The body participating: a qualitative study of early rehabilitation participation for patients with severe brain injury and low level of consciousness

Abstract

Background: The literature on participation in rehabilitation by those with the most severe acquired brain injury is very sparse.

Objectives: The aim of this study was to explore how physiotherapists promote the participation of patients with severe brain injury in therapeutic and daily-life situations in early rehabilitation.

Methods: In a qualitative study employing phenomenological philosophy, several video-recorded sessions of patients with a Rancho Los Amigos Scale score of 3-4 were analysed. Empirical themes were identified by four different investigators through individual and consensus-based analyses. The results were theoretically stated and supported.

Results: In an effort to achieve patient participation, the following four themes seemed to be significant: 1) consciously encountering the patient in the moment, 2) the employment of concepts surrounding the interaction between body and environment, 3) timing and flow of the activities and 4) comprehensive bodily support, guidance and facilitation of the activity and participation in daily-life skills.

Conclusions: The dynamic use of these four themes seemed to enrich early rehabilitation interventions for patients with severe brain injury and low level of consciousness in terms of their participation and functioning in everyday life.

Keywords:

• Participation
• body schema
• phenomenology
• consciousness
• environment
• early rehabilitation
• physiotherapy

Acknowledgements

A special thank you goes to the patients included in this study, as well as the clinicians and the management at the Early Clinic, who opened the door and welcomed the research.

Disclosure statement

The study was supported by the Danish Physiotherapists’ Research Fund.