Excerpts

Introduction

Importance of Functional Rehabilitation

During seven years of providing brain injury rehabilitation in a residential facility in numerous capacities including direct care staff, rehabilitation therapist, case manager and speech pathologist, I learned the importance of functional rehabilitation. Functional rehabilitation involves teaching basic skills that are related to the everyday activities which are needed for individuals to become more independent with a variety of tasks. It has been my experience that direct care staff tend to view their role as one of making sure basic needs are met regardless of an individual’s participation in meeting these needs, as opposed to teachers who facilitate learning new skills. When staff or family members interact in a way that only ensures basic needs are met, without a focus on increasing independence, the opportunity for providing functional rehabilitation is lost. The individual with a disability does not learn the necessary skills to become independent because these tasks are done for the individual.

A tremendous need was realized- how do we as clinicians teach direct care staff how to provide functional therapy? The skill of knowing how to teach basic everyday activities, ones that are taken for granted by a person without a disability, in a positive therapeutic manner, is very much a learned skill. However, learning how to interact in a way that teaches others how to perform activities more independently takes experience, time, appropriate models, and a willingness to learn how to interact differently.

Step-by-Step Approach to Therapeutic Tasks The purpose of this manual is to teach this therapeutic way of interacting through the step-by-step format. This gives a caregiver, even one without models of how to interact in this teaching manner, all the tools needed to help individuals become more independent. Someone with little or no experience working with persons with disabilities can pick up this manual and immediately be able to interact in a therapeutic manner, while instantly facilitating independence. The goal is to generalize this interaction style to other areas and activities. By using this approach, direct care staff will develop an array of tools and methods for effective rehabilitation.

Functional Rehabilitation Activities are therapeutic tasks designed to facilitate an individual’s independence with activities of daily living. The activities are implemented by caregivers and consist of step-by-step instructions for teaching specific tasks. Caregiver refers to direct care staff, family, teachers, etc., who work with individuals with special needs. Throughout the manual, caregivers are referred to as “staff”. The activities are divided into four areas: cognition, behavior, activities of daily living, and leisure. Each activity targets a specific skill area and describes the task. The procedure takes the caregiver step-by-step through completion of the activity, beginning with simply asking the individual to participate in the task. Next, tasks are broken down into simple steps. One of the most important features of each activity is to provide verbal praise and positive reinforcement for the individual’s efforts regardless of accuracy or successful completion. Any form of participation should be reinforced.

Activities for all Disabilities and Settings

These activities are useful for children or adults who have experienced any type of disability. The majority of these activities provide basic everyday fundamental skills that are appropriate for habilitation or rehabilitation. This manual was initially written for use with persons with acquired brain injury. By the time it was finished, we realized that the skills taught are appropriate for adults or children with many other types of disabilities or those who simply lack skills in particular areas. Throughout this manual, the individual completing the activity is referred to as “participant”.

Many people with disabilities may not receive formal rehabilitation to the extent needed to become independent with these skills. Families are often unsure how to help their loved one become more independent. The activities included in this manual are appropriate for use in the home setting, as well as rehabilitation programs, residential programs, outpatient facilities, schools, etc.

The activities in this manual were created by conceptualizing how, as clinicians, we teach these skills. The activities are designed to be an extension of clinical therapy goals, while promoting positive quality therapeutic interactions between caregiver and the individual. The manual may be used in a variety of ways. Individuals may choose which activities to complete in a specific area or the caregiver may suggest activities that are daily activities.

I hope you find these activities useful and that through their use you are able to facilitate independence by providing functional rehabilitation through positive interactions.

Niki Ziarnek