Rehabilitation in place : experiences of daily occupations after acquired brain injury

Abstract

The general aim of this thesis was to better understand and describe the experiences of occupations in the context of daily life and the meaning of actions in different places (training apartment, rehabilitation setting, home and workplace) for persons of working age with acquired brain injury (ABI) during a rehabilitation process.

The aim of the study I was to investigate how persons with acquired brain injury experienced their 1-week stay in an apartment fitted with electronic aids to daily living (EADL). Eleven participants with acquired brain injury (of working age) were interviewed on the last day of their stay. A phenomenological method was used during analysis. The findings are presented in a meaning structure comprising 4 main characteristics: Plunging into the EADL-equipped environment, landing and feeling comfortable with the new environment, incorporating the new in daily activities, and taking off for the future.

The aim of study II was to identify what characterized the lived experience of memory impairment in daily occupations during the first year after acquired brain injury. Four participants, aged 22-61, were interviewed over four occasions during the first year after acquiring a brain injury. A phenomenological method was used during analysis. The findings are presented in a meaning structure comprising 4 main characteristics that reflects the temporal process of rehabilitation over a year: 1) A chaotic life-world, 2) struggling for a coherent doing in new contexts, 3) conscious strategies in new contexts, and 4) achieving new habits.

The aim of study III was to describe the meaning of actions in different places during one year of rehabilitation after stroke. Qualitative interviews with seven persons, aged 42-61, done over the course of a year were analyzed using a grounded theory method. Seven categories emerged and were presented in overlapping phases as: 1) Workplace in mind, 2) experiences at home enabling reflection, 3) rehabilitation setting creates uncertainty, 4) retrieving inspiration from familiar places, 5) matching the complexity of tasks across places, 6) understanding the reality by confrontation, and 7) on the way to place integration. From these themes, a core category as the main finding in this study emerged: The desire for place integration inspires engagement in rehabilitation.

The aim of study IV was to examine the meaning of acting with others in different places over the course of one year post-stroke. Qualitative interviews with nine persons, aged 42-61, done over the course of a year were analyzed using a grounded theory method. Four categories were identified from the analysis of the participants experiences during the year of rehabilitation and were presented in the sequence that they emerged: (1) Not recognized as the person I am, (2) the burden of burden, (3) connection with others through daily life activities, and (4) inspiration from engaging with others. From these themes a core category as the main finding in this study emerged: A process of belonging for integration.

A main conclusion of the findings in the four studies is that the meaning of actions in different places was experienced as a desire for place integration which inspired engagement in rehabilitation. Findings suggest that the following implications can be implemented in clinical practice in order to support rehabilitation after ABI: 1) Connecting activities across places in rehabilitation, 2) integrating familiar activities and places into rehabilitation, 3) creating places that inspire, and 4) supporting acting with others for belonging.