School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada.
Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada.
Aust Occup Ther J. 2024 Feb;71(1):35-51. doi: 10.1111/1440-1630.12906. Epub 2023 Oct 5.
Individuals with traumatic brain injury (TBI) frequently need assistance to manage complex everyday activities. However, little is known about the types of cognitive assistance that can be used to facilitate optimal independence. A conversion mixed method study using video analysis was conducted to describe assistance provided by trained occupational therapists during three everyday tasks carried out in the participants' homes and surrounding environments.
Forty-five people with moderate and severe TBI were tested by three occupational therapists using the Instrumental Activities of Daily Living Profile, an observation-based assessment that documents independence in complex everyday activities and the minimal assistance required to attain task goals. Using video analysis, difficulties experienced by the people with TBI during a meal preparation and grocery shopping task, and the cognitive assistance provided by the occupational therapists in response to these difficulties, were documented. Statistical analyses were also completed to identify the main difficulties and types of cognitive assistance provided during the evaluation, for the whole group and depending on their level of independence.
Nine types of cognitive assistance were used by occupational therapists, including implicit (stimulating thought processes), and more explicit assistance (cueing), to facilitate task performance. When needed, motivational assistance, which consisted of encouraging participants to think for themselves, was also used. Stimulating thought processes was mostly used to support goal formulation and planning, whereas cueing was used in numerous instances. Participants with lower levels of independence received more assistance of almost all types to support them.
Using these findings, training could be developed for caregivers and occupational therapists to support them in providing minimal and personalised cognitive assistance. Further research is needed to examine the extent to which all types of cognitive assistance are effective in helping various cognitive profiles of people with TBI attain optimal independence.
患有创伤性脑损伤 (TBI) 的个体经常需要帮助来管理复杂的日常活动。然而，对于可以用来促进最佳独立性的认知辅助类型知之甚少。本研究采用视频分析的转换混合方法，描述了经过培训的职业治疗师在参与者家中和周围环境中进行的三项日常任务中提供的帮助。
45 名中重度 TBI 患者由 3 名职业治疗师使用日常生活活动工具包（一种基于观察的评估工具）进行测试，该评估记录了复杂日常活动中的独立性和实现任务目标所需的最小帮助。使用视频分析记录了 TBI 患者在准备膳食和杂货店购物任务中遇到的困难，以及职业治疗师针对这些困难提供的认知帮助。还完成了统计分析，以确定整个组在评估过程中遇到的主要困难和提供的认知帮助类型，以及根据他们的独立性水平。
职业治疗师使用了九种认知辅助类型，包括隐式（刺激思维过程）和更显式辅助（提示），以促进任务表现。在需要时，还使用了动机性辅助，包括鼓励参与者独立思考。刺激思维过程主要用于支持目标制定和计划，而提示则在许多情况下使用。独立性较低的参与者接受了几乎所有类型的更多帮助来支持他们。
利用这些发现，可以为护理人员和职业治疗师开发培训，以支持他们提供最小化和个性化的认知帮助。需要进一步研究来检查所有类型的认知辅助在帮助不同认知特征的 TBI 患者实现最佳独立性方面的有效性。
