Getting Better in the Kitchen: Cooking can be part of rehabilitation after brain injuries

When Carole Thouvenot’s son, Dan, progressed to outpatient treatment for a serious head injury he suffered in an auto accident a couple of years ago, she was understandably happy and relieved. After all, Dan had survived the accident that almost killed him and the critical brain surgery that followed. But something puzzled Thouvenot, who lives in O’Fallon, Ill.: Why was he baking all those cakes?

She soon learned that baking was part of her son’s therapy at the Rehabilitation Institute of St. Louis, used to help address the short-term memory loss he suffered from his brain injury. With the type of brain injury he had, he was often left asking, “What do I do next, what do I do next?” Thouvenot said.

His experience is not unusual. Cooking is used extensively in occupational therapy to help those who suffer brain damage develop their memory and ability to follow through on multiple tasks. “It’s one of the main things therapists are trying to do – to look at activities of daily living and try to incorporate those tasks back into the lives of the person who was hurt,” said Kelly Vogl, an occupational therapist with the institute, an 80-bed hospital solely dedicated to acute medical rehab services that specializes in patients with brain injury, stroke and other neurological deficits. Those activities of daily living include getting up, getting dressed, brushing one’s teeth, brushing one’s hair, driving – and cooking.

“It just depends on what the person is having a problem with,” Vogl explained. “When somebody is injured and they’re in acute rehabilitation, they start with the basics like bathing and dressing and simple grooming types of things. And then they will advance to things like cooking, which is a higher-level activity.”

Therapists can use cooking to evaluate problem-solving skills, multitasking and the ability to follow directions in a sequential order. “Cooking has all of those tasks embedded in it,” Vogl said. “You’re not usually trying to teach new skills in rehab, although sometimes … you might be doing a new skill to see if they can do that to look at their memory or problem-solving or improvement. So you give them a task they’ve never done before to see if they can figure it out. It can be used that way as well.”

Susan Wilson, occupational therapist and medical services coordinator for the not-for-profit Center for Head Injury Services, agreed that cooking can play an important role in therapy following a brain injury. “There are a lot of changes that occur with a brain injury,” Wilson said. “Things that used to be so simple are not simple anymore – things we take for granted.”

Additionally, cooking is an activity that involves “the whole thought process of being able to come up with all kinds of plans that you have to do,” Wilson said. “It’s what we in the rehab field call executive functioning – being able to think about what you’re going to do, being able to make the plans and being able to carry through with those plans to a completion.”

Baking is often used in therapy because projects need not be complex to be effective; projects can even be as “simple as just adding water [to a mix],” Wilson said. “But then you’ve got to turn on the stove, preheat the oven, mix everything and put it in the cake pan, put the pan in the oven and wait for the baking to be completed. You can make it as simple or as complex as you need to depending on the injury and where the patient’s having problems, so you’ll see baking used with people with brain injuries or people who have had a stroke.”

Cooking works best as a therapy only if the patient cooked before the injury, Vogl said. That is key in determining whether or not cooking should be included in the patient’s therapy. “If you have a 37-year-old male … whose wife does all the cooking and he never does any of it, it’s really not motivating for him to cook. He couldn’t care less if he cooks,” she said. “But if he used to make himself peanut butter-and-jelly sandwiches all the time, it would make sense to him to make sandwiches ... because he’s probably going to have to do that again some day. But if he never cooked a four-course meal before his injury, he wouldn’t care to do it now.”

Safety is another reason cooking is used in therapy, Wilson said. “A lot of our people are going to have to be able to live by themselves,” she said. “Some stroke victims are not able to use both hands, so we teach them how to use simple things around the house or how to do simple tasks they can no longer can do [as easily].”

Therapists might also teach people who have lost the ability to read to learn how to read recipes, said Wilson. “Some people have to have recipes adapted into pictures or use [other] strategies that will help them be as independent as possible,” she said.

After retraining clients in its vocational program, the center helps them find gainful employment, sometimes in restaurants. “We do the coaching with them so the employer doesn’t have to do that,” Wilson said. The center’s training helps clients learn to write a menu, figure out how many people they’re going to serve and the quantities they need to make, go to the store to get the ingredients and prepare the meal. They even collect the money and serve the food, Wilson said.

At the Rehabilitation Institute inpatients staying in independent living apartments cook, as do those in outpatient day-treatment therapy. Inpatients cook at a much simpler level, Vogl said.

“We might just do brownies, and we would have all of the ingredients on hand.” But when the patients progress to the outpatient program, the cooking gets more complicated. “We might start with, ‘Let’s make a grocery list and go to the grocery store,’” said Vogl. “They have to buy the groceries, handle the money and come back and fix the meal.”

In addition to the mental skills cooking develops, there’s another reason it’s used in therapy: emotional rewards. “It’s something that [patients] can take some pride in,” Wilson said. “It’s not for everybody but it is good for the people who have an interest in it. We have some people – men and
women – who just take so much pride in cooking; they like to cook and prepare things for other people.”

“It’s fun,” Vogl said. “You have a finished product, you get to see what you’ve done and you get to eat it, so it’s sort of motivating for people.”