A study of engagement in casual leisure occupations by individuals who are living with neuropalliative conditions

Abstract

Purpose. This study explored the following research questions:

1. What are the normal and sensory-overloaded behaviours exhibited by adults living with neuropalliative conditions?

2. How does engagement in casual leisure alter with different levels of sensory attributes?
It did this to determine whether there might be an approximate optimal level of sensory attributes that maximises occupational-engagement while minimising the potential for sensory-overload. The aim therefore was to create an occupational environment that participants could handle competently and enjoyably. This sensory threshold can only be approximate, since each individual has unique sensory preferences, interests and experience.

Method. The preliminary study involved a structured interview with a Residence Manager in order explore the normal and sensory-overloaded behaviours exhibited by nine adults living with neuropalliative conditions. The second study built upon this by conducting a multiple, case quasi experimental study involving marginal-participant time-sampled observations of engagement of individuals with neuropalliative conditions, with casual leisure occupations using the Individual Child Engagement Record. This study investigated whether engagement occupations alters with different levels of sensory attributes. Observations were made of 14 participants engaging in eight cases, who experienced profound levels of disability, each case differed (as part of the replication logic) by having different levels of sensory attributes.

Results. Analysis suggests that the symptoms of sensory-overload may be experienced by adults living with neuropalliative conditions. The effects of sensory-overload appears similar to definitions of a passive state (of engagement or non-engagement). The thesis therefore presents the linkage between passive engagement/ passive non-engagement and an individual's behaviour when experiencing sensory-overload, hopefully leading to increased vigilance and therefore avoidance. Furthermore, engagement was shown to alter with a combination of different levels of sensory and non sensory attributes, including supporter facilitation and with the potential for active participation. These contextual factors are proposed to pertain to the individual, the occupation itself, and to the physical and social environment; the role offered or level of support available. Therefore, enhancing active leisure engagement requires consideration of the occupation, the individual and their sensory preferences and the occupational environment.

Conclusions. Despite the reporting of sensory-overload symptoms by the participant of the preliminary study, the results showed that the anticipated reduction in engagement at the higher levels of sensory attributes (given the effects of sensory-overload) did not occur. In fact, engagement with leisure occupations appeared to increase as the sensory attributes levels increase, with larger differences in engagement level occurring where there are larger differences in the combined level of sensory attributes involved, a range of factors in the occupational context, are suggested to influence engagement, some of which pertain to the individual, the occupation and the environment.

Clinical Messages. The role of the leisure supporter was suggested to include adapting leisure to fit the person, including offering the choice of what, when, where, with whom and how to "do" their leisure occupations, including offering active participation and a sense of choice.

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Identifiers

ORCID for Anne Fenech: orcid.org/0000-0002-5187-2912

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