Differences between persons with right or left cerebral vascular accident on the Assessment of Motor and Process Skills

Occupational therapists' descriptions of their work with persons suffering from cognitive impairment following acquired brain injury

The aim of the present study was to investigate how Swedish occupational therapists describe their work with persons suffering from cognitive impairment following acquired brain injury. A qualitative descriptive approach was used and interviews were conducted with 12 occupational therapists working in community and county council care. Qualitative content analysis was used and revealed three main themes: (1) "To make the invisible visible", (2) "To collaborate-a prerequisite for success", and (3) "Dilemmas to handle". The findings showed a complex scenario where the occupational therapists worked to make the cognitive impairments visible to themselves, the clients, and persons close to the client. Collaboration was perceived as a key factor. The dilemmas concerned different aspects in the rehabilitation process, which affected the occupational therapists' work with the clients. Identified areas in need of improvement are prioritizations and additional education regarding both intervention methods and theory. A reluctance to use standardized assessments was expressed and research that identifies and overcomes those hindrances in clinical practice is needed. Therapeutic use of self was described as important. To understand and illuminate the occupational therapists' comprehension of the concept further research is required.

Arm use after left or right hemiparesis is influenced by hand preference

BACKGROUND AND PURPOSE

Despite strong evidence for hand preference and its impact on motor performance, its influence on stroke rehabilitation has not been routinely considered. Previous research demonstrates that patients with hemiparetic stroke use their ipsilesional, nonparetic arm 5 to 6 times more frequently than their paretic arm, but it is unknown if such use varies with laterality of hemiparesis. The purpose of our study was to determine if the right arm is used more frequently in right-handed patients with stroke.

METHODS

We assessed relative use of the right, left, and both arms with wrist accelerometers on patients with unilateral, paretic stroke matched for degree of paresis (12 with right hemisphere damage, 17 with left hemisphere damage) and 25 neurologically intact control participants as they performed the Arm Motor Ability Test.

RESULTS

We showed: (1) ipsilesional arm use was greater after right hemisphere damage than left hemisphere damage; (2) the left hemisphere damage group used both arms together more often than the right hemisphere damage group but less often than the control group; and (3) both stroke groups used their contralesional, paretic arm to the same degree.

CONCLUSIONS

These findings emphasize the influence of hand preference on arm use after stroke for the ipsilesional but not the contralesional arm. Although both stroke groups used their ipsilesional more than their contralesional arm, the difference was greater for the right hemisphere damage group who used their ipsilesional arm 4 times more frequently than their contralesional arm, whereas the left hemisphere damage group used their ipsilesional arm 2 times more frequently than their contralesional arm.

Home versus day rehabilitation: a randomised controlled trial

OBJECTIVE

to assess the effect of home versus day rehabilitation on patient outcomes.

DESIGN

randomised controlled trial.

SETTING

post-hospital rehabilitation.

PARTICIPANTS

two hundred and twenty-nine hospitalised patients referred for ambulatory rehabilitation.

INTERVENTIONS

hospital-based day rehabilitation programme versus home-based rehabilitation programme.

MAIN OUTCOME MEASURES

at 3 months, information was collected on hospital readmission, transfer to residential care, functional level, quality of life, carer stress and carer quality of life. At 6 months, place of residence, hospital re-admissions and mortality status were collected.

RESULTS

there were significant improvements in the functional outcomes from baseline to 3 months for all participants. At discharge, carers of patients in day hospital reported higher Caregiver Strain Index (CSI) scores in comparison to home rehabilitation carers (4.95 versus 3.56, P = 0.047). Patients in day hospital had double the risk of readmission compared to those in home rehabilitation (RR = 2.1; 95% CI 1.2-3.9). This effect persisted at 6 months.

CONCLUSIONS

day hospital patients are more likely to be readmitted to hospital possibly due to increased access to admitting medical staff. This small trial favours the home as a better site for post-hospital rehabilitation.

Differences in Schoolwork Performance between Typically Developing Students and Students with Mild Disabilities

The purpose of this study was to examine whether students with mild disabilities differed from typically developing students in their ability to perform schoolwork tasks. The participants, selected from the School Assessment of Motor and Process Skills (School AMPS) database, comprised 175 students in each group. Their data were subjected to many-faceted Rasch analyses and then analyzed for statistically significant differences in mean school motor and school process abilities between groups. The relative and actual item difficulty calibration values were then compared to identify meaningful differences between groups. The results revealed a statistically significant mean difference in school motor and school process ability between groups (large effect sizes), essentially stable relative skill item hierarchies between groups, and actual hierarchies that differed such that some school motor and almost all school process skill items (occupational performance skills) were more difficult to perform for the mild disabilities group. The results of this study also provided evidence of validity for the use of the School AMPS measures to assist in identifying lower than expected schoolwork performance of students with mild disabilities.

The Use of the Assessment of Motor and Process Skills (AMPS) in Predicting Need of Assistance for Adults with Mental Retardation

Because the ability to perform activities of daily living (ADL) is associated with global aspects of community functioning, it is critical to evaluate whether the information gained from specific ADL assessments contributes to a reliable prediction of the overall amount of assistance needed for a person to function in the community. The purpose of this study was to evaluate the predictive use of an ADL assessment, the Assessment of Motor and Process Skills (AMPS), to determine which people with mental retardation need support or assistance to function in the community. A sample of 380 data records from the AMPS international database of people with various levels of mental retardation was included in the study. Many-faceted Rasch analyses and logistic regression models were used for data analysis. The results indicated that only the AMPS ADL process ability measures contributed significantly and substantially to the prediction of the level of assistance required to function in the community for individuals with mild to moderate mental retardation when used in conjunction with age, gender, and level of mental retardation. The results have clinical implications for occupational therapists working with these people because ADL process ability can be improved by occupational therapy interventions.

Relationship between measures of dementia severity and observation of daily life functioning as measured with the Assessment of Motor and Process Skills (AMPS)

BACKGROUND

Cognitive impairment is mostly regarded as the core symptom of dementia, but several other domains (such as daily functioning) are equally relevant to assess the severity of dementia. The relationship between these domains is unclear. The Assessment of Motor and Process Skills (AMPS) is a relatively unexplored instrument in people with dementia, measuring severity by direct observation.

OBJECTIVE

To study the relationship between the AMPS and scores on several commonly used outcome measures for the assessment of dementia severity, and to examine the possible influence of neuropsychiatric symptoms on these relationships in patients with cognitive disorders.

METHODS

Cross-sectional data of 118 patients with cognitive disorders were used; data on cognition (Mini-Mental State Examination, MMSE; CAMCOG), global severity (Global Deterioration Scale, GDS), daily life functioning (Instrumental Activities of Daily Living, IADL), and neuropsychiatric symptoms (Neuropsychiatric Inventory, NPI) were collected and analyzed using correlation and regression analyses. Different combinations of the severity measures were tested for their ability to predict the AMPS process ability scores.

RESULTS

Scores on the MMSE, CAMCOG and GDS were moderately associated with the AMPS process ability score. These measures explained between 27 and 44% of the variance in the AMPS score. The presence of apathy influenced the association between the cognitive measures and the AMPS score.

CONCLUSION

Commonly used measures of dementia severity are only moderately associated with observation of performance on daily activities. This underlines the need for direct observation of daily activities in dementia patients. This relationship between several approaches of assessing dementia severity needs further study.

Preparing Home Health Clients for Work Opportunities With Workplace Accommodation

Few people with chronic health conditions actively engage in work activities. Yet workplace accommodations including assistive technologies and more accessible environments are creating the potential for more employment opportunities. Occupational therapists are trained to assist clients in maximizing participation in self-care, work activities, and leisure. Home health services often address self-care and leisure; however, little attention is given to home health discharge planning directed at transitions to work. This article explores some of the policies that affect work opportunities for people with disabilities, some workplace accommodations that can be used to increase access to the workplace and maximize capacities of persons with disabilities to complete job tasks, and implications for how home health occupational therapy practitioners can facilitate referrals and inform client decisions about workplace accommodations.

Individuals with the dominant hand affected following stroke demonstrate less impairment than those with the nondominant hand affected

OBJECTIVE

The purpose was to determine if upper extremity impairment and function in individuals with chronic stroke is dependent upon whether the dominant or non-dominant hand is affected.

METHODS

Ninety-three community-dwelling individuals with stroke. The Modified Ashworth Scale (tone), handheld dynamometry (isometric strength), monofilaments (sensation), Brief Pain Inventory (pain), Chedoke Arm and Hand Activity Inventory Motor Activity Log (paretic arm use), and Reintegration to Normal Living Index (participation) were used to form impairment and function models.

RESULTS

Multivariate analysis models (Dominance x Severity) were created for impairment and function variables. There was a significant interaction and main effect of Dominance for the impairment model (P = 0.01) but not the function model (P = 0.75). The dependent variables of tone, grip strength, and pain were all significantly affected by Dominance, indicating less impairment if the dominant hand was affected. All dependent variables except pain were affected by Severity.

CONCLUSION

This study looked at the effect of the dominant hand being affected versus the nondominant in individuals with chronic stroke. Individuals with the dominant hand affected demonstrated less impairment than those with the nondominant hand affected. However, there was no effect of dominance on paretic arm use or performance in activities of daily living. Prospective studies to further explore the issue of hand dominance and poststroke function are suggested.

Giving meaning to measure: linking self-reported fatigue and function to performance of everyday activities

Fatigue, a common symptom of cancer patients, particularly those on active treatment, is generally evaluated using self-report methods, yet it remains unclear how self-reported fatigue scores relate to performance of daily activities. This study examines the relationships among self-reported and performance-based measures of function in patients receiving chemotherapy (CT) to link self-reported fatigue measures to self-report and performance-based measures of function. Self-reported fatigue using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and self-reported physical function using the physical function 10 subscale of the Short Form 36 (SF-36) (PF-10) were measured in 64 patients within 2 weeks of beginning CT (n=64) and after three cycles of CT (n=48). Motor and cognitive functions were captured using five self-reported and seven observed-performance measures at each time point. Significant correlations between self-reported and observed measures ranged from 0.30 to 0.71. Self-reported fatigue correlated (0.30-0.45) with performance-based function. FACIT-F scores in the range of 30 and below and PF-10 scores in the range of 50 and below were related to an increased difficulty performing everyday activities. Observed measures of physical performance correlate moderately with self-reported fatigue and self-reported physical function. These relationships enable one to begin linking fatigue scores directly to a person's ability to perform everyday activities.

Gender differences in the performance of activities of daily living11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVES

To verify that the activities of daily living (ADL) motor and process skill items and tasks in the Assessment of Motor and Process Skills (AMPS) are free from gender bias, and to compare mean differences in ADL motor and process ability between men and women.

DESIGN

Descriptive comparison; convenience sample.

SETTING

Existing data from the AMPS database.

PARTICIPANTS

Potential participants included nonwell persons (age range, 18-99y) matched within 3 age groups, first by functional level and then by diagnostic category. The resulting sample included 9250 men and 9250 women.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The AMPS, a standardized observational assessment of the quality of ADL task performance.

RESULTS

None of the AMPS task calibrations and 1 motor skill item calibration (Lifts) demonstrated an observable difference between men and women. Men had higher ADL motor ability (F(1,18494)=11.58, P<.01) and women had higher ADL process ability (F(1,18494)=76.18, P<.01).

CONCLUSION

The results suggest that the AMPS is free of gender bias. Although differences were found between men and women in mean ADL motor and process ability, they were not considered clinically detectable differences.

Validity of a performance assessment of activities of daily living for people with developmental disabilities

BACKGROUND

Since clients with different types of developmental disabilities often experience difficulties in activities of daily living (ADL), it is critical that assessments of ADL are evaluated in order to ensure that one can make valid judgements based on the results of the appraisal. The purpose of the present study was to evaluate the validity of a specific performance assessment instrument, the Assessment of Motor and Process Skills (AMPS), when used by occupational therapists with clients with developmental disabilities. Unlike global ADL assessments, the AMPS is used not only to evaluate the level of ADL dependence, but also to estimate the quality of each specific action performed when a person is performing ADL tasks.

METHODS

Data were gathered from 1724 participants with different developmental disabilities, including intellectual disability (ID), cerebral palsy and spina bifida. Many-Facet Rasch (MFR) analysis was used to examine person-response validity, and task and item scale validity.

RESULTS

Goodness-of-fit statistics showed that the tasks and items had acceptable scale validity. The participants had acceptable person-response validity on the ADL motor scale, but had slightly lower than expected levels of person-response validity on the ADL process scale. The results indicate that clients with more severe forms of ID may have a higher proportion of different performance profiles in ADL than is expected by the MFR model of the AMPS. Since the proportion of participants who did not meet the criteria was only 3% lower than expected and in accordance with other studies, the difference may not be clinically meaningful. Otherwise, the results indicated that the AMPS is a valid tool when used with clients with developmental disabilities.

CONCLUSIONS

Further research is needed to evaluate the use of the AMPS in clinical assessment and intervention planning for this group of clients.

Rasch analysis of a new stroke-specific outcome scale: the Stroke Impact Scale

OBJECTIVES

To assess multiple psychometric characteristics of a new stroke outcome measure, the Stroke Impact Scale (SIS), using Rasch analysis, and to identify and remove misfitting items from the 8 domains that comprise the SIS.

DESIGN

Secondary analysis of 3-month outcomes for the Glycine Antagonist in Neuroprotection (GAIN) Americas randomized stroke trial.

SETTING

A multicenter randomized trial performed in 132 centers in the United States and Canada.

PARTICIPANTS

A total of 696 individuals with stroke who were community-dwelling and independent prior to acute stroke.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Rasch analysis was performed using WINSTEPS, version 3.31, to evaluate 4 psychometric characteristics of the SIS: (1) unidimensionality or fit (the extent to which items measure a single construct), (2) targeting (the extent to which the items are of appropriate difficulty for the sample), (3) item difficulty (the ordering of items from least to most difficult to perform), and (4) separation (the extent to which the items distinguish distinct levels of functioning within the sample).

RESULTS

(1) Within each domain, most of the items measured a single construct. Only 3 items misfit the constructs and were deleted ("add and subtract numbers," "get up from a chair," "feel emotionally connected") and 2 items ("handle money," "manage money") misfit the combined physical domain. These items were deleted to create SIS, version 3.0. (2) Overall, the items are well targeted to the sample. The physical and participation domains have a wide range of items that capture difficulties that most individuals with stroke experience in physical and role functions, while the memory, emotion, and communication domains include items that capture limitations in the most impaired patients. (3) The order of items from less to more difficult was clinically meaningful. (4) The individual physical domains differentiated at least 3 (high, average, low) levels of functioning and the composite physical domain differentiated more than 4 levels of functioning. However, because difficulties with communication, memory, and emotion were not as frequently reported and difficulties with hand function were more frequently reported, these domains only differentiated 2 (high, low) to 3 (high, average, low) strata of patients. Time from stroke onset to administration of the SIS had little effect on item functioning.

CONCLUSION

Rasch analysis further established the validity of the SIS. The domains are unidimensional, the items have an excellent range of difficulty, and the domain scores differentiated patients into multiple strata. The activities of daily living/instrumental activities of daily living, mobility, strength, composite physical, and participation domains have the most robust psychometric characteristics. The composite physical domain is most able to discriminate difficulty in function in individuals after stroke, while the communication, memory, and emotion domain items only capture limitations in function in the more impaired groups of patients.

The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment

BACKGROUND AND PURPOSE

Chronic hemiparetic patients often retain the ability to manage activities requiring both hands, either through the use of the affected arm or compensation with the unaffected limb. A measure of this overall ability was developed by adapting and validating the ABILHAND questionnaire through the Rasch measurement model. ABILHAND measures the patient's perceived difficulty in performing everyday manual activities.

METHODS

One hundred three chronic (>6 months) stroke outpatients (62% men; mean age, 63 years) were assessed (74 in Belgium, 29 in Italy). They lived at home and walked independently and were screened for the absence of major cognitive deficits (dementia, aphasia, hemineglect). The patients were administered the ABILHAND questionnaire, the Brunnström upper limb motricity test, the box-and-block manual dexterity test, the Semmes-Weinstein tactile sensation test, and the Geriatric Depression Scale. The brain lesion type and site were recorded. ABILHAND results were analyzed with the use of Winsteps Rasch software.

RESULTS

The Rasch refinement of ABILHAND led to a change from the original unimanual and bimanual 56-item, 4-level scale to a bimanual 23-item, 3-level scale. The resulting ability scale had sufficient sensitivity to be clinically useful. Rasch reliability was 0.90, and the item-difficulty hierarchy was stable across demographic and clinical subgroups. Grip strength, motricity, dexterity, and depression were significantly correlated with the ABILHAND measures.

CONCLUSIONS

The ABILHAND questionnaire results in a valid person-centered measure of manual ability in everyday activities. The stability of the item-difficulty hierarchy across different patient classes further supports the clinical application of the scale.

Functional status of cortical and subcortical nonhemorrhagic stroke survivors and the effect of lesion laterality

The purpose of this study is to examine the effects of cortical and subcortical infarcts and lesion laterality on the functional status of stroke survivors. Medical records of 72 stroke survivors admitted to an acute inpatient rehabilitation facility with a single nonhemorrhagic lesion were retrospectively reviewed. Multivariate analysis of variance was used to assess the effects of lesion level and hemisphere on admission and discharge Functional Independence Measure (FIM) and FIM gain. Admission FIM-Total and its subdimensions exhibited significant overall level (Wilk's lambda = 2.5; P = 0.03) and hemisphere-specific (Wilk's lambda = 2.3; P = 0.04) effects. Significant interaction between factors was noted only for the communication subdimension. Significant level and hemisphere-specific main effects were noted for admission FIM-Total (P < 0.01 and P = 0.02, respectively). There were significant level-specific main effects for self-care (P = 0.01) and mobility (P = 0.03) and hemisphere and level-specific main effects for communication (P < 0.01 and P < 0.01, respectively) and social cognition (P = 0.02 and P = 0.01, respectively). Discharge FIM-Total and its subdimensions exhibited significant overall level (Wilk's lambda = 2.5; P = 0.03) and hemisphere-specific (Wilk's lambda = 3.4; P = 0.01) effects. Discharge FIM subdimensions did not exhibit significant interaction between factors. Discharge FIM-Total was significant with respect to lesion level (P = 0.01) but not with respect to hemisphere (P = 0.08). There was a significant level-specific main effect for self-care (P = 0.01) and level and hemisphere-specific main effects for communication (P < 0.01 and P < 0.01, respectively) and social cognition (P = 0.01 and P = 0.01, respectively). FIM gain scores did not exhibit significant level (Wilk's lambda = 1.1; P = 0.36) or hemisphere-specific (Wilk's lambda = 1.4; P = 0.24) effects. The data suggest that the lesion level and hemisphere are important determinants of the function of nonhemorrhagic stroke survivors during inpatient rehabilitation.

Environment effect of functional task performance in adults with acquired brain injuries: use of the assessment of motor and process skills

OBJECTIVE

To examine household task performance in both familiar (home) and unfamiliar (clinic) environments in adults with acquired brain injuries.

DESIGN

The research performed was a comparison study examining the effect of the environment on functional task performance. Individuals were evaluated using the Assessment of Motor and Process Skills both in their homes and in an unfamiliar clinic setting.

PARTICIPANTS

Twenty individuals with acquired brain injuries living in the community.

MAIN OUTCOME MEASURES

The Assessment of Motor and Process Skills, an observational, standardized, occupational therapy assessment tool, was used to evaluate household task performance.

RESULTS

Paired one-tailed t tests indicated a significant difference between home and clinic performance measures in process ability (t=-4.28, p=.00), but no significant difference in motor ability performance measures (t=-1.84, p=.410). Scatter plot analyses showed that performance scores of 6 of the 20 subjects differed in a clinically meaningful way, and that instrumental activities of daily living motor performance scores for 3 of the 20 differed in a clinically meaningful way.

CONCLUSIONS

Individuals with acquired brain injuries may be influenced by their environment when performing household tasks, although further study is necessary to determine the extent of the environmental effect.

Assessment of ability/disability in patients treated with chronic thalamic stimulation for tremor

Chronic thalamic stimulation (CTS) has a documented good effect on tremor in patients with Parkinson's disease (PD) and essential tremor (ET). This study evaluates whether the alleviation of impairment, i.e., tremor, translates into improvement of the patient's ability in performing instrumental activities of daily living (IADL). Thirteen patients were assessed with an occupational therapy tool called Assessment of Motor and Process Skills (AMPS). This observation-based scale rates the patient's motor and process skills needed to perform a given task. The evaluations were done at a mean of 13 months after surgery in the patient's home, and included assessments of IADL with the CTS activated and switched off, respectively. The results showed that most patients improved to variable degrees in their IADL ability when the thalamic stimulation was on. The improvement was more marked in patients operated on for tremor of their dominant hand. The improvement concerned mainly the skill items related to the patients' abilities of coordination, calibration, endurance, and accommodation during IADL task performance. The authors concluded that for some patients with tremor, CTS can improve independence in domestic activities of daily living.

Male and female performance on the assessment of motor and process skills

OBJECTIVE

To examine the validity of the assertion that men and women do not differ significantly on the Assessment of Motor and Process Skills (AMPS), a functional assessment tool used to evaluate the interaction between component motor and process skills and IADL (instrumental or domestic activities of daily living) performance capacity.

DESIGN

Descriptive comparison. Using many-faceted Rasch analysis, the AMPS motor and process scales were examined for differential item response between gender subgroups. Mean motor and process ability measures of age-matched groups of male and female subjects were also compared.

PARTICIPANTS

A convenience sample of more than 3,500 men and women from the standardization sample for the pilot version of the AMPS computer-scoring software. The subjects had a variety of physical disabilities or psychiatric diagnoses.

MAIN OUTCOME MEASURES

Hypotheses were as follows: (1) no differential item response would be found on the motor or process scales; (2) if differential item response was found, it would not have an impact on the final estimation of client ability; (3) men and women would not differ in mean AMPS motor or process ability.

RESULTS

Of the 36 AMPS items, only one (Lifts) differed between men and women. This differential item response did not disrupt the final estimation of client ability. Men and women did not differ in mean motor ability. Women on the whole were more able than men in mean process ability.

CONCLUSIONS

The AMPS is valid for use across gender subgroups. Men and women do not differ in AMPS motor ability, but overall, women are slightly more able than men in AMPS process ability.

Functional outcome of hemorrhagic and nonhemorrhagic stroke patients after in-patient rehabilitation

Differences in functional prognosis for patients with hemorrhagic and nonhemorrhagic strokes are unclear. The purpose of this study is to compare the functional outcome of hemorrhagic and nonhemorrhagic stroke patients after inpatient stroke rehabilitation. By retrospective review, 25 hemorrhagic stroke patients were matched with 25 nonhemorrhagic stroke patients on the basis of age and onset to admission interval. Discharge Functional Independence Measure (FIM), FIM gain, FIM efficiency, length of stay (LOS), and discharge disposition were compared. Admission FIM, gender, and comorbidities were similar between the two groups. There were no differences in discharge FIM, FIM gain, and discharge to home rates between groups. However, the hemorrhagic group had a significantly shorter LOS (31.7 v 37.6 days; P = 0.05) with higher FIM-total efficiency (0.84 v 0.60; P = 0.02). The FIM-motor scale accounted for most of the gains in efficiency (0.71 v 0.53; P = 0.05) with no significant difference in FIM-cognition efficiency between groups. Post hoc analysis revealed that onset to admission interval was a strong predictor of LOS (r = 0.62; P < 0.0001). Hemorrhagic stroke patients appear to exhibit functional gains somewhat faster than nonhemorrhagic counterparts. Confirmation of these preliminary findings must await future studies.