Neuro Occupational Therapy - reflecting on the complexities of the Christmas period

It is a gift that keeps on giving! Krysalis Clinical Director, Jo Throp examines how Neuro OT keeps spirits lifted throughout the Christmas festivities.

I must begin by saying I have had a busy week! With Christmas just around the corner, the run up to the main event has been anything but routine. 

End of term Christmas madness has been followed swiftly by late night wrapping marathons, nativity play preparations and baking sessions, to name a few!

Whilst the festive period offers little in the way of a consistent routine, for many of us Christmas brings family traditions or religious rituals.

The predictability of these traditions offer meaning; a feeling of shared unity within family and community networks which are, in general, thought to be good for our physical and emotional wellbeing. 

But it is important to consider how this period impacts on families and individuals living with brain injury. 

We must ensure as clinicians we are, at all times, cognisant of the pressures experienced at this time of year by survivors of brain injury and their families.  

   For individuals with cognitive and executive limitations, or families juggling the additional responsibility of supporting a loved one, festive tasks can feel overwhelming   

Christmas is a time when our roles and responsibilities change. Whilst for some working over the festive period is accepted, many of us will stop work to spend time with family and friends.

The activities we choose to do, or must do, for ourselves and other people over this period are guided in many ways by those family traditions.

It is these activities and responsibilities that give us a sense of purpose, define who we are, and influence the way we live our life and our interactions with others.

Each one of us is unique and this uniqueness impacts on our choices and, in turn, influences how we think, act and behave.  

For our clients and the families of those with acquired brain injury, Christmas can be a difficult time.

   The toasting of chestnuts on our woodburning stove, leaving mince pies out on the mantle, or soaking a whole turkey in a bucket of seasoned water is not something that is done in our house every day!   

The unpredictability of the festive season and the perceived ‘pressures’ surrounding delivering a ‘perfect’ Christmas can make it hard.

For individuals with cognitive and executive limitations, or families juggling the additional responsibility of supporting a loved one, festive tasks can feel overwhelming. 

Social events and the party season can be challenging for some individuals with social communication disorders or physical communication challenges.

Families supporting individuals with behavioural or sensory needs may struggle to adapt quickly enough to the dramatic changes in the shared physical environments in the wider community, leading to exclusion and isolation.

All these challenges will impact greatly on how an individual perceives themselves. What they are capable of doing and how they spend their time may have shifted radically. 

Moreover, the opportunities available to them to engage in activities may have shrunk, and the impact can be more keenly felt at Christmas time. 

   Neuro OTs are unique in that they have a comprehensive understanding of the impact of disability in relation to daily activities   

An OT considers an individual’s ability to participate in activities, alongside environmental and geographical elements and the political climate. 

In addition to this, there has to be an awareness of the significant sociocultural, temporal and client-centred elements that are guiding and influencing participation in activities during the festive period.

We are going to explore these briefly, including how they influence occupation specifically relating to brain injury at Christmas time. 

Living with brain injury: past, present and future

The temporal elements of occupation and an individual’s experience of participation relating to the past, present and future is an essential consideration for Neuro OTs. 

Our performance and participation in activities is affected by our own view of the world; the expected and familiar patterns, sequences, rhythms and experiences that are unique to us. 

Our experiences, of course, are a combination of thoughts and feelings that emerge while completing an activity, and our interpretation of that event afterwards.

At Christmas especially, our performance and participation is also affected and influenced by our feelings of anticipation prior to completing an activity. The Advent calendar is just one example of this.

All these elements, ultimately, influence our participation in activities, our activity choices and our behaviour. 

But, although routines and rituals unique to an individual and their family may well have ‘always been done’ at Christmas, that does not mean that they should be considered as a fixed entity.

The reinvention of new traditions that are equally valuable and important can be seen as a positive step forward, and attributing these new traditions with special significance or meaning will acknowledge their value for future generations.

Great expectations

Sociocultural norms are sets of rules and regulations, unspoken or written, that guide a group, people or society regarding what is appropriate or inappropriate behaviour. 

These include attitudes and expectations which arguably play a significant part at Christmas in influencing how we act and behave. 

Many of us over the festive period have in our minds an often-unrealistic expectation of the big day itself. 

For families living with the consequences of acquired brain injury, the self-imposed expectations or attitudes of others sometimes magnify the daily challenges that may be more keenly felt at this time of year.  

Unique intervention 

Every client I have ever met has wanted to engage and participate in activities and have a clear sense of purpose. Each of them is unique in their personality, likes, dislikes and motivators.

These unique parameters, combined with clinical observations of functional ability, environment, routines, rituals, values and beliefs, enable our Neuro OTs to provide advice and therapeutic intervention to help clients achieve their goals.

We all participate in activities with which we have the functional ability, interest and desire to engage. Equally as important, however, are the situational elements that promote successful performance and participation. 

It is the shared values and morals in the occupational therapy community that shine the brightest at this time of year, along with the belief that, regardless of a disability, everyone has a right to live a full, active and fulfilled life not only on one day, but throughout the rest of the year. 

Happy Christmas one and all. 

Further reading

Christmas planning post brain injury

Self awareness following acquired brain injury

Nutrition and brain injury rehabilitation

Fatigue and traumatic brain injury

Family matters - recognizing the complex needs of a family following a traumatic brain injury