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Embracing positive risk taking in neuro-rehab

Natalie Mackenzie, director at BIS Services, discusses the challenges and opportunities of risk-taking



Rehabilitating individuals with acquired brain injuries is a multifaceted and challenging process. These injuries often bring profound physical, cognitive, and emotional changes to individuals’ lives. In rehabilitation, a shift towards embracing positive risk-taking has proven to be a beneficial strategy for optimising the recovery process and enhancing the quality of life for ABI survivors.

Multi-disciplinary teams must endeavour to explore the concept of positive risk-taking, the benefits it offers when working with individuals with acquired brain injuries, and strategies to implement it effectively.

Understanding positive risk-taking

Rippon (2010) found that individuals desire more autonomy and control over their lives and the risks they choose to take. Despite potential risks in pursuing personal priorities and goals, the perceived benefits in terms of quality of life outweighed them.

However, Mitchell et al. (2012) noted that there is widespread uncertainty and insufficient evidence on how professionals can effectively support various groups of service users in positive risk-taking.

According to Morgan and Williamson (2014), the principles guiding our language use include:

• Positive risk-taking focuses on making well-informed decisions rather than relying on chance.
• There is no such thing as a risk-free decision; even seemingly safe options come with their own risks
• Evaluating risks involves weighing the positive benefits against the negative effects of risk avoidance.
• Positive risk-taking is context- specific and represents a clear statement of action and intent, unlike more general terms like “positive risk” and “positive risk management” that can be easily misinterpreted.

Positive risk-taking involves calculated and reasoned decision-making, recognising that risk-free choices do not exist.

It requires a balance between the benefits and consequences of risk, framed within individual contexts.

Positive risk-taking is a therapeutic approach that acknowledges the importance of calculated and well-managed risks as part of the rehabilitation process.

While safety remains a paramount concern, positive risk-taking encourages professionals to explore new strategies, interventions, and activities that may involve some level of risk but offer potential benefits in terms of progress and independence for ABI clients.

The concept of positive risk-taking is rooted in the understanding that taking no risks at all can result in stagnation, limiting the opportunities for growth, recovery, and reintegration into everyday life.

This can impact motivation and engagement in rehabilitation provision, having negative outcomes relating to goal attainment and potentially complex medico-legal process.

By carefully weighing the potential benefits against the possible risks, rehabilitation professionals can guide clients in making informed choices, enabling them to explore their capabilities and regain a sense of control over their lives.

Benefits of positive risk-taking in ABI rehabilitation

Encouraging Independence and Self-Efficacy: Positive risk-taking empowers ABI survivors to take ownership of their recovery journey.

When individuals are encouraged to take calculated risks, they often discover new abilities and regain a sense of control over their lives.

This fosters a sense of self-efficacy, which is crucial for their motivation and well-being.

As we all know, finding the ‘hooks’ to engage our clients with can be limited if we are not thinking outside the box and engaging in the positive risk-taking process.

Facilitating cognitive rehabilitation: Brain injuries frequently result in cognitive deficits, such as memory problems and reduced attention span.

Positive risk-taking can involve challenging cognitive tasks that stimulate the brain and aid in cognitive rehabilitation.

These tasks may help individuals regain lost skills and adapt to their difficulties and ongoing challenges. Seeing progress and goal attainment is crucial to long term engagement in rehabilitation as well as positive mental health.

Enhancing emotional resilience: Positive risk-taking can contribute to emotional resilience.

By encouraging individuals to venture out of their comfort zones and take on new challenges, they learn to cope with anxiety and frustration.

Overcoming these challenges builds emotional strength and can potentially reduce the risk of depression and anxiety. Promoting social reintegration: Acquired brain injuries often lead to social isolation, as individuals withdraw from social activities due to fear and uncertainty.

Positive risk-taking can involve social reintegration strategies, such as joining support groups or participating in community activities.

This fosters connections, reduces feelings of isolation, and improves overall quality of life.

With support and encouragement to place themselves in environments which may, at times, be flagged as ‘risky’ and unwise’ clients can take great strides to forming new social relationships, in an assessed and safe manner.

Clients may have increased vulnerability and the modern world can open the door to a great number of risks for our vulnerable clients, but we must not lose sight that this is often the case for many individuals living without an injury.

Enabling physical rehabilitation: Physical deficits, such as mobility issues, can be addressed through positive risk-taking.

This may involve activities that require increased physical effort and balance, helping individuals regain physical independence and reduce the risk of secondary health issues.

Adapting to new challenges: Positive risk-taking plays a crucial role in enabling ABI survivors to adapt to new challenges and various situations they may encounter in their daily lives.

This preparation becomes even more essential for individuals who are striving to regain their independence.

By embracing calculated risks and exploring unfamiliar territories, ABI survivors gradually gain resilience, confidence, and the necessary skills to navigate the complexities of their rehabilitation journey effectively.

This process involves continuously pushing personal boundaries and embracing growth opportunities that promote both physical and emotional recovery.

Through this proactive approach, survivors can acquire invaluable experiences and strategies that foster their progress towards regaining control over their lives.

Increasing confidence: One of the many benefits of taking calculated risks is the substantial boost it provides to individuals’ self-confidence.

When individuals successfully navigate challenges and achieve positive outcomes, it instils a sense of belief in their abilities and increases their self-assurance.

This newfound confidence has a profound impact on various aspects of their lives, motivating them to explore new opportunities and fostering growth.

Strategies for implementing positive risk-taking

As is standard and best practice in all work we undertake with our clients, we must start by conducting a thorough assessment of the client’s abilities, challenges, and goals, in collaboration with the family where possible.

Understanding their desires and interests, and identify areas where positive risk-taking can be beneficial.

All too often our personal values and reluctance to engage in risk can form a barrier that needn’t be present.

Personal reflection as to the impact on our own norms on client progress should and occur on a regular basis.

Collaboration with the client, family and other important people in their lives, to set achievable and realistic goals should occur from the outset.

These goals should challenge, but not overwhelm. Establish short-term and long- term objectives that are specific, measurable, and relevant to their rehabilitation journey, their sense of self and their longer-term aspirations.

Educate the client about the potential benefits and risks associated with each proposed activity or intervention.

Encourage them to make informed decisions and take an active role in their rehabilitation plan.

Empowering clients to make decisions based on individualised education, whilst sometimes falling into the ‘unwise’ bracket is a positive process for all involved.

Gradually introduce positive risk- taking activities and interventions, starting with low-risk challenges and progressing to more complex ones.

This approach allows individuals to build confidence and competence over time, whilst also allowing the MDT to gain evidence of processes and outcomes, both positive and negative to learn from.

Indeed, those outcomes that may be deemed as ‘failures’ are the ones to learn most from.

Continuously monitor the client’s progress and provide constructive feedback, which can be a huge challenge when working with clients with reduced insight and awareness, and those that may lack capacity.

Think of novel ways to present the feedback in an engaging and joint-working manner. Celebrate their successes and support them when faced with setbacks.

A collaborative approach helps individuals stay motivated and resilient.

Develop interventions that are tailored to the individual’s specific needs and interests.

This personalisation enhances the client’s engagement and motivation, increasing the likelihood of positive outcomes.

This should be standard practice, and it goes without saying any program of rehabilitation should be individualised, but this is not always the case.

Positive risk-taking is: “weighing up the potential benefits and harms of exercising one choice of action over another. Identifying the potential risks involved (i.e. good risk assessment), and developing plans and actions (i.e. good risk management) that reflect the positive potentials and stated priorities of the service user (i.e. a strengths approach). It involves using “available” resources and support to achieve the desired outcomes, and to minimise the potential harmful outcomes” (Morgan, 2013).

In conclusion, embracing positive risk-taking in the rehabilitation of individuals with acquired brain injuries not only promotes recovery but also nurtures hope, resilience, and a sense of purpose in the face of adversity.

By tailoring rehabilitation strategies to the individual’s specific needs, abilities, and interests, remarkable progress and an improved quality of life can be achieved.

Together, with a collaborative effort from the client, their caregivers, and the rehabilitation team, positive risk- taking becomes a dynamic and valuable approach that empowers individuals to regain independence and rebuild their lives.

To find out more, visit thebiss.co.uk.