Occupational therapists’ descriptions of their work with persons suffering from cognitive impairment following acquired brain injury

Abstract

The aim of the present study was to investigate how Swedish occupational therapists describe their work with persons suffering from cognitive impairment following acquired brain injury. A qualitative descriptive approach was used and interviews were conducted with 12 occupational therapists working in community and county council care. Qualitative content analysis was used and revealed three main themes: (1) "To make the invisible visible", (2) "To collaborate-a prerequisite for success", and (3) "Dilemmas to handle". The findings showed a complex scenario where the occupational therapists worked to make the cognitive impairments visible to themselves, the clients, and persons close to the client. Collaboration was perceived as a key factor. The dilemmas concerned different aspects in the rehabilitation process, which affected the occupational therapists' work with the clients. Identified areas in need of improvement are prioritizations and additional education regarding both intervention methods and theory. A reluctance to use standardized assessments was expressed and research that identifies and overcomes those hindrances in clinical practice is needed. Therapeutic use of self was described as important. To understand and illuminate the occupational therapists' comprehension of the concept further research is required.

Occupational therapist practice patterns in relation to clients with cognitive impairment following acquired brain injury

“…A questionnaire that was based on a former qualitative study [13] was used. The questionnaire had been evaluated for content validity using content validity index (CVI) [26].…”

“…Within occupational therapy research, the term has generally included the content and forms of intervention as well as the environment in which the intervention is provided [7,9,10], the theoretical foundations used [9][10][11], the professional development and further education of the OT [9,12] and collaboration with team members [10,12]. An earlier interview study investigating practice patterns for clients with CIABI [13] revealed a complex OT practice due to the hidden nature of the impairments, the relation between clients' self-awareness and motivation and the need for extensive collaboration with others besides the client. This interview study identified some additional practice areas compared to earlier research.…”

“…The use of oneself therapeutically is included as an aspect of collaboration with the client, meaning the OTs intentional use of personal traits and attitude as means in intervention [14]. Therapeutic use of self has been emphasized as an important factor for successful intervention when targeting clients with CIABI [13,15], especially in relation to enhancing clients' self-awareness and realistic goal-setting [13,16].…”

Internal Memory Rehabilitation Strategies in the Context of Post-acute Brain Injury: A Pilot Study

“…The long-term persistence of memory impairments and the risk that these impairments will affect functional activities often cause clinicians to target the memory issues as a therapy goal. Cognitive rehabilitation providers report learning and memory as primary post-injury target of rehabilitation [9]. Memory rehabilitation usually involves educating patients about memory functioning and also discussing and practicing a range of interventions.…”

Translating measurement findings into rehabilitation practice: An example using Fugl-Meyer Assessment-Upper Extremity with patients following stroke

“…For example, a multicenter retrospective review of medical charts showed that only 13 percent of 248 individuals with stroke were assessed for unilateral neglect with standardized assessments as recommended by practice guidelines [7]. A recent survey of 253 Canadian occupational therapists revealed that only 27 percent reported using standardized assessments of unilateral spatial neglect [8], and a qualitative interview with 12 Swedish occupational therapists working with individuals with brain injury revealed that the therapists were reluctant to use standardized assessments [9]. In a survey of 300 Canadian physiotherapists conducted by Abrams et al, 90 percent agreed that "health professionals should monitor the outcome of their treatment using reliable and valid tools," yet less than 30 percent reported routine use of standardized assessments [10].…”