According to the ACRM (American Congress of Rehabilitation Medicine) SIG for Brain injury, task specific treatment in memory is the practice standard for more severe memory impairments.
The brain injury SIG also notes that the practice standard recommendation for severe memory stroke and TBI is external compensations.
Practice option for these patients should be the use of errorless learning for learning specific skills.
What does task specific mean to you?
For me, this is when the setting your patient is in and their personal goals and lifestyle are vital. I have had the pleasure of working in all settings …sarcasm… but each has come with its lessons and caseload.
Here are some ideas and examples using the following patient profile assuming that his deficits were moderate -severe at all levels of care:
A 63 year old male had a brain anyerusm rupture resulting in a brain bleed (subarachnoid hemorrhagic stroke) and emergent intubation. Patient had a prolonged hospital stay and was seen by SLP for memory. Patient is a father of 2 and worked as an independent carpenter. He made custom kitchens and tables; wood working was his specialty. He was recently made a grandfather of a baby girl named Mia. He resides with his wife and son and likes to cook and read about history in his free time.
- Inpatient Acute: Keep it simple since this is a new environment. Education to family is vital. Write down wife’s phone number on phone and stick to back of phone if unable to find number. Use plexy frame or use marker board in room to write most important item to recall such as orientation and name of grandaughter. Use errorless learning techniques.
- Inpatient Rehabilitation: Build on acute care learning. Establish routine with simplified daily schedule and demonstrate often. Patient wants to ask wife to bring foods he’s craving but forgets to let her know. Establish routine phoning wife and making requests or writing down in memory book daily requests for food. Making simple recipes in therapy using visual steps.
- Outpatient: Educating family and patient on visual aids at home. Bring Calendar/agenda to schedule main dates and decide on what to cook each week for “family dinners”.
- SNF: Visual aid for history channel. Building simple structures using visual steps.
- Home Health: Calendar for important dates visual placed in an location that is referenced often. Errorless learning recalling granddaughter’s birthday. Visual steps on how to make coffee with items within reach and in sequential order initially to avoid errors.
Hope this information helps spark your thinking on task specific tasks. It’s hard when a patient is so severe but if you always include the patient in your focus plus research you will have a more motivated patient with the likely hood of best outcomes.
Little bit of take way…how do you make your morning beverage and what does it mean to you?
