Guidance & Direction: Occupational Therapy in Brain Injury Rehabilitation
Blackwood, Karen, Wilson, Linda H., New Zealand Journal of Occupational Therapy
Guidance for practice comes in a variety of forms. Many of us, as new graduates, will be guided by an occupational therapist who we consider an expert and exudes experience and know-how. Consequently, their way is often adopted and becomes our way, our practical skill or craft, underpinned by our own beliefs and developing experience. Other guidance comes in the form of literature sources: texts and peer-reviewed articles describing the variety of interventions and approaches that may be appropriate for a given client group. In recent times, with the emergence of evidence-based practice (EBP) we have also become more aware and mindful of, the need to base our practice on sound and credible evidence, not just on our individual beliefs and experience (Dickson, 2002).
The area of brain injury rehabilitation is presumably no different from other areas of occupational therapy practice as being one in which clinicians need both guidance and direction. In this article, the term direction is used to relate to existing clinical evidence that, within professional clinical reasoning and judgement, could be expected to direct the nature of interventions that are used or not used. Guidance refers to the broader range of information, clinical and professional, that a clinician will take into account when developing or providing services. Clinicians need to be aware of the right approach and the preferable form of intervention for their clients in order to deliver best practice. This article explores formal sources of guidance and direction for therapists, drawing on selected publications related to acquired brain injury rehabilitation over the past ten years. Acquired brain injury (ABI) includes both traumatic brain injuries such as a closed head injury as well as non-traumatic brain injuries such as stroke. Both types of ABI will be referred to in this article. The issues arising for both therapists and students striving to develop, and deliver, best practice in this field will be discussed. Additionally, the article examines present day practices in relation to current published approaches and proposes the establishment of a 'community of practice' to facilitate guidance in brain injury rehabilitation.
Brain injury rehabilitation is an exciting area of practice for occupational therapists and one in which the diversity and variability of problems clients present pose a range of challenges for both therapists and researchers seeking to investigate and follow best practice (Rice-Oxley & Turner-Stokes, 1999). Each year in New Zealand approximately 7,600 people have a stroke (New Zealand Guidelines Group, 2003). Further, national and international data suggest there are between 20,000 to 30,000 cases of traumatic brain injury per year in this country (New Zealand Guidelines Group, 2006).
Over the past two decades, there have been many changes in the management of people with brain injury. Much of this change has occurred as a result of research providing clearer evidence of what constitutes best practice alongside the growing movement of EBP. EBP requires the careful and thorough application of current best evidence to aid in clinical decision making around the care of clients (Taylor, 2007). In the areas of stroke rehabilitation for example, the research has been influential in re-evaluating the settings in which people with stroke are best managed (Langhorne & Pollock, 2002; Walker, Gladman, & Lincoln, 1999). In addition, the literature discusses who is involved in that management, and at what point in the recovery process active involvement should begin.
In a number of countries, including New Zealand, guidelines have been written by a variety of agencies with the aim of providing guidance to both professionals and managers around best practice (Intercollegiate Stroke Working Party, 2004; New Zealand Guidelines Group, 2003, 2006; Scottish Intercollegiate Guidelines Network, 2002). …