Occupational Participation in Patients with Neurocognitive Impairments Postneurosurgical Intervention Using Functional-based Structured Cognitive Interventions: A Case Series

Abstract

Neurocognitive impairments are a common clinical manifestation in postoperative patients recovering in neurosurgery intensive care unit (ICU). Along with the specific cognitive impairments, patients are at risk of developing a number of ICU syndromes such as delirium, disorders of consciousness, physical weakness due to prolonged bed rest, and mental health consequences. This often leads to person’s occupational deprivation in the ICU and prevents early meaningful interaction with the environment. Keeping this in mind, we used functional-based structured cognitive interventions to facilitate early occupational participation in patients in neurosurgery recovery unit (NSRU) and promoted smooth transition to further rehabilitation postdischarge. The aim of this study was to assess the level of occupational participation and facilitate patient’s early meaningful interaction with the environment in NSRU. Five patients ( n = 5) who underwent neurosurgical interventions and had neurocognitive impairments were intervened using the functional-based structured cognitive interventions in the NSRU. Activities designed were structured and a comprehensive kit was formed to improve the patient’s meaningful interaction with the environment and occupational participation. Problem areas in functional cognition and perception were noted based on the comprehensive neurological evaluation. Pittsburgh Rehabilitation Participation Scale (PRPS) was used to assess the patients’ level of participation pre- and postintervention and also during each subsequent session till discharge from NSRU. A comprehensive functional cognition tool kit was used for intervention which comprised 12 graded occupation-based activities which range from basic multisensory stimulation to higher-level executive functions. Activities presented during each session were graded and modified contingent on the patient’s improvement in participation and performance. At the time of discharge, the level of participation scores of 5 patients ( n = 5) on PRPS improved from 3 (50%), 3 (50%), 2 (33%), 3 (50%), 3 (50%) to 4 (67%), 5 (83%), 4 (67%), 4 (67%), 5 (83%), respectively. This study highlights the importance of acute care occupational therapy. The results suggest that using functional-based structured cognitive intervention in five patients recovering from neurosurgical procedures in ICU helped in improving their occupational participation, thereby improving their quality of life.