Ronny Part 2: How OT helped to reform a principled family man after a motorbike crash

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Ronny’s anxiety over his performance was making him defensive to accepting help or direction six years after his brain injury.

He would use his “unconventional lifestyle” as a barrier to avoid engagement with occupational therapy.

And he presented with very few, positive coping strategies, preferring to either avoid or put off completing activities.

His behaviour suggested that he did not value daily activities, although this contradicted his strong belief in self-reliance.

And there were signs that he did not value himself either.

Ronny lacked engagement in routine, sometimes spending long episodes in bed which would significantly disrupt his weekly plans.

On occasion, he would be confrontational; using an overtly masculine communication style with others.

He was angered by the medico legal process that was still whirling around him six years after the accident.

He felt disconnected from it; disempowered, and he would often state: “It is all out of my control.”

Part of the case was to assess compensation for Ronny’s injuries, but he was not motivated by this aspect.

He felt that while any money he received would compensate him for the injuries, the proposed settlement was “greedy”.

His mother, he said, would have “turned in her grave” if she had known the proposed amount.

Values and beliefs…

So what were the core values and belief systems that Ronny held so dear? What was important and meaningful to him?

Gathering this information would enable our Neuro OT to make her intervention relevant in Ronny’s world.

She discovered that her new client had a positive childhood. He was raised by his mother and grandparents and told her that, growing up, they had little money.

He explained that his family had strong views about money, life and the way someone should behave.

Examples included: speaking your mind; treating people with respect; and not making assumptions about others based on appearance.

Ronny stated that his family’s views made an impression on him as a young boy and influenced his adult life.

So, family was clearly important to him. He felt they gave him a strong foundation for life; encouraging him to develop self-reliance, a strong independent streak and a non-conformist attitude.

Ronny stated that he felt the influence of these values from a young age and that they continued to guide him as an adult.

Into adulthood, Ronny had his own family and was married for several years. After separating form his wife, they remained close friends and Ronny continued to value this relationship along with those he enjoyed with his two adult daughters.

The environment…

We all live and work within a variety of environments that can significantly impact on our performance and participation in activities:

the physical environment, or the space and objects around us, and
the social environment, or the people who may influence us.

Ronny perceived the attitudes towards him from the wider community to be negative.

When out in his small rural community, for example, he believed others viewed as him being a “druggy”, an alcoholic or “a problematic individual” due to his physical disabilities.

Life for him had shrunk. He was unable to work as he did before and, therefore, lacked the social networking opportunities that work used to offer him.

He attended his biker meetings but could not ride as much as he would have liked due to physical limitations and fatigue.

His cognitive and sensory limitations made it difficult for him to express himself in busy environments.

And, in turn, busy or noisy environments often limited his functional ability, leaving him feeling “out of control” and “anxious”.

Ronny’s home environment was also unsettling for him. He rented two properties, neither of which were suitable due to their size and location.

He presented as disengaged from activities and required significant encouragement to participate.

Occasionally, there were aggressive and angry outbursts directed at family members, therapy teams and support staff.

He would utilise avoidance behaviour as a coping mechanism or jokes to divert attention when he felt exposed.

Ronny’s choices and actions were reinforcing his motivation, or lack of it, for activities which, as a result, was influencing his thoughts and feelings.

Ronny’s personal convictions, his strong sense of obligation and his belief in ‘the right way’ to act were being challenged daily by the medico-legal process.

And his perception of how the community viewed was exacerbating his inability to complete tasks at which he was once proficient.

All these factors combined significantly impacted on Ronny’s behaviour and his performance and participation in the activities of daily living.

Ronny Part 3 is here: In the final part of our series on bike crash casualty, Ronny, our Neuro OT comes up with five ways to help him transform his life…