National Rehabilitation Hospital

Compensatory strategies for activities of daily living: a comparison of occupational therapists’ expectations and actual use following discharge from rehabilitation for acquired brain injury

Investigators: Dr Mark Delargy (Principal Investigator), Dr. Jacinta McElligott (Co-Principal Investigator), Co-Investigators:  Ms. Nicola Kavanagh, Ms. Anne Marie Langan, & Professor Agnes Shiel

Summary of Project

We developed a questionnaire to ascertain client usage of compensatory strategies and devices post rehabilitation. Through a literature review, interviews with Occupational Therapists and observation of rehabilitation sessions, we identified compensatory strategies and devices for the questionnaire. We piloted the questionnaire with a group of clients from the outpatient department. Thirty-five participants fulfilled the study’s inclusion criteria. These participants were posted the questionnaire, consent form and participant information sheet.

Results

16 questionnaires were returned reflecting a response rate of approximately 46%; 15 of these were analysed.

Strategies taught: The most frequent therapy taught strategies included: fatigue management or energy conservation techniques; training in adaptive kitchen aids; and hemi-dressing techniques (for example dressing affected side of body first, using adaptive dressing aids such as a button hook). Techniques for completing tasks with functional use of one hand (for example, using a dycem mat to stabilise a mixing bowl while breaking an egg into the bowl with one hand), using a diary, daily planner or list were frequently therapy taught strategies also.

Strategy usage: All of the strategies in the questionnaire had reported use by some participants. No strategy had reported use by all participants. Over 50% of participants use: alarm or reminder functions on mobile phones; written and/or picture instructions; planning and prioritisation techniques; and shop during quieter supermarket hours. Taking regular breaks to conserve energy, using lists/notebooks/diaries/calendars, and finding a quiet place to concentrate were reported as used by over half of participants also.

Device usage:  Devices with the highest reported usage included: a buttering board (has a raised lip on two sides of board to “hold” bread in place while buttering with one hand); a spike board (holds vegetables or fruit on “spike” to enable user to peel or slice the item with functional use of one hand); and a dycem/non-slip mat. A plate guard (additional rim clipped onto a plate to, for example, prevents food slipping off the plate while eating with functional use of one hand), elastic shoelaces, shower chair, transfer board, and a wheelchair had similar levels of reported usage by participants.

Outcome

There is evidence that strategies taught by therapists are used after discharge. Rehabilitation had a positive effect leading to increased strategy usage. Further investigation of reasons for poor compensatory device usage is warranted as the factors leading to limited device usage need to be determined. Therapists can then modify or discontinue compensatory device training so that they can be confident that all the techniques they teach are useful and will be used long-term.

Final Report presented to the NRH Ethics Committee –  July 2011