Occupational therapy practice for clients with cognitive impairments following acquired brain injury

102 Pages·2012·1.01 MB·English

by  Bo Karlsson

Occupational therapy practice for clients with cognitive
impairments following acquired brain injury

Örebro Studies in Care Sciences 41

KAJSA LIDSTRÖM HOLMQVIST

Occupational therapy practice for clients with cognitive
impairments following acquired brain injury

– Occupational therapists' perspective
© Kajsa Lidström Holmqvist, 2012
Title: Occupational therapy practice for clients with cognitive impairments
following acquired brain injury - Occupational therapists' perspective.

Publisher: Örebro University 2012
www.publications.oru.se
[email protected]

Print: Örebro University, Repro 11/2012
ISSN 1652-1153
ISBN 978-91-7668-903-5
Abstract

Kajsa Lidström Holmqvist (2012): Occupational therapy practice for clients
with cognitive impairment following acquired brain injury - occupational
therapists' perspective. Örebro Studies in Care Sciences 41, 89 pp.

The overall aim of this thesis was to describe occupational therapy practice
for clients with cognitive impairment following acquired brain injury (CIA-
BI) from the perspective of practicing occupational therapists (OTs).
To fulfill this aim, qualitative and quantitative approaches were used in-
cluding interviews (Study I) and questionnaires (Studies II -IV). Based on the
qualitative descriptions generated in Study I, a questionnaire was developed
and evaluated for content validity and test-rest validity (Study II). The ques-
tionnaire was then used in a survey (Study III). The reactive Delphi tech-
nique was used to empirically define the aspects that OTs found to be con-
sistent with the concept of therapeutic use of self (Study IV).
The results showed that a predominant practice pattern was the use of ADL
activities for intervention regardless of whether limitations in occupational per-
formance or cognitive function were assessed, or whether the approach to ther-
apy was remedial or compensatory. General ADL-instruments were used more
than instruments focused on impairment level. Therapies covering a wide range
of cognitive impairments, and abilities important to organizing and executing
occupational performance were commonly targeted. Therapies targeting clients’
activity limitations were prioritized before remediating impairment. Therapeutic
use of self was regarded as being important and the results identified client-
specific aims not earlier described in relation to therapeutic use of self. Another
prominent practice pattern was the collaborative approach toward clients, rela-
tives, and other staff. Theories used to support practice were primarily general.
Occupational therapy practice for clients with CIABI was found to be complex,
and the practice patterns were affected by circumstances such as the ‘hidden’
nature of the cognitive impairments, perceived lack of knowledge, and organiza-
tional issues. The results of this thesis can be used as a foundation for further
research on practice patterns or the specific therapies used. It can facilitate dis-
cussions on strengths and weaknesses with current practice, the need for devel-
opment, and research utilization.

Keywords: occupational therapy, cognition, rehabilitation, practice, acquired
brain injury, stroke, TBI, assessment, intervention.

Kajsa Lidström Holmqvist, Institutionen för hälsovetenskap och medicin
Örebro University, SE-701 82 Örebro, Sweden,
[email protected]

Publications

This thesis is based on the following papers, which are referred to in the
text by their Roman numerals:

I. Holmqvist K, Kamwendo K, Ivarsson A-B. Occupational ther-
apists’ descriptions of their work with persons suffering from
cognitive impairment following acquired brain injury. Scandi-
navian Journal of Occupational Therapy 2009; 16(1): 13-24.

II. Holmqvist K, Kamwendo K, Ivarsson A-B. Occupational ther-
apists’ practice patterns for clients with cognitive impairment
following acquired brain injury – Development of a question-
naire. Scandinavian Journal of Occupational Therapy 2012;
19(2): 150-163. Epub 2011 Jun 1.

III. Holmqvist K, Ivarsson A-B, Holmefur M. Occupational thera-
pists’ practice patterns in relation to clients having cognitive
impairment following acquired brain injury. In manuscript.

IV. Therapeutic use of self as defined by Swedish occupational
therapists working with clients with cognitive impairments fol-
lowing acquired brain injury – A Delphi study. Australian Oc-
cupational Therapy Journal, In press.

All articles are reproduced with permission of the publishers.
List of abbreviations

ABI Acquired brain injury
ADL Activities of daily life
AMPS Assessment of Motor and Process Skills
CI Confidence interval
CIABI Cognitive impairments following acquired brain injury
CMOP Canadian Model of Occupational Performance
COPM Canadian Occupational Performance Measure
CVI Content Validity Index
I-ADL Instrumental activities of daily life
Md Median
MMSE Mini Mental State Examination
MoCA Montreal Cognitive Assessment
MoHO Model of Human Occupation
OT Occupational therapist
OTPPQ-cog Occupational Therapy Practice Pattern Questionnaire-
cognition
PA Percentage agreement
P-ADL Personal activities of daily life
RP Relative position
RC Relative concentration
RV Relative rank variance
TBI Traumatic brain injury
Content
INTRODUCTION ................................................................................... 11
Occupational therapy ............................................................................... 12
Persons with acquired brain injury ........................................................... 15
Cognitive functions .................................................................................. 16
Cognitive impairments and its consequences in daily activities ............ 18
Rehabilitation of persons with acquired brain injury ............................... 19
Occupational therapy for clients with cognitive impairment following
acquired brain injury ................................................................................ 20
Practice models and approaches for cognitive rehabilitation used in
occupational therapy ............................................................................ 20
Occupational therapy practice ............................................................. 22
Assessment ........................................................................................... 22
Therapy................................................................................................ 23
Evaluation of therapy outcome ............................................................ 25
Interaction between client and occupational therapist ......................... 25
Practice patterns ................................................................................... 26
Rationale for the thesis............................................................................. 27
AIMS ....................................................................................................... 29
Specific aims ............................................................................................. 29
METHODS .............................................................................................. 30
Design ...................................................................................................... 30
Participants .............................................................................................. 30
Methods of data collection ....................................................................... 33
Methods of data analysis ......................................................................... 36
Content analysis ................................................................................... 36
Descriptive statistics ............................................................................. 36
Non parametric statistics ..................................................................... 37
Ethical considerations .............................................................................. 38
RESULTS ................................................................................................. 39
Occupational therapists’ descriptions of their work with clients with CIABI
(study I) .................................................................................................... 39
Occupational Therapy Practice Pattern Questionnaire – cog (study II) .... 43
Occupational therapists practice patterns in relation to clients with CIABI
(study III) ................................................................................................. 46
Content of intervention ........................................................................ 46
Assessment ........................................................................................... 46
Therapy................................................................................................ 48
Evaluation of therapy outcome ............................................................ 48
Collaboration with client, relatives, team and other professionals ....... 48
Professional knowledge and theoretical foundations ............................ 49
The concept therapeutic use of self in relation to clients with CIABI (Study
IV) ............................................................................................................ 49
DISCUSSION ........................................................................................... 51
Content of intervention ............................................................................ 52
Environment of intervention .................................................................... 56
Collaboration and interaction with the client, relatives, team and other
professionals ............................................................................................ 57
Prioritisations ........................................................................................... 60
Professional knowledge and theoretical foundations ................................ 60
Methodological considerations................................................................. 62
CONCLUSIONS ...................................................................................... 66
IMPLICATIONS FOR PRACTICE AND RESEARCH ............................ 67
SVENSK SAMMANFATTNING (SWEDISH SUMMARY) .................... 69
ACKNOWLEDGEMENTS ...................................................................... 73
REFERENCES ......................................................................................... 75
APPENDIX A .......................................................................................... 91