1
|
Hammelef E, Zakaria SJ, Andersen SH, Kelly TJ, Grampurohit N, Avery M, Napoli A, Mulcahey MJ, Serruya MD. A Pilot Feasibility Trial of an Upper Extremity Assistive System. Arch Rehabil Res Clin Transl 2023; 5:100308. [PMID: 38163018 PMCID: PMC10757169 DOI: 10.1016/j.arrct.2023.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To develop and clinically evaluate a customizable active upper extremity (UE) assistive system with integrated functional electrical stimulation (FES) that improves function and independence of individuals during activities of daily living (ADLs). Design Single-arm, prospective, open-label cohort feasibility trial. Setting An academic research institution. Participants Subjects were 5 adults with a medical history of stroke resulting in distal UE impairment (N=5). The subjects volunteered from recruitment materials that detailed information about the study. Interventions A novel, wearable, lightweight, low-profile, and patient-tailored UE assistive system. It comprises a splint component and FES unit that may each be controlled by electromyography (EMG) signals, inertial measurement units (IMUs), manual control source (joystick), and/or voice control. Main Outcome Measures Several occupational therapy outcome measures were used, including the Canadian Occupational Performance Measure (COPM), Action Research Arm Test (ARAT), The Box and Blocks Test (BBT), the ABILHAND-Manual Ability Measure, and Patient Reported Outcomes Measurement Information System (PROMIS) UE Short Form. Results All participants learned to use our UE assistive system to perform ADLs and were able to use it independently at home. Most participants experienced a clinically meaningful improvement in both performance and satisfaction for the majority of their COPM goals while using the system. All participants experienced improvement in hand grip and release as shown by their baseline and post assessment scores for hand function (BBT, ARAT) and patient-reported outcomes (ABILHAND, PROMIS). Conclusions The clinical outcomes suggest that our UE assistive system improves functional performance in patients with UE impairment, allowing them to engage more actively in ADLs. Further innovation including elbow and shoulder components will allow users to have more degrees of freedom during tasks.
Collapse
Affiliation(s)
- Emma Hammelef
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
| | - Saami J. Zakaria
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
| | - Sarah H. Andersen
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
| | - Thomas J. Kelly
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
| | - Namrata Grampurohit
- Center for Outcomes and Measurement, College of Rehabilitation Sciences, Thomas Jefferson University, 901 Walnut Street, Suite 642, Philadelphia, PA 19107
| | - Mikael Avery
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
- Studio Krea, Collingswood, NJ
| | - Alessandro Napoli
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
| | - Mary Jane Mulcahey
- Center for Outcomes and Measurement, College of Rehabilitation Sciences, Thomas Jefferson University, 901 Walnut Street, Suite 642, Philadelphia, PA 19107
| | - Mijail Demian Serruya
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
| |
Collapse
|
2
|
Ekstrand E, Brogårdh C. Life satisfaction after stroke and the association with upper extremity disability, sociodemographics, and participation. PM R 2021; 14:922-930. [PMID: 34541828 DOI: 10.1002/pmrj.12712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/25/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Remaining disability after stroke can reduce a person's life satisfaction. Because previous studies of life satisfaction show inconsistent results, there is a need for more knowledge regarding perceived life satisfaction after stroke and associated factors. OBJECTIVE To assess perceived life satisfaction after stroke in relation to Swedish reference values; and the association with upper extremity disability, sociodemographics, and participation. DESIGN Cross-sectional study. SETTING University hospital. PARTICIPANTS Seventy-five persons (72% male) with mild to moderate disability in a stable phase after stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11), which includes one global item Life as a whole and 10 domain-specific items. Global life satisfaction and explanatory factors were evaluated in two multivariate logistic regression models. RESULTS Fifty-three percent of the participants were satisfied with Life as a whole. Highest satisfaction was found for Family life (78%) and Partner relationship (77%) and lowest satisfaction for Vocational situation (32%), Sexual life (25%), and Physical health (23%). Life as a whole and most domain-specific items showed a significantly lower proportion of satisfied persons compared to Swedish reference values. In the first regression model with factors of upper extremity disability, manual ability was the strongest explanatory variable for Life as a whole (p value = .032, Nagelkerke R Square 0.117). In the second regression model, participation, social, and working status were the final explanatory variables (p value = .006, Nagelkerke R Square = 0.207). CONCLUSION Our findings indicate that persons with mild to moderate disability after stroke perceive overall less satisfaction with Life as a whole and domain-specific items than the general Swedish population. To increase a person's life satisfaction after stroke, rehabilitation interventions should target a variety of aspects including enhancing functioning of upper extremity, reducing participation restrictions, and providing support regarding social and vocational situation.
Collapse
Affiliation(s)
- Elisabeth Ekstrand
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Christina Brogårdh
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
3
|
Chui A, Mazzitti D, Nalder E, Cameron D, Polatajko HJ, Dawson DR. Therapists' experience of the cognitive orientation to daily occupational performance (CO-OP) approach: Shifting from conventional practice. Scand J Occup Ther 2018; 27:133-141. [PMID: 29983084 DOI: 10.1080/11038128.2018.1483424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: The CO-OP ApproachTM has been increasingly used in research and practice, yet its critical elements and implementation challenges are largely undescribed. Obtaining therapists' perspectives on CO-OP may reveal insights into potential critical and mediating factors.Aim/Objective: To explore the experiences of CO-OP therapists by understanding their perceptions on the approach compared with conventional practice, and by identifying mediating factors in its implementation.Material and Method: This exploratory study utilized a qualitative descriptive design. A purposive sample of occupational therapists (n = 3) was interviewed. Data were analyzed using thematic analysis and themes were validated within a focus group.Results/Findings: Three themes were identified: 'CO-OP works,' 'CO-OP delivery is mediated by contextual factors,' and 'CO-OP shifts the therapeutic approach.' Therapists perceived CO-OP to be efficacious for client-centred goal attainment. Guided discovery and the problem-solving strategy were identified as unique and challenging CO-OP elements. Mediating factors such as level of cognitive impairment and quality of family member involvement may affect CO-OP efficacy.Conclusions: Therapists found CO-OP to be efficacious and adopted unique elements into their professional approaches.Significance: This is the first study to investigate CO-OP therapists' experiences. Future research is recommended to enhance training of therapists in key CO-OP features.
Collapse
Affiliation(s)
- Adora Chui
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
| | - Daniela Mazzitti
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Emily Nalder
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,March of Dimes Canada, Toronto, Canada
| | - Debra Cameron
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Helene J Polatajko
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Deirdre R Dawson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| |
Collapse
|
4
|
Demers M, Levin MF. Do Activity Level Outcome Measures Commonly Used in Neurological Practice Assess Upper-Limb Movement Quality? Neurorehabil Neural Repair 2017; 31:623-637. [DOI: 10.1177/1545968317714576] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Marika Demers
- McGill University, Montréal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Canada
| | - Mindy F. Levin
- McGill University, Montréal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Canada
| |
Collapse
|
5
|
Ekstrand E, Rylander L, Lexell J, Brogårdh C. Perceived ability to perform daily hand activities after stroke and associated factors: a cross-sectional study. BMC Neurol 2016; 16:208. [PMID: 27806698 PMCID: PMC5093923 DOI: 10.1186/s12883-016-0733-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/25/2016] [Indexed: 12/03/2022] Open
Abstract
Background Despite that disability of the upper extremity is common after stroke, there is limited knowledge how it influences self-perceived ability to perform daily hand activities. The aim of this study was to describe which daily hand activities that persons with mild to moderate impairments of the upper extremity after stroke perceive difficult to perform and to evaluate how several potential factors are associated with the self-perceived performance. Methods Seventy-five persons (72 % male) with mild to moderate impairments of the upper extremity after stroke (4 to 116 months) participated. Self-perceived ability to perform daily hand activities was rated with the ABILHAND Questionnaire. The perceived ability to perform daily hand activities and the potentially associated factors (age, gender, social and vocational situation, affected hand, upper extremity pain, spasticity, grip strength, somatosensation of the hand, manual dexterity, perceived participation and life satisfaction) were evaluated by linear regression models. Results The activities that were perceived difficult or impossible for a majority of the participants were bimanual tasks that required fine manual dexterity of the more affected hand. The factor that had the strongest association with perceived ability to perform daily hand activities was dexterity (p < 0.001), which together with perceived participation (p = 0.002) explained 48 % of the variance in the final multivariate model. Conclusion Persons with mild to moderate impairments of the upper extremity after stroke perceive that bimanual activities requiring fine manual dexterity are the most difficult to perform. Dexterity and perceived participation are factors specifically important to consider in the rehabilitation of the upper extremity after stroke in order to improve the ability to use the hands in daily life.
Collapse
Affiliation(s)
- Elisabeth Ekstrand
- Department of Health Sciences, Lund University, Lund, Sweden. .,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.,Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Christina Brogårdh
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
6
|
Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev 2014; 2014:CD010820. [PMID: 25387001 PMCID: PMC6469541 DOI: 10.1002/14651858.cd010820.pub2] [Citation(s) in RCA: 337] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Improving upper limb function is a core element of stroke rehabilitation needed to maximise patient outcomes and reduce disability. Evidence about effects of individual treatment techniques and modalities is synthesised within many reviews. For selection of effective rehabilitation treatment, the relative effectiveness of interventions must be known. However, a comprehensive overview of systematic reviews in this area is currently lacking. OBJECTIVES To carry out a Cochrane overview by synthesising systematic reviews of interventions provided to improve upper limb function after stroke. METHODS SEARCH METHODS We comprehensively searched the Cochrane Database of Systematic Reviews; the Database of Reviews of Effects; and PROSPERO (an international prospective register of systematic reviews) (June 2013). We also contacted review authors in an effort to identify further relevant reviews. SELECTION CRITERIA We included Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs) of patients with stroke comparing upper limb interventions with no treatment, usual care or alternative treatments. Our primary outcome of interest was upper limb function; secondary outcomes included motor impairment and performance of activities of daily living. When we identified overlapping reviews, we systematically identified the most up-to-date and comprehensive review and excluded reviews that overlapped with this. DATA COLLECTION AND ANALYSIS Two overview authors independently applied the selection criteria, excluding reviews that were superseded by more up-to-date reviews including the same (or similar) studies. Two overview authors independently assessed the methodological quality of reviews (using a modified version of the AMSTAR tool) and extracted data. Quality of evidence within each comparison in each review was determined using objective criteria (based on numbers of participants, risk of bias, heterogeneity and review quality) to apply GRADE (Grades of Recommendation, Assessment, Development and Evaluation) levels of evidence. We resolved disagreements through discussion. We systematically tabulated the effects of interventions and used quality of evidence to determine implications for clinical practice and to make recommendations for future research. MAIN RESULTS Our searches identified 1840 records, from which we included 40 completed reviews (19 Cochrane; 21 non-Cochrane), covering 18 individual interventions and dose and setting of interventions. The 40 reviews contain 503 studies (18,078 participants). We extracted pooled data from 31 reviews related to 127 comparisons. We judged the quality of evidence to be high for 1/127 comparisons (transcranial direct current stimulation (tDCS) demonstrating no benefit for outcomes of activities of daily living (ADLs)); moderate for 49/127 comparisons (covering seven individual interventions) and low or very low for 77/127 comparisons.Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality and a relatively high dose of repetitive task practice, suggesting that these may be effective interventions; moderate-quality evidence also indicated that unilateral arm training may be more effective than bilateral arm training. Information was insufficient to reveal the relative effectiveness of different interventions.Moderate-quality evidence from subgroup analyses comparing greater and lesser doses of mental practice, repetitive task training and virtual reality demonstrates a beneficial effect for the group given the greater dose, although not for the group given the smaller dose; however tests for subgroup differences do not suggest a statistically significant difference between these groups. Future research related to dose is essential.Specific recommendations for future research are derived from current evidence. These recommendations include but are not limited to adequately powered, high-quality RCTs to confirm the benefit of CIMT, mental practice, mirror therapy, virtual reality and a relatively high dose of repetitive task practice; high-quality RCTs to explore the effects of repetitive transcranial magnetic stimulation (rTMS), tDCS, hands-on therapy, music therapy, pharmacological interventions and interventions for sensory impairment; and up-to-date reviews related to biofeedback, Bobath therapy, electrical stimulation, reach-to-grasp exercise, repetitive task training, strength training and stretching and positioning. AUTHORS' CONCLUSIONS Large numbers of overlapping reviews related to interventions to improve upper limb function following stroke have been identified, and this overview serves to signpost clinicians and policy makers toward relevant systematic reviews to support clinical decisions, providing one accessible, comprehensive document, which should support clinicians and policy makers in clinical decision making for stroke rehabilitation.Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions. Effective collaboration is urgently needed to support large, robust RCTs of interventions currently used routinely within clinical practice. Evidence related to dose of interventions is particularly needed, as this information has widespread clinical and research implications.
Collapse
Affiliation(s)
- Alex Pollock
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Sybil E Farmer
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Marian C Brady
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
| | - Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Frederike van Wijck
- Glasgow Caledonian UniversityInstitute for Applied Health Research and the School of Health and Life SciencesGlasgowUK
| | | |
Collapse
|
7
|
Test-Retest Reliability of the ABILHAND Questionnaire in Persons With Chronic Stroke. PM R 2014; 6:324-31. [DOI: 10.1016/j.pmrj.2013.09.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 08/27/2013] [Accepted: 09/25/2013] [Indexed: 11/24/2022]
|
8
|
Slijper A, Svensson KE, Backlund P, Engström H, Sunnerhagen KS. Computer game-based upper extremity training in the home environment in stroke persons: a single subject design. J Neuroeng Rehabil 2014; 11:35. [PMID: 24625289 PMCID: PMC3995595 DOI: 10.1186/1743-0003-11-35] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 03/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the present study was to assess whether computer game-based training in the home setting in the late phase after stroke could improve upper extremity motor function. METHODS Twelve subjects with prior stroke were recruited; 11 completed the study. DESIGN The study had a single subject design; there was a baseline test (A1), a during intervention test (B) once a week, a post-test (A2) measured directly after the treatment phase, plus a follow-up (C) 16-18 weeks after the treatment phase. Information on motor function (Fugl-Meyer), grip force (GrippitR) and arm function in activity (ARAT, ABILHAND) was gathered at A1, A2 and C. During B, only Fugl-Meyer and ARAT were measured. The intervention comprised five weeks of game-based computer training in the home environment. All games were designed to be controlled by either the affected arm alone or by both arms. Conventional formulae were used to calculate the mean, median and standard deviations. Wilcoxon's signed rank test was used for tests of dependent samples. Continuous data were analyzed by methods for repeated measures and ordinal data were analyzed by methods for ordered multinomial data using cumulative logistic models. A p-value of < 0.05 was considered statistically significant. RESULTS Six females and five males, participated in the study with an average age of 58 years (range 26-66). FMA-UE A-D (motor function), ARAT, the maximal grip force and the mean grip force on the affected side show significant improvements at post-test and follow-up compared to baseline. No significant correlation was found between the amount of game time and changes in the outcomes investigated in this study. CONCLUSION The results indicate that computer game-based training could be a promising approach to improve upper extremity function in the late phase after stroke, since in this study, changes were achieved in motor function and activity capacity.
Collapse
Affiliation(s)
| | | | | | | | - Katharina Stibrant Sunnerhagen
- Rehabilitation Medicine, The Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Per Dubbsgatan 14 3rd floor, SU/Sahlgrenska, Göteborg SE-413 45, Sweden.
| |
Collapse
|
9
|
Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010820] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
10
|
Bowyer P, Lee J, Kramer J, Taylor RR, Kielhofner G. Determining the Clinical Utility of the Short Child Occupational Profile (SCOPE). Br J Occup Ther 2012. [DOI: 10.4276/030802212x13261082051373] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective:The purpose of this study was to propose a process for the study of clinical utility and to illustrate its implementation in the development of an assessment.Method:A mixed methods approach was used to understand the clinical utility of an assessment in development. An exploratory qualitative/quantitative (QUAL?QUANT) approach was used to identify perspectives of the clinical utility of the assessment. The design placed equal status on the two methods used: focus groups and surveys.Results:The proposed process for the study of clinical utility resulted in targeted revisions based upon data obtained from 21 practitioners in three focus groups during a systemised examination of clinical utility.Conclusion:A mixed methods process can be used to ensure the clinical utility of assessments during the development process.
Collapse
Affiliation(s)
- Patricia Bowyer
- Associate Professor and Associate Director, Department of Occupational Therapy, Texas Woman's University, Houston, Texas, USA
| | - Jenica Lee
- Postdoctoral Research Associate, Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jessica Kramer
- Assistant Professor, Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
| | - Renee R Taylor
- Professor, Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Gary Kielhofner
- Formerly Professor, Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
11
|
Rowland TJ, Turpin M, Gustafsson L, Henderson RD, Read SJ. Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9): perceived clinical utility within 14 days of stroke. Top Stroke Rehabil 2011; 18:382-93. [PMID: 21914604 DOI: 10.1310/tsr1804-382] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9) is an activity-based assessment developed to include relevant functional tasks and to be sensitive to clinically important changes in upper limb function. The aim of this study was to explore both therapists' and clients' views on the clinical utility of CAHAI-9 within 14 days of stroke. METHOD Twenty-one occupational therapists actively working in stroke settings were recruited by convenience sampling from 8 hospitals and participated in semistructured focus groups. Five clients within 14 days of stroke were recruited by consecutive sampling from 1 metropolitan hospital and participated in structured individual interviews. The transcripts were analyzed thematically. RESULTS Six themes emerged from the focus groups and interviews: collecting information, decisions regarding client suitability, administration and scoring, organizational demands, raising awareness, and clients' perceptions of CAHAI-9 utility. All therapists agreed CAHAI-9 was suited for the stroke population and assisted identification of client abilities or difficulties within functional contexts. Opinions varied as to whether CAHAI-9 should be routinely administered with clients who had mild and severe upper limb deficits, but therapists agreed it was appropriate for clients with moderate deficits. Therapists made suggestions regarding refinement of the scoring and training to increase utility. All clients with stroke felt that the assessment provided reassurance regarding their recovery. CONCLUSION The findings indicate that CAHAI-9 shows promise as an upper limb ability assessment for clients within 14 days of stroke.
Collapse
Affiliation(s)
- Tennille Jane Rowland
- Neurology Research Centre, Royal Brisbane and Women's Hospital, Queensland, Australia
| | | | | | | | | |
Collapse
|
12
|
Wang TN, Lin KC, Wu CY, Chung CY, Pei YC, Teng YK. Validity, responsiveness, and clinically important difference of the ABILHAND questionnaire in patients with stroke. Arch Phys Med Rehabil 2011; 92:1086-91. [PMID: 21704789 DOI: 10.1016/j.apmr.2011.01.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 01/27/2011] [Accepted: 01/31/2011] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate the criterion-related validity, responsiveness, and clinically important differences of the ABILHAND questionnaire in patients with stroke. DESIGN Validation and clinimetric study. SETTING Three medical centers. PARTICIPANTS Patients with stroke (N=51). INTERVENTIONS A total of 51 patients with stroke received 1 of 3 upper extremity rehabilitation programs for 4 weeks. MAIN OUTCOME MEASURES The ABILHAND and the criterion measures, including the Stroke Impact Scale (SIS), FIM, Nottingham Extended Activities of Daily Living (NEADL), and accelerometers, were administered at pretreatment and posttreatment. The score of the ABILHAND, given in logits, was based on the conversion of the ordinal score into a linear measure of ability. RESULTS Correlation coefficients (Pearson r) were moderate to large between the ABILHAND and SIS physical domains (.54-.66), fair to moderate between the ABILHAND and FIM-motor and NEADL (.28-.48), and moderate between the ABILHAND and accelerometer data (.45-.54). The responsiveness of the ABILHAND was large (standardized response mean=1.27). The minimal clinically important difference range for the ABILHAND was .26 to .35, and 51.0% of the patients showed a positive change that exceeded the lower bound of a clinically important difference after intervention. CONCLUSIONS The results support that the ABILHAND is an appropriate outcome measure for assessing upper extremity performance in daily activities in patients with stroke and is sensitive to detect change after rehabilitative interventions. The change score of a patient with stroke on the ABILHAND should reach .26 to .35 logits points to be regarded as a clinically important change.
Collapse
Affiliation(s)
- Tien-ni Wang
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | | | | | | | | | |
Collapse
|
13
|
Alt Murphy M, Persson HC, Danielsson A, Broeren J, Lundgren-Nilsson A, Sunnerhagen KS. SALGOT--Stroke Arm Longitudinal study at the University of Gothenburg, prospective cohort study protocol. BMC Neurol 2011; 11:56. [PMID: 21612620 PMCID: PMC3120665 DOI: 10.1186/1471-2377-11-56] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 05/25/2011] [Indexed: 01/30/2023] Open
Abstract
Background Recovery patterns of upper extremity motor function have been described in several longitudinal studies, but most of these studies have had selected samples, short follow up times or insufficient outcomes on motor function. The general understanding is that improvements in upper extremity occur mainly during the first month after the stroke incident and little if any, significant recovery can be gained after 3-6 months. The purpose of this study is to describe the recovery of upper extremity function longitudinally in a non-selected sample initially admitted to a stroke unit with first ever stroke, living in Gothenburg urban area. Methods/Design A sample of 120 participants with a first-ever stroke and impaired upper extremity function will be consecutively included from an acute stroke unit and followed longitudinally for one year. Assessments are performed at eight occasions: at day 3 and 10, week 3, 4 and 6, month 3, 6 and 12 after onset of stroke. The primary clinical outcome measures are Action Research Arm Test and Fugl-Meyer Assessment for Upper Extremity. As additional measures, two new computer based objective methods with kinematic analysis of arm movements are used. The ABILHAND questionnaire of manual ability, Stroke Impact Scale, grip strength, spasticity, pain, passive range of motion and cognitive function will be assessed as well. At one year follow up, two patient reported outcomes, Impact on Participation and Autonomy and EuroQol Quality of Life Scale, will be added to cover the status of participation and aspects of health related quality of life. Discussion This study comprises a non-selected population with first ever stroke and impaired arm function. Measurements are performed both using traditional clinical assessments as well as computer based measurement systems providing objective kinematic data. The ICF classification of functioning, disability and health is used as framework for the selection of assessment measures. The study design with several repeated measurements on motor function will give us more confident information about the recovery patterns after stroke. This knowledge is essential both for optimizing rehabilitation planning as well as providing important information to the patient about the recovery perspectives. Trial registration ClinicalTrials.gov: NCT01115348
Collapse
Affiliation(s)
- Margit Alt Murphy
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | | | | | | | | | | |
Collapse
|
14
|
Rowland T, Gustafsson L, Turpin M, Henderson R, Read S. Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9): a multi-centre investigation of clinical utility. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.5.290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims: Assessment of upper limb ability is a common focus of the occupational therapist in acute stroke. Chedoke Arm and Hand Activity Inventory - 9 (CAHAI-9) is an activity based assessment developed to include relevant functional tasks and to be sensitive to clinically important changes in upper limb function. The aim of this study was to investigate the clinical utility of CAHAI-9 in an acute stroke setting. Methods: Thirty-two occupational therapist participants from eight hospitals completed 100 CAHAI-9 assessments, on 92 patients with stroke, over six months. Occupational therapists completed questionnaires regarding the clinical utility of CAHAI-9. Findings: The mean patient age was 69 years and mean CAHAI-9 score was 39/63. The mean administration time was 16 minutes. Eighty-three percent of therapists indicated they would use CAHAI-9 again. Eight-seven percent agreed CAHAI-9 was useful for patients with mild and moderate (91%) upper limb deficits however only 25% agreed for severe deficits. Conclusions: The findings indicate that CAHAI-9 shows promise as an upper limb ability assessment in acute stroke, with therapists indicating they would use CAHAI-9 again. However, further investigation of the scoring issues may be warranted before CAHAI-9 is ready for clinical use in Australian acute care settings.
Collapse
Affiliation(s)
- Tennille Rowland
- Occupational Therapy Department; Royal Brisbane and Women's Hospital
| | - Louise Gustafsson
- Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland
| | - Merrill Turpin
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland
| | | | - Stephen Read
- Royal Brisbane and Women's Hospital; Queensland, Australia
| |
Collapse
|
15
|
Sunnerhagen KS, Lundgren‐Nilsson Å, Willén C. Functioning of the upper extremity in persons with late polio. Eur J Neurol 2011; 18:354-358. [DOI: 10.1111/j.1468-1331.2010.03156.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K. S. Sunnerhagen
- From the Institute of Neuroscience and Physiology – Section for Clinical Neuroscience and Rehabilitation Gothenburg University, Göteborg Sweden
- Sunnaas Rehabilitation Hospital and Faculty of Medicine, University of Oslo, Norway
| | - Å. Lundgren‐Nilsson
- From the Institute of Neuroscience and Physiology – Section for Clinical Neuroscience and Rehabilitation Gothenburg University, Göteborg Sweden
| | - C. Willén
- From the Institute of Neuroscience and Physiology – Section for Clinical Neuroscience and Rehabilitation Gothenburg University, Göteborg Sweden
| |
Collapse
|
16
|
Öhrvall AM, Eliasson AC. Parents' and therapists' perceptions of the content of the Manual Ability Classification System, MACS. Scand J Occup Ther 2010. [DOI: 10.3109/11038120903125101] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
17
|
Abstract
BACKGROUND Rehabilitation professionals strive to provide high-quality evidence-based services for children. Developing systems to measure and monitor the benefits of our services, and health outcomes for children is complex and challenging. The Community Outcome Project aims to introduce systematic outcome measurement across the network of paediatric community-based brain injury services within the New South Wales Brain Injury Rehabilitation Program (BIRP) to support clinical practice and service evaluation. METHODS A literature review informed the development of the evaluative framework and identified available paediatric outcome measures which may be appropriate. Extensive consultation with clinicians supported project planning and identified clinical priorities that the outcome measures needed to capture. Outcome measures were shortlisted by matching them to identified clinical priorities, and then trialled in clinical practice. Qualitative feedback regarding clinical utility and feasibility was obtained from clinical staff. The process has utilized change management strategies to ensure the success of the project and keep staff engaged. RESULTS The process identified the three main clinical priorities for outcome measurement - family functioning, school performance and participation. Three outcome measures were chosen for the pilot project that is currently underway. They are Family Burden of Injury Interview, Academic Competence and Evaluation Scales and Child and Adolescent Scale of Participation. Plans for analyses of outcome data within the paediatric BIRP services are discussed. CONCLUSIONS Extensive preparation is required to optimize staff engagement in a project that systematically introduces outcome measures that are useful to clinicians, clients and service providers. Managing the change required is a key focus of the project. Benefits and costs to clinicians and services will be discussed.
Collapse
Affiliation(s)
- H Badge
- University of Sydney, Outcomes Manager, GMCT Brain Injury Rehabilitation Directorate, Liverpool Hospital, Liverpool, UK
| | | | | |
Collapse
|
18
|
Rowland TJ, Gustafsson L, Henderson RD, Turpin M, Read SJ. Review of upper limb ability assessments in acute stroke care, from a practice perspective. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2009. [DOI: 10.12968/ijtr.2009.16.12.45434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tennille J Rowland
- Royal Brisbane and Women's Hospital, Occupational Therapy Department, Queensland, Australia
| | - Louise Gustafsson
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | | | - Merrill Turpin
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Stephen J Read
- Royal Brisbane and Women's Hospital, Queensland, Australia
| |
Collapse
|
19
|
Prosthetic Outcome Measures for Use With Upper Limb Amputees: A Systematic Review of the Peer-Reviewed Literature, 1970 to 2009. ACTA ACUST UNITED AC 2009. [DOI: 10.1097/jpo.0b013e3181ae9637] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Holmqvist K, Kamwendo K, Ivarsson AB. Occupational therapists' descriptions of their work with persons suffering from cognitive impairment following acquired brain injury. Scand J Occup Ther 2009; 16:13-24. [PMID: 18609240 DOI: 10.1080/11038120802123520] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
Collapse
|
21
|
Rowland TJ, Gustafsson L, Henderson RD, Turpin M, Read SJ. Review of upper limb ability assessments in acute stroke care, from a practice perspective. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2008. [DOI: 10.12968/ijtr.2008.15.12.45424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims: The purpose of this study was to compare three upper limb ability assessments - the Action Research Arm Test (ARAT), Arm Motor Ability Test (AMAT), and Chedoke Arm and Hand Activity Inventory (CAHAI) - in acute stroke occupational therapy practice during a 6-month period, to identify whether any or all were appropriate for use in acute stroke care. Methods: Medical records of clients with stroke admitted to an acute stroke unit were reviewed retrospectively. Inclusion criteria were: (a) admission between March and August 2006, (b) new diagnosis of stroke, (c) upper limb involvement, and (d) assessed by an occupational therapist with ARAT, AMAT or CAHAI. Included records were reviewed and the following noted: diagnosis, upper limb weakness, gender, age, assessment score, when assessed, time to administer, test items completed, and qualitative notations. Findings: Thirty three records satisfied the inclusion criteria. A range of stroke subtypes were assessed. The mean ARAT score was 21.4/45, CAHAI was 66.5/91 and AMAT was 3.0/5. The median number of days post-stroke when assessed was 9 days. Conclusions: Overall, ARAT, CAHAI and AMAT were useful for assessment of upper limb ability. The results cannot specifically identify which assessment is most suited to the acute stroke setting. The findings do support the inclusion of ARAT, CAHAI and AMAT in standard clinical care.
Collapse
Affiliation(s)
- Tennille J Rowland
- Royal Brisbane and Women's Hospital, Occupational Therapy Department, Queensland, Australia
| | - Louise Gustafsson
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | | | - Merrill Turpin
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Stephen J Read
- Royal Brisbane and Women's Hospital, Queensland, Australia
| |
Collapse
|
22
|
Abstract
The aim of this paper was to review the psychometric properties and clinical utility of assessments of upper limb ability following stroke. Upper limb ability was defined as the use of the arm in meaningful activity. The database searches identified 13 assessments of upper limb ability. The inclusion criteria were (a) an evaluation of upper limb ability post-stroke, (b) a quantitative assessment yielding a numerical score, (c) able to be administered by an occupational therapist and (d) published information building on the results of a review in 2001. The assessments included were reviewed with respect to the ability measured, equipment required, evidence of reliability and validity, and advantages and disadvantages of use. Seven assessments satisfied the inclusion criteria. These assessments have undergone varying degrees of psychometric testing as outcome measures for upper limb recovery and all demonstrate at least adequate levels of reliability and validity. There is variation in the availability of instruction manuals and time commitments for test administration. All test items are generally available and inexpensive, enabling departments to set up the assessments with minimal financial outlay. The assessments described are regularly used in research and all demonstrate psychometric properties that suggest that they could be incorporated into clinical practice. Occupational therapists are encouraged to consider how they may include these assessments into their own clinical practice. An important step in this process may be further research into the clinical utility of these assessments.
Collapse
Affiliation(s)
- Tennille J Rowland
- Royal Brisbane and Women's Hospital and Postgraduate Student, The University of Queensland, Australia
| | | |
Collapse
|