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Mulhern M. Cognitive Rehabilitation Interventions for Post-Stroke Populations. Dela J Public Health 2023; 9:70-74. [PMID: 37701470 PMCID: PMC10494803 DOI: 10.32481/djph.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Affiliation(s)
- Meghan Mulhern
- Christiana Care Health System & Good Shepherd Penn Partners
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Beit Yosef A, Refaeli N, Jacobs JM, Shames J, Gilboa Y. Exploring the Multidimensional Participation of Adults Living in the Community in the Chronic Phase following Acquired Brain Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11408. [PMID: 36141678 PMCID: PMC9517339 DOI: 10.3390/ijerph191811408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/19/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
This exploratory study aimed to examine multiple aspects of the participation of adults in the chronic phase following acquired brain injury (ABI), considering different disability levels. Our study included 25 adults ≥6 months after ABI (predominantly stroke), living at home, without severe cognitive decline. Primary measures included the Canadian Occupational Performance Measure (subjective participation) and the Mayo-Portland Adaptability Inventory-4 Participation Index (objective participation). The results indicated subjective participation problems in all of the International Classification of Functioning, Disability and Health participation domains. In addition, objective participation was reported as most limited in the areas of leisure and recreational activities, residence, and employment. Both subjective and objective participation profiles varied according to the disability level except for the social and leisure areas, which were found to be similar across all subgroups. However, only partial compatibility was found between the subjective and objective participation aspects. To conclude, our findings indicated that chronic ABI survivors report a variety of subjective and objective participation concerns that varied according to their disability levels. Moreover, the incongruity between the participation aspects suggests that the level of limitation may not necessarily correspond to the importance of a particular participation area. This highlights the need for comprehensive assessments to determine unique individual participation profiles in order to facilitate client-centered interventions supporting the rehabilitation of community-dwelling ABI survivors.
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Affiliation(s)
- Aviva Beit Yosef
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9124001, Israel
| | - Nirit Refaeli
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9124001, Israel
| | - Jeremy M. Jacobs
- School of Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Department of Geriatrics and Geriatric Rehabilitation, Hadassah Medical Center, Jerusalem 9124001, Israel
| | - Jeffrey Shames
- Medical and Health Professions Division, Maccabi Health Services, Tel Aviv 6812509, Israel
| | - Yafit Gilboa
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9124001, Israel
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Hauger SL, Borgen IMH, Løvstad M, Lu J, Forslund MV, Kleffelgård I, Andelic N, Røe C. Community-Based Interventions After Acquired Brain Injury-A Systematic Review of Intervention Types and Their Effectiveness. J Head Trauma Rehabil 2022; 37:E355-E369. [PMID: 35125426 DOI: 10.1097/htr.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Comprehensive review of existing types and effectiveness of community-based interventions delivered to adults (mean age 18-65 years) with long-lasting (≥6 months) difficulties following acquired brain injury (ABI). DESIGN Systematic review of controlled intervention studies published until February 2021. MAIN MEASURES Systematic searches in databases (MEDLINE, PsycINFO, Database of Abstracts of Reviews of Effects [Cochrane Library], and Cochrane Central Register of Controlled Trials [Cochrane Library]) and inclusion of English peer-reviewed full-text articles; randomized or controlled community-based intervention studies; sample size of 20 or more participants; and 3 or more intervention sessions. Two reviewers independently extracted data for the synthesis and assessed the methodological quality. Data extraction included study characteristics, demographics of participants, content and dose of intervention, outcome measures, and findings. RESULT The search returned 7386 publications, of which 49 eligible studies were included, revealing a diverse range of community-based interventions and a myriad of outcome measures applied for assessing functional capacities, participation, and quality of life in the chronic phase of ABI. Intervention types encompassed 14 holistic, 23 physical, and 12 specific interventions. A large heterogeneity regarding intervention frequency and intensity was found. Meta-analyses performed on the holistic, physical, and specific interventions did not indicate any significant pooled effects but showed highly variable effects between individuals, both in persons with traumatic and nontraumatic brain injuries. CONCLUSIONS Because of lack of pooled effects within types of community-based interventions, specific evidence-based recommendations within holistic, physical, and specific interventions designed to mitigate long-lasting ABI problems cannot be made. This review highlights the need for future studies to address methodological issues concerning larger sample size, lack of clear description interventions and comparator, missing reports of effects in change scores, need for consistent use of recommended outcome measures, and investigating the wide variety in intervention responsiveness among participants with ABI. Systematic review registration: PROSPERO (CRD42019124949).
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Affiliation(s)
- Solveig Lægreid Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway (Drs Hauger and Løvstad); Department of Psychology, Faculty of Social Sciences (Drs Hauger and Løvstad and Ms Borgen), Institute of Clinical Medicine, Faculty of Medicine (Dr Røe), and Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society (Dr Andelic), University of Oslo, Norway; Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, USA (Dr Lu); and Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Norway (Ms Borgen and Drs Forslund, Kleffelgård, Andelic, and Røe)
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Merchán-Baeza JA, Pérez-Cruzado D, González-Sánchez M, Cuesta-Vargas A. Development of a New Cognitive-Motor Outpatient Index in Older People. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2021.1998287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- José Antonio Merchán-Baeza
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - David Pérez-Cruzado
- Department of Occupational Therapy, San Antonio Catholic University of Murcia, Murcia, Spain
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A Performance-Based Teleintervention for Adults in the Chronic Stage after Acquired Brain Injury: An Exploratory Pilot Randomized Controlled Crossover Study. Brain Sci 2022; 12:brainsci12020213. [PMID: 35203976 PMCID: PMC8870671 DOI: 10.3390/brainsci12020213] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
This pilot study aimed to investigate the initial effect of a remotely delivered performance-based client-centered intervention on activity performance and participation among adults in the chronic phase after acquired brain injury (ABI). Sixteen participants living at home with little to no assistance in basic daily activities were allocated into intervention or waitlist control groups. Assessments were conducted at the baseline, after the 3-month intervention/wait period, and at a 3-month follow-up. The primary outcomes were activity performance using the Canadian Occupational Performance Measure (COPM) and the Performance Quality Rating Scale (PQRS) and participation using the Mayo-Portland Adaptability Inventory-4 (MPAI-4). The intervention included weekly videoconferencing sessions using the Cognitive Orientation to Daily Occupational Performance approach (tele-CO-OP). The participants identified five functional goals, of which three were directly addressed. Wilcoxon signed-ranks test results showed no significant improvements in the control group at the end of the 3-month wait period. Pooled data from both groups showed significant improvements in COPM scores for trained and untrained goals following the intervention. Significant improvements were also found in the PQRS and MPAI-4 scores. Improvements were partially maintained at follow-up. Our preliminary results suggest that tele-CO-OP may positively impact the lives of adults after ABI who are coping with long-term disability.
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Ávila-Villanueva M, Gómez-Ramírez J, Ávila J, Fernández-Blázquez MA. Alzheimer's Disease and Empathic Abilities: The Proposed Role of the Cingulate Cortex. J Alzheimers Dis Rep 2021; 5:345-352. [PMID: 34189406 PMCID: PMC8203285 DOI: 10.3233/adr-200282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In recent years there has been increasing interest in examining the role of empathic abilities in Alzheimer’s disease (AD). Empathy, the ability to understand and share another person’s feelings, implies the existence of emotional and cognitive processes and is a pivotal aspect for success in social interactions. In turn, self-empathy is oriented to one’s thoughts and feelings. Decline of empathy and self-empathy can occur during the AD continuum and can be linked to different neuroanatomical pathways in which the cingulate cortex may play a crucial role. Here, we will summarize the involvement of empathic abilities through the AD continuum and further discuss the potential neurocognitive mechanisms that contribute to decline of empathy and self-empathy in AD.
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Affiliation(s)
- Marina Ávila-Villanueva
- Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofía Foundation Alzheimer Center, Madrid, Spain
| | - Jaime Gómez-Ramírez
- Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofía Foundation Alzheimer Center, Madrid, Spain
| | - Jesús Ávila
- Center of Molecular Biology Severo Ochoa (CSIC-UAM), Campus de Cantoblanco, Madrid, Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Miguel A Fernández-Blázquez
- Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofía Foundation Alzheimer Center, Madrid, Spain.,Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Complutense University of Madrid (UCM), Campus de Somosaguas, Pozuelo de Alarcón, Madrid, Spain
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Rodríguez-Bailón M, López-González L, Merchán-Baeza JA. Client-centred practice in occupational therapy after stroke: A systematic review. Scand J Occup Ther 2020; 29:89-103. [PMID: 33353470 DOI: 10.1080/11038128.2020.1856181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Client-centred practice aims to involve the person in making decisions during the therapeutic intervention process, giving him or her a central and active role.Objectives: To analyze the effects of client-centred practice in occupational therapy on issues related to occupational performance and participation among people with stroke and traumatic brain injury.Material and methods: A systematic review of randomized clinical trials examining the effects of a client-centred practice carried out by occupational therapists in patients with stroke or traumatic brain injury aged over 18 years was conducted. PubMed, Web of Science, Scopus, OT Seeker, PsycINFO and EBSCO were used to retrieve potentially eligible publications.Results: Eight studies, from 294 identified, were included. The extracted data showed that the application of client-centred practice in occupational therapy improved satisfaction with occupational performance compared to conventional interventions. However, client-centred practice and conventional intervention had similar effects on functionality (Activities of Daily Living), life satisfaction and burden on caregivers.Conclusions and significance: Client-centred practice has the effect of achieving greater satisfaction with occupational performance. This suggests that client-centred practice in occupational therapy helps patients to accept the new limitations on their occupational performance. Further studies are needed to determine the effects of client-centred practice on other aspects.
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Affiliation(s)
| | | | - Jose Antonio Merchán-Baeza
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Spain
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Gagin R, HaGani N, Levy I, Norman D. There Is No Place Like Home: A Survey on Satisfaction and Reported Outcomes of a Home-Based Rehabilitation Program Among Orthopedic Surgery Patients. J Patient Exp 2020; 7:1715-1723. [PMID: 33457635 PMCID: PMC7786787 DOI: 10.1177/2374373519892764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Home-based rehabilitation (HBR) was previously found to be associated with positive outcomes that are equal to inpatient rehabilitation. Few studies have examined the challenges patients are facing during rehabilitation and recovery and their satisfaction from HBR. OBJECTIVE The purpose of this study was to examine the overall satisfaction and reported outcomes of HBR. METHODS A telephone survey was conducted among 146 orthopedic surgery patients who participated in an HBR program, at the end of the HBR and 6 months after. The questionnaire included information about level of independence, satisfaction from HBR, and difficulties during HBR. FINDINGS The overall satisfaction was high (73.1%). Patients reported on improvements in level of independence between the time of hospital discharge, the end of the program (P = .0001), and the 6 months follow-up (P = .004). Long wait for beginning of HBR, being a widower, and residing in a facility or with a nonfamilial caregiver were associated significantly with less general well-being and independence. The repeated measures analysis showed age lower than 71 and private health insurance ownership were associated with a better recovery. The most common difficulties reported were physical difficulties, lack of function, and caregivers' burden. CONCLUSIONS Patients and families need more emotional, social, and physical support during HBR. The increase in health services delivered in community settings requires a more clear-cut policy and supervision for HBR and the follow-up services.
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Affiliation(s)
| | | | - Itay Levy
- Rambam Medical Center, Haifa, Israel
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Maggio MG, Maresca G, Stagnitti MC, Anchesi S, Casella C, Pajno V, De Luca R, Manuli A, Calabrò RS. Social cognition in patients with acquired brain lesions: An overview on an under-reported problem. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:419-431. [PMID: 32301351 DOI: 10.1080/23279095.2020.1753058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Social cognition (SC) consists of mental representations of interpersonal relationships, which are used flexibly by the individual to promote functional social behaviors and achieve the goals. SC is a multidimensional construct and is supported by the activity of distributed neural networks in which different cortical and subcortical regions of the brain are involved. The review aims to evaluate the current literature on SC taking into account how it is compromised in acquired brain injury. Studies performed between 2010 and 2019 and fulfilling the selected criteria were searched on PubMed, Scopus, Cochrane and Web of Sciences databases. Impairment of SC is a neglected but common consequence of ABI, often leading to disordered interpersonal functioning and poor regulation of personal behavior with impaired social adaptation and quality of life of both the patient and his/her family. This review supports the idea that SC could have an important role in the management of neurological patients by both clinicians and caregivers.
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Gilboa Y, Helmer A. Self-Management Intervention for Attention and Executive Functions Using Equine-Assisted Occupational Therapy Among Children Aged 6–14 Diagnosed with Attention Deficit/Hyperactivity Disorder. J Altern Complement Med 2020; 26:239-246. [DOI: 10.1089/acm.2019.0374] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Yafit Gilboa
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anne Helmer
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Beit Yosef A, Jacobs JM, Shenkar S, Shames J, Schwartz I, Doryon Y, Naveh Y, Khalailh F, Berrous S, Gilboa Y. Activity Performance, Participation, and Quality of Life Among Adults in the Chronic Stage After Acquired Brain Injury-The Feasibility of an Occupation-Based Telerehabilitation Intervention. Front Neurol 2019; 10:1247. [PMID: 31866924 PMCID: PMC6908485 DOI: 10.3389/fneur.2019.01247] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/08/2019] [Indexed: 12/26/2022] Open
Abstract
Objective: Acquired brain injury (ABI) is a leading cause of long-term disability. This calls for effective and accessible interventions to support participation in the community over time. One promising avenue to answer this need is telerehabilitation. Prior to conducting a larger trial, the main objective of this pilot study is to explore the feasibility, acceptability, and preliminary efficacy of a metacognitive occupation-based intervention in a telerehabilitation format with adults and older adults in the chronic phase after ABI. Methods: Five community dwelling participants (ages 65–72), 6–10 months post-ABI, with scores 2–4 on the modified Rankin scale and without dementia, completed the teleintervention. The intervention included ~10 weekly videoconferencing sessions administered by an occupational therapist using the Cognitive Orientation to Daily Occupational Performance approach. Each participant defined five functional goals and three were trained and two were not trained during the intervention. Evaluations were conducted at pre, post, and 3-month follow-up. The primary outcome measures included activity performance (The Canadian Occupational Performance Measure; COPM), participation (the Mayo-Portland Adaptability Inventory-4 Participation Index; MPAI-4-P), and quality of life (QoL) (stroke impact scale; SIS). Other measures included a feedback interview, satisfaction questionnaire, field notes, and a treatment fidelity checklist. Results: The teleintervention was found to be feasible and the participants expressed a high degree of satisfaction with the intervention and the technology use. A Wilcoxon Signed-Ranks test indicated statistically significant improvements post intervention in COPM performance (z = −2.023, p = 0.043) and satisfaction (z = −2.023, p = 0.043) ratings. Additionally, clinically significant improvements (≥2 points) in both performance and satisfaction with performance were found for each participant in at least three of their five defined functional goals. Trends toward significant improvement were found in MPAI-4-P ratings post intervention (z = −1.826, p = 0.068). Furthermore, clinically significant improvements (≥15 points) post intervention were found for each participant in some subscales of the SIS. Results were partially maintained at 3-month follow-up. Conclusions: This pilot study demonstrated the feasibility of a metacognitive occupation-based telerehabilitation intervention and its potential benefits in activity performance, participation, and QoL for older adults coping with long-term disability following ABI. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03048708.
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Affiliation(s)
- Aviva Beit Yosef
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jeremy M Jacobs
- Faculty of Medicine, Department of Geriatrics and Geriatric Rehabilitation, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shira Shenkar
- Occupational Therapy Department, Maccabi Health Services, Jerusalem, Israel
| | - Jeffrey Shames
- Medical and Health Professions Division, Maccabi Health Services, Tel Aviv-Yafo, Israel
| | - Isabella Schwartz
- Faculty of Medicine, Physical Medicine and Rehabilitation Department, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yehudit Doryon
- Occupational Therapy Department, Medical and Health Professions Division, Maccabi Health Services, Tel Aviv-Yafo, Israel
| | - Yuval Naveh
- Maccabi Health Care Services Group, Occupational Therapy Department, Bayit Balev Hospital, Bat Yam, Israel
| | - Fatena Khalailh
- Occupational Therapy Department, Hadassah Medical Center, Jerusalem, Israel
| | - Shani Berrous
- Occupational Therapy Department, Maccabi Health Services, Jerusalem, Israel
| | - Yafit Gilboa
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Cicerone KD, Goldin Y, Ganci K, Rosenbaum A, Wethe JV, Langenbahn DM, Malec JF, Bergquist TF, Kingsley K, Nagele D, Trexler L, Fraas M, Bogdanova Y, Harley JP. Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. Arch Phys Med Rehabil 2019; 100:1515-1533. [DOI: 10.1016/j.apmr.2019.02.011] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
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Giles GM. Neurocognitive Rehabilitation: Skills or Strategies? Am J Occup Ther 2019; 72:7206150010p1-7206150010p16. [PMID: 30760391 DOI: 10.5014/ajot.2018.726001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The author describes personal and professional milestones in becoming an occupational therapist and his early experience in the first behavior disorder program for neurologically based aggression in the world. A real clinical example is used to bring these early lessons into vivid focus. New evidence underlines occupational therapists' unique role in skill-habit training in clients with severe neurological impairment. For clients with milder impairments, irrespective of diagnosis, strategy training may maximize community independence and reduce hospital recidivism. The concept of functional cognition is described as an important development for the profession. Even in an environment of rapid innovation, occupational therapists need to recognize that it is the commonplace activities that have meaning for the individual that really matter. This is both the art and science of occupational therapy, and it will never be superseded by technological innovation because true creativity and genuine empathy cannot be mechanized.
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Affiliation(s)
- Gordon Muir Giles
- Gordon Muir Giles, PhD, OTR/L, FAOTA, is Professor, Samuel Merritt University, Oakland, CA, and Director of Neurobehavioral Services, Crestwood Treatment Center, Fremont, CA;
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Occupational Therapy in Complex Patients: A Pilot Randomized Controlled Trial. Occup Ther Int 2018; 2018:3081094. [PMID: 30250407 PMCID: PMC6140010 DOI: 10.1155/2018/3081094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/09/2018] [Accepted: 08/05/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction To determine effect size and feasibility of experimental occupational therapy (OT) intervention in addition to standard care in a population of complex patients undergoing rehabilitation in a hospital-home-based setting. Method 40 complex patients admitted to the rehabilitation ward of the Local Health Authority-Research Institute of Reggio Emilia (Italy) were randomized in a parallel-group, open-label controlled trial. Experimental OT targeting occupational needs in the areas of self-care, productivity, and leisure was delivered by occupational therapists. Standard care consisted of task-oriented rehabilitation delivered by a multiprofessional team. Results The experimental OT intervention was completed by 75% of patients assigned to this group. The average changes in the Canadian Occupational Performance Measure (COPM) performance score significantly and clinically favored experimental OT [-3,06 (-4.50; -1.61); delta > 2 points, resp.]. Similar trends were detected for COPM satisfaction and independence in instrumental activities of daily living (ADL). At follow-up, level of social participation was higher for patients treated with experimental OT (p = 0.043) than for controls. Conclusions Experimental OT was feasible in complex patients in a hospital-home-based setting. It ameliorated both patients' performance and satisfaction in carrying out relevant activities and improved independence in instrumental ADL. The trial is registered with ClinicalTrials.gov NCT02677766.
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Social Cognition Deficits: Current Position and Future Directions for Neuropsychological Interventions in Cerebrovascular Disease. Behav Neurol 2017; 2017:2627487. [PMID: 28729755 PMCID: PMC5512037 DOI: 10.1155/2017/2627487] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 06/06/2017] [Indexed: 12/22/2022] Open
Abstract
Neuropsychological assessments of cognitive dysfunction in cerebrovascular illness commonly target basic cognitive functions involving aspects of memory, attention, language, praxis, and number processing. Here, I highlight the clinical importance of often-neglected social cognition functions. These functions recruit a widely distributed neural network, making them vulnerable in most cerebrovascular diseases. Sociocognitive deficits underlie most of the problematic social conduct observed in patients and are associated with more negative clinical outcomes (compared to nonsocial cognitive deficits). In clinical settings, social cognition deficits are normally gleaned from collateral information from caregivers or from indirect inferences made from patients' performance on standard nonsocial cognitive tests. Information from these sources is however inadequate. I discuss key social cognition functions, focusing initially on deficits in emotion perception and theory of mind, two areas that have gained sizeable attention in neuroscientific research, and then extend the discussion into relatively new, less covered but crucial functions involving empathic behaviour, social awareness, social judgements, and social decision making. These functions are frequently impaired following neurological change. At present, a wide range of psychometrically robust social cognition tests is available, and this review also makes the case for their inclusion in neuropsychological assessments.
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Prescott S, Fleming J, Doig E. Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: A systematic scoping review. Brain Inj 2015; 29:1515-29. [DOI: 10.3109/02699052.2015.1075152] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shea CK, Jackson N. Client perception of a client-centered and occupation-based intervention for at-risk youth. Scand J Occup Ther 2014; 22:173-80. [PMID: 25328060 DOI: 10.3109/11038128.2014.958873] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A community-based occupational therapy program aims to provide client-centered and occupation-based interventions to at-risk youth. OBJECTIVE This pilot study explores how at-risk youth experiencing psychosocial and environmental barriers to occupation respond to client-centered and occupation-based occupational therapy in the community. METHOD One-on-one semi-structured interviews were conducted with five youth participants receiving individual therapy interventions through a community-based occupational therapy program. The transcript data were analyzed qualitatively. RESULTS Three themes emerged: (i) client-centered and occupation-based OT interventions, (ii) the youths' increased self-advocacy, and (iii) the enhancement of youths' perception of their future. CONCLUSION AND SIGNIFICANCE The youth in this study described OT interventions exemplifying client-centered and occupation-based therapy, a non-prescriptive approach that validates the individual and may prove especially effective in serving the at-risk youth population.
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Affiliation(s)
- Chi-Kwan Shea
- Occupational Therapy Department, Samuel Merritt University , Oakland, CA , USA
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Clark-Wilson J, Giles GM, Baxter DM. Revisiting the neurofunctional approach: conceptualizing the core components for the rehabilitation of everyday living skills. Brain Inj 2014; 28:1646-56. [PMID: 25153760 PMCID: PMC4266071 DOI: 10.3109/02699052.2014.946449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 02/08/2014] [Accepted: 06/30/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Introduced in the 1980s, the neurofunctional approach (NFA) is one of the few interventions designed primarily for clients with severe deficits following traumatic brain injury (TBI). Specifically the NFA was intended for those individuals who were limited in their ability to solve novel problems or generalize skills from one setting to another and whose lack of insight limited their engagement in the rehabilitative process. DESCRIPTION OF THE APPROACH: The NFA is a client-centred, goal-driven approach that incorporates the principles of skill learning and promotes the development of routines and competencies in practical activities required for everyday living. Programmes based on the NFA are developed specifically to meet each client's unique needs, using a range of evidence-based interventions. RECENT EVIDENCE: Recently the NFA has been found to be more effective than cognitive-retraining for some individuals with moderate-to-severe TBI who have deficits in activities of daily living. This paper aims to define the core features of the NFA, outline the theoretical basis on which it is founded and consider implications of the findings for rehabilitation after TBI in general. The NFA is highly relevant for clients living in the community who require a case manager to direct an integrated, rehabilitation programme or provide structured input for the long-term maintenance of skills.
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Affiliation(s)
- Jo Clark-Wilson
- Managing Partner, Occupational Therapist and Case ManagerHead First, HawkhurstKentUK
| | - Gordon Muir Giles
- Director of Neurobehavioral services, Crestwood Treatment CenterFremont, CAUSA
- Professor, Department of Occupational Therapy, Samuel Merritt UniversityOakland, CAUSA
| | - Doreen M. Baxter
- Consultant Clinical Neuropsychologist, Head FirstHawkhurst, KentUK
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