Interdisciplinary facilitation of the minimal participation of patients with severe brain injury in early rehabilitation

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Aim: The purpose of the study was to shed light on the participatory aspect of early rehabilitation, when contact, communication and interaction between the patients and the professionals is minimal, because of the patients’ severe brain injury and complex conditions.Methodology: A qualitative study was chosen. The field study involved five patients (aged 39–64) and included: participant observation and video recordings of 41 rehabilitation situations, five individual interviews and one focus group interview with multidisciplinary rehabilitation experts; together with document review of hospital charts and memos. The data were analyzed using a four-step phenomenological analysis and NVivo 10.Major findings: Participation comes into play in various practices around the patient. Three main themes seem to be important: (1) The dynamic interplay of the multidisciplinary team as an element that influences participation, (2) significant relational encounters and meetings as aspects that impact on the promotion of participation, and (3) significant frameworks that affect involvement, engagement and participation.Principal conclusion: Patients’ participation and recovery are facilitated by a combination of the clinicians’ professional skills, their ability to create a rehabilitation environment in which patients can perform activities, the right framework for the meeting, and a suitable approach, to facilitate fruitful interaction with the patients.