Injury rehabilitation Clinical practice guidelines recommend that people with an acquired brain injury (ABI) should engage in at least three hours of scheduled therapy a day, and opportunities for increased practice outside these times should be encouraged (Stroke Foundation, 2017). However, it is often challenging to meet this target within inpatient rehabilitation, with only a fraction of the day spent actively completing rehabilitation in a structured therapy program (Janssen et. al., 2014). As occupational therapists, it is important to consider how to help patients increase intensity and duration of participation in functional activities within the ward environment to meet guideline recommendations and prepare for discharge. Within the ABI rehabilitation unit, it was identified that opportunities for patients to initiate routine daily activities were limited. Additional opportunities for brain injury rehabilitation can be provided in groups, like upper limb, community mobility, fatigue management and meal preparation groups. Activities may include applying cognitive strategies during functional tasks, using aids and equipment, grading tasks, and practising social skills such as taking turns and 28 otaus.com.au
working with others. While breakfast groups have been extensively used, particularly in the general rehabilitation settings (Scaffa, 2013), there is limited evidence of meal groups to improve participation or function in the ABI population.
Do-It-yourself breakfast program evaluation This project aimed to explore and evaluate an independent ‘do-it-yourself breakfast group program. Observational audits were completed before and after the unsupervised group was implemented to evaluate the program. In addition to patient participation, Functional Independence Measure (FIM™) and Functional Autonomy Measurement System (SMAF) scores, activity participation, frequency and time of use before and after the program was implemented were also recorded. Patients in the 42-bed ABI rehabilitation ward were invited to attend the DIY breakfast program if they: Had a rehabilitation goal of independent meal preparation; or Their treating occupational therapist considered they were nearing independence with this goal. Patients did not attend the DIY breakfast program if they: Had behaviours of concern that affected the safety of others;
Were on modified diets that could not be managed themselves Required assistance with walking; or Had significant cognitive issues that could pose a risk to self or others.
Environment and resources A review of the ward was completed, and a suitable room in an accessible, highly visible area – which could be locked if required for the safety of others (for example, if patients were exhibiting behaviors of concern) – was identified. Internal windows between the nurses’ station and the identified room further increased visibility. This room contained equipment and furniture including: • Fridge/freezer (ingredients milk, yoghurt, bread etc); • shelving unit (with plates, cups, cutlery, cereals and spreads); • Kettle; • Table and chairs; • Tea towels; • Whiteboard; • Trolley to put dirty dishes; and • Hand hygiene station. Due to fire alarm regulations a toaster could not be used in this setting.
