HT and Neurorehabilitation: Working with people with TBI

By Lynn Larkin in Peterborough, Ontario.

My background is more in horticulture than human services….18 years in the horticulture industry and 4 in human services.  For 2 years now I have been working as a rehabilitation assistant (RA) in the community with people with traumatic brain injury (TBI).  The treatment plans are set up with client by the therapists of the interdisciplinary team.  I assist client and report back to the team.  The horticultural therapy (HT) courses, the experiences shared by Christine Pollard and classmates and courses that I have attended through the Ontario Brain Injury Association (OBIA) have been of great benefit to me.  Aside from learning new knowledge,  these courses always remind me when working with people with disabilities whether cognitive or physical about the need to always be mindful, present, client centred and professional.

In the community setting the RA is the person who spends the most time with the client with regard to the interdisciplinary team.  The RA becomes part of the client’s life and this is why it is so important to maintain professionalism and client-centredness….the friendly professional I suppose.  It is my job to support the client toward meeting their goals whether it be to live independently, re-enter community or return to work/school.  The ‘real life’ context in which I work can be challenging, requires big shoulders and great patience because I have to be able to deal with the behaviours that accompany TBI which usually take form in angry outbursts or inappropriate comments.

  • Brain first approach….If something is going wrong think in terms of the injured brain first.
  • Where is the brain injured?  Dr. Sherrie  Bieman Copeland & Dr. Dawn Good

Judith Falconer PhD writes “Head injured individuals require tight structure in their daily lives to survive, grow and improve. Most of us lead highly structured lives….which allows us to put  our lives on automatic pilot. Far too often, head injured individuals have no structure in their daily lives and therefore accomplish very little each day.  Tight structure increases the capabilities of the injured individual and reduces the need to continually make decisions”.  I work with a client who sustained a TBI to frontal lobe.  He said that time means nothing to him.  He puts things off that he wouldn’t have pre-injury, he is unable to multitask, easily distractable, has trouble paying attention to things, gets frustrated very easily, has a poor memory.  He is not the person he used to be. I see him 3x/wk for 3-4 hours each time. His goal is to live safely and independently and he is working on that by developing  routines around instrumental activities of daily living (IADL) such as cooking, banking/paying bills, grocery shopping.  Roger Wood, Professor of clinical neuropsychology writes that continuum of care needs to be ’slow stream’  because of the persisting cognitive deficits that impose important constraints on learning and rehabilitation.

More excerpts from my notes on Neurobehavioural disability by Roger Wood….

Often people with TBI lose their social role.  Many are not able to live independently in the community, maintain employment, maintain relationships….goal is to prevent disability from becoming a social handicap. He talks about structured rehab, assisting person with TBI to ‘live life’.  Rehabilitation is   long-term, not intensive, interdisciplinary, community based and  psycho-social, goals have to be meaningful to the client. The rehab team helps the person with TBI accept the disability without  losing  identity.

  • A good read…‘Participate to Learn’:  A promising practice for community ABI rehabilitation, Brain Injury, October 2006: 20(11): 1111-1117.  Study done in Ontario
  • Participate to learn vs. Learn to participate
  • Learning is result of experience in real life activities
  • 3 important characteristics…living, loving, doing

I work with an OT who promotes my experience in horticulture to clients who have an interest in gardening and I have had the opportunity to use HT in some treatment plans.  The activities varied from sowing seeds, garden planning, walking through the local ecology garden, making plant labels.  She will also encourage my clients to attend the farmers market with me for the social outing.  I have used HT to simply build rapport with a client who was considered ‘difficult’ by the team.  She became more flexible as she was able to make some decisions about her treatment, gained some confidence by just getting out to the garden and is now willing to work at her original goals.

My long term goal (dream) is to develop a community garden with programs for people living with TBI and  mental illness.  A community garden program would help to meet the physical, cognitive, emotional, social needs of the population I work with. To be able to provide a welcoming/safe environment for them to be socially included and a vocational outlet  for clients to learn skills needed to ‘live life’ by helping them to generalize what they learn to home, work and meaningful activities.  I cannot say when this will happen because there will be so much to do to get this off the ground.  Assignment #4 is in the works!!

Thanks for reading…please email any comments/questions to larkin [at] nexicom [dot] net