Life goals in residential rehabilitation: interpretive phenomenological analysis of the experiences of people with complex acquired brain injury.

Abstract

Background and purpose: There is the need for research exploring goal adjustment processes in the context of complex neurological impairment. This is particularly evident for people with cognitive and communication issues who have a limited voice within the body of life goal literature. This investigation explored the experience of people with complex acquired brain injury, regarding the role of life goals within the context of being a recipient of residential rehabilitation services.

Methodology: Five people (three women and two men) with acquired brain injury (ABI) were interviewed using semi-structured interviews. These interviews were recorded, transcribed and subject to Interpretative Phenomenological Analysis (IPA).

Results: The supraordinate themes emerged capturing how participants’ perceptions of the facilitators and barriers to life goal achievement were connected and dynamically balanced. Within the results there was a strong emerging theme related to the importance of social connectedness. This was reflected in first theme ‘Being part of things’ and was related to the desire for all participants to be actively integrated, connected and encountering within their social relationships and as citizens of the world. The other two themes referenced a dynamic interplay existing between interpersonal factors related to an ‘Unchanged, changed and changing’ self, and the presence or absence of ‘Opportunities arising’ in the participants’ milieu.

Discussion: Participants’ narratives in the present study support a growing body of literature highlighting a need to focus on the role of social identity and the environment in the delivery of person-centred rehabilitation services for people with ABI. If we are to support people to achieve their life goals following a severe ABI, then we will need to continue to develop theoretical frameworks and interventions that better support people in terms of social relationships and social identity throughout their lives. There is also a need to be aware that the person’s milieu is susceptible to change even after severe ABI and that people in residential care following ABI require increased environmental support and creative solutions to facilitate life goal attainment. Recommendations for providing a rehabilitation service that can better support people to live well with a brain injury throughout their lives include the following: regular, in depth and open discussions in which individual’s values and preferences are discovered; a focus on facilitating coherence between daily activities and the person’s life goals; and consideration of how an individual’s life goals change and are reprioritised over time. Attention to life goals will allow future research and theory to be more representative of, and responsive to, the experiences of people who need to access services and support following an ABI.