A Consecutive Series of Adults With Brain Injury Treated With a Washing and Dressing Retraining Program Gordon Muir Giles, Jonathan Edward Ridley, Ann Dill, Susan Frye Key Words: activities of daily living • brain injuries • rehabilitation Gordon Muir Giles, MA, Dip COT, OTR, is Direcror ofClinicaJ Services, The Neurobehavioral Program at Highview, 1301 East 31 st Street, Oakland, California 94602, and Assistant Professor of Occupational Therapy, Samuel Merritt College, Oakland, California. At the time of this study, he was Clinical Direcror, Transitions of Berkeley, Berkeley, California. Jonathan Edward Ridley, is Polysomnographic Technologist, Stanford Sleep Disorders Center, Stanford, California. At the time of this study, he was Rehabilitation Assistant, The Neurobehavioral Program at Highview, Oakland, California. Ann Dill, MEd, CCC/SLP, is Direcror of Speech-Language Pathology, Guardian Health Group, Inc., Corre Madera, California. At the time of this study, she was Assistant Clinical Director, Transitions of Berkeley, Berkeley, California. Susan Frye, MS, OTR, is Occupational Therapist in Home Care Settings, Therapy Resources, Inc., Sonoma, California. At the time of this study, she was Occupational Therapist, Transitions of Berkeley, Berkeley, California. This artide wets acceptedfOr publication June 1, 1996 Objectives. Single-case reports indicate that behavioral methods can assist persons with brain injury to redevelop se/fcal"e skiLLs. However, the proportion of patients who could benefit from these interventions is unknown. The present study used a specific retraining protocol to treat aLL patients admitted to a single facility over a 3-year period who were unable to wash and dress independently. Method. Four patients out of 48 met the study crite- ria and were treated with the washing and dressing proto- coL. Three had traumatic brain injury, and one had brain injury after cerebral bleed. The training program involved behavioral observation, task analysis, consistent practice, and cue filding. The Adaptive Behavior Scale was used to measure behavior change. Results. Three subjects achieved rapid independence in washing and dressing (20 days, 37 days, and 11 days oftreatment), and one did not show significant clinical improvement. Conclusion. ALL patients admitted to the facility dur- ing a 3-year period who required washing and dressing retraining were treated with the same protocol. The con- secutive series design prevented researchers from selecting patients who they believed were good treatment candi- dates; therefore, the findings support the general applica- bility ofthe training program. I ndependence in activities of daily living (ADL) is a central factor in determining the future placement and quality of life of persons with brain injury. Basic ADL deficits occur in 5% to 15% of persons with severe brain injury Qacobs, 1988; Jennett & Teasdale, 1981). Typically, in acute rehabilitation settings, persons with brain injury are either dressed by nursing staff members or provided with adaptive equipment and intermittent dressing instruction. For many, this type of intervention, in combination with spontaneous recovery, results in functional independence. For a subgtoup of persons with severe brain injury, particularly those with both physical and cognitive disorders, such intervention does not produce self-care independence. One method used to address functional deficits is specific task training (Giles & Clark-Wilson, 1993). A number of single-case studies have described attempts to increase independence in real-world settings (Burke, Wesolowski, & Lane, 1988; Cohen, 1986; Giles & Clark- Wilson, 1988; Giles & Morgan, 1989; Lewis, Nelson, Nelson, & Reusink, 1988). The interventions reponed are often designed to meet the idiosyncratic needs of specific patients, and little is known about their general applica- bility. This article describes a retraining procedure used April 1997, Volume 51, Number 4 256 Downloaded from http://ajot.aota.org on 01/11/2019 Terms of use: http://AOTA.org/terms