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Occupational therapy research method

The focus of the work which I did as a coordinator was determined by the needs which I identified Barry as having after an extended period of observation. It was clear to me that he had a need for occupation which was not being met and I set about meeting this need in the work I did with him. The research questions sprang directly from the work which I was doing as a practitioner. A description of the method is given to allay any ethical concerns which arise when practice and research are so closely alligned.

Having worked with him for ten months I wrote an account of the first couple of months that I had worked with him. Before writing this account I spent an intense period looking through the daybooks which were written as a record to be shared between the team of facilitators and through the journals which I had kept daily. I made notes and graphs analysing aspects of what he did and didn’t do in great detail, before abandoning these and simply began to what I remembered, on the premise that what I remembered was what was significant to me as a practitioner. As I developed this account I realised that I was experiencing it as a series of stories, each with their own denouement. At the time of writing them, the stories were not intended to be used as part of the research, they came to me very easily and fluidly as a product of the intense involvement which I had had with the protagonist. In a sense, they presented themselves to me as stories which I simply had to tell because of my deep involvement.

I began to write a commentary which was shaped by my understanding of what the stories were saying to me in the light of what I was now understanding from my continued involvement with the protagonist. I also added a couple of stories, but these did not seem to require comment in the same way. The first one came from a presentation which Barry, Margaret and I did at an occupational therapy conference. In the leadup to this conference I realised that I could not speak about Barry as a subject while my prime responsibility to him was as a practitioner, so I invited both his mother and himself to present with me. I was pleased with his ease in the situation and the first story gives some of the context for the rest, while allowing his voice to be heard more clearly.

It was a breakthrough for me to realise that my research was constantly informing my practice and was not something separate. This process continued and my research from this point became a continuing process of reflecting, which regularly fed back into my practice. The last story, about the supported employment situation, was added during the course of the final writeup, when I realised that I needed a counterpoint to the work stories. There were many more stories which could have been told, but this one illustrated something which had a significant relationship with the original stories. It rounded the other stories off in a way which felt satisfying and necessary and this seemed like a good point to bring the work of this thesis to a halt.

It seemed to me that I had begun with a need and ended up with demonstrating that this need had been met in some way. At this point I intensified my reading in an attempt to find a framework which would elucidate what I had done and found that a framework based on occupation was within my grasp.

The discussion is an attempt to draw together some of the ways that the content of the stories illustrate this occupation framework. The stories allude to occupation constantly. I also discovered that the stories were in themselves a demonstration of the occupation that I was doing with Barry. This notion of the way that reflection is part of occupation was an important one in shaping the way that this thesis was presented.

Evidence of efficacy of occupational therapy in working with severe brain injury

In the first place it was necessary to do a thorough assessment of the situation, which I was well qualified to do from my previous experience as an occupational therapist working with severe brain injury and having had occasional contact with Barry over the course of three years. Regardless of the approach which would subsequently be used it was essential that the assessment move away from the clinical approach which had so resolutely failed to produce results over the past several years. He had been massively over-assessed and underprovided for, and therefore there was never any question of using a standardised or clinical form of assessment. I assessed the situation therefore as a participant observer, a method which I was adequately qualified to use, both from my training as a therapist and as a folklorist.

As a therapist and coordinator it was not possible to remain in the position of observer for very long, even if this had been desirable. I had to become a participant, with the emphasis on the participation. The mode of participation was strongly influenced by the occupation framework which was taught at the school of Occupational Therapy where I was working. This was to say that I was persuaded to participate in the activity with him, with the intention of seeing where it would lead. As a practitioner I had to remain open to possibility that other approaches might be more appropriate. My experiences as a clinician and subsequently as a lecturer in neurorehabilitation ensured that I was qualified to make a judgement about the most appropriate method to use at all times. I did in fact use a couple of other approaches at different times, but the predominant one is that described in this thesis.

I believe that the method that I used ensured that the my primary responsibility as a practitioner was not interfered with in any detrimental way. Over the course of time I found a way in which my research could actually feed positively into my work as a practitioner. I believe that the conference presentation was an illustration of the fact that I did not allow a conflict of interest to ensue, but always put his needs first and found that there could be a happy coincidence in our objectives at times. Our relationship has not been boundaried by the research that I am doing and has continued long after the completion of this particular piece of work.

The boundaries that are around our relationship are practice boundaries, which put his needs before my own. It would not have been right to bring our relationship to a close with the end of a particular piece of academic work. Finally, I hope that I have given enough evidence in the stories to show that the focus on occupation which I brought to my work was in his best interests. In corroboration of this I quote the neuropsychologist report which was written after I had been working with him for about 18 months:

It is my opinion that Barry has shown some significant gains in the past 3 years, considering the nature and extent of his disabilities. The methods currently being employed are likely to be responsible for much of this gain, and would, in my view, be the best way to maximise future gains.

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