Emmah Doig, Pim Kuipers, Sarah Prescott, Petrea Cornwell, Jennifer Fleming; Development of Self-Awareness After Severe Traumatic Brain Injury Through Participation in Occupation-Based Rehabilitation: Mixed-Methods Analysis of a Case Series. Am J Occup Ther 2014;68(5):578-588. doi: 10.5014/ajot.2014.010785.
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© 2019 American Occupational Therapy Association
OBJECTIVE. We examined participation in goal planning and development of self-awareness for people with impaired self-awareness after traumatic brain injury.
METHOD. We performed a mixed-methods study of 8 participants recently discharged from inpatient rehabilitation. Self-awareness was measured using discrepancy between self and significant other ratings on the Mayo–Portland Adaptability Index (MPAI–4) at four time points. We calculated effect size to evaluate the change in MPAI–4 discrepancy over time.
RESULTS. Seven participants identified their own goals. We found a large reduction in mean MPAI–4 discrepancy (M = 8.57, SD = 6.59, N = 7, d = 1.08) in the first 6 wk and a further small reduction (M = 5.33, SD = 9.09, N = 6, d = 0.45) in the second 6 wk of intervention. Case data indicated that 7 participants demonstrated some growth in self-awareness.
CONCLUSION. Engagement in occupation-based, goal-directed rehabilitation appeared to foster awareness of injury-related changes to varying extents.
It has to be a compromise. . . . They’ll get maybe 2 steps forward, but in the person’s head they want to get to 20. . . . If you just set the goal 2 steps forward to what you think they’ll achieve, they won’t accept it and therefore they may not engage in it. . . . Even if it’s not realistic in your terms as a therapist, it needs to be something that they perceive as acceptable to aim for. (therapist of Participants 1, 3, 5, and 8)
The COPM can be used with people with impaired self-awareness to identify meaningful rehabilitation goals. People experiencing difficulty identifying occupational performance areas using the COPM were able to agree to work on goals identified with input to identify occupational performance problems by significant others and therapists.
Engagement in occupation-based rehabilitation that targets goals that are meaningful and important to the client provides opportunities for graded, supported challenges.
The experience of unexpected challenges as well as unexpected improvements in meaningful occupations can have benefits for enhancing self-awareness and engagement in rehabilitation.
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