In the inpatient rehab setting, group therapy activities can be one of the most engaging and meaningful ways to provide treatment to move toward someone’s individualized goals. However, this mode of therapy is often an intimidating thing to approach for many therapists. In the hustle and bustle of the day, we are all trying to efficiently and effectively get to our individual treatments… and our perception is often that there is not enough time and not enough room to fit a whole group of patients into an already busy schedule. But… with a little bit of creativity and scheduling gymnastics, group therapy activities can bring a lot of fun and enjoyment to a sometimes painful and emotionally exhausting situation!
How will group therapy activities help… really?
Maintaining participation despite increasing disability:
Group therapy activities can provide an outlet for your patients to be involved and enjoy daily life despite the barriers and limitations that they are currently working through. Being in the hospital and going through rehab can be a very isolating situation, despite having many people all around caring for you. No matter what your patient’s current level of ability may be, participating in a group can bring meaning to the day through opportunities to use the skills that are present and build on skills that are falling short. Group therapy activities also allow for a more enriched environment for people with cognitive challenges to learn and practice skills. Therapists at times feel that having cognitive impairment would lead to a patient being inappropriate for group participation, however having cognitive impairment is a great reason to include someone in a group!
Receive feedback and strategies from group members and leaders:
When in the setting of a functional group activity, your patients will be able to learn from the experiences of others and apply strategies that other people use to their own unique challenges. Whatever the individual impairment each of them has or whatever their individual goals are, they will be able to help each other move forward through the feedback that they give and the feedback that they are able to get from the other participants.
Group problem solving helps to normalize the use of compensatory strategies:
Depending on what the focus of the group is, this mode of therapy also allows people from different levels of ability and people with different impairment to come together and problem solve through barriers they are facing. Your patients may need to use compensatory strategies in order to facilitate independence… and seeing other people using similar strategies and work through the same struggles, can be a powerful way to normalize a different way of doing things!
Peer support and socialization:
Being around people who are going through similar situations can be a powerful support! Group therapy activities allows the patients to be in a setting where they can socialize with other people going through the same or similar experiences, sympathize with each other, share their own story, encourage each other, and simply interact with people who aren’t caring for them.
Provides training opportunities through various modes of learning:
As most of us know, we all don’t learn in the exact same way. Some people are visual learners, some are auditory, and some are kinesthetic learners. Sometimes a combination of learning modes is what someone needs. Group therapy activities provides each type of learner with what is most meaningful to them. The visual learner will be able to see the facilitator demonstrate and will be able to watch the other participants complete the skill. The auditory learner will have opportunity to listen to the instructions for task completion as well as the open conversation that happens when problem solving occurs. And the kinesthetic learner will be able to have hands-on practice.
Improves patient engagement in the overall rehab process:
Patients always know when group therapy is scheduled! They often find these sessions very meaningful and fun! This helps to improve their engagement in the rest of their rehab process as well. They become more in tune with the rest of their schedule, with planning discharge, and they start to help to identify barriers they should be working on in order to get home safely.
And when it comes down to it… group therapy will certainly help improve your patients’ outcomes! They will improve in the functional tasks that you have incorporated into the groups, and they will be less likely to have falls and re-hospitalization because you’ve addressed the individual challenges they will have once discharged.
What should the group focus on???
When coming up with a group focus, it is important to remember that you want the group to have as much meaning to the patients as possible. This will allow them to be more engaged in the group itself and engaged in the process of the group helping them get closer to their individualized goals. So, ideally a group should be either ‘barrier-centered’ or ‘outcomes-centered’.
As we work with our patient to plan their discharge, we are constantly identifying barriers that they may encounter along the way. Common barriers we encounter are patients that live alone and do not have adequate support, patients who are ‘partial weight bearing’ and have a full flight of steps to enter their home, or other safety or cognitive impairment that would limit the patient’s ability to perform tasks independently.
Most of the functional activities in rehab that are tracked from admission to discharge can be turned into an engaging group! Groups that focus on outcomes could include upper body and lower body dressing, walking, stairs, walking on uneven surfaces, car transfers, etc. These are all activities that you will be training your patients in anyway in order to track your outcomes and this would be a great opportunity to get a group of patients together in order to work through their individual impairments to move them closer to meeting their individualized goals for that particular outcome.
Let’s explore a few examples of barrier-centered groups as well as outcome-centered groups! This is not a complete list… but will hopefully get your creative juices flowing!
Kitchen safety group –
If your patient lives alone or has limited support, they will likely need to access the kitchen and be able to identify how to safely operate appliances and safely maneuver around the space itself. A kitchen safety group is a very engaging and meaningful way to achieve improvement in patient’s safety awareness around kitchen tasks. A way that you can accomplish this is by setting up a kitchen space with several different unsafe scenarios – examples could be electrical cords lying in the sink, paper or cloth on the burners of the stove, metal in the microwave, the oven door being left wide open, water on the floor. Then you ask your group to go through and identify some of the safety hazards and give suggestions for solutions in order to maintain safety. This gives the opportunity for the group to have open discussion and build off of the feedback that each one gives to the situation.
The second stage in running this group, after all of the hazards have been identified and corrected… Would be to walk the participants through scenarios that they may encounter on a daily basis. These could include carrying items around the kitchen or out of the kitchen, reaching for items out of the refrigerator or a cabinet, getting items ready to prepare a meal, etc. Introduce different strategies to optimally set up the countertops or cabinets so that reaching frequently used items would be easier and therefore safer for the patients to access. You could also introduce different pieces of equipment that would be useful in kitchen mobility scenarios – such as walker baskets, bags, or trays. You would demonstrate how you would carry or transport various items throughout the kitchen in a safe manner while still being able to hold on to the walker with both hands.
This kind of group and these scenarios in it can be easily translated into other rooms in the house – you can take the same template and create a bathroom safety group or a general home mobility group.
Medication Management –
Another example of a barrier-centered group activity could be medication management. If someone lives alone or their caregivers would not be able to manage this on a consistent basis, this may come up as a barrier for them to be safely discharged home. Doing these sorts of activities in a group setting could help the patients learn different strategies from each other that have worked for each individual, and also facilitate a setting where they could problem solve various errors that are made during the group. Each participant could have a weekly pill organizer and the group facilitator would go through step-by-step instructions on different things that the patient would have to do in order to successfully organize their medication for the week. As they go through, the patients can have a discussion on strategies that they use and help each other to work through difficulties that they may have.
After everyone organizes their pills… You could then ask questions like, “What are some other ways that you could make sure your medications are taken each day at the right time?”, “If you accidentally spill your pill bottles or your pill organizer… Do you have a strategy in place that would help you identify what pill is what medication?” Then you could talk about different ways that they could better identify what exactly all of their medications are and what the pills look like, so there are no medication errors if the pills get mixed up or dropped. Patients often have systems in place that work for them and through sharing these experiences in a group setting they could help somebody else overcome this type of barrier in order to discharge home safely.
Elevations Group –
When we talk about outcomes centered groups… As mentioned previously this could encompass anything from dressing, transfers, walking, stairs and elevations. One engaging and functional example would be running a group with a focus on the stairs, curb, and ramp. The group facilitator can demonstrate all the various ways that the patient may need to climb the stairs or manage uneven surfaces. So depending on each individual’s needs and circumstances, the facilitator will demonstrate step-to and reciprocal stepping patterns, using two railings, using one railing, coming down the stairs backwards, folding a walker and carrying it up and down the stairs, and even hopping up and down the steps if the patient has weight-bearing restrictions.
Demonstrating all of these variations could help the patients to understand how to safely maneuver on the stairs if they encounter a set of stairs that might be different from their own. They could also learn from the performance of the other patients as each takes their turn being trained on the stairs. Sometimes errors are made and it can be very meaningful to point them out in real time and talk through how to more safely and effectively complete the activity so that the group can be a part of a problem-solving discussion. And then the same sort of demonstration would happen on the ramp and the curb. The facilitator can demonstrate various ways that the patients may need to handle those elevations.
Lower Body Dressing –
Another functional outcome that would be a meaningful group focus could be the use of adaptive equipment with lower body dressing. There are times when patients are hesitant to use the equipment because they may think that it is not really completing the activity in a normal way. Or they may think that the equipment is too cumbersome, or it takes too long… However, completing this activity in a group setting and demonstrating the use of all the adaptive equipment during the group can be a great way for the patients to feel more comfortable and more competent with the compensatory strategies. So, this would be a matter of demonstration and then having the patients perform the activity with the opportunity to learn different strategies from the facilitator and from the other group participants.
Once you start to think through ways to build groups that are focused on barriers and outcomes, it’s easy to expand on them and come up with more and more ways to create engaging and meaningful group therapy activities! Yoga, although more of an impairment centered group, can be a great way to introduce your patients to how useful group learning can be!
Check out ‘Update Your Care Plan: Balance Rehab’ to find out how to incorporate Yoga into your patients’ home exercise programs as well!
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