A model for neurorehabilitation after severe traumatic brain injury: facilitating patient participation and learning

Gateway to Recovery: A Comparative Analysis of Stroke Patients' Experiences of Change and Learning in Norway and Denmark

Objectives

The recovery process is reported by stroke survivors to be a change process fraught with crises and hazard. Interaction with health professionals and others may play a central role in establishing renewed control over life.

Research Questions

(1) How do patients handle and overcome experienced changes after stroke? (2) How do they experience the support to handle these changes during the first year after stroke? (3) How do the similarities and differences transpire in Danish and Norwegian contexts? Methodology. A qualitative method was chosen. Six patients from Denmark and five patients from Norway (aged 25-66) were followed up until one year after stroke, by way of individual interviews. The data were analyzed (using NVivo 11) by means of phenomenological analysis.

Findings

The participants described four main issues in the recovery process that impacted the experienced changes: (i) strategies and personal factors that promote motivation, (ii) the involvement of family, social network, and peers, (iii) professionals' support, and (iv) social structures that limit the recovery process. There was a diversity of professional support and some interesting variations in findings about factors that affected recovery and the ability to manage a new life situation between Central Denmark and Northern Norway. Both Norwegian and Danish participants experienced positive changes and progress on the bodily level, as well as in terms of activity and participation. Furthermore, they learned how to overcome limitations, especially in bodily functions and daily activities at home. Unfortunately, progress or support related to psychosocial rehabilitation was almost absent in the Norwegian data.

Effects of video modelling on emerging speech in an adult with traumatic brain injury: preliminary findings

PRIMARY OBJECTIVE

Research has shown that traumatic brain injury (TBI) can affect a person's ability to perform previously learned skills. Dysexecutive syndrome and inattention, for example, alongside a number of other cognitive and behavioural impairments such as memory loss and lack of motivation, significantly affect day-to-day functioning following TBI. This study examined the efficacy of video modelling in emerging speech in an adult male with TBI caused by an assault.

RESEARCH DESIGN

In an effort to identify functional relations between this novice intervention and the target behaviour, experimental control was achieved by using within-system research methodology, overcoming difficulties of forming groups for such an highly non-homogeneous population.

METHODS AND PROCEDURES

Across a number of conditions, the participant watched a videotape in which another adult modelled a selection of 19 spoken words. When this modelled behaviour was performed in vivo, then generalization across 76 other words in the absence of a videotape took place.

MAIN OUTCOMES AND RESULTS

It was revealed that video modelling can promote the performance of previously learned behaviours related to speech, but more significantly it can facilitate the generalization of this verbal behaviour across untrained words.

CONCLUSIONS

Video modelling could well be added within the rehabilitation programmes for this population.

External Memory Aid Training after Traumatic Brain Injury: ‘Making it Real’

Introduction:

A number of options exist for the rehabilitation of memory after traumatic brain injury, and research suggests that the use of external memory aids is one of the best approaches. Unfortunately, there is very little evidence to guide therapists in training clients to use external memory aids and to ensure the sustainable use of the aids long term.

Method:

Grounded theory methodology was used to explore the question of how occupational therapists train clients to use external memory aids after a traumatic brain injury. Semi-structured interviews, with eight occupational therapists working in neurological rehabilitation, were conducted until data collection reached a saturation point. The data were analysed following the constant comparative method proposed by Strauss and Corbin.

Findings:

Analysis revealed four overlapping processes: developing client insight, getting client buy-in, getting others on board and making it real. Making it real emerged as the core process that encompassed and ran through the other three. It emphasised the need for occupational therapists to use meaningful, functional activities in order to establish an aid that fitted the client's real life.

Conclusion:

The processes uncovered by this study give occupational therapists working in the field of brain injury rehabilitation guidance for clinical practice.