A Service User Perspective Informing the Role of Occupational Therapy in School Transition Practice for High School Learners with TBI: An African Perspective

Towards occupational resilience: A model to facilitate high school participation post traumatic brain injury

Background: This article describes the model components of a study that applied a two-phased approach towards the development of an occupational resilience model. OBJECTIVE: The occupational therapy practice model that is proposed seeks to facilitate high school re-entry and school participation post traumatic brain injury (TBI). The study’s first phase generated results on participants’ experiences of high school re-entry and school participation post TBI. These findings contributed to the second phase of developing a practice model to improve upon school transition practice for learners post TBI. METHODS: The study’s first phase comprised a qualitative multi-case study of eight cases. Data collection involved semi-structured interviews, participant and contextual observation, and document analysis. Data analysis was performed via an inductive process combined with cross-case synthesis. Phase 2 employed theory generation, suggesting an occupational therapy practice model for facilitating high school participation post TBI. RESULTS: Participant responses revealed, following the onset of the TBI, a need for adolescents to display resilience in order to re-participate in school. This was displayed by adolescents adapting through drawing upon personal and environmental resources as well as preparing for and engaging in occupation. CONCLUSION: A deeper understanding of the experiences of key role players involved in the school transition post TBI, combined with theory generation, formed the basis of developing the proposed model of occupational resilience. Occupational resilience, through a series of resilience-promoting tasks, is offered as a mechanism to increase learners’ capacity to adapt to occupational challenges and meaningfully participate in school post TBI.

The Burden of Traumatic Brain Injury in Sub-Saharan Africa: A Scoping Review

BACKGROUND

Despite the growing incidence of traumatic brain injury (TBI) in Sub-Saharan Africa, there is yet to be a study to map the current burden of the disease on the continent. This scoping review aims to outline the literature on TBI.

METHODS

This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews. A search string was developed to identify studies relating to TBI epidemiology, management, and outcomes. The search was applied to Medline, Embase, and Global Medicus Index.

RESULTS

In total, 107 studies were included in the final analysis. More than one half originated from South Africa. Seventy-five studies were published in 2013 or later. Studies recruited a median of 115 patients: 83.5 male and 31 female. TBI affected all age groups (range = 0-105 years) and sexes but was more common among young males aged 20-40. Road traffic accidents caused TBI in a median of 71 patients. Other major causes included assault (median = 39.5) and falls (median = 12.5). Craniectomies were the most commonly reported surgical treatment (18.7%) followed by burr holes (7.5%). Four studies (3.7%) reported delays in seeking neurotrauma care, with delays in reaching a neurotrauma facility and delays in receiving care being reported in 15 studies (14%) each. Glasgow Outcome Scale score was reported in 28 (26.1%) studies, whereas quality of life measures were reported in 2 (1%). Younger age was associated with favorable outcomes.

CONCLUSIONS

There is an increased need for TBI research, education, and training in Sub-Saharan Africa. This will aid stakeholders in optimizing patient management and outcome.