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Consequences of cognitive impairments in daily occupations after stroke

There is limited knowledge of the consequences of cognitive impairments in daily occupations after stroke and how rehabilitation interventions can support functioning and wellbeing in daily life. This project comprises several different studies focusing different aspects of living with cognitive impairments in daily occupations. Earlier studies examined aspects of rehabilitation in people with unilateral neglect and increased awareness of disability after stroke. In ongoing studies we are identifying the lived experience of daily occupations in different contexts in people with cognitive impairments and how occupations and environments can contribute to change in the therapeutic process. Another project focuses specifically on driving ability after stroke and another study on the relationship between awareness of disability and occupational performance in a group of elderly people with stroke.

Project leader

Kerstin Tham, professor,


Kurt Johansson,PhD., Traffic Medicine Center; Gunnar Karlsson, Professor, Stockholm University; Gary Kielhofner, Professor, University of Illinois, Chicago; Anders Kottorp, PhD.

Doctoral students

Anette Eriksson, Lisa Ekstam, Ann-Helen Patomella


1) To identify consequences of cognitiv impairments in daily occupations after stroke,

2) To develop assessment instruments identifying consecuences of contivie impairments in daily occupations,

3) To identify how occupations and environments can be used as therapeutic tools,

4) To develop and evaluate intervention strategies focusing learning and functioning in daily occupations.


In this project different designs and methods are used. In several studies, a phenomenological approach (EPP-method) is used in order to describe the lived experience of daily occupations in person living with cognitive impairments. Other studies aim to develop new assessment instrument, as for example, Baking Tray Task (neglect test), P-Drive (driving ability test) and Assessment of Awareness of Disability. In a few studies we have evaluated intervention in daily occupations.

Long term goals

To develop a better understanding of how people with cognitive impairments experience and handle their disability in daily occupations and to develop evidence based methods for assessment and intervention that can be implemented in rehabilitation after stroke.

Financial support

Vardal Foundation, SLL, CfV, National research school of health care sciences.

Publications in the project

Robertson, I., Tegnér, R., Tham, K., Lo, A., & Nimmo-Smith, I. (1995). Sustained Attention Training in Unilateral Neglect. Journal of Clinical and Experimental Neuropsychology, 17, 416-430.

Tham, K., & Tegnér, R. (1996). The baking tray task. A test of spatial neglect. Neuropsychological Rehabilitation, 6, 19-25.

Tham, K., & Borell, L. (1996). Motivation for training. A case study of four

persons with unilateral neglect. Occupational Therapy in Health Care, 10, 65-79.

Tham, K., & Tegnér, R. (1997). Video Feedback in Rehabilitation of patients with Unilateral Neglect . Archives of Physical Medicine and Rehabilitation, 78, 410- 413.

Tham, K., Bernspang, B., & Fisher, A. (1999). Development of Assessment of Awareness of Disability (AAD). The Scandinavian Journal of Occupational Therapy, 6,184-190.

Tham, K., Borell., L., & Gustavsson, A. The discovery of disability: A phenomenological study of unilateral neglect. (2000). The American Journal of Occupational Therapy, 4, 398-406.

Tham, K., Ginsburg, E., Fisher, A.G., & Tegnér, R. (2001). Training to improve awareness of disability in clients with unilateral neglect. The American Journal of Occupational Therapy, 55, 46-54.

Tham, K., & Kielhofner, G. (2003). Impact of the social environment on occupational experience and performance among persons with unilateral neglect. American Journal of Occupational Therapy, 57, 403-412.

Lampinen, J., & Tham, K. (2003). Interaction with the physical environment in everyday occupation after stroke: a phenomenological study of visuospatial agnosia. Scandinavian Journal of Occupational Therapy, 10, 147-156.

Erikson, A., K., Karlsson, G., Söderström, M., Tham, K. (2004). A Training apartment with electronic aids of daily living: Lived experiences of persons with brain damage. American Journal of Occupational Therapy, 58, 261-271.

Patomella, A-H., Caneman, G., Kottorp, A., & Tham, K. (2004). Identifying Scale and Person Respons Validity of a new Assessment of Driving Ability, Scandinavian Journal of Occupational Therapy,11, 70-77.

Appelros, P., Karlsson, G., Thorwalls, A., Tham, K., & Nydevik, I. (2004). Unilateral neglect: Further validation of the baking tray task. Journal of Rehabilitation Medicine, 258-261.

Patomella, A-H, Tham, K., Kottorp, A (2006). P-drive - an assessment of driving performance after stroke. Journal of Rehabilitation Medicine, 38: 273-279.

Erikson, A, Karlsson, G., Borell, L. & Tham, K. (in press). The lived experience of memory impairment in daily occupation after acquired brain injury One year of rehabilitation. OTJR: Occupation, Pariticipation and Health.

Boman, I-L. Tham, K. Granqvist, A. Bartfai, A. Hemmingsson (accepted). Using Electronic Aids to Daily Living after Acquired Brain Injury: A study of the learning process and the usability. (Disability and Rehabilitation: Assistive Technology

Ekstam, L., Kottorp, A., & Tham (submitted). The relationship between awareness of disability and occupational performance during the first year subsequent to stroke.

Patomella, A-H., Kottorp, A., & Tham, K. (submitted). Exploration of awareness of driving ability after stroke.