Treating yourself with compassion. Self care part 2
Goals, compassion, and self-care activities within Neurological Occupational Therapy
Part one is available here.
Individuals living with brain injury and complex needs, can sometimes, post-injury be easily overwhelmed by the consequences of their illness or injury. This can lead to feelings of hopelessness, lack of energy and resolve.
There is some evidence to support the benefit of doing minor repetitive tasks as part of a rehabilitation programme. These activities require less effort, are not necessarily cognitively demanding, and can help to soothe and calm the mind and promote a feeling of self-efficacy and wellbeing.
Keep in mind some ‘easy wins’!
Easy to achieve or enjoyable value-based tasks, should be considered and introduced as part of a neurological occupational therapist’s rehabilitation programme. When working with a client with brain injury, a neuro OT should set goals that are achievable and measurable.
It is essential, however, that a balance is struck between challenging goals and those that are, viewed by the individual, as mildly challenging, (possibly) repetitive, and attainable. These ‘easy wins’ act to provide daily positive reinforcement for independence and will, if achieved, promote feelings of self-efficacy.
Recognising and acknowledging the value of completing the small steps or tasks that are considered routine, is often the biggest barrier, not only for the individual but also for the neurological occupational therapist. The small goals, or ‘easy wins’, often reflecting activities relevant to self-care, can sometimes be overlooked by OTs who do, quite rightly, have high aspirations for their clients and therefore ‘set the bar’ high.
Neuro OT and practical strategies for supporting self-care activities
Keeping a diary is one strategy that might help an individual to write about their feelings and emotions. Considering anxiety for example and reflecting on what triggers their anxiety and what helps to reduce anxiety levels. This can be something kept private or shared with the OT to help work towards reducing anxiety as a core goal.
Other practical strategies include:
- Use a planner or a calendar to intentionally schedule “me time.”
- Listen to music
- Playdo / plasticine
- List a few good things in your life - this can help focus your emotions on the positive things
- Prepare a meal, no matter how simple.
- Listen to a podcast about something that interests you that you haven’t yet explored.
- Send a postcard to someone far away. Decorate it before sending it.
- Learn a new board game
- Have a haircut
- Have a massage
- Listen to a chapter or two from an audiobook
- Enjoy nature sounds
The possibilities are endless
Given the wide range of activities available to promote self-care, the infinite number of options and possibilities, including the broad range of individual motivators and experiences that impact the choice, it is impossible to list every activity here. However, the list below offers a starting point for discussion where, together with a neuro OT, activities can be explored and considered.
Arts, crafts and creative activities
Arts and crafts are hugely satisfying. Many older people will have spent their leisure time enjoying a range of hobbies (before people had televisions and computers). Creative activities provide an opportunity for individuals to relax and disconnect, or to explore their emotions through different art mediums or simply to reconnect with a previously enjoyed activity.
A neuro OT can help with modifying activities and environments to make them accessible for people with a wide variety of needs including physical limitations.
Drama can encourage people to express themselves creatively, to interact with others to refine social communication skills. It can also be a form of movement and physical exercise.
For some drama involves learning lines, a task that challenges cognitive skills, but that will offer a significant feeling of achievement at the end of each performance.
Wearing costumes could offer a chance to escape and redefine ourselves for a moment each week. Sessions should be properly planned. People might feel self-conscious about joining in these activities at first, so start with simple exercises and activities to build up their confidence.
We know that as little as 30 minutes exercise in the mornings can increase the blood flow to your brain increasing concentration, mood, and mental well-being.
The National Institute for Health and Care Excellence (NICE) and the Chief Medical Officers for the UK recommend 30 minutes of physical activity a day on five or more days a week. The 30 minutes can be broken down into 10-minute bursts.
Our neuro OTs have facilitated engagement in local sports groups providing enjoyment and social connections. For the home we have recommended pop up badminton nets, football goals with targets, basketball nets, boxing bags, ‘clip-on’ table tennis and even less physically active sports like darts and pool to name but a few.
For some individuals, the activity of sport has provided the opportunity to engage more closely with their family, especially young children.
Food and drink
Whilst our ability to feed our self and prepare a meal is something, we all take for granted, often following brain injury a neuro OT will need to support an individual to re-learn these essential skills.
The achievement of preparing a meal for ourselves and or for others could ultimately be considered one of the tangible expressions of self-care and should not be underestimated. Chris talks openly about the importance of food as part of his daily routine and why it matters to him here.
Cookery activities can range from no-cook recipes to baking or cooking meals. It is also not essential to be confined to the kitchen, our neuro OTs have looked at utilising all environmental opportunities including the chance to learn new skills such as cooking on a BBQ.
You don’t need a sunny day and a big garden or greenhouse. You can carry out many gardening projects indoors or in a window box.
For some clients with brain injury, our team has explored the value of gardening as a meaningful activity. We have engaged brain injured survivors in small scale growing of herbs on the windowsill with a mini greenhouse and tending to succulents in a glass terrarium.
Larger projects such as planting in the garden or pots have also been highly therapeutic. For one brain-injured survivor who likes construction, we have organised for a portable greenhouse to be delivered. He has built it with the help of his support worker, identified the equipment he needs during his neuro OT sessions and now has the responsibility of the daily check and watering of seeds. The bonus is that come harvest time he will have the opportunity to prepare and cook his produce.
Many people enjoy music and it plays a significant role in social and cultural events. It can be calming and restful or stimulating and stirring.
Making space and time for self-care
Self-care activities provide an opportunity, if we are open to it, for us to reconnect with ourselves. Putting theory into practice, however, is not easy and is often considerably harder following brain injury.
Octavia Hill was an influential social reformer in the 1800s and a co-founder of the National Trust. She believed that the environment could have a positive or negative impact on an individual, ultimately impacting on their wellbeing, self-management, and potential. Her theories were adopted in the early evolutions of the occupational therapy profession.
She is quoted as saying ‘our lives are overcrowded, overexcited and overstrained. We all want quiet. We all want beauty...we all need space. Unless we have it, we cannot reach that sense of quiet in which whispers of better things come to us gently.’
Within the context of brain injury, I believe it is the responsibility of the neuro OT to help individuals, and their family, to connect with what brings them joy and help to find a sense of quiet in the chaos. To be ‘their own best friend’ and to make time for activities that reaffirm feelings of wellbeing.
A neurological occupational therapist should facilitate or structure an environment so an individual can listen for the ‘whispers of better things to come’, which is, in itself, the ultimate expression of self-care.
Within the context of human function our thoughts, feelings and doing of activities is fed by our internal reflections and experience which in turn influences our occupational choices. The value of reflections:
What the experts say - stress and anxiety advice for brain injury survivors during the Covid-19 pandemic. Turn off the news, engage with nature, practice mindfulness, stick to a routine and suss your stressors ...
More resources to help brain injury survivors and their families during Covid-19 here: Krysalis public resources