Biographical disruption, adjustment and reconstruction of everyday occupations and work participation after mild traumatic brain injury. A focus group study

Abstract

Purpose: To explore traumatic brain injury (TBI) as a biographical disruption and to study the reconstruction of everyday occupations and work participation among individuals with mild TBI.

Methods: Seven focus groups were conducted with 12 women and 8 men (22–60 years) who had sustained mild TBI and participated in a return-to-work program. Interviews were analyzed using qualitative content analysis.

Results: Four interrelated themes emerged: disruption of occupational capacity and balance; changes in self-perceptions; experience of time; and occupational adjustment and reconstruction. The meaning of the impairments lies in their impact on the individual’s everyday occupations. The abandonment of meaningful daily occupations and the feeling of not recognizing oneself were experienced as threats to the sense of self. Successful integration of the past, present and future was paramount to continuing life activities. The unpredictability of the future seemed to permeate the entire process of adjustment and reconstruction of daily life.

Conclusions: Our findings show that the concept of time is important in understanding and supporting the reconstruction of daily life after TBI. The fundamental work of rehabilitation is to ameliorate the disruptions caused by the injury, restoring a sense of personal narrative and supporting the ability to move forward with life.

Implications for Rehabilitation

• Individuals with a protracted recovery after a mild traumatic brain injury must reconstruct a new way of being and acting in the world to achieve biographical continuity.

• The perceived anxiety regarding changes in self and occupational identity, as well as loss of control over the future, can be attenuated through informational sessions during the hospital stay and at follow-up visits.

• The significant personal costs of returning to full-time employment too early indicate the need for early and ongoing vocational support in achieving a successful return to work.

Keywords:

• Daily life
• work
• occupations
• participation
• qualitative interviews
• vocational rehabilitation

Acknowledgements

The authors thank the participants in this study, as well as our leaders and colleagues in the traumatic brain injury team at the Department of Physical Medicine and Rehabilitation at the Oslo University Hospital.

Declaration of interest

The study is part of a ‘return to work’ project initiated by the Norwegian Directorate of Health and the Ministry of Labour and Social Affairs and funded by the Norwegian Ministry of Health and Care Services. The authors report no conflicts of interest.