Social distancing, stay at home and COVID-19; the hashtags that have dominated our screens for what seems an eternity.
But lockdown is just a couple of weeks old, and this is only the beginning.
Our first thoughts in community cognitive rehabilitation were; how do we see our clients? How do we practice function? What about goal attainment, orientation training, functional transfer and providing evidence? How do we support staff out there in the field?
There was an urgent requirement to shift focus, almost overnight, in order to support one of the most vulnerable groups in society.
This is a group which relies on specialist support to learn new skills and practice and habituate new tasks, suddenly being asked to move to a completely new way of being supported and living.
There are many that still need a presence in their homes due to complex needs and safety requirements.
But there is also a large proportion of individuals with brain injury who fall out of that category but still require support to enable them to maintain independence – and to move forward in their lives.
They cannot be forgotten; their desires to attain their goals have not changed, nor should they.
And it is for these individuals, who thrive on and require structure, routine and repetition, that this interruption is even more disabling. Months, maybe years, of repetition and consolidation has been brought to an abrupt halt. Or have they?
Those of us working in rehabilitation are a resourceful bunch. Our automatic processes always navigate us towards solutions to problems.
We are adept at thinking outside the box to come up with innovative and imaginative methods of engaging and motivating clients.
The COVID-19 challenge is another opportunity for us all to get our creative processes flowing yet again.
And what better time to be doing so when the world is so engrossed in online processing and information gathering, with us all spending more and more time engaging in online activities than we do real life ones?
Now is the time to bring together all the knowledge we have gained from navigating different social media platforms, computerised systems, conference calling options and celebrity ‘how tos’.
The challenge we all face, as we did in our pre-crises existence, is making it relevant and personalised to the needs of our clients, and how we get the clients on board. Literally.
The answer? Whatever it takes. Trial and error. There will be glitches, frozen screens, frustration, probable swearing, a lot of late pyjama wearing sessions and a cacophony of ‘No’s.
But we must persevere, we must be flexible, adjust, adapt and constantly monitor. It is what we always do in rehabilitation.
The most important element is to ensure that individuals living within the uncertainly of life with a brain injury, feel safe, and secure that the teams they have built around them can weather this storm, and have their needs at the forefront of their thinking. That these individuals, often burdened with rigidity of thought and concrete behaviours, know that those supporting them will just make it work for them, however that may be presented.
Wellbeing is top of the list right now. A Skype, Zoom, or Facetime call, albeit not a replacement for face-to-face skill practice has a place, a very important one.
Isolation is not welcome for these individuals, a time when negative thought patterns and behaviours can take over, when rumination becomes the norm and when motivation plummets.
Teams must engage and enable initiation, via even the subtlest methods. Even a text conversation now is a lifeline for many.
Bring groups together, offer peer support, allow individuals to be frustrated, listen to their tirades that they are angry that their favourite food outlet has shut down, or that they can’t workout; this matters.
Individuals will new learn skills and engage in the virtual method of rehabilitation, and it will work, just with some bumps along the way.
But is this not how we always expect rehabilitation to be? Service providers and community staff will learn along the way and will build their own toolboxes further.
When this temporary change becomes the new norm, we can then move to focus on the cognitive elements of every activity that we present during tele-sessions.
Every skill and goal that was identified prior, will continue, just with a different slant. We will recover with a new method of delivering services in the community that will only serve to support people with brain injuries even further.
It will take time, but right now we have a lot of that.
Natalie Mackenzie is director of BIS Services
