number of questions about Occupational Therapy, severe brain injury
Will an investigation of occupation be more helpful than
an investigation of neurology for this approach?
A knowledge of neurology is an essential component of any work
done with people with brain injury as factor which is to be
taken into account. However, this knowledge is not the focus
of the practice when the need is identified for occupation.
If this is the need which is identified then a study and understanding
of occupation is more helpful.
How do you know how to go on when working with a client
with an occupational predicament?
You gain your cues from your past and from the situation in
which you find yourself, especially the latter. Once you get
started, you keep on going doing whatever it is that needs to
be done. And then you stop when it is done. You know how to
keep on going because you have had success in one thing and
this begins to provide the cues for the next thing to be done.
If you are really stuck you find someone who is able to help
How do you know how to go on as a practitioner with an
You diagnose the origin of dysfunction as being one of lack/distortion
of engagement, and spend time gaining a thorough understanding
of the situation the client is in. Then you take your part as
a full participant within that situation. You know how to go
on because you heed the situation and have the kind of knowledge
that means you understand what needs to be done.
The kinds of things that the practitioner would heed include:
the ambience of the activity and all the things that are associated
with it; the ergonomics necessary to ensure the success of the
activity; the kind of communication that is generated by the
activity and that which is supportive of it; the ways that the
meaning of the activity is manifested over time.
Who is the client?
The client is someone who does not know how to go on and who
has not got the resources in their immediate environment to
find a way out of their predicament.
Who is the practitioner?
The practitioner is someone who can identify and meet the need
for occupation in others.
What do they do?
They both take their parts in a situation. The client is occupied
in doing what needs to be done in his life, the practitioner
is occupied in facilitating the process of engagement for the
As I wrote this conclusion I was entering into my third year
of working with Barry. Remembering the film ‘Benny and Joon’,
I cannot say that he has found his ‘Sam’ yet. But,
like Joon in the film, he has come to need less support and he
has got more life. He already needs much less support than I described
in this thesis, but I cannot imagine a time when he will need
no support. He said to me recently that he had a social network
now, which suggests that he is beginning to be part of a community.
The neuropsychologist who reassessed him could find no significant
changes in his clinical scores, and yet his life is very different.
I can only now imagine the possibility of a fulfilled and meaningful
life for him, in a way that I could not a few years ago. I have
hope for him now and in conceiving that hope I have changed the
way that I see the world. However, in spite of all this, it is
still very difficult to get him out of bed!
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