Occupational Therapist – Jacana ABI Centre
Chantelle Bowles is an Occupational Therapist at Jacana Acquired Brain Injury Service. She has worked closely with her multidisciplinary colleagues, to develop a team based approach to sensory rehabilitation.
STARTT – Sensory Training for Arousal Recovery by a Transdisciplinary Team
With advances in medicine, more young adults with severe brain injury are surviving and requiring rehabilitation. Due to the complex interaction of deficits following severe ABI, it is difficult for a single allied health professional to successfully address any aspect of functional performance without collaboration from other members of the multidisciplinary team. Currently, there are no published guidelines for clinicians to draw upon in their practice with this population. Adults with very severe ABI currently have prolonged hospital admissions, receive limited intervention, and have high care and support needs on discharge.Sensory Training for Arousal Recovery by a Transdisciplinary Team – (STARTT) is a rehabilitation program for people with severe brain injury. It was developed to provide a consistent framework based on current research. The Jacana multidisciplinary team completed a literature review in each sensory modality – visual, auditory, gustatory, olfactory, somatosensory, multisensory enrichment, family involvement and sensory intervention by nurses on the ward. The STARTT program takes the best practice principals from each area and brings them together to form a comprehensive intervention. STARTT develops individualised programs based around recorded familiar auditory stimulation. A family member retells a shared memory and the team adds referenced music, visual, somatosensory, olfactory and gustatory stimulation appropriate to the client’s needs. The program is prescribed by a multidisciplinary team, including Occupational Therapist, Speech Pathologist, Physiotherapist, Music Therapist, and Psychologist, as each participant will require varying degrees of stimulus within each sensory domain. This creates a personally relevant, enriched sensory experience which is then delivered intensively by team members and, where appropriate, by trained family members. STARTT streamlines intervention processes and increases staff capacity to deliver therapy by integrating goals. To date, two patients have participated in the pilot program and will be presented as case studies illustrating STARTT and showing initial results. Both started the program at a minimally conscious state and have since emerged. Outcome measures include arousal, functional recovery, and goal attainment (GAS). Sustainability of the program in the workplace is being currently measured, with measures including staff surveys and family surveys. Funding has been recently sourced to ensure the program is sustainable as part of standard care and for gathering of sufficient clinical data to inform a single case study design research project for publication.