Neuro occupational therapy in action: managing negative behaviour caused by brain injury
Introducing Claire, a mum working full-time who experienced a brain injury caused by encephalitis.
In her 40s, Claire had already overcome many barriers to her independence due to having a disability since birth.
Her mother was prescribed a drug during pregnancy called Thalidomide. It was known to help with morning sickness. However, it was later discovered this drug caused babies to be born with birth defects that affected limbs.
This did not stop Claire achieving great success in both her education and work goals.
She was working full-time when she had a brain injury caused by encephalitis, which is swelling in the brain.
The need
After, Claire was unable to organise or plan due to her brain injury. She could not remember information or faces, she wouldn’t leave the house, and she was behaving in negative ways that risked her health.
She refused to do personal care tasks such as washing herself or brushing her teeth. She didn’t want to change her clothes or bed linen; Claire resorted to washing her clothes in the toilet.
At times, Claire also had physical outbursts such as body blows, head pushing, kicking or throwing things, and shouting at others.
The question
Claire was conflicted between her new behaviours and barriers to independence, and the values she had held her entire life.
She needed support to organise herself and her daily routine. Her usual ways of coping were not working due to the effects of her brain injury, and this was triggering her behavioural outbursts.
However, it offended Claire when, even in her best interests, people tried to help her complete tasks. She was so used to proving that she was self-reliant, despite her Thalidomide-linked disability.
Our neurological occupational therapist set out to understand Claire and her view of the world, and she needed to know the barriers in Claire’s daily activities.
It all left our neurological occupational therapist asking the most important question of all: how could we ensure Claire managed her behaviour?
Seeing the whole picture
Our neurological occupational therapist noted that Claire enjoyed showing how she could perform tasks independently, and she was keen to teach others her techniques.
Claire was also a determined person, after overcoming disability barriers since birth, it was clear to our OT that these motivators that would prove key to Claire’s progress in managing her negative behaviours.
Our neuro OT also guided Claire’s family and support team around their expectations of her. They learned more about the benefits of pacing Claire’s activities, setting a routine, consistency, and ensuring she had a safe and familiar base.
Specialist support
With our OT’s support, Claire was encouraged to engage with her daily routine. This would improve her independence, mood, behaviour, and quality of life.
It was also implemented for Claire to use a weekly planner board and a clock with a date display. Sensors were fitted to operate Claire’s toilet and body dryer – these replaced verbal prompts that may have caused issues.
Our neurological occupational therapist also introduced activities that were carried out indoors to suit Claire’s comfort zone, but gradually she started doing outdoor activities in her garden again.
Did we support Claire in managing her behaviour?
Claire successfully engaged in her neurological occupational therapy. It created opportunities for her to show others how independent and able she was.
It also helped her to feel empowered, meaning there were less triggers that would cause an outburst.
With support, Claire now accesses her community for activities such as shopping and theatre trips.
She also upkeeps her personal hygiene, and her aggressive outbursts stopped, along with a reduced frequency in other negative behaviours.
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