DayRehab Outings: Transitioning back to Independence

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The DayRehab model of care is a tiered system that allows a patient to transition back to functioning as independently as possible within their “normal” life. We are excited to be able to offer patients the opportunity to work in quiet, individual settings with a therapist who has customized tasks focused on working toward the patient’s specific goals. However, life isn’t quiet and structured is it? In order to prepare patients for return to their dynamic lifestyles, we incorporate treatment with groups of patients across all types of therapies; working with others toward similar goals. 

Our goal is to get our patients out of the clinic and comfortable in different settings throughout the community during special treatment sessions or outings. During outings, we are able to accompany patients to practice their skills within various, personally-relevant settings. Although our most common outing is to the grocery store to prepare for a cooking session in OT, we like to keep things interesting around here and tend to venture to some interesting places depending on patient preferences! Some of our most popular outing locations are: craft stores, home improvement stores, the pumpkin patch, bowling, mini golfing, and local forest preserves.

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A week before an outing, patients will gather in a speech or OT group to begin the planning process. As a therapy team, we will do some background work to assemble a group of patients who have similar goals or interests, but the rest of the work is up to the patients. No matter which type of outing we are working on, all require a good plan. We will have a series of group sessions to plan the following: 

• Common interests amongst group members 
• Options of places 
• Distance from clinic 
• Therapy goals (i.e. walking endurance, improved memory, etc.) 

Once we have determined our target location, then the fun begins! A big goal that we share across all disciplines is to teach patients how to train themselves; in other words, we want patients to know how to incorporate their new skills, strategies and modifications across all settings. For example, if a patient is working on strengthening their left arm, we want them to be able to think of ways to challenge themselves to use their left arm in their daily lives. We also want patients to know how and when to compensate when something is too heavy or requires movement outside of their current range of motion. Naturally, our next step is to figure out how to make this outing therapeutic.

There are three types of outings that we utilize with patients:

• Functional outings
• Project-based outings
• Work-based

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One of my favorite outing planning groups was a group of lovely patients who all shared the interest of literature and reading. Not surprisingly, they all came up with the idea to venture to a local bookstore with their therapists for an afternoon.

After planning the route, the distance from the clinic, and the amount of time to spend at the store; the patients began to think about “how can we make this therapeutic?” After some discussion, they decided that they wanted to be accompanied by a speech therapist as well as a physical therapist in order to incorporate physical activity in conjunction with cognitive challenges.

Our next session was spent planning out an agenda for the afternoon. This particular group of patients decided that they wanted to practice standing/walking for at least 20 minutes before they sat for a break in order to increase their environmental endurance. They were also excited to practice using the escalator, so that was added to our list!

Each member was then assigned a role or a job for the afternoon:

• The timekeeper was in charge of keeping the group productive and letting us know when it was time to return to the clinic. 
• The scribe was a patient who was working on their handwriting and brought with a clipboard to keep track of all of the items on the agenda and to jot down any pertinent details along the way. 
• The historian was in charge of working on keeping track of things that we found/learned; this patient was working on improving their memory. 

The day of the outing, we hopped in our “Shirley Ryan AbilityLab Van” and ventured out of the clinic. The patients came prepared with their own plans as to what they wanted to find/purchase. After completing all of their target goals, we returned to the clinic where we spent some time reviewing how the session went, what was successful, and what we feel each patient wanted to spend more time focusing on. To top it off – this group of patients decided they wanted to start a speech therapy book club that we continued for several weeks!

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In addition to special interest outings, we also get the opportunity to complete various community projects within the clinics. We recently had a patient design and build us a rolling garden bed all within his therapy sessions – after creating his blueprints and planning the steps, he went to Home Depot to gather all of the items that he had fit into his budget. Afterwards, he built the structure in OT and we still use it to this day for patients to work on gardening skills in OT sessions. We love a multidisciplinary task here in DayRehab!

We also like to incorporate outings that are very personally motivating or rewarding to patients. For example, our incredible PTs have taken advantage of the beautiful weather this summer to venture over to the local forest preserve for a bike ride! Typically the therapist will jog alongside the patient while they work on their strength, balance, and endurance – how awesome is that?

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Finally, not only are we working to get patients back out into the community, but we also have a large number of patients who have goals to return to work. Our “work group” is a structured program to help patients with these high-level goals and involves a “final project” of a community service outing that the patients organize and plan themselves. These involve anything from volunteering at a local food pantry, to collaborating with community stores to organize a winter coat drive. Another work-based outing involves practicing a commute to work with a PT: taking the Metra downtown, walking to their office, and returning to the clinic. No matter the challenge our unique request – we try to accommodate so we can help our patients feel confident and ready to return to their jobs. 

My favorite part about outings is that patients get to see the carryover of all of the work they have done here in the clinic in a customized, community-based experience. 

Outings bring the staff and the patients a lot of enjoyment – including our annual outing to the pumpkin patch, community rummage sales, mini golfing, bowling, and trips to the botanical garden. Although we have made some safety modifications to our outings protocol for COVID-19 distancing, we are so glad to be able to finally venture back into the community with our patients!

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For four years, Kate Self has worked as a speech-language pathologist in the DayRehab setting, currently at Shirley Ryan AbilityLab's Arlington Heights DayRehab Center. She values the collaborative treatment that DayRehab offers, and is interested in working toward the continuation of treatment across all disciplines and settings. Kate earned her Master of Science in Speech and Language Pathology from Eastern Illinois University, and has a Certification of Clinical Competence from the American Speech-Language-Hearing Association.