Cognitive assistance to support individuals with traumatic brain injury using a minimal and personalised approach: A conversion mixed methods study using video analysis

INTRODUCTION

Individuals with traumatic brain injury (TBI) frequently need assistance to manage complex everyday activities. However, little is known about the types of cognitive assistance that can be used to facilitate optimal independence. A conversion mixed method study using video analysis was conducted to describe assistance provided by trained occupational therapists during three everyday tasks carried out in the participants' homes and surrounding environments.

METHODS

Forty-five people with moderate and severe TBI were tested by three occupational therapists using the Instrumental Activities of Daily Living Profile, an observation-based assessment that documents independence in complex everyday activities and the minimal assistance required to attain task goals. Using video analysis, difficulties experienced by the people with TBI during a meal preparation and grocery shopping task, and the cognitive assistance provided by the occupational therapists in response to these difficulties, were documented. Statistical analyses were also completed to identify the main difficulties and types of cognitive assistance provided during the evaluation, for the whole group and depending on their level of independence.

RESULTS

Nine types of cognitive assistance were used by occupational therapists, including implicit (stimulating thought processes), and more explicit assistance (cueing), to facilitate task performance. When needed, motivational assistance, which consisted of encouraging participants to think for themselves, was also used. Stimulating thought processes was mostly used to support goal formulation and planning, whereas cueing was used in numerous instances. Participants with lower levels of independence received more assistance of almost all types to support them.

CONCLUSION

Using these findings, training could be developed for caregivers and occupational therapists to support them in providing minimal and personalised cognitive assistance. Further research is needed to examine the extent to which all types of cognitive assistance are effective in helping various cognitive profiles of people with TBI attain optimal independence.

Using values in cognitive and behavioral therapy: A bridge back to philosophy

Ancient therapeutic practices have influenced the development of cognitive behavioral therapy (CBT) theories such as Albert Ellis's rational emotive behavior therapy and Aaron Beck's cognitive therapy. By drawing inspiration from Socratic questioning, the importance of philosophy in evidence-based practices in human mental health can be acknowledged. Stoicism has also informed CBT, notably its emphasis on establishing psychological distance from emotions. Cognition and emotion are two aspects of mental processes, and irrational demands are processed through rational deliberation. Using mental imaging techniques and acceptance strategies (to accept oneself and the world as imperfect), avoiding catastrophic interpretations and acknowledging emotions are also included among such practices. METHODS: We will explore the use of values across CBT, acceptance and commitment therapy (ACT), and radically open dialectical behavioral therapy (RO DBT) to clarify their use of values. RESULTS: In this framework, values are conceptualized as life-orienting principles and are now widely used across CBTs, such as acceptance and commitment therapy and radically open dialectical behavioral therapy. In recent years, the development of CBT has involved a renewed relationship with philosophy through the use of values, interest in dialectics and development of self-questioning practices reminiscent of classical Socratic principles. This movement from applied clinical psychology toward philosophical skills has also encouraged the recent emergence of philosophical health considerations. The opposition between psychological and philosophical health can be questioned, and the fundamental issue of philosophical skills implemented in psychiatric treatment (and not solely as practices of enhancement for the sane) needs to be considered.

A participação social como um caminho possível para a justiça social e ocupacional

Resumo Introdução Justiça social, justiça ocupacional e participação social são termos utilizados por terapeutas ocupacionais e cientistas ocupacionais para nortear, construir e informar suas práticas, formação profissional, pesquisas e produções teóricas. Objetivo Identificar e refletir sobre as possibilidades, limites e desafios da prática de terapeutas ocupacionais brasileiras na busca pela participação social e como isso pode ou não contribuir para construção da justiça social e ocupacional. Método Por meio de uma metodologia colaborativa, terapeutas ocupacionais docentes e da assistência, atuantes no estado de São Paulo, Brasil, foram convidadas a responderem um questionário. Com esse instrumento, buscou-se caracterizar as colaboradoras, conhecer o trabalho desenvolvido nos contextos de ensino, pesquisa, extensão e assistência e identificar como discutem e realizam a participação social nos campos teórico e prático. Resultados As 65 colaboradoras estavam inseridas em instituições públicas, privadas e filantrópicas, em diferentes campos de saber e de prática, e desenvolviam trabalhos e estudos com/para várias populações com demandas e necessidades específicas. Elas descreveram distintas possibilidades de participação social, algumas de natureza individual, focada no sujeito e na funcionalidade e outras orientadas para e com base no coletivo. Os limites e desafios estiveram relacionados às instituições de trabalho, aos aspectos individuais, coletivos e estruturais e ao próprio núcleo de saber e de prática da terapia ocupacional. Conclusão Com embasamento nas experiências das colaboradoras e na compreensão das profissionais sobre participação social, considera-se que esse pode ser um caminho teórico-conceitual e prático para refletir e buscar justiça social e ocupacional junto a indivíduos, grupos e comunidades.

Social participation as a possible way forward for social and occupational justice

Abstract Introduction Social justice, occupational justice, and social participation are terms used by occupational therapists and occupational scientists to guide, build, and inform their practices, professional training, research, and theoretical productions. Objective To identify and reflect on the possibilities, limits, and challenges of Brazilian occupational therapists' practice in the search for social participation and how this may or may not contribute to the construction of social and occupational justice. Method Through a collaborative methodology, academics, and assistance occupational therapists, working in the state of São Paulo, Brazil, were invited to answer a questionnaire. This instrument characterized the collaborators, and their work in teaching, research, and assistance, and identified how they discuss and carry out social participation in the theoretical and practical fields. Results The 65 collaborators were inserted in public, private and philanthropic institutions, in different fields of knowledge and practice, and developed work and studies with/for various populations with specific demands and needs. They described different possibilities of social participation, some of an individual nature, focused on the subject and functionality, and others oriented towards and from the collective. The limits and challenges were related to work institutions, individual, collective, and structural aspects, and the field of knowledge and practice of occupational therapy. Conclusion Based on the experiences of the collaborators and the professionals' understanding of social participation, it is considered that this may be a theoretical, conceptual, and practical path to reflect on and seek occupational and social justice with individuals, groups, and communities.

Securing occupational rights by addressing capabilities: A professional obligation

BACKGROUND

The World Federation of Occupational Therapists asserts that all occupational therapists are obligated to promote occupational rights, and has highlighted the importance of Amartya Sen's concept of 'capabilities' to the work of securing the occupational rights to which all are equally entitled.

AIMS

To outline the capabilities approach and highlight its relevance and importance for the occupational therapy profession.

MATERIAL & METHODS

Drawing from Sen's work, and that of other scholars who have critiqued and adapted his capabilities approach, this paper describes the foundational components of the capabilities approach and identifies important overlaps with issues of concern to occupational therapy.

RESULTS

Sen's capabilities approach employs a contextualised view of human wellbeing; attending to whether people have the abilities to do the things they would value doing, and whether their circumstances actually provide the real opportunities to choose to do what they would value doing.

CONCLUSIONS

The capabilities approach, with its attention to abilities and actions, options and opportunities, empowerment and choice, justice and participation, has clear relevance for occupational therapists.

SIGNIFICANCE

A capabilities perspective provides a valuable framework for occupational therapists striving towards equalising people's opportunities, possibilities and choices - their capabilities - to secure their occupational rights.

The role and scope of occupational therapy in Africa

Purpose: Occupational therapy (OT) is a global health profession that promotes participation in meaningful occupations to enhance well-being, particularly for persons with disabilities. Occupational therapy is relatively new in many African countries and there is limited research regarding the role of OT in this region. Thus, this study aims to understand the role and scope of OT in Africa by exploring its unique contribution to healthcare and cultural considerations for practicing OT in various African contexts.Methods: We conducted an exploratory qualitative descriptive study involving semi-structured interviews with 15 occupational therapists from 11 African countries. Interview questions focused on participants' work activities, rewards and challenges of their work, and perceived contribution to healthcare. We audio-recorded and transcribed interviews followed by inductive thematic analysis.Results: All participants described maintaining multiple roles. Four main themes (with sub-themes) emerged: advocacy (clients and the profession), collaboration (multi-disciplinary team, professional support, and internationally), maintaining core OT principles (occupation, function, participation, empowerment, and holistic practice), and contextual considerations (community-based services, practice approaches, sustainability, cultural norms, and spirituality).Conclusions: Occupational therapists working in African contexts have a unique and challenging role involving advocacy and collaboration. They need to maintain core OT values whilst addressing contextual considerations to ensure culturally relevant practice.Implications for RehabilitationOccupational therapists have an important role in promoting health and well-being; however, practice is influenced by the cultural context.Occupational therapists in Africa maintain multiple roles, including advocacy for their clients and the profession, and collaboration within a multidisciplinary team, for professional support and internationally.African occupational therapists need to be rooted in core OT principles whilst considering their unique context to ensure culturally relevant practice.

Using appreciative inquiry to explore and enhance perceptions of empowerment for those experiencing homelessness: A pilot study

BACKGROUND

Individuals experiencing homelessness endure occupational injustices in the form of marginalization and deprivation at higher rates than their counterparts who are not experiencing homelessness. This population's expressed interests, needs, and desires are frequently ignored or unsolicited by a system of care that continues to exercise power over this fragile and underserved group. Marginalization and deprivation can lead to disempowerment. Few studies have been conducted that explore the perceptions of empowerment by those experiencing homelessness. Providing a "space" for the voice of those experiencing homelessness to be heard can promote occupational justice as an outcome of occupational therapy intervention.

OBJECTIVE

This pilot research sought to explore perceptions of empowerment by attendees of a day shelter for those experiencing homelessness.

METHODS

Researchers used an Appreciative Inquiry approach to elicit responses to the question, "For those experiencing homelessness who attend a day shelter, what are their perceptions of how the shelter environment supports empowerment?" This qualitative approach promotes and maintains focus on positivity and inclusivity with respect to the change process from solution identification to maintenance of identified changes. Shelter attendees participated in one of three focus groups. Based upon qualitative analysis of the data, environmental enhancements were made by the researchers and post-environmental enhancement surveys collected data related to perceptions of those enhancements to promote empowerment.

RESULTS

Six themes emerged from the data and pointed to both internal and external factors that are perceived to impact empowerment.

CONCLUSION

Results of this study can be used by occupational therapy practitioners to support and develop inclusive and empowerment-focused approaches for those experiencing homelessness.

Disability Rights in Botswana: Perspectives of Individuals With Disabilities

Even though the United Nations Convention on the Rights of Persons With Disabilities (UN-CRPD) 2006 has been in existence for the last 10 years, the Government of Botswana has not ratified the convention. As a result, individuals with disabilities (IWDs) fail to access services and are at the mercy of the service providers. This qualitative study involved in-depth interviews with 30 IWDs about their experiences related to disability rights. Analysis of the data indicated that IWDs face several challenges in exercising their basic rights; these challenges being (a) stigmatization, (b) infrastructural barriers, (c) transport barriers, and (d) information barriers. Findings suggested that awareness of disability rights among IWDs, caregivers, and the general public was generally low. As a result, many IWDs were not aware of their rights and therefore could not exercise their rights fully.

An occupational therapy community development practice process

BACKGROUND.

Little research has focused on the application of the Canadian Practice Process Framework (CPPF) to occupational therapists' work in community development (CD).

PURPOSE.

This study sought to describe Canadian occupational therapists' CD practice processes.

METHOD.

Using interpretive description, Canadian occupational therapists engaged in CD practice participated in an initial interview and follow-up interview or focus group. Content analysis was used to analyze the data.

FINDINGS.

Eight occupational therapists participated in describing a process that focused on five key elements: (1) getting to know the community, (2) getting the ball rolling/planning together, (3) building (upon) occupational opportunities, (4) revisiting the approach, and (5) striving for sustainability. These elements occurred within a practice context and frames of reference related to CD practice.

IMPLICATIONS.

Participants outlined a process that was less discrete than the CPPF and highlighted the knowledge and skills needed along with the less tangible attitudes/approaches required to engage with communities.

A randomized controlled trial protocol investigating effectiveness of an activity-pacing program for deconditioned older adults

Background.

Acute hospitalization of older adults can lead to deconditioning and the need for rehabilitation to facilitate a return to home and previous lifestyle. An occupational therapy intervention to combat deconditioning is activity pacing, an active self-management strategy where individuals learn to modify how and when activities are completed with the aim of improving participation in occupation.

Purpose.

This study will examine the effectiveness of occupational therapy with activity pacing during rehabilitation for deconditioned older adults.

Method.

A randomized controlled trial is proposed with inclusion criteria of older adults, 65+ years old, living independently in the community prior to admission, with adequate cognition and language to participate in the intervention. Participation, health status, self-efficacy in daily activities, self-efficacy in activity pacing techniques, and symptom management (pain and fatigue) will be measured at admission, discharge, and 3 months postdischarge.

Implications.

Determining if an activity-pacing program is effective will provide occupational therapists with evidence to support service delivery.

Overview of the Assisted Decision-Making (Capacity) Act (2015)

Purpose

In Ireland, the Assisted Decision Making (Capacity) Act 2015 provides a statutory framework to adults who are experiencing difficulties with decision-making. This legislation has significant implications for all who work in health and social care. Increasing age and life expectancy, alongside the rising incidence of chronic health conditions and dementia-related diseases, indicates that more individuals are likely to experience challenges regarding decision-making capacity. Therefore, the need for more consistent, best-practice processes to assess decision-making capacity is likely to increase. To ensure occupational therapists are responsible in their contributions, and to ensure those with disabilities are supported, clinicians must be well-informed of the principles underscoring the Act. The purpose of this paper is to provide an overview of this multidisciplinary issue, including recent legislation, and consider how occupational therapy can contribute.

Design/methodology/approach

The authors reviewed current literature and considered occupational therapy’s role in decision-making capacity assessment.

Findings

Occupational therapists have potential to play a key role in multi-disciplinary assessments of decision-making capacity for clients. Further research is required to explore professional issues, identify clinical best practices and determine training and resource needs.

Originality/value

This paper seeks to provoke consideration of how occupational therapists can contribute to capacity assessment from a client-centred, occupation-based perspective that is mindful of ethical and legislative considerations.

Creating opportunities for occupational development using the concerns report method

BACKGROUND

Little research has focused on working with communities to promote and support children's occupational development.

AIM/OBJECTIVE

We used the Concerns Report Method (CRM) to identify community supports for parents with young children that could enhance children's occupational development.

MATERIAL AND METHOD

We conducted interviews/focus groups with parents (n = 29) and service providers (n = 11). We used content analysis to identify four themes: availability, barriers and facilitators, parent/child transitions, and making connections. The themes were used to create a concerns report survey for parents and service providers. A random sample of parents (n = 319) and convenience sample of service providers (n = 47) in one community area of a Canadian urban center completed the on-line survey. We held a community forum to review the results and identify solutions for action.

RESULTS

Parents' highest priorities included childcare, supports in community schools, preschool programs, and supports in one location. Service providers highest priorities included: identification of developmental concerns; parenting education; programs for fathers, programs that offer child care, a doctor, and child care.

CONCLUSIONS

Service providers need to engage parents and consider parents' perspectives when planning services to ensure community supports will meet parent identified needs.

SIGNIFICANCE

Using community-based participatory research approaches, occupational therapists can contribute to children's occupational development.

Empowerment, self and engagement in day center occupations: A longitudinal study among people with long-term mental illness

BACKGROUND

Day centers are a common form of mental health service internationally. They are aimed at enhancing occupational engagement and social relations, but there is a need to clarify the outcomes of day center programs, including the impact on important aspects of recovery such as empowerment.

AIMS

The aim of this study was to explore whether perceived empowerment changed over time among Swedish day center users and whether self-esteem, quality of life, socio-demographic data and self-reported diagnosis, type of program and level of engagement in day center occupations could predict future empowerment.

METHOD

The study involved a re-analysis of longitudinal data from 14 day centers, where measures of perceived empowerment and other individual factors were collected over a 15-month period. Non-parametric statistics were used, including Wilcoxon's signed-rank test and logistic regression analysis.

RESULTS

There were no significant changes in day center attendee empowerment scores. Self-esteem and level of engagement in day center occupations were found to be predictors of empowerment, together explaining 34% of the variation.

CONCLUSIONS

Developing empowerment in the day center context involves a complex interaction of individual, social and material factors. Potential barriers to empowerment are discussed along with considerations related to measuring empowerment as an outcome of day center programs.