Syftet med studien var att beskriva användning av strategier och den betydelse de har för engagemang i aktivitet hos vuxna personer med förvärvad hjärnskada. En kvalitativ litteraturstudie har genomförts. Datainsamlingen skedde via sökning i lämpliga databaser utefter studiens syfte. Totalt 15 artiklar inkluderades till denna litteraturstudie. Insamlat data analyserades efter Fribergs anvisningar för kvalitativa litteraturstudier. Resultatet presenteras under ett övergripande tema; ”Strategier för engagemang i aktivitet” som innefattar de fyra huvudkategorierna ”Planering av aktiviteter i vardagen”, ”Selektera och prioritera aktiviteter utefter situation och sammanhang”, ”Planera det specifika utförandet” samt ”Omgivningens stöd för engagemang i aktiviteter”. Studien påvisade att personer med förvärvad hjärnskada använde sig av flera olika strategier för att möjliggöra engagemang i aktivitet men dess betydelse för individen skilde sig åt. Vissa strategier innebar att personerna själva kunde bemästra aktiviteter, medan andra strategier omfattade stöd från omgivning och personer i deras närhet för engagemang i aktiviteter. Samtidigt som stöd av andra personer främjade engagemang kunde detta upplevas som ett hinder för självständighet i aktivitet. Att planera sina aktiviteter kunde även förvärra symtom från skadan. Att tillämpa strategier kunde således medföra en problematik i aktivitet. Att samla denna kunskap har betydelse för det fortsatta arbetet inom arbetsterapi i att utforma mer precisa och individanpassade interventioner för personer med förvärvad hjärnskada och därmed bidra till en förbättrad rehabilitering. / The purpose of this study was to describe the use of strategies and its meaning for the engagement in activity for adults with acquired brain injuries. A qualitative study where used as method and 15 articles where included in this study. The collected data has been analyzed using Friberg’s suggestion for studying qualitative studies. The result is presented under an overall theme "Strategies for engagement in activities", which includes the four main categories “Planning of activities in the everyday”, “Select and prioritize activities according to the situation and context”, “Planning of the specific performance” and “The support from others for engagement in activities”. The study showed that people with acquired brain injury were using many strategies to enable engagement in activities but the value for the individual differed. Some strategies meant that the individuals independently were able to master activities, while other strategies included support from people in their environment for engagement in activities. While support from other people improved engagement, it could be perceived as a hindrance to independence in activity. Planning activities could also exacerbate their symptoms from injury. To apply strategies could thus cause problem in activity. This knowledge is important for the continued work in occupational therapy in designing more precise and individualized interventions for people with acquired brain injury and thereby improve rehabilitation.

Objectives: The World Health Organisation has predicted that by 2020, brain injury will be one of the leading causes of disability in the world (Hyder et al, 2007). Psychological difficulties are common in this population, with up to 60% of individuals experiencing mental health difficulties (Acquired Bain injury Outreach Service, 2012). Therefore, with the rapid rise in referrals, services are under increasing pressure to provide innovative ways of offering effective and cost-efficient care. This research aimed to evaluate a novel transdiagnostic Acceptance and Commitment Therapy group approach for supporting individuals adjusting to life following the diagnosis of a neurological condition. Methods: A mixed-methods waiting-list control design was used and carried out across two sites of Hertfordshire Neurological Outpatients Service. The outcomes of the group were assessed using four outcome measures evaluating acceptance, self-identified difficulties, low mood and anxiety, as well as a semi-structured interview to identify mediators of change. Results: Ten participants from the intervention group completed, equating to a 76.9% completion rate. The results indicated that those in the intervention group made significant improvements across all measures of acceptance, self-identified difficulties and psychological distress. Those in the waiting list groups did not experience any change in these domains. The qualitative feedback from participants was also highly positive. Participants reported the usefulness of the ACT strategies, in addition to valuing being in a group with others with a range of difficulties. Participants reported greater awareness and acceptance, as well as increased activity and improved mood. Conclusions: The ACT group is a potentially effective and cost-efficient method of supporting individuals with adjustment following diagnosis of a neurological condition. Despite these promising findings it is important to acknowledge the limitations, such as the small sample size and research design. Further research would be beneficial in order to evaluate the intervention using more rigorous methods.

Aquired brain injury (ABI) of various etiology is one of the major causes of health impairment, disability and death in adult population. It has a wide scale of physical, psychological and social consequences impacting the lives of patients and their relatives. Neuropsychological rehabilitation (individual and group) has become an integrated part of the complex rehabilitation of ABI supported by evidence-based research and practice. Theory and research suggest new perspective on psychotherapy and its role in this process, though its use in the Czech republic may be limited. The goal of the theoretical part of this thesis was to explore the status of the knowledge and practice of neuropsychological rehabilitation of ABI with focus on group work and psychotherapy and their effectiveness. The empirical part aimed to analyze effectiveness of short-term group dynamic psychotherapy in sample of patients with ABI. The intervention was applied in a realistic setting of two selected rehabilitation centers. The patients completed European Brain Injury Questionnaire for Patients (EBIQ-P) and Zung's Self-rating Depression Scale pre-, after 6 weeks and post- intervention covering researched symptoms. The results suggest that there was a significant change in perception of various categories of problems...

La lésion cérébrale acquise (LCA) engendre des séquelles dont la chronicité est à l’origine de difficultés dans les activités familiales, sociales et professionnelles. L’interaction des facteurs lésionnels, personnels de la personne cérébrolésée et ceux de son environnement vont contribuer au handicap. Face à la complexité de ce handicap, des programmes d’aide à l’intégration communautaire (IC), comme les UEROS, ont été développés pour favoriser l’insertion familiale, sociale et professionnelle des patients et améliorer leur qualité de vie (QDV). Mieux connaitre les déterminants de l’IC et l’évolution des processus psychologiques au cours de ces programmes semble nécessaire. Le premier objectif de ce travail vise à améliorer l’évaluation de l’IC après LCA en validant en français le Community Integration Questionnaire-Revised (CIQ-R) de Callaway et al. (2016). Les résultats de l’étude transversale menée auprès 191 patients cérébrolésés montrent les qualités psychométriques du CIQ-R. Celui-ci permet d’évaluer quatre dimensions de l’IC ainsi qu’un score global. Le deuxième objectif de ce travail est double : repérer les déterminants du devenir professionnel des patients 36 mois après leur entrée à l’UEROS-Aquitaine et étudier l’évolution des processus psychologiques, de la qualité de vie (QDV) et de l’IC tout au long de leur participation au programme. Dans le cadre d’une étude longitudinale, 49 patients cérébrolésés ont été inclus à leur entrée à l’UEROS-Aquitaine. Des données psychologiques, de QDV et d’IC ont été recueillies à 5 reprises sur 24 mois et le devenir professionnel a été évalué à 36 mois. Trois facteurs, parmi ceux évalués à l’inclusion, discriminent les patients ayant retrouvé une activité professionnelle (AP) de ceux sans AP 36 mois plus tard: un âge jeune, un faible besoin d’aides en vie quotidienne et l’utilisation de la pensée positive pour faire face aux difficultés liées à la LCA. Des modélisations par équations structurales montrent que la symptomatologie dépressive et le coping « Evitement » diminuent jusqu’à 1 an après l’inclusion puis augmentent au cours de la deuxième année. La dimension « Soi » de la QDV et la satisfaction de vie augmentent jusqu’à 1 an puis diminuent ensuite. La QDV « Physique » augmente tout au long des 2 ans. Enfin, les résultats indiquent une absence d’évolution significative des scores d’estime de soi, de sentiment d’auto-efficacité et d’IC sur 2 ans. L’ensemble de nos résultats suggère des implications cliniques tant pour l’évaluation de l’IC que pour l’accompagnement à long terme des personnes cérébrolésées. / Acquired brain injury (ABI) causes disorders with chronicity at the origin of difficulties in daily, social and professional activities. The interaction of brain-injured people’s lesional, personal and environmental factors will contribute to the resulting disability. Given the complexity of this disability, Community Integration (CI) training programs have been developed, such as the UEROS, to promote family, social and professional integration. A better understanding of the determinants of CI and the evolution of psychological processes during these programs seems necessary. The first objective of this work aims to enhance the evaluation of CI after ABI by validating, for the french language, the Community Integration Questionnaire-Revised (CIQ-R) by Callaway et. al (2016). The results of the transversal study carried out with 191 ABI patients show the psychometric qualities of the CIQ-R. This tool allows evaluation of four dimensions of CI as well as an overall CI score. The second objective of this work is twofold: to identify determinants of the professional outcome of patients 36 months after their entry into the UEROS-Aquitaine program and to study evolution of psychological processes, quality of life (QoL) and CI throughout their participation in the program. In the context of longitudinal study, 49 ABI patients were included upon entry to UEROS-Aquitaine program. Psychological, QoL and CI data were collected at 5 moments during 24 months and professional outcome was evaluated at 36 months. Three factors among those evaluated upon inclusion discriminate patients having found a professional activity (PA) from those with no PA 36 months later: young age, a low need for aids in daily living and use of positive thinking to cope with the difficulties associated with the ABI. Structural equation modeling indicates that depressive symptomatology and avoidance coping decrease until 1 year after inclusion and then increase in the second year. The "self" dimension of QOL and life satisfaction increase up to the first year and then decrease during the second year. Physical QoL increases over 2 years. Finally, the results indicate a lack of significant change in self-esteem scores, self-efficacy and CI over 2 years. The results as a whole have clinical implications both for the evaluation of ABI patients' CI and for their long-term support.

This thesis is focused on quality of life theme, satisfaction with life topic and social self- efficacy subject, with emphasizing of the acquired brain injury context and specific and unique brain injury consequences. Thesis is based on theoretical fundament of all mentioned concepts, but mainly there are actual quantitative data and results of quality of life, satisfaction with life and social self-efficacy and other-efficacy in the framework of acquired brain injury research sample in Czech Republic. Not only description of quality of different life parts subjective perception, but also search of possible relationships strength between quality of life and social efficacy has been probed. All of these has been used in application of lots of standardized and also new questionnaire and methods. Keywords: acquired brain injury, quality of life, satisfaction with life, social self-efficacy, social other- efficacy

Deficient executive functioning influences significantly the ability to manage every day life requirements. Nowdays different structured programmes for EF rehabilitation are available for aquired brain damage patiens. Their efficiency had been confirmed by meta- analysis, yet cognitive-behavioural rehabilitation programmes in clinical praktice still lack some kind of systematic intervention particularly aimed at EF. The topic of the theoretical part is an introduction of selected theoretical models of EF and a summary of existing knowledge about EF rehabilitation. I have created a rehabilitation programme specificly focused on the ability of planning and organizing acitivities, which are complex abilities closely linked to the primary components of EF. This programme was created to help patiens with aquired brain damage to work on improvment of such abilities, whose disruption makes managing every day life requirements difficult. Along with that we tried to improve the quality of their lifes. This programme is also being introduced wihin the theoretical part of this work. Further the process of research is being analyzed. The rehabilitation programme was used with 9 aquired brain damage patiens and it's efficiency was measured. Reasons why I used small-n design are analyzed in detail as well as the...

Thèse réalisée en cotutelle France- Québec / Les troubles cognitifs et comportementaux après une lésion cérébrale peuvent entraîner des limitations d’activité sévères et des restrictions de participation. Les personnes cérébrolésées acquises nécessitent une prise en charge adaptée et spécifique tant au niveau de la rééducation que de la réadaptation. Un programme de réadaptation a été développé dans le service de Médecine Physique et de Réadaptation de la Pitié-Salpêtrière, Paris, France. Le but de cette présente thèse est d’explorer l’efficacité de ce programme sur l’activité et la participation. Spécifiquement, les objectifs sont de : 1) définir et valider le programme de réadaptation par l’équipe multidisciplinaire; 2) mesurer les effets du programme de réadaptation sur l’activité et la participation des participants et 3) explorer des liens possibles entre le problème ciblé par le programme, ses interventions et les effets du programme sur l’activité et la participation. Pour répondre à l’objectif 1 de l’étude, un modèle logique (Champagne et al., 2009) est utilisé. Des entretiens semi-dirigés sont menés auprès de l’équipe multidisciplinaire. La documentation de chaque activité du programme est validée par des groupes d’experts. Pour répondre à l’objectif 2, une étude quasi expérimentale avec «cas uniques» et multiples mesures répétées est utilisée. Six mesures répétées sont effectuées : trois en pré-programme, puis trois en post-programme jusqu’à six mois. L’interprétation des résultats est réalisée à partir (i) de l’analyse visuelle de données graphiques représentant l’évolution du sujet dans le temps et (ii) d’analyse statistique. Au préalable de cette étude, une première étape a consisté à identifier les outils de mesure des déficiences, de l’activité et de la participation. Des outils de mesure situationnels fiables et valides sont choisis. Les critères de jugement principaux sont (i) le niveau d’activité évalué par le Cooking Task (Chevignard et al., 2000) et le Profil des Activités Instrumentales (PAI) (Bottari et al., 2009) et (ii) la participation évaluée par le PAI et la Mesure des Habitudes de vie (MHAVIE) (Noreau et al., 2002).   Pour répondre à l’objectif 3, l’analyse logique théorique s’appuie sur le modèle cognitif des fonctions exécutives de Lezak (1982) et sur la CIF. Les résultats de cette étude montrent que l’analyse logique théorique de l’activité cuisine valide cette activité au sein du programme de réadaptation. La mesure des effets du programme fait ressortir des différences significatives entre les périodes pré et post-programme au nombre total d’erreurs au Cooking Task (6/7 participants) et en besoin en aide (PAI) (6/7 participants). L’item « préparation de repas » de la MHAVIE suggère une amélioration pour 4/7 sujets. L’ensemble des résultats suggère une amélioration globale de l’activité « préparer un repas » qui se maintient dans le temps. L’identification des outils de mesure favorise un choix éclairé des outils à préconiser pour l’évaluation des programmes de réadaptation dédiés aux personnes cérébrolésées. Cette thèse contribue à l’avancement des connaissances en réadaptation. De fait, peu d’études sont allées aussi loin dans la documentation d’un programme de réadaptation multidisciplinaire et holistique et dans la compréhension des liens entre les processus de soins et les retombées du programme. / The cognitive and behavioral sequelae of brain injury can severely limit activities and restrict participation. People with acquired brain injury require adapted and specific reeducation and rehabilitation. To respond to these needs, a rehabilitation program was developed within the Physical and Rehabilitation Medicine Service of Pitié-Salpêtrière, Paris, France. This thesis seeks to explore the effectiveness of this program on participant’s levels of activity and participation. More specifically, the objectives were to: 1) define and validate the rehabilitation program with the multidisciplinary team; 2) measure the effects of the rehabilitation program on participant participation levels and 3) explore possible links between the problem, the interventions in the program, and the effects of the program on participant’s activity and participation levels. With respect to the first objective of documenting the rehabilitation program, we used the logic model of Champagne et al., 2009). Semi-structured interviews were carried out with members of the multi-disciplinary team. The documentation of each program activity was validated by groups of experts. For the second objective, a quasi-experimental study was carried out with ‘single-case’ multiple repeated measures. Six repeated measures were used: three pre-program and three post-program up until six months. Results were analyzed using (i) visual analysis of graphic data which represented the evolution of participants over time and (ii) statistical analyses. In the initial preparation phase, tools measuring body functions and structure, activity and participation were identified. The situational measurement tools chosen were reliable and valid. Principal outcomes were (i) participants’ activity level evaluated by the Cooking Task (Chevignard et al., 2000) and the Instrumental Activities of Daily Living Profile (IADL Profile) (Bottari et al., 2009) and (ii) participants’ participation level evaluated by the IADL Profile and the Life Habits assessment’ (LIFE-H) (Noreau et al., 2002). For the third objective, a logic theory analysis was based on the cognitive model of executive functions of Lezak (1982) and on the International Classification of Functioning, Disability and Health (ICF). This analysis demonstrates the validity of the cooking activity and thereby promotes the recognition of such activities within multidisciplinary rehabilitation programs. For the measurement of the effects of the rehabilitation program, significant differences in the total number of errors in the Cooking Task (for 6/7 participants) and in the need for help (IADL Profile) (6/7 participants) between the pre- and post-program phases were observed. On the LIFE-H assessment, some improvements were shown for the ‘preparation of meal’ item for 4/7 participants. The overall results of the Cooking Task, IADLP and LIFE-H scale suggest a global improvement for the activity ‘meal preparation’ after the rehabilitation program. This improvement is maintained over time. The identification of tools to measure limitations in activity and participation levels in real life situations assists informed decision-making in rehabilitation. This thesis contributes to the advancement of knowledge in rehabilitation. Few studies have gone this far in documenting a multidisciplinary and holistic rehabilitation program and in understanding the relation between its effects and care processes.

Background People with rheumatic or neurologic conditions are commonly referred for occupational therapy because of decreased ability to perform ADL tasks. Upon referral, occupational therapists use a client-centred, occupationfocused approach when evaluating a person's perceived and observed quality of ADL task performance to clarify the nature and extent of the person’s problems, plan interventions and determine effectiveness of interventions. Evaluation of the extent of problems and change following intervention require the use of linear measures of ADL. The aim of this doctoral thesis was to develop and validate linear measures of perceived and observed quality of ADL task performance for occupational therapy clinical praxis and research. Methods To develop linear measures of observed quality of ADL task performance based on Rasch measurement methods, clients with ABI (n=70) were evaluated using a 3-category rating scale and the ADL Taxonomy. Similarly, to develop linear measures of perceived quality of ADL task performance women with rheumatic diseases (n=118) reported their ability on a questionnaire and in an interview based on the ADL Taxonomy and a 4- category rating scale. To further validate the ADL ability measures of the Assessment of Motor and Process Skills (AMPS) data were collected in two samples. In a sample of women with chronic widespread pain (CWP) or fibromyalgia (FM) (n=50) the ADL ability measures were validated with regard to discrimination, stability and sensitivity to changes. Discrimination was examined by comparing AMPS data from women with CWP/FM to those of healthy women. Stability and sensitivity to change were examined based on repeated AMPS observations pre and post intervention. In addition, sensitivity to change was examined in a sample of clients with ABI (n=36) using a pre- and post-test design. Finally, the validity of the AMPS ADL ability measures in relation to perceived ADL ability was examined in women with rheumatic diseases (n=118) and women with CWP/FM (n=50). Results Based on the results of the four studies in this thesis, we were able to conclude that it was possible to obtain linear measures of observed quality of ADL task performance based on a revised version of the ADL Taxonomy (ADL-O). It was also possible to obtain linear measures of perceived quality of ADL task performance based on revised versions of the ADL Taxonomy using the formats of questionnaires (ADL-Q) and interviews (ADL-I). Moreover, it was possible to establish further evidence of validity of the ADL ability measures of the AMPS. Thus, the AMPS ADL ability measures could discriminate between women with CWP/FM and healthy women. The ADL ability measures of remained stable when no intervention was provided and the ADL motor ability measures were sensitive to change among women with CWP/FM. Moreover, the ADL ability measures were sensitive to change among clients with low ADL ability following ABI. Finally, only low to moderate correlations were found between measures of perceived and observed ADL ability. Conclusions Rasch analyses of revised versions of the ADL Taxonomy suggest that the majority of the ADL tasks and rating scales focused on quality of ADL task performance can be used to obtain linear measures of quality of ADL task performance based on methods of questionnaire, interview or observation. Furthermore, the studies provided evidence of validity of the ADL ability measures of the AMPS in relation to discrimination, stability and sensitivity to change and relation to perceived ADL ability. The results may, therefore, enhance the use of ADL instruments that provide linear measures of perceived and observed quality of ADL task performance in occupational therapy clinical praxis and research.

The researcher has a daughter who was born with an encephalocele and her neuropsychological assessment indicates a Nonverbal Learning Disability (NLD). The difficulties of the educational experiences that emerged over time, mainly because her learning profile was not understood, prompted reflection on the consequences for other students who present with this profile. A concern for the long-term implications for students and parents of the frequent misunderstandings of the NLD has inspired this study. A review of the literature suggested a need to raise educator awareness about the subtle but disabling nature of the NLD syndrome. This study explored the perceptions of teachers, teacher aides and parents involved with 5 students who showed hallmark signs of an NLD. The theoretical foundation rests in the understanding that a student's learning experiences are influenced by past and present school experiences, the attitudes of peers, and parental expectations. The purpose of this thesis is to help parents, teachers and others appreciate the school experiences of children at Level 1 risk of developing an NLD, those with a hydrocephalic condition. It does not purport to offer ultimate solutions or to contribute to diagnosis but rather to act as a starting point for a body of theory to guide development of suitable learning environments for such children. Of further importance is emphasis on the need for similar studies to be conducted into the learning experiences of other children who demonstrate specific syndromes or mosaic forms of those syndromes. Naturalistic Inquiry methodology was used to explore the educational experiences of five students who attended different Australian schools. After completion of all interviews, psychological testing assessed general intelligence and the NLD status of each student. All students were found to be severely learning disabled and all were high on the NLD parameter. Educators generally did not reveal understanding of the NLD syndrome &quotNonverbal, what is it? So is it a visual ..." Some teachers devised innovative strategies to help the student cope in class while others expressed frustration ... if the traditional instruction &quotdoesn't work either, what does?" What stood out was an absence of understanding about nonverbal deficits. Frustration about poor organisation, decision making, task completion and problem-solving was expressed and a mixture of concern and criticism was levelled at social incompetence. Students who could not work independently were perceived by some teachers and aides as &quotlazy" or &quotmolly-coddled" and problems with everyday living skills were sometimes blamed on the student's family. Findings revealed a compelling need to raise educator awareness about the range of cognitive, learning and social problems associated with shunted hydrocephalus and spina bifida. They also highlighted a need for teachers to question &quotWhy can't this student do things one would expect they could do" and demand answers that explicate the serious difficulties being experienced.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.