Skills for independence

Why do we encourage independence?

There are many reasons for encouraging independence:

• Defining ourselves: What we do helps us to identify who we are, our lives are made up of a series of events and experiences which shape our own and others perceptions of us.
• Sense of Achievement: When we complete a task or activity we gain a sense of achievement  that helps us feel good about ourselves.
• Sense of Control: When we complete a task or activity we feel in control of our actions and daily life.
• Providing Choice: It allows us to choose what we do, when we do it and how we do it.
• Reducing Dependence: It reduces our reliance on others which makes it easier for carers and families to support us.

Brain injury and skills for independence

Promoting / teaching independence can sometimes be a slow, frustrating and difficult process. Encouraging independence relies on:

Consistency

completing tasks in the same way (i.e. following a checklist)

Timing

completing tasks at appropriate times (i.e. meal preparation at meal times)

Context

completing tasks in the right situation/environment (i.e. shaving in bathroom)

Patience- learning takes time

It can often seem easier to ‘do’ the task for the person as it tends to be quicker, however this only reinforces deficits and encourages dependence.

 

A person's abilities

 

 

Daily life activities

Daily living activities are those tasks and roles a person routinely performs throughout their day. Some examples include:

• Personal care tasks (e.g. showering, grooming, toileting and personal
  hygiene)
• Mobility – ‘getting around’ – including walking, road sense, orientation, using transport
• Meal and snack preparation
• Domestic tasks (i.e.laundry, house cleaning, home maintenance)
• Shopping
• Paying bills and budgeting
• Taking medication
• Using the telephone
• Dealing with emergencies
• Organising activities for the day/week/month

What physical and cognitive skills do you need for these activities?

All daily living activities require a combination of physical and cognitive skills. A person with a brain injury will often have a number of deficits which will impact on their ability to complete daily activities. Some examples of skills include:
Physical:

• Mobility
• Transfers
• Arm/Leg (movement, strength, coordination)
• Sitting balance

Cognitive:

• Memory
• Initiation
• Attention
• Problem solving
• Planning and organising
• Concentration
• Communication
• Motivation
• Self monitoring
• Behaviour
• Insight

Impact on daily living skills

Injury to a particular part of the brain can cause a person to have difficulty performing one or more of the skills they require for daily living activities.

Below is a list of common ways that skills required for daily living activities are affected by traumatic brain injury:

• Memory – difficulty remembering events, appointments, names, requests, telephone numbers, messages. i.e. not remembering home phone number.

• Planning and organising – difficulty planning activities, organising work areas, coordinating tasks or appointments and getting ready “on time”. i.e. always being late to appointments.

• Attention/Concentration – difficulty maintaining focus on tasks and completing tasks. i.e. not monitoring items cooking on stove.

• Physical abilities – muscle weakness and/or loss of coordination (arms, legs, trunk, head), spasticity/tone/contracture,  difficulty walking and transferring. i.e. needs a wheelchair for mobility.

• Communication – may have slurred speech, word finding difficulties, decreased ability to understand words or express themselves appropriately. i.e. not able to ask for items or assistance when shopping.
• Energy  - difficulty maintaining energy levels to complete tasks i.e. unable to walk distance to local shopping centre.
• Motivation – difficulty identifying and completing relevant tasks due to lack of interest or enthusiasm for the task. i.e. refusing to shower daily.

• Self monitoring – difficulty recognising when they are making mistakes or are inappropriate in their behaviour. i.e. repetitively doing the same task incorrectly.

• Behaviour management – difficulty monitoring/controlling their own behaviour including anger, inappropriate conversation and/or offensive behaviour. i.e. yelling at random people in shopping centre for no reason.

• Problem solving – difficulty identifying there is a problem and determining the best solution. i.e. catching wrong train and not getting off to try to find the correct train.

 

Tips and Tools

 

i) Teaching strategies

There are five common strategies you can use to help a person with a TBI to be more independent at home and in the community:

 

ii) Managing fatigue

 

iii) Memory tips

Here are some suggestions you could make to clients to help them with memory difficulties:

 

iv) Useful tools

There are lots of specific strategies in Toolkit B Promoting Independence, e.g.