Monday, August 13, 2012

Brownie Therapy

Late for my occupational therapy (OT) observation with Jamie in the Green Therapy Pavilion (CORF), I arrive to find Jamie and Jill, her occupational therapist, preparing to make brownies in the OT kitchen.  Wondering why these gals are going all “Martha Stewart” on me, I figured Why not? Brownies have been a form of therapy for me in the past. Giggling to myself, I settle into a chair to observe.  Jamie, ever the sweet friendly gal, enthusiastically greets me as I slide into the session in attempt not to disrupt.  I’ve noticed in past observations Jamie becomes easily distracted, but Jill keeps her on track by giving her a bag of brownie mix asking her what they need to get started.

How many times have you and I made a box of Duncan Hines brownies?  Do you remember the last time you actually read the box recipe directions?  Can you recite any of them?  I admit I didn’t until I did a Google search.  At best I scan the pictures for how many eggs, how much oil and/or water, what oven temperature it requires, and how long to bake them.  You and I take for granted our automatic grasp of baking a simple box of brownies but the follow-through on these simple steps challenges Jamie’s success.  With her cognitive challenges, distractions come easily for her and her attention to details and thus, follow-through suffers.
Jamie reads the package aloud, noting they will need two eggs, ¼ cup oil and ½ cup of water.  Jill sends Jamie to the refrigerator for two eggs while she herself pulls oil and a measuring cup out of a cabinet.  Next, Jamie reads the first step of the recipe instructions, Preheat oven to 350 degrees.  Jill helps Jamie figure out our dinosaur of an oven in OT.  This oven comes from the dark ages with its knobs and dials!  Jamie turns the knob to 350 degrees with Jill’s guidance and explanation on how to actually turn the oven on with a second knob.  Oven preheating, they move to the next step in the recipe directions. 

“GREASE bottom of pan with shortening or cooking spray.”  Jill pulls out a can of cooking oil so Jamie may spray the pan.  With this task complete, Jill asks Jamie to continue:  Empty brownie mix, egg(s), oil and water into large bowl.  Jamie follows the instructions, though Jill has Jamie review the recipe step again because she forgot to add one of the ingredients.  As I observe, Jamie not surprisingly becomes easily distracted as she asks Jill about her wedding plans, or says how tired she is, or asks her if she watches the TV show “Friends” rather than fully focus on what she’s doing.  Jill gently redirects Jamie’s attention to the task at hand.

Stir until well-blended (about 50 strokes); spread in greased pan and bake immediately. Once Jamie begins stirring, Jill takes the opportunity to answer a couple of her questions.  I notice awkwardness in Jamie’s body as she simultaneously holds the bowl and stirs the brownie mix.  Jamie manages the task fine but the coordination challenge presents itself.

Spread the batter evenly into the pan.  Jamie now struggles with the coordination of holding the bowl while manipulating the spoon to dump the batter into the pan.  Jamie’s upper-body strength or the lack thereof comes into play here too.  Jill notices, and suggests that Jamie hold the bowl a different way, giving her specifics on how to do so. Jamie concedes that’s easier and continues pouring the batter.  Jill asks Jamie to review the instructions one more time to determine the baking time.  She helps Jamie set the timer, then opens the oven door so Jamie can place the brownies inside, cautioning her to be careful.  Once the brownies are in the oven, we move to another OT activity until the timer goes off.  When the timer buzzes, a quick check with an inserted knife reveals the brownies aren’t done.  Jill explains to Jamie they need to bake the brownies a little while longer, in this case, another ten or so minutes. 
Jill later explained to me that Jamie wants to be independent at home which means cooking more of her favorite things on her own.  Additionally, she explained her struggle with following through on task activities, such as a following a recipe, checking on what’s baking, remember she has something baking, etc. to the final outcome:  a warm batch of brownies fresh out of the oven.

What about the brownies, you ask?  Well, what I know for sure is they smelled awesome and I didn’t get any!

In the Next Blog Entry: A Wild Ride - Mildly off balance by the sudden, disorienting flow and rhythm of the conversation, I struggled to track Jamie’s line of thinking as she jumps around within the exchange.

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