Occupational resilience : an occupational therapy practice model facilitating high school participation post traumatic brain injury

Jacobs-Nzuzi Khuabi, Lee-Ann Juliana (2018-12)

Thesis (PhD)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : School participation may be disrupted post traumatic brain injury (TBI). Adolescents have to adjust to their developmental stage, multiple impairments and increased dependence resulting from the TBI. This combined with contextual factors may affect their school participation post TBI. There are no clear occupational therapy guidelines facilitating school re-entry post TBI and hence inconsistencies are noted in school transition practices. Furthermore, existing school transition programs for learners with TBI are informed by the recommendations of studies conducted in developed contexts. This study therefore sought to explore the perspectives on and experiences of adolescent high school learners’ school re-entry and school participation post TBI within a developing context. It was anticipated that this would provide an improved understanding of the enablers and barriers to high school participation post TBI. The main aim of this study was to develop a practice model with a view to improve service delivery that aims to adequately prepare and support learners for high school participation post TBI. The first phase of the study included a qualitative multi-case study. Each of the eight cases consisted of an adolescent learner, his/her primary care-giver, teacher and principal. Data collection methods included document analysis, semi-structured interviews and semi-structured observation. Analysis included an inductive process, combined with cross case synthesis. The findings indicated that personal, multi-system environmental and occupational factors served as both enablers and barriers to school re-entry and school participation post TBI. Learners reported that to overcome occupational challenges and participate in the occupation of school, required a process of adaptation (i.e. adapting for and through occupation). This process of adaptation required that learners draw upon internal resources as well as navigate and negotiate the availability and accessibility of personally and culturally relevant external resources. That is, it required a display of resilience from learners. A theory generative design promoted by Chinn and Kramer (2015) and Walker and Avant (2015), was used to conduct the second phase of the study. This included an analysis of the concept of occupational resilience that was uncovered in the first phase of the study. The second phase of the study further included the construction of relationship statements; a description of the model as well as the evaluation and operationalization of the model, i.e. Occupational Resilience: An Occupational Therapy practice model to facilitate high school participation post TBI. The practice model highlights that occupational therapists may promote resilience to facilitate the participation in valued occupation (i.e. promote occupational resilience). Occupational resilience may be facilitated through a series of resilience-promoting tasks that include cultivating resilience thinking, developing and employing strategies to overcome occupational challenges, engagement in occupation and fostering an enabling environment. The model further highlights that throughout the process of facilitating occupational resilience, it is necessary to create opportunities for the adolescent to display agency. The thesis concludes with recommendations for occupational therapy practice and education. Further recommendations to the Departments of Health and Education as well as the Road Accident Fund were explicated to facilitate optimum support provision for adolescent learners with TBI.

AFRIKAANSE OPSOMMING : Skooldeelname is 'n primêre Aktiwiteit wat na ‘n traumatiese breinbesering (TBB) ontwrig kan word. Adolessente moet aanpas by 'n verskeidenheid van inperkings en verhoogde afhanklikheid as gevolg van die TBB. Hierdie aanpassings - gekombineer met kontekstuele faktore - kan implikasies inhou vir hul deelname aan skoolaktiwiteite na TBB. Daar is geen duidelike arbeidsterapie-riglyne wat terugkeer skooltoe fasiliteer nie en daarom word daar teenstrydighede in skooloorgangspraktyke aangetref. Daarbenewens word bestaande programme wat skooloorgang ná 'n nuutverworwe besering ondersteun deur die aanbevelings van studies uitgevoer in ontwikkelde kontekste. Hierdie studie het dus gepoog om die perspektiewe en ervarings van hoërskoolleerders se skooltoetrede en skooldeelname ná TBB binne 'n ontwikkelende konteks te ondersoek. Daar is verwag dat dit 'n beter begrip sal bied van instaatstellers en hindernisse vir hoërskoolhervatting van skooldeelname deelname na TBB. Die hoofdoel van hierdie studie was om 'n praktykmodel te ontwikkel met die oog op die verbetering van dienste wat daarop gemik is om hoërskoolleerders voor te berei en te ondersteun om weer te kan inskakel by die skool na ‘n TBB. Die eerste fase van hierdie studie het 'n kwalitatiewe, meervoudige gevalstudie behels. Elkeen van die agt gevalle het bestaan uit 'n adolessente leerder, sy/haar primêre versorger, onderwyser en skoolhoof. Data-insameling is uitgevoer d.m.v dokument-analise, semi-gestruktureerde onderhoude en semi-gestruktureerde waarneming. Ontleding is uitgevoer d.m.v ‘n induktiewe proses, gekombineer met kruisgeval sintese. Die bevindings het aangedui dat persoonlike, multi-stelsel omgewings- en beroepsfaktore gedien het as beide instaatstellers en hindernisse vir die hertoetrede en deelname aan skoolaktiwiteite na TBB. Leerders het gerapporteer dat ten einde die uitdagings van skoolaktiwiteite te kan oorkom en om deel te neem aan die waardevolle Aktiwiteit van skoolgaan, 'n proses van aanpassing vereis, word d.w.s aanpassing in en deur Aktiwiteit. Hierdie aanpassingsproses verg dat leerders interne bronne moet inspan, en dat hulle die beskikbaarheid en toeganklikheid van persoonlike en kultureel-toepaslike eksterne bronne moet beding. Dit is dus nodig dat leerders se veerkragtigheid na vore tree. 'n Teoretiese generatiewe ontwerp wat deur Chinn en Kramer (2015) en Walker en Avant 2015) voorgestel is, is gebruik om die tweede fase van die studie uit te voer. Dit is gedoen deur middel van 'n analise van die konsep van Aktiwiteitsveerkragtigheid wat in die eerste fase van die studie onthul is. Die tweede fase van die studie het verder die konstruksie van verhoudingsverklarings; 'n beskrywing van die model sowel as die evaluering en operasionalisering/werking van die model, ingesluit, naamlik Aktiwiteitsveerkragtigheid: 'n Arbeidsterapie-praktykmodel om hoërskooldeelname na ‘n TBB te fasiliteer. Die model beklemtoon dat arbeidsterapeute veerkragtigheid kan bevorder om deelname in waardevolle aktiwiteite te fasiliteer. Aktiwiteitsveerkragtigheid kan fasiliteer word deur stelselmatige veerkragtigheids-bevorderende take soos bv. die aankweek van veerkragtigheidsrelevante denke, die ontwikkeling en gebruik van strategieë om uitgdagings te oorkom, deelname aan Aktiwiteite te bevorder en om ’n instaatstellende omgewing te skep. Verder beklemtoon die model dat daar gedurende hierdie fasilitering, geleenthede vir die adolessent geskep moet word om agentuur (agency) te toon. Die studie word afgesluit met aanbevelings vir arbeidsterapie praktyk en onderrig. Verdere aanbevelings aan die Departemente van Gesondheid en Opvoeding sowel as die Padongeluksfonds word uiteengesit ten einde optimale ondersteuning aan adolessent leerders met TBB te kan verseker.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105169
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