Reorientation script: Theory and preliminary development of an accessible intervention for disorientation and unawareness following acquired brain injury

• Published in: Practice innovations (Washington, D.C.) D.C.), 2024-12
• Main Authors: Mulligan, Bryce P, Pallikaras, Vasilios
• Format: Article
• Language: English
• Subjects: Anosognosia; Awareness; Brain Injuries; Human; Neurorehabilitation; Rehabilitation
• ISSN: 2377-889X; 2377-8903
• DOI: 10.1037/pri0000265

Disorientation and anosognosia (low awareness of deficits) limit engagement in and opportunities to benefit from rehabilitation following acquired brain injury (ABI). There are very few standardized interventions to promote orientation and awareness for persons with ABI, despite broad appreciation of their conceptual underpinnings, prevalence, and relevance for ABI rehabilitation. In particular, there is a need for research- and practice-informed interventions that (a) can be tailored for diverse patients and practice settings; (b) do not require specialized or proprietary technologies or training; and (c) are standardized to facilitate repeated observations of individual patients over time and to allow for the intervention to be systematically evaluated and refined. Here, we present the literature review-based rationale, parameters, and worked examples to introduce Reorientation Script (ROS), a novel intervention designed to enhance treatment engagement and rehabilitation progress for persons with disorientation and/or anosognosia following ABI. Our clinical experience (evidence of benefit to patient progress and feedback from interprofessional rehabilitation team members) has demonstrated the value of incorporating ROS into rehabilitation plans to address disorientation and low awareness for patients with varying backgrounds and presenting concerns. Drawing from this clinical experience, we demonstrate some applications and benefits of ROS using hypothetical case vignettes. ROS has proven value for the treatment of post-ABI disorientation and anosognosia in our clinical rehabilitation setting. Research employing this standardized approach would aid in rigorous establishment and improvement of the validity of the ROS and allow for eventual clinical implementation to promote engagement, adaptation, and community reintegration following ABI. (PsycInfo Database Record (c) 2024 APA, all rights reserved) (Source: journal abstract)