Exploration des effets d’un programme de réadaptation visant l’amélioration des activités et la participation des personnes cérébrolésées. Application à l’activité cuisine

The cognitive and behavioral sequelae of brain injury can severely limit activities and restrict participation. People with acquired brain injury require adapted and specific reeducation and rehabilitation. To respond to these needs, a rehabilitation program was developed within the Physical and Rehabilitation Medicine Service of Pitié-Salpêtrière, Paris, France. This thesis seeks to explore the effectiveness of this program on participant’s levels of activity and participation. More specifically, the objectives were to: 1) define and validate the rehabilitation program with the multidisciplinary team; 2) measure the effects of the rehabilitation program on participant participation levels and 3) explore possible links between the problem, the interventions in the program, and the effects of the program on participant’s activity and participation levels.  With respect to the first objective of documenting the rehabilitation program, we used the logic model of Champagne et al., 2009). Semi-structured interviews were carried out with members of the multi-disciplinary team. The documentation of each program activity was validated by groups of experts.  For the second objective, a quasi-experimental study was carried out with ‘single-case’ multiple repeated measures. Six repeated measures were used: three pre-program and three post-program up until six months. Results were analyzed using (i) visual analysis of graphic data which represented the evolution of participants over time and (ii) statistical analyses. In the initial preparation phase, tools measuring body functions and structure, activity and participation were identified. The situational measurement tools chosen were reliable and valid. Principal outcomes  were (i) participants’ activity level evaluated by the Cooking Task (Chevignard et al., 2000) and the Instrumental Activities of Daily Living Profile (IADL Profile) (Bottari et al., 2009) and (ii) participants’ participation level evaluated by the IADL Profile and the Life Habits assessment’ (LIFE-H) (Noreau et al., 2002). For the third objective, a logic theory analysis was based on the cognitive model of executive functions of Lezak (1982) and on the International Classification of Functioning, Disability and Health (ICF). This analysis demonstrates the validity of the cooking activity and thereby promotes the recognition of such activities within multidisciplinary rehabilitation programs. For the measurement of the effects of the rehabilitation program, significant differences in the total number of errors in the Cooking Task (for 6/7 participants) and in the need for help (IADL Profile) (6/7 participants) between the pre- and post-program phases were observed. On the LIFE-H assessment, some improvements were shown for the ‘preparation of meal’ item for 4/7 participants. The overall results of the Cooking Task, IADLP and LIFE-H scale suggest a global improvement for the activity ‘meal preparation’ after the rehabilitation program. This improvement is maintained over time.   The identification of tools to measure limitations in activity and participation levels in real life situations assists informed decision-making in rehabilitation.    This thesis contributes to the advancement of knowledge in rehabilitation. Few studies have gone this far in documenting a multidisciplinary and holistic rehabilitation program and in understanding the relation between its effects and care processes.

Keyphrases: Lésion cérébrale acquise, C.I.F, Acquired brain injury, I.C.F, Program evaluation, Cooking activity, Measurement of effects