The use of group based Occupational Therapy Breakfast Preparation Retraining to improve the independence in meal preparation tasks for people with brain injury.

A single site pilot randomised controlled trial will be conducted over 12- 18 months. Qualitative methods will be used to explore the satisfaction of breakfast group (intervention) to participants. Twenty patients participating in an inpatient BIRU program will be assigned to receive a 5 day per week (Monday to Friday) breakfast preparation group based program (intervention) for 4 weeks facilitated by a minimum of one occupational therapist and one occupational therapy assistant. Group participants will receive retraining based on procedural learning principles and support provided according to a most to least hierarchy of prompts. On day one of intervention, the treating therapist will provide orientation to the patient pertaining to the environmental set up and provide a list of meal options. The patient is able to select what they would like to prepare for breakfast each morning. The Therapist completes a functional assessment to determine their level of functioning and level of support required. The Therapist will generate a treatment plan using the hierarchy of prompts to then handover to staff involved for intervention to be implemented. The intervention will be delivered via group facilitation with a maximum of 1:4 staff to patient ratio. As patients arrive to the group each day, the patients will be allocated to a staff member to provide the intervention and supervise the patient’s meal preparation. Patients will not be allocated prior to the group intervention as there will be variations with patient arrival time dependent on other influencing factors such as completion of self-care routines, medical procedures, and wake up times. Patient progresses in the group with regular handover between group facilitator to adjust the intervention accordingly. The intervention given is group/not group, both of which are characterised as 'good practice' Occupational Therapy (either individual or group). To ensure competency in the stage 1 task analysis (primary outcome measure), a two hour training session will be provided to therapists involved in the project who have not completed the Perceive Recall Plan Perform (PRPP) training. In addition, this training will also cover the hierarchy of prompts to ensure adherence of the intervention being delivered in line with the protocol. Therapists will also complete attendance checklists to monitor participant attendance in the study.