In search of self after stroke: a longitudinal qualitative study in the context of client-centred rehabilitation

Figures & data

Table I. The nine components of the client-centred activities of daily living (CADL)intervention.

The 1^st component was the first meeting with the client which aimed to create a relationship between the client and the occupational therapist (OT) based on trust. In the 2^nd component the client was observed when performing an activity. A combined strategy of collecting information from conversations and observations in actual practical situations was used by the OT to create a picture and an understanding of the client’s situation. The 3^rd component entailed scoring the activity together with the client using the Canadian Occupational Performance Measure (COPM) and to identify problem-solving strategies for successful performance of the chosen activity. In the 4^th component the client, together with the OT formulated goals by using the COPM. In the 5^th component the OT was using a Goal-Plan-Do-Check strategy to guide the client in the discovery and formulation of an intervention plan to meet the goals. In the 6^th component the client was introduced to using a diary as a structure for training. In the 7^th component Reporting and involving others the OT supported the client to inform persons related to them, e.g., significant others, staff members at the rehabilitation clinic about their goals and planned strategies for the CADL intervention. In the 8^th component the client was training to perform and integrate activities by using the global problem-solving strategy as a structure for doing in a new way. The clients practiced the chosen activities named in the intervention plan using the planned strategies, both on their own and with the OT. The 9^th component included a session in which the OTs and the clients evaluated the goals, reviewed the strategies, and then formulated new goals to facilitate transfer of learning to activities and situations outside therapy.

Figure 1. The “new” self becomes reality through challenging everyday experiences.

Table II. Overview of the participant characteristics.

ID #	Sex	Age	Living situation	Barthel Index before stroke^†	Barthel Index after stroke^†	Stroke hemisphere	Speech limitation after stroke
A	Male	61	Lived with wife	100	40	Left	None
B	Male	63	Lived alone	100	10	Left	Limited vocabulary
C	Male	60	Lived with wife	100	85	Left	None
D	Male	53	Lived with wife and children	100	30	Left	None

^†Barthel Index, range 0–100