Date of Award

2009

Document Type

Scholarly Project

Degree Name

Master of Occupational Therapy (MOT)

Department

Occupational Therapy

First Advisor

Jan Stube

Keywords

Brain Injuries -- rehabilitation; Child; Social Support

Abstract

Children and adolescents who sustain a traumatic brain injury (TBI) demonstrate changes in personality, such as mood swings, irritability, impulsivity, argumentative behaviors, decreased frustration tolerance, and difficulty cooperating (Prigatano & Gray, 2007; Prigatano & Gray, 2008; Souza, Braga, Filho, & Dellatolas, 2007). These clients also have an increased susceptibility to psychiatric disorders, including mood and anxiety disorders, later in the lifespan as physical and cognitive demands increase (Koponen et al., 2002; Luis & Mittenberg, 2002; Viguier, Dellatolas, Gasquet, Martin, & Choquet, 2001). Despite these substantial risk factors, a significant number of children and adolescents continue to have unrecognized or unmet behavioral, emotional, and social needs as a result of inadequate mental health services (Greenspan & MacKenzie, 2000; Hawley, 2004; Slomine, McCarthy, Ding, MacKenzie, Jaffe, Aitken, et al., 2006; Souza et al., 2007). Therefore, the purpose of this scholarly project was the development of a clinical guide for occupational therapy (OT) practitioners in pediatric rehabilitation settings that provides a framework to address psychosocial issues experienced by pediatric clients with TBIs.

An extensive review of developmental, educational, medical, psychological, occupational therapy, and rehabilitation literature was conducted to examine the psychosocial symptoms associated with pediatric TBI. Subsequently, the impact depression and mood disorders, personality and cognitive-behavioral changes, impaired social skills, and decreased self-esteem/self-efficacy have on occupational functioning was considered. The need for OT programs to address psychosocial impairments with pediatric clients who have sustained a TBI was supported by findings that there is a high unmet need for services that address mental health issues following a head injury (Greenspan & MacKenzie, 2000; Hawley, 2004).

As a result of the literature findings, a clinical guide for OT practitioners was created to help practitioners incorporate psychosocial issues into the evaluation, intervention planning, and intervention implementation processes. The clinical guide encompasses information regarding relevant background information on TBI, psychosocial symptoms, OT practitioner’s holistic role in addressing psychosocial symptoms, pediatric psychosocial assessments, sample goals, and interventions that address psychosocial deficits. The OT Practice Framework, 2nd ed. (2008), Occupational Adaptation frame of reference, and the adult learning theory were used to help structure the clinical guide in a manner that is meant to assist OT practitioners through the clinical reasoning process in providing holistic, client-centered care to the pediatric client and his or her family. Reproducible handouts, including educational materials for family members and school professionals, were also provided in a workbook format.

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