Liddle Jacki, Hayes Rebecca, Gustafsson Louise, Fleming Jennifer
UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.
Aust Occup Ther J. 2014 Aug;61(4):215-23. doi: 10.1111/1440-1630.12119. Epub 2014 Feb 28.
BACKGROUND/AIM: The ability to drive safely can be affected by an acquired brain injury. Following acquired brain injury, clients may experience driving disruptions, formal assessment, return to driving or permanent cessation. Health professionals may be involved in formal driving or component skills' assessment and rehabilitation, or interventions for continued community participation. Meeting the needs of clients related to driving remains a challenging area of clinical practice. The aim of this study was to investigate how driving issues are currently managed by acquired brain injury rehabilitation teams.
This study utilised a qualitative phenomenological approach to gain insight into the approaches undertaken by four rehabilitation teams working with clients post-acquired brain injury. Semi-structured, audiotaped interviews were conducted with 25 participants who had identified driving as part of their role.
Health professional participants described three major areas of clinical focus, describing strategies and challenges associated with each. These were as follows: 'Integrating driving goals into rehabilitation' which involved optimising timing and acknowledging the clients' focus on driving while enhancing driving and rehabilitation outcomes; 'Managing emotional responses' which required protecting therapeutic relationships and providing information, as well as responding to more extreme responses; and finally 'Managing unlicensed driving and meeting long-term needs', which participants identified as the most challenging aspect. Strategies involved using set procedures, building on knowledge of the client, supporting the family and exploring alternatives.
The teams described a range of strategies used to address the challenges related to driving and driving cessation which can be applied to successfully manage this issue in acquired brain injury rehabilitation.
背景/目的:后天性脑损伤可能会影响安全驾驶能力。后天性脑损伤后,患者可能会经历驾驶障碍、接受正式评估、恢复驾驶或永久停止驾驶。卫生专业人员可能会参与正式的驾驶或驾驶技能组成部分的评估与康复,或参与促进患者持续参与社区活动的干预措施。满足患者与驾驶相关的需求仍然是临床实践中一个具有挑战性的领域。本研究的目的是调查后天性脑损伤康复团队目前如何处理驾驶问题。
本研究采用定性现象学方法,以深入了解四个为后天性脑损伤患者提供服务的康复团队所采用的方法。对25名将驾驶视为其角色一部分的参与者进行了半结构化的录音访谈。
卫生专业人员参与者描述了三个主要临床关注领域,并阐述了与之相关的策略和挑战。具体如下:“将驾驶目标纳入康复过程”,这涉及优化时间安排,承认患者对驾驶的关注,同时提高驾驶和康复效果;“管理情绪反应”,这需要维护治疗关系、提供信息,以及应对更极端的反应;最后是“管理无照驾驶和满足长期需求”,参与者认为这是最具挑战性的方面。策略包括采用既定程序、基于对患者的了解、支持家庭以及探索替代方案。
这些团队描述了一系列用于应对与驾驶及停止驾驶相关挑战的策略,这些策略可应用于成功管理后天性脑损伤康复中的这一问题。