Brain injury rehabilitation in the context of COVID-19

How the COVID-19 climate can affect clients with brain injuries

COVID-19 will result in significant changes to life including reduced activity, changes in structure, reduced social contact and reduced independence. Activity/occupation, routine, social contact and independence are often protective factors for our clients’ emotional well-being as well as providing vital scaffolding for their brain injury related difficulties (e.g. executive functioning deficits). The removal of these, place our clients at risk of low mood, increased frustration/irritation and increased difficulties engaging with their adaptive daily living skills.

It can also be a worrying time for our clients as they may excessively worry about becoming ill. A tendency to ruminate will be exacerbated when they no longer have access to activities which provide them with a sense of mastery and pleasure and they may also have difficulty initiating activities to keep themselves occupied.  In other cases, they may not understand the severity of the virus and may not be willing to comply with the social restrictions.

Examples of neuropsychological recommendations

It may be prudent that clients’ emotional well-being continues to be regularly monitored and that additional factors are put in place to prevent any further negative consequences as a result of COVID-19. This may include the following:

  • Clients may need to be reviewed by their existing therapists (Occupational Therapy (OT), Speech and Language) as they may be more likely to require an increased amount of therapeutic contact/input. Support workers may also benefit from an increased amount of guidance from therapists in order to effectively support them during this time.
  • It may be important for clients to be provided with an opportunity to share and discuss worries and frustrations regarding COVID-19 and for them to implement strategies to minimise any negative impact (e.g. encouraged to limit amount of news they watch/listen to). Psychologists can provide interventions for this such as FACE COVID (https://www.baps.org.uk/content/uploads/2020/03/FACE-COVID-by-Russ-Harris-pdf-pdf.pdf).
  • If they do not understand COVID-19 and do not engage with restrictions, this can be addressed by their psychologist within a health belief model which promotes understanding and behavioural change.
  • An increase in contact with family and friends could actively be promoted and facilitated by support workers, for example, (virtual) face-to-face contact where possible.
  • It may be important to increase timetabling and structured planned activity. This could include a visual list of possible activities for them to select from.
  • They may require increased support worker input. If face-to-face input is not possible (e.g. due to illness), this can be provided with a telephone call or preferably virtual input if they are able to access this without assistance.
  • Previous activities that they are no longer able to attend can be replicated where possible in the home environment (e.g. the implementation of a DIY project or tactile hobby, facilitated by support workers).
  • They can be supported to structure one small positive activity or ‘treat’ (positive activity planning) in to every day. For example, this could be: a call with a loved one, a coffee in the garden listening to the birds or a food treat such as a slice of their favourite cake (food treats limited to once per week).
  • They can be encouraged and supported to set and complete small weekly SMART goals. For example, something practical that they ‘need’ to do (e.g. hoovering once per week) and something they ‘want’ to do (e.g. gardening).
  • Exercise slots (indoors and outdoors) can also be included on the timetable.
  • They can be encouraged to celebrate achievements.