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Seasonal considerations in cognitive rehabilitation

Natalie Mackenzie at BIS Services discusses strategies of support at Christmas time for people with brain injury

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Natalie Mackenzie, director of BIS Services, discusses the challenges that often face brain injury survivors during the Christmas season, and what strategies and measures can be put in place to support them

 

Christmas. The holiday season is often seen as a joyful and festive time, filled with cherished traditions, family gatherings, and celebrations. A time of year for key skills of executive functioning to shine. 

Pre planning, budgeting, organisation, time management and thoughts for others are all necessary, but I often wonder if we, as rehabilitation therapists, look at the challenges of this for our clients, and are prepared for it. 

Certainly, if we look at our own lives outside of work settings, I’m sure that we all begin planning far sooner than is needed; although I hold my hands up, I am a last minuter, Arnold Schwarzenegger “Jingle All The Way” type Christmasser! Not the best executive functioning skills! 

Consideration for the skills needed at this time of year, should be factored into any rehabilitation program, with a personalised approach. There may be many clients who are part of a large family who take control, or a parent of young children, with magical memories to create, but many are living alone.

Successfully managing daily responsibilities while navigating the demands of rehabilitation requires a confident and knowledgeable approach from those of us supporting these clients. Here we explore the cognitive and task prioritisation challenges faced during the holiday season in cognitive rehabilitation and provide strategies to help overcome them.

Individuals with brain injuries often struggle with organisation and planning, which can be exacerbated during the Christmas season. The tasks of decorating the house, buying gifts, and preparing meals can become overwhelming. Simple activities like creating a shopping list or managing a schedule may pose significant challenges.

Strategies to implement:

  • Break down tasks into smaller, manageable steps. Planning and chunking appropriately.  
  • Utilise visual aids and reminders, that are already familiar. Now is not the time for new trials.
  • Ensure that you are involving family members for task delegation, with advanced planning. Clients may have the creativity and motivation to bring “Elf on the Shelf’ to life but may struggle with the overwhelming task of creating a present list.

The holiday season is known for its sensory stimulation, with bright lights, loud music, crowded shops and busy social events. 

These sensory overload experiences can be overwhelming for individuals with brain injuries, leading to increased stress and anxiety. I often see clients retreat quickly from these places, or turn down invitations to parties, leading to worries of social exclusion or anxiety.

Some key considerations:

  • Create a quiet and calming space at home where they can retreat when feeling overwhelmed. Utilise support at home to ensure a visually calming environment.
  • Plan outings during less crowded times or opt for online shopping. Ideally, present buying could be done a couple of months in advance, without the madness of Christmas crowds.
  • This is an excellent exercise around financial budgeting skills, buying gifts overtime can allow for better cashflow management, rather than a poorly planned spree!
  • Encourage the use noise-cancelling headphones or earplugs in noisy environments.
  • Create a ‘crib’ sheet for parties, and practice role play for exit plans to ensure confidence to be able to retreat to quieter spaces or leave early. 

Engaging in social interactions and maintaining effective communication can be difficult for individuals with brain injuries. The expectations of socialising and engaging in conversations during holiday gatherings may induce anxiety and frustration.

There are other opportunities to engage without entirely avoiding:

  • Encourage open communication with loved ones about their challenges and limitations, education and awareness is key. It’s not about not caring about others, or lacking empathy and being a ‘kill joy’.
  • Suggest alternative ways to connect, such as writing cards, or emails or participating in smaller, quieter gatherings. Often being with people that understand the difficulties is preferable, but some clients may actively avoid these, wanting to go to the more social events. These will need more preparation.
  • Provide support by offering to be a designated conversation partner or advocating for their needs in social settings, utilise rehab assistants or support workers in social events to monitor and provide cognitive prompts when needed.

The Christmas season can evoke a range of emotions, including joy, nostalgia, and stress. It may, for some, be actively avoided if there have been relationship breakdowns post injury. 

For individuals with brain injuries, managing these emotions can be particularly challenging. The pressure to participate in activities, meet expectations, and create meaningful experiences can lead to heightened anxiety and feelings of isolation.

Things to consider in the lead up:

  • Practice self-care and encourage self-compassion, clients will have very different versions of self-care and recharge methods. Again, these should be practiced and repeated in advance, so they are habilitated and familiar.
  • Engage in activities that bring joy and reduce stress, such as listening to calming music, engaging in creative outlets, or practicing relaxation techniques.
  • If a client is seeking to avoid festivities entirely, listen. Our feelings of how others ‘should’ spend Christmas is not valid here.
  • Seek professional support from support groups specialised in brain injury, many of them will be planning events for groups, with peer support and a safe environment. These events alone can replace the actual big day for many. Headway groups, local charities for single celebrators and charities such as Brains Matter and Same You can provide much needed support at this time of year.

Fatigue management must be a key consideration at this time, unarguably the most social and busy time of the year. Clients will need to plan and prioritise activities, allowing for breaks in between to rest and recharge. 

Breaking larger tasks into smaller, manageable segments to avoid overwhelming fatigue, and forward planning social events is key. Consider limiting the numbers of social engagements, focusing perhaps on those with minimal travel time, or with lower numbers of people.

While the challenges of the Christmas season can be daunting for individuals with brain injuries and executive function problems, it is important to remember that they can still find joy and meaning during this time. 

By understanding their unique struggles and implementing strategies to support their needs, we can help them navigate the holiday season with greater ease and promote their overall wellbeing.

Remember, each individual’s experience may differ, so tailoring support and strategies to their specific needs is crucial.

HIWIN

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