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This study aims to explore the difference in cognitive strategy use during observed occupational performance between and within different levels of impaired awareness of deficits of individuals with acquired brain injury (ABI).

A cross-sectional study (N = 24) of individuals with ABI receiving rehabilitation and with the capacity to demonstrate goal-directed behaviour (Allen cognitive level screen score = 4.0) was undertaken. Cognitive strategy use during occupational performance of daily activities (measured with the perceive, recall, plan and perform [PRPP]) was evaluated between and within different awareness levels (awareness levels measured by the self-regulation skill interview). Statistical analyses, using independent t-test, Mann Whitney U test, ANOVA and Friedman test, were executed.

Significant differences were shown for both strengths and weaknesses in cognitive strategy use between emergent (n = 13) and anticipatory awareness (n = 11) groups on PRPP items “perceive”, “sensing” and “mapping”; and “searches”, “recall steps”, “identify obstacles”, “calibrates”, “stops”, “continues” and “persists”. Within emergent awareness group, participants scored lowest related to “perceive”, “plan”, “sensing”, “mapping”, “programming” and “evaluating”. Within anticipatory awareness group, participants scored lowest related to “plan”, “programming” and “evaluating”.

This study showed differences in cognitive strategy application during task performance in individuals with emergent or anticipatory awareness deficits that fit with theoretical expectations. It is recommended to make use of the PRPP assessment results (strengths and weaknesses in cognitive strategy application) to support the level of awareness determination. The PRPP assessment results and the level of awareness tailor the clinical reasoning process for personalised intervention planning and cognitive strategy training.

Because impaired awareness has so much impact on the course and outcome of rehabilitation (Rotenberg-Shpigelman et al., 2014), in clinical practice, it is of paramount importance to be aware of the level of awareness of the client (Smeets et al., 2017) and the effect on occupational performance.

Sensory processing difficulties can negatively affect children with autism at school. There is limited evidence to guide practice in this area. The purpose of this study is to evaluate the efficacy of a sensory activity schedule (SAS) used in a school setting on task mastery and occupational performance in the classroom.

A randomised control trial (RCT) was conducted with 30 children to evaluate the efficacy of a school-based SAS. Children in the intervention group received SAS intervention and usual teaching. Children in the control group received only usual teaching. Outcome measures were the perceive, recall, plan and perform stage one procedural task analysis and goal attainment scaling.

Children in the intervention group demonstrated statistically significant improvements in school performance when compared with the control group in both outcome measures.

This was a pilot study with small sample size, so results should be interpreted with caution. Further research is needed to replicate these findings.

A classroom-based SAS may have a positive effect on classroom performance for children with autism. This has implications for professionals who support children with autism and sensory processing difficulties in a school setting.

To the best of the authors’ knowledge, this study was the first of its kind in evaluating SAS intervention in a school setting using RCT methodology.