Occupational performance priorities and outcomes in long-term transitional rehabilitation for young adults with acquired brain injury

Authors

  • Charlotte Heurlin Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
  • Marie-Louise Schult Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden https://orcid.org/0000-0002-3141-4009
  • Aniko Barfai Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden https://orcid.org/0000-0002-0815-2485
  • Annelie Rosén Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden https://orcid.org/0000-0003-0613-730X
  • Jan Ekholm Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
  • Monika Löfgren Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden https://orcid.org/0000-0002-8701-0206

DOI:

https://doi.org/10.2340/jrm.v58.45144

Keywords:

rehabilitation, acquired brain injury, comprehensive rehabilitation, young adults, Canadian Occupation Performance Measure (COPM), Glasgow Outcome Scale-Extended interview (GOSE)

Abstract

Background: In a new long-term transitional rehabilitation service following acquired brain injury, occupational performance problems are analysed.

Aim: The objective was to describe these problems and the participants’ prioritization, and also to describe the changes between admission and discharge. Another objective was to describe changes in assessed independence-related disability.

Design: Observational clinical study.

Patients: Young adults (18–25 years), (n = 46), who had earlier undergone traditional medical rehabilitation following acquired brain injury.

Methods: The Canadian Occupational Performance Measure (COPM) was used on both admission and discharge. Independence-related general disability was assessed using the Glasgow Outcome Scale–Extended (GOSE).

Results: Patients identified 122 occupational performance problems as important. Most problems were in socialization (3/7), community activities (1/3), and finding paid or unpaid work (1/4).

Self-rated levels of performance and satisfaction in COPM were significantly higher on discharge compared with admission. The range of GOSE scores increased from 4–6 to 4–8 between admission and discharge.

Conclusion: Young adults with acquired brain injury tend to prioritize rehabilitation goals to reduce difficulties in establishing relationships and/or in professional life. On discharge, ratings of implementation and satisfaction of performance were distinctly elevated, while assessed global disability was decreased.

Clinical rehabilitation impact: The results highlight the need for transitional rehabilitation for patient-centred remediating measures.

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References

Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health 2018; 2: 223–228. DOI: https://doi.org/10.1016/S2352-4642(18)30022-1

Gilmore N, Mirman D, Kiran S. Young Adults with acquired brain injury show longitudinal improvements in cognition after intensive cognitive rehabilitation. J Speech Lang Hear Res 2022; 65: 1494–1520. DOI: https://doi.org/10.1044/2021_JSLHR-21-00324

Worm MS, Kruse M, Valentin JB, Svendsen SW, Nielsen JF, Thomsen JF, et al. Acquired brain injury among adolescents and young adults: a nationwide study of labor market attachment. J Occup Rehabil 2023; 33: 592–601. DOI: https://doi.org/10.1007/s10926-023-10097-4

Todis B, Glang A, Bullis M, Ettel D, Hood D. Longitudinal investigation of the post-high school transition experiences of adolescents with traumatic brain injury. J Head Trauma Rehabil 2011; 26: 138–149. DOI: https://doi.org/10.1097/HTR.0b013e3181e5a87a

Keetley R, Radford K, Manning JC. A scoping review of the needs of children and young people with acquired brain injuries and their families. Brain Inj 2019; 33: 1117–1128. DOI: https://doi.org/10.1080/02699052.2019.1637542

Keetley R, Manning JC, Williams J, Bennett E, Westlake M, Radford K. Understanding barriers and facilitators to long-term participation needs in children and young people following acquired brain injuries: a qualitative multi-stakeholder study. Brain Impair 2024; 25. DOI: https://doi.org/10.1071/IB23100

Young NL, Barden WS, Mills WA, Burke TA, Law M, Boydell K. Transition to adult-oriented health care: perspectives of youth and adults with complex physical disabilities. Phys Occup Ther Pediatr 2009; 29: 345–361. DOI: https://doi.org/10.3109/01942630903245994

van Markus-Doornbosch F, van der Holst M, de Kloet AJ, Vliet Vlieland TPM, Meesters JJL. Fatigue, participation and quality of life in adolescents and young adults with acquired brain injury in an outpatient rehabilitation cohort. Dev Neurorehabil 2020; 23: 328–335. DOI: https://doi.org/10.1080/17518423.2019.1692948

Leonard R, Linden MA, Holloway M. Case management for acquired brain injury: a systematic review of the evidence base. Brain Inj 2025; 39: 337–358. DOI: https://doi.org/10.1080/02699052.2024.2438785

McKinlay A, Linden M, DePompei R, Aaro Jonsson C, Anderson V, Braga L, et al. Service provision for children and young people with acquired brain injury: Practice recommendations. Brain Inj 2016; 30: 1656–1664. DOI: https://doi.org/10.1080/02699052.2016.1201592

Botchway-Commey E, Muscara F, Greenham M, D’Cruz K, Bonyhady B, Anderson V, et al. Rehabilitation models of care for children and youth with traumatic brain and/or spinal cord injuries: a focus on service structure, service organization, and the barriers and facilitators of rehabilitation service provision. Neuropsychol Rehabil 2023; 33: 1697–1727. DOI: https://doi.org/10.1080/09602011.2022.2147196

Enemark Larsen A, Rasmussen B, Christensen JR. Enhancing a client-centred practice with the Canadian Occupational Performance Measure. Occup Ther Int 2018; 2018: 5956301. DOI: https://doi.org/10.1155/2018/5956301

Donnelly C, Eng JJ, Hall J, Alford L, Giachino R, Norton K, et al. Client-centred assessment and the identification of meaningful treatment goals for individuals with a spinal cord injury. Spinal Cord 2004; 42: 302–307. DOI: https://doi.org/10.1038/sj.sc.3101589

Kirsh B, Cockburn L. The Canadian Occupational Performance Measure: a tool for recovery-based practice. Psychiatr Rehabil J 2009; 32: 171–176. DOI: https://doi.org/10.2975/32.3.2009.171.176

Law M, Baptiste S, Carswell A, Polatajko H, Pollock N. Canadian Occupational Performance Measure. 5th ed. Ottawa: CAOT Publications ACE; 2014.

Cicerone KD, Goldin Y, Ganci K, Rosenbaum A, Wethe JV, Langenbahn DM, et al. Evidence-based cognitive rehabilitation: systematic review of the literature from 2009 through 2014. Arch Phys Med Rehabil 2019; 100: 1515–1533. DOI: https://doi.org/10.1016/j.apmr.2019.02.011

Cicerone K, Dams-O’Connor K, Eberle R, Fraas M, Ganci K, Langenbahn D, et al. Cognitive rehabilitation manual and textbook: translating evidence-based recommendations into practice. 2nd ed. Reston: ACRM Publishing; 2022.

Polatajko HJ, Mandich AD, Miller LT, Macnab JJ. Cognitive orientation to daily occupational performance (CO-OP): part II – the evidence. Phys Occup Ther Pediatr 2001; 20: 83–106. DOI: https://doi.org/10.1300/J006v20n02_06

Carswell A, McColl MA, Baptiste S, Law M, Polatajko H, Pollock N. The Canadian Occupational Performance Measure: a research and clinical literature review. Can J Occup Ther 2004; 71: 210–222. DOI: https://doi.org/10.1177/000841740407100406

Sohlberg MM, Mateer CA. Effectiveness of an attention-training program. J Clin Exp Neuropsychol 1987; 9: 117–130. DOI: https://doi.org/10.1080/01688638708405352

Wilson L, Boase K, Nelson LD, Temkin NR, Giacino JT, Markowitz AJ, et al. A Manual for the Glasgow Outcome Scale–Extended Interview. J Neurotrauma 2021; 38: 2435–2446. DOI: https://doi.org/10.1089/neu.2020.7527

Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1: 480–484. DOI: https://doi.org/10.1016/S0140-6736(75)92830-5

Ohno K, Tomori K, Sawada T, Kobayashi R. Examining minimal important change of the Canadian Occupational Performance Measure for subacute rehabilitation hospital inpatients. J Patient Rep Outcomes 2021; 5: 133. DOI: https://doi.org/10.1186/s41687-021-00405-y

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum; 1988.

Keptner KM, Rogers R. Competence and satisfaction in occupational performance among a sample of university students: an exploratory study. OTJR (Thorofare N J) 2019; 39: 204–212. DOI: https://doi.org/10.1177/1539449218813702

Ylvisaker M, Feeney T. Pediatric brain injury: social, behavioral, and communication disability. Phys Med Rehabil Clin N Am 2007; 18: 133–144, vii. DOI: https://doi.org/10.1016/j.pmr.2006.11.007

Plach HL, Sells CH. Occupational performance needs of young veterans. Am J Occup Ther 2013; 67: 73–81. DOI: https://doi.org/10.5014/ajot.2013.003871

Verhoef JA, Roebroeck ME, van Schaardenburgh N, Floothuis MC, Miedema HS. Improved occupational performance of young adults with a physical disability after a vocational rehabilitation intervention. J Occup Rehabil 2014; 24: 42–51. DOI: https://doi.org/10.1007/s10926-013-9446-9

Lindsay S, Stoica A. A systematic review of factors affecting driving and public transportation among youth and young adults with acquired brain injury. Brain Inj 2017; 31: 1257–1269. DOI: https://doi.org/10.1080/02699052.2017.1321140

Enemark Larsen A, Wehberg S, Christensen JR. Looking into the content of the Canadian Occupational Performance Measure (COPM): a Danish cross-sectional study. Occup Ther Int 2020; 2020: 9573950. DOI: https://doi.org/10.1155/2020/9573950

Bonn MM, Dickey JP, Moran B, McGuire S, Graham L. Completing an interdisciplinary outpatient intervention improves patient rehabilitation goals following a mild traumatic brain injury. Physiother Theory Pract 2023; 39: 310–316. DOI: https://doi.org/10.1080/09593985.2021.2022046

Lebrault H, Martini R, Manolov R, Chavanne C, Krasny-Pacini A, Chevignard M. Cognitive orientation to daily occupational performance to improve occupational performance goals for children with executive function deficits after acquired brain injury. Dev Med Child Neurol 2024; 66: 501–513. DOI: https://doi.org/10.1111/dmcn.15759

Wagman P, Håkansson C. Exploring occupational balance in adults in Sweden. Scand J Occup Ther 2014; 21: 415–420. DOI: https://doi.org/10.3109/11038128.2014.934917

Leufstadius C, Erlandsson LK, Eklund M. Time use and daily activities in people with persistent mental illness. Occup Ther Int 2006; 13: 123–141. DOI: https://doi.org/10.1002/oti.207

Håkansson C, Lissner L, Björkelund C, Sonn U. Engagement in patterns of daily occupations and perceived health among women of working age. Scand J Occup Ther 2009; 16: 110–117. DOI: https://doi.org/10.1080/11038120802572494

Eklund M, Leufstadius C, Bejerholm U. Time use among people with psychiatric disabilities: implications for practice. Psychiatr Rehabil J 2009; 32: 177–191. DOI: https://doi.org/10.2975/32.3.2009.177.191

COPM The Canadian Occupational Performance Measure. COPM responsiveness and clinically important change. [cited 2026 17 April] Available from: https://www.thecopm.ca/casestudy/responsiveness-of-the-copm/

Roe C, Skandsen T, Anke A, Ader T, Vik A, Lund SB, et al. Severe traumatic brain injury in Norway: impact of age on outcome. J Rehabil Med 2013; 45: 734–740. DOI: https://doi.org/10.2340/16501977-1198

Worm MS, Valentin JB, Johnsen SP, Nielsen JF, Forchhammer HB, Svendsen SW. Predictors of disability in adolescents and young adults with acquired brain injury after the acute phase. Brain Inj 2021; 35: 893–901. DOI: https://doi.org/10.1080/02699052.2021.1927183

Norup A, Svendsen SW, Doser K, Ryttersgaard TO, Frandsen N, Gade L, et al. Prevalence and severity of fatigue in adolescents and young adults with acquired brain injury: a nationwide study. Neuropsychol Rehabil 2019; 29: 1113–1128. DOI: https://doi.org/10.1080/09602011.2017.1371045

Pantelatos RI, Stenberg J, Follestad T, Sandrød O, Einarsen CE, Vik A, et al. Improvement in functional outcome from 6 to 12 months after moderate and severe traumatic brain injury is frequent, but may not be detected with the Glasgow Outcome Scale Extended. Neurotrauma Rep 2024; 5: 139–149. DOI: https://doi.org/10.1089/neur.2023.0109

Zuckerman DA, Giacino JT, Bodien YG. Traumatic brain injury: what is a favorable outcome? J Neurotrauma 2022; 39: 1010–1012. DOI: https://doi.org/10.1089/neu.2021.0356

Dikmen S, Machamer J, Miller B, Doctor J, Temkin N. Functional status examination: a new instrument for assessing outcome in traumatic brain injury. J Neurotrauma 2001; 18: 127–140. DOI: https://doi.org/10.1089/08977150150502578

Nelson LD, Magnus BE, Temkin NR, Dikmen S, Manley GT, Balsis S. How do scores on the functional status examination (FSE) correspond to scores on the Glasgow Outcome Scale-Extended (GOSE)? Neurotrauma Rep 2022; 3: 122–128. DOI: https://doi.org/10.1089/neur.2021.0057

Green L, Godfrey C, Soo C, Anderson V, Catroppa C. A preliminary investigation into psychosocial outcome and quality-of-life in adolescents following childhood traumatic brain injury. Brain Inj 2013; 27: 872–877. DOI: https://doi.org/10.3109/02699052.2013.775506

Published

2026-06-04

How to Cite

Heurlin, C., Schult, M.-L., Barfai, A., Rosén, A., Ekholm, J., & Löfgren, M. (2026). Occupational performance priorities and outcomes in long-term transitional rehabilitation for young adults with acquired brain injury. Journal of Rehabilitation Medicine, 58, jrm45144. https://doi.org/10.2340/jrm.v58.45144

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Original Report

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