Gordon Muir Giles

Occupational Therapy in the Treatment of the Patient with Chronic Pain

This paper discusses the role of the occupational therapist in the treatment of chronic pain. It begins with a critical evaluation of our current theoretical understanding of pain, concentrating on the link between physical and psychological factors. A unit for the treatment of patients with chronic pain is described and assessment and practical treatment approaches are outlined. Emphasis is placed on a functional approach which maximizes the individuals control over his own pain.

The behavioural treatment of verbal interaction skills following severe head injury: a single case study

This study reports the improvement of verbal interaction skills in a 27-year-old severely head-injured male who presented with an inappropriate attention-seeking circumlocutory conversational style. The patient was baselined on verbal response to three differing question forms, and then treated using combined cognitive behavioural methods on a daily sessional basis. Treatment resulted in a significant clinical change out of sessions, whilst the overall in-session improvement proved significant at the 0.05 level. Follow-up at 2 months indicated that the trend of improvement had continued beyond the treatment period.

Training functional skills following herpes simplex encephalitis: A single case study

This paper presents a treatment program for the development of personal hygiene behavior in a patient who was 5 years post herpes simplex encephalitis. The patient has severe memory and organizational problems, but is of average overall intelligence. The program consists in part of chaining a series of nine discrete activities by using linking phrases. The program allowed the patient to structure his behavior and wash in a well-organized nonrepetitive way. Results are discussed in the light of previous failures to affect behavior using apparently similar methods.

Occupational Therapy in the Treatment of Anorexia Nervosa: A Contractual-Coping Approach

In this article the authors claim that there is no single adequate treatment for anorexia nervosa. They examine some treatment strategies and suggest a contractual-coping model which emphasizes the essential input of the occupational therapist. Finally, they make some recommendations for the assessment and practical treatment of the anorexic patient.

Self-Instruction in the Training of Functional Skills: A Single Case Study

This article presents a treatment programme for the development of personal hygiene behaviour in a patient who had herpes simplex encephalitis 5 years earlier. The patient has severe memory and organisational problems, but is of average overall intelligence. The programme consists, in part, of chaining a series of nine discrete activities by using linking phrases. The programme allowed the patient to structure his behaviour and wash in a well organised non-repetitive way. The results are discussed in the light of previous failures to affect behaviour using apparently similar methods.

Behaviour Modification with Disturbed Adolescents: The Role of the Occupational Therapist

This paper reports on the work of the occupational therapist in a token economy system. The unit described specializes in the treatment of behaviourally disordered adolescents who have a mild to moderate degree of mental impairment and who have presented intractable management problems elsewhere. The paper outlines the criteria for patient referral and describes the ward setting and the token economy system. Occupational therapy is examined under the headings of assessment, functional and educational skills, work and recreation, and specific treatment options are outlined. Occupational therapy is also discussed in relation to other treatments and disciplines, and particular attention is paid to the problems of resettlement.

Management of the brain-injured patient in the acute stage of recovery

This chapter provides an overview of the aims of treatment in the acute care setting, thus emphasizing the role of the therapist at the early stages of the patient’s recovery. Models of recovery are discussed in Chapter two. The involvement of therapists in the acute medical setting depends on local practice, especially their ‘role’ in the intensive care unit (ICU). Therapists have an important role to play in the very early stages of recovery of function and their work assumes major importance in patients whose coma duration is protracted.

Physical changes following brain injury

The type of damage to the neurophysiological and/or musculo-skeletal systems influence the most appropriate type of rehabilitation, and the patient’s potential for recovery. This chapter briefly describes the sensory and motor systems, and provides an overview of the effects of damage to them.

Psychological consequences of brain injury

The most complex human functions — which are the most difficult to quantify — are also the most vulnerable to trauma. As the severity of injury increases, so does the likelihood that basic functional activities will also be disrupted. In addition, psychological disorders hamper the individual’s ability to develop methods to compensate for functional, vocational and interpersonal skills deficits. Central to the individual’s problems is the inability to adapt to novel circumstances. The brain-injured individual may be unable to determine what is interfering with his functioning and as a result be unable to change his behaviour to improve performance. This chapter describes some of the psychological deficits which may affect individuals after brain injury. An attempt is made to relate the more abstract description of deficits to the patient’s actual difficulties in functional activities. This chapter discusses the psychological sequelae of brain injury under the headings of arousal and attention, perception, memory and information processing, language and problem solving. Although these functions are described separately, it should be remembered that the human brain is an integrated unit and division by cognitive function is only on a conceptual level (Stuss and Benson, 1987).

Social skills retraining following severe brain injury

The cognitive, behavioural and physical deficits which frequently follow brain injury are likely to interfere with the development and maintenance of social relationships (see Chapters 4, 10 and 11). More severe deficits may affect multiple domains and be evident in all social interactions, whereas less severe deficits may only become apparent in complex social situations.