Research Reports - Disruption, adjustment and reconstruction of everyday occupations and work participation after mild traumatic brain injury

Disabil Rehabil. 2016 Nov;38(23):2296-304. doi: 10.3109/09638288.2015.1129445.
Epub 2016 Mar 23.

Sveen U(1,)(2), Søberg HL(1,)(2), Østensjø S(2).

PURPOSE: To explore traumatic brain injury (TBI) as a biographical disruption and
to study the reconstruction of everyday occupations and work participation among
individuals with mild TBI.
METHODS: Seven focus groups were conducted with 12 women and 8 men (22-60 years)
who had sustained mild TBI and participated in a return-to-work program.
Interviews were analyzed using qualitative content analysis.
RESULTS: Four interrelated themes emerged: disruption of occupational capacity
and balance; changes in self-perceptions; experience of time; and occupational
adjustment and reconstruction. The meaning of the impairments lies in their
impact on the individual's everyday occupations. The abandonment of meaningful
daily occupations and the feeling of not recognizing oneself were experienced as
threats to the sense of self. Successful integration of the past, present and
future was paramount to continuing life activities. The unpredictability of the
future seemed to permeate the entire process of adjustment and reconstruction of
daily life.
CONCLUSIONS: Our findings show that the concept of time is important in
understanding and supporting the reconstruction of daily life after TBI. The
fundamental work of rehabilitation is to ameliorate the disruptions caused by the
injury, restoring a sense of personal narrative and supporting the ability to
move forward with life. Implications for Rehabilitation Individuals with a
protracted recovery after a mild traumatic brain injury must reconstruct a new
way of being and acting in the world to achieve biographical continuity. The
perceived anxiety regarding changes in self and occupational identity, as well as
loss of control over the future, can be attenuated through informational sessions
during the hospital stay and at follow-up visits. The significant personal costs
of returning to full-time employment too early indicate the need for early and
ongoing vocational support in achieving a successful return to work. 

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