Exploring verbal assistance used by occupational therapists to improve financial management skills after brain injury: A case study

Abstract

Cognitive difficulties following a brain injury can impact an individual's capacity to complete activities of daily living (ADLs). Combining metacognitive strategies, such as those parts of the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach and assistive technology for cognition (ATC) can facilitate financial management (Poncet, 2017). The objective of this study was to examine how the COOP approach was implemented by paying attention to the type of verbal assistance (VA) provided by the therapist throughout the intervention and how it affected the participant's process of taking ownership of the CO-OP approach and therefore improving his ability to manage his finances. Case study of a 41-year old man, XC, who suffered a moderate traumatic brain injury (TBI). He participated in 10 individual therapy sessions where he learned to use CO-OP in combination with ATC. Throughout the sessions, an emphasis was placed on his personal goal of managing his grocery expenses. A qualitative analysis of the verbatim of the therapist-client interactions was completed. Two (representative) extracts from sessions 6 (first independent use of CO-OP) and 9 were selected to illustrate how XC established a goal to improve the management of grocery expenses. The quantity and type of VA changed between sessions 6 and 9 (i.e. n = 8 VA to 2). In session 6, the therapist provided several restarting and scaffolding assistances in order for XC to formulate a goal (Le Dorze, 2014). However, in session 9, the therapist only used restarting and explicit advice to support XC in formulating a goal, indicating improvement. This study begins to fill a gap with regards to the use of CO-OP by examining how a therapist assisted an individual with TBI in taking ownership of cognitive strategies for managing expenses. A more in-depth understanding of the use of VA could benefit therapists in their clinical practice.