The Effect of Virtual Reality-Based Therapy on Improving Upper Limb Functions in Individuals With Stroke: A Randomized Control Trial

Background: Stroke is a common cause of motor disability. The recovery of upper limb after stroke is poor, with few stroke survivors regaining some functional use of the affected upper limb. This is further complicated by the fact that the prolonged rehabilitation is accompanied by multiple challenges in using and identifying meaningful and motivated treatment tasks that may be adapted and graded to facilitate the rehabilitation program. Virtual reality-based therapy is one of the most innovative approaches in rehabilitation technology and virtual reality systems can provide enhanced feedback to promote motor learning in individuals with neurological or musculoskeletal diseases.

Purpose: This study investigated the effect of virtual reality-based therapy on improving upper limb functions in individuals with chronic stroke.

Methods: Forty Saudi individuals with chronic stroke (6–24 months following stroke incidence) and degree of spasticity ranged between 1, 1 + and 2 according to Modified Ashworth Scale were included in this study. Participants were randomly assigned into two groups, experimental and control, with the experimental group undertaking a conventional 1-h functional training program, followed by another hour of virtual reality-based therapy using Armeo Spring equipment and the control group received 2 h of a conventional functional training program. The treatment program was conducted three times per week for three successive months. The change in the scores of Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), WMFT-Time (time required to complete the test) and Hand Grip Strength (HGS) were recorded at baseline and after completion of the treatment. Parametric (paired and unpaired t-tests) non-parametric (Wilcoxon and Mann–Whitney tests) statistical tests were used to identify the differences within and between groups (experimental group and control group) and evaluation times (pre- and immediately post-treatment).

Results: Both groups showed significant differences (all, P < 0.05) in all measured variables after 3 months of the treatment. Individuals with stoke in the experimental group had a better improvement in ARAT (P < 0.01), WMFT (P < 0.01) and WMFT-Time (P < 0.01) scores after completion of the treatment compared to the control group. No significant difference in HGS scores was detected between groups after completion of the treatment (P = 0.252).

Conclusion: The use of combined treatment of virtual reality-based therapy and conventional functional training program is more effective for improving upper limb functions in individuals with chronic stroke than the use of the conventional program alone.

The Use of Fair Access to Care Services' Eligibility Criteria for Equipment Provision within Local Authorities in England

In April 2003, the national eligibility framework for the provision of community care services, Fair Access to Care Services (FACS), was implemented. The aim of the framework was to ensure geographical equity in the provision of services, including equipment and minor works, so ending the postcode variability of care described in the Audit Commission report Fully Equipped.

This study reports a postal questionnaire survey of a representative sample of 100 local authority occupational therapy teams across England to examine the implementation and use of the criteria for equipment provision. A 60% response rate revealed that only 9 out of 60 teams (15%) used solely FACS criteria; the remainder still used local criteria. Between-colleague differences in equipment provision persisted (68%). This suggests that the implementation of the FACS eligibility criteria has not achieved its goal.

Dressing after a Stroke: A Survey of Current Occupational Therapy Practice

The objective of this study was to determine occupational therapists' beliefs about the influence of cognitive impairment on dressing difficulties and to ascertain current practice when treating dressing problems. The study design was a questionnaire survey of occupational therapists experienced in stroke care who treated patients with dressing difficulties.

Out of 137 questionnaires sent, 76 (55.5%) were returned. The frequency of dressing practice provided by the occupational therapists ranged from two to four times a week. Only 43% of the therapists used standardised assessments and the most common one used was the Rivermead Perceptual Assessment Battery. Apraxia was reported by 76% of the therapists as influencing a patient's ability to dress, neglect by 71 % and memory problems by 63%. Seventy-six per cent of the therapists reported that orientating clothing and relating it to body parts was a major dressing difficulty. Other dressing difficulties reported were sequencing by 56% and failing to dress the affected side by 34%. Ninety-eight per cent of the therapists spent time providing the practice of specific functional skills on a repetitive basis; however, 60% continued to use table-top tasks aimed at targeting a particular cognitive impairment.

The majority of the therapists felt that cognitive impairment was a major reason for dressing difficulties in stroke patients. With the exception of one, all the therapists provided repetitive practice on dressing tasks and over half continued to use table-top tasks. The evidence to support the types of treatment used by occupational therapists remains controversial. Further research into this area is required.

Improvement in Upper Limb Motor Performance following Stroke: The Use of Mental Practice

Mental practice is a technique that involves imagery and rehearsal of movement without movement actually occurring. This study considers the evidence that indicates whether mental practice is successful in improving upper limb motor performance after a stroke. The use of mental practice in the traditional fields of sport, music and dance is identified and a theoretical premise for its application in stroke rehabilitation is presented. Eight studies on the use of mental practice in the rehabilitation of motor performance following a stroke are critiqued. These studies suggest that mental practice improves upper limb motor ability and appears to be applicable to a range of participants, especially those with moderate impairment, although good cognitive and communication skills are required.

The article suggests reasons that this relatively new approach should be considered by occupational therapists involved in stroke rehabilitation. The limited number of studies and small sample sizes are highlighted. Further research is recommended in order to identify people who will benefit from mental practice, to investigate the generalisation of results and to establish guidelines for the effective provision of mental practice in terms of length, format and content in stroke rehabilitation.

Scholarship of Practice: Making Occupation-Focused, Theory-Driven, Evidence-Based Practice a Reality

National and local policies require the profession to provide evidence on which practice is based. This paper illustrates an approach to meeting the expectations of these policies. Specifically, it describes the development of the United Kingdom Centre for Outcomes Research and Education (UKCORE).

UKCORE was developed within a ‘scholarship of practice’ framework, which supports the development of robust partnerships between academia and practice whereby academic knowledge influences practice and practice knowledge influences academia. Within the partnership, all academic participants (educators, researchers and students) and practice participants (clinicians, clients and administrators) are called ‘practice scholars’ and are focused on practice scholarship.

UKCORE was founded in London in 2001 in order to support the delivery of existing evidence into occupational therapy practice while simultaneously supporting practice to engage in generating new evidence for occupational therapy practice. This article provides an overview of the academic and practice changes that have been put into place. The changes are designed to support the development of practice that is occupation focused, theory driven and evidence based.

Comparing an Occupational Therapy Definition and Consumers' Experiences: A Q Methodology Study

Occupational therapy has been defined as a complex intervention (Creek 2003), on behalf of the College of Occupational Therapists. This definition was generated from a study involving occupational therapists but not consumers of services. The aim of the present study was to explore how Creek's (2003) definition of occupational therapy compared with the experience of ex-consumers whose contact with occupational therapy had been through stroke services.

A Q methodology study was conducted with 16 participants recruited through stroke clubs in two large cities. A Q-sort pack of 32 statements was developed based upon Creek's (2003) definition of occupational therapy. Participants sorted the statements along a ‘least to most’ continuum, indicating how much each statement reflected their own experience of receiving occupational therapy.

Following analysis, six factors were identified which suggested that, for these participants, occupational therapy: facilitated and improved their sense of self; recognised the importance of being heard; provided practical assistance; assisted with maintaining autonomy; generated the desire for involvement; and had general benefits. The factors identified reflected aspects of Creek's (2003) definition of occupational therapy and suggested congruence in certain concepts between the professional body and consumers. Although limited by the fact that the participants had accessed different occupational therapy services some time ago, this study also introduces a method of obtaining consumers' views of occupational therapy.

Occupational Therapy in Nursing and Residential Care Settings: A Description of a Randomised Controlled Trial Intervention

This article describes an occupational therapy intervention for stroke that was provided as part of a randomised controlled trial in order to evaluate the effects of the intervention of an occupational therapist in a nursing and residential home setting. The intervention was developed and described to enable it to be reproduced in further evaluations, as recommended by the Medical Research Council's guidelines for clinical trials.

Initially, the published evidence was reviewed and advice was sought to identify the process, content and recording methods needed to treat clients in a care home setting. This resulted in a clearly defined, evidence-based treatment package and a predetermined recording system.

Sixty residents received occupational therapy: the mean number of visits was 8.5 and the mean total time per participant was 4.7 hours. During 508 visits, the majority of time was spent on activities of daily living training and mobility practice (40%), followed by assessment and goal setting (31%), communication with residents, staff, relatives and other agencies (15%), adaptive equipment (10%) and the treatment of impairments (4%).

It is possible to develop evidence-based targeted occupational therapy interventions to be used in the context of a controlled clinical trial. Further work is required to examine the validity of the recording methods and the reproducibility of the intervention.

Examining the Evidence Base for Occupational Therapy with Clients following Stroke

In order to conduct occupational therapy services that are evidence based, studies are urgently required which demonstrate the effectiveness of interventions offered. This paper presents the findings of a study undertaken to determine occupational therapy outcomes for clients with stroke during inpatient rehabilitation.

The participants were 43 clients with stroke and four occupational therapists. Therapy outcomes for personal activities of daily living were measured using the Functional Independence Measure (Adult FIMSM); instrumental activities of daily living were measured using the Assessment of Living Skills and Resources (ALSAR); and quality of life was measured using the Quality of Life Index (Q-L Index) and a semi-structured interview. The semi-structured interview was also used to understand clients' perceptions of the outcome of their participation in occupational therapy. The data were collected at client admission, discharge and 3 months' follow-up.

The results indicated that the clients believed that their ability to perform activities of daily living (Adult FIMSM t (38) = −7.80, p = 0.000, and ALSAR t (35) = 4.82, p = 0.000) and their quality of life (Q-L Index t (39) = −7.23, p = 0.000) improved over the course of their inpatient rehabilitation. The therapists also rated the clients as improving during their rehabilitation in relation to activities of daily living (Adult FIMSM t (42) = −9.71, p = 0.000, and ALSAR t (40) = 7.75, p = 0.000) and quality of life (Q-L Index t (39) = −11.20, p = 0.000). Many of the clients interviewed attributed these gains to participation in the occupational therapy programme.

In conclusion, this study demonstrated that a triangulated approach to data collection and analysis was useful in providing evidence that occupational therapy, as part of comprehensive rehabilitation, made a difference to the lives of many of the clients studied.

2001 College of Occupational Therapists' Research and Development Strategic Vision and Action Plan

The Research and Development Strategic Vision and Action Plan proposes a flexible approach for the next 5 years, being responsive to changes in the policy context and reflecting the needs of members, consumers and carers. Equal importance is attached both to research and to development. This strategic shift will support action to produce quality outcomes from all occupational therapy personnel, together with the production of the national research agenda by the College of Occupational Therapists.

Axonal Sprouting and Neuronal Connectivity following Central Nervous System Insult: Implications for Occupational Therapy

Based on selected contemporary research, this paper presents a critical analysis of central nervous system (CNS) reorganisation following insult and the need for therapists better to understand the processes that constitute reorganisation and their possible contribution to the development of spasticity. In the treatment of the sequelae of CNS lesions, the synaptic reorganisation as a result of losses caused by injury - in the form of axonal sprouting - is illustrated, focusing on neuronal reconnectivity. Critical analysis of laboratory, electron microscopy and other animal and human studies is also conducted to integrate the controversies identified and to highlight the concepts that become relevant for occupational therapists, in order to optimise therapeutic intervention for maximising restitution in patients with CNS insult. The paper further discusses the capacity of the CNS to compensate and the need to utilise occupational therapy interventions, such as imagining, mental rehearsals, constraint-induced therapy, virtual reality, biofeedback and the traditional repetitive tasks, which leads to ensuring and facilitating the emergence of new synapses to perform motor tasks and manual skills and to prevent secondary changes. These external stimulations provided by the therapists are likely to stimulate both the damaged hemisphere cross-innervation and/or collateral sprouting. These scientifically based treatment strategies and neurological rehabilitation programmes would, in turn, contribute to improving the quality of life of people with CNS insult.

The Casson Memorial Lecture 2003: Past Conditional, Present Indicative, Future Indefinite

The Casson Memorial Lecture 2003, given on 11 July at the 27th Annual Conference of the College of Occupational Therapists, held at the Scottish Exhibition and Conference Centre, Glasgow. The conference theme was ‘Design for Living Life’.

The Use of Evidence-Based Practice by Occupational Therapists Who Treat Adult Stroke Patients

The study identified the extent to which members of the National Association of Neurological Occupational Therapists (NANOT) who treated adult stroke patients used evidence-based practice (EBP). A random sample of NANOT members (n = 200) was surveyed by a postal questionnaire on the use of EBP and the results were analysed for the 125 therapists who worked with adult stroke patients.

The principal factor that ‘greatly’ influenced the choice of intervention of three-quarters of the respondents was working with other therapists, followed by attendance at postgraduate courses; gaining postgraduate qualifications had the least influence. Although over 90% of the respondents considered that they used EBP at some time, the most frequently reported levels of evidence used were custom and practice and expert opinion, which were at the lower end of the hierarchy. Therefore, although the respondents who treated adult stroke patients did use EBP, they did not use the higher levels recommended. The respondents who used the higher levels of evidence were those who were most recently qualified. The factors influencing the use of EBP were the relevance of research to practice, time, lack of therapists' knowledge and lack of support.

Challenges to Measuring Outcomes in Occupational Therapy: A Qualitative Focus Group Study

The aim of this study was to explore the process used by occupational therapists to measure the effect of their interventions. A second aim was to explore the challenges associated with this process. Stroke rehabilitation was chosen as the focus for the study.

This qualitative study was conducted in Sydney, Australia. Ten occupational therapists from both hospital and community-based services participated in one of three focus groups. The data were analysed using constant comparison techniques.

The participants struggled when describing the process used to measure outcomes. They focused more on the challenges to measuring outcomes, which were described as focusing on occupation, deconstructing occupation and lacking knowledge, skills and assistance.

The participants in this study had difficulty in articulating and setting measurable goals linked to interventions. As a result, they could not easily select appropriate outcome measures. Education is needed to help such occupational therapists to develop the required skills and to begin to measure clinical outcomes. Further research should determine if similar experiences and challenges are faced in other areas of practice and by occupational therapists in other countries.

The Journal Club: A Method for Occupational Therapists to Bridge the Theory-Practice Gap

There are still major problems being encountered by occupational therapists when they attempt to access relevant research material. One of the main reasons for this is that there are currently relatively few occupational therapists who are involved in any form of research on a regular basis.

This article highlights the potential of the journal club as a means of introducing occupational therapists to research that will both be relevant to their work area and form a substantial part of their continuing professional development. A brief overview of the format and content of journal clubs both in occupational therapy and in other health care professions is intended to encourage occupational therapists to initiate their own journal clubs as a method of bridging the theory-practice gap that still exists in their profession.

Screening for sensory impairment in older adults: Training and practice of occupational therapists in Quebec

BACKGROUND

The goal of occupational therapy education is to train generalists who can refine their knowledge after graduation according to the requirements of the professional environment. However, it is currently unclear to what extent sensory screening should be included in the educational curricula.

PURPOSE

The purpose of this study was to examine the sensory screening education for and practice by occupational therapists working with older adults.

METHOD

A cross-sectional survey was used to collect data from members of the Quebec Order of Occupational Therapists. Descriptive statistics were used in the analysis.

FINDINGS

Data from 102 respondents indicated that training on sensory impairment-related topics was minimal and in stark contrast to the proportion who reported serving clients with a visual (92%), hearing (84%), or combined impairment (53%).

IMPLICATIONS

Occupational therapy considers numerous aspects of physical, cognitive, and emotional well-being. The question remains as to what extent vision and hearing health should take their place among these priorities.

Occupational Performance Coaching for stroke survivors: A pilot randomized controlled trial protocol

Background.

Many stroke survivors report participation challenges. Occupational Performance Coaching for stroke survivors (OPC-Stroke) is designed to assist stroke survivors to develop the ability to plan and manage engagement in occupation. This approach combines emotional support, individualized education, and goal-focused problem solving to promote occupational engagement.

Purpose.

This study will explore the potential efficacy of OPC-Stroke and the feasibility of the research methods for use in a larger trial.

Method.

A pilot randomized controlled trial will be undertaken. Participants will be randomly assigned to receive 10 sessions of OPC-Stroke or usual care. Participation, perceived goal performance, satisfaction and self-efficacy, emotional well-being, and cognition will be measured at three time points.

Implications.

This research will test the potential usefulness of OPC-Stroke as well as the study methods, and thereby inform the continuing development of OPC-Stroke and further studies to measure its effectiveness.

Occupational Therapy for Care Home Residents with Stroke: What is Routine National Practice?

Introduction:

Information is currently lacking on the provision of occupational therapy for care home residents with stroke. The aim of this study was to identify current routine occupational therapy practice for this stroke population.

Method:

A questionnaire targeting qualified occupational therapists with work experience in a care home setting was designed, piloted, and transferred to an online survey. An invitation to participate was distributed via three of the College of Occupational Therapists Specialist Sections, social networking sites, and flyers at conferences.

Findings:

Responses were analysed from 114 respondents representing the United Kingdom, the majority (72%) of whom were employed by the National Health Service. Ninety-two respondents (81%) had delivered occupational therapy to a care home resident with stroke in the last year but only 16% were ‘stroke specialists’. The most common aims of intervention were to: maintain participation in activities of daily living, improve posture and positioning, and provide training. Non-standardized assessment was the most common form of assessment used. The functional approach was most frequently adopted. The most frequently provided intervention was ‘seating and positioning’.

Conclusion:

Occupational therapy is available to some stroke survivors in care homes; however, interventions are not commonly evidence based and are not routinely delivered by stroke specialists.

Occupational Therapy for Upper Limb Post-Stroke Sensory Impairments: A Survey

Purpose:

Upper limb post-stroke sensory impairments have an impact on a significant number of stroke survivors. There is limited research in this area and it is unclear how occupational therapists are addressing sensory impairments in clinical practice. This study aimed to investigate the clinical practice patterns of occupational therapists, perceived barriers to providing interventions and information sources used when addressing upper limb post-stroke sensory impairments.

Methods:

A survey was sent to 500 randomly selected occupational therapists in the United States.

Findings:

The majority of the 145 respondents reported frequently assessing sensation, and half reported providing interventions for sensory impairments. Interventions primarily focused on providing passive sensory stimulation followed by compensatory strategies. Most therapists provided patient/caregiver education about safety. Therapists cited lack of knowledge and skills, patients' short length of stay and lack of time as barriers to utilizing interventions. Most therapists reported not being up to date with current research and requested continuing education to support practice.

Conclusion:

This survey established a profile of American occupational therapists' practice with people with upper limb post-stroke sensory impairments. Therapists have a need for information and training in all aspects of the management of upper limb post-stroke sensory impairment. Further research, evaluating the effectiveness of interventions and exploring therapists' clinical decision making when choosing interventions, is also needed.

A Review of Measures to Evaluate Participation Outcomes Post-Stroke

Background:

Stroke is one of the most common disabling conditions of adulthood. Participation problems are extremely common post-stroke. Occupational therapists, by virtue of their commitment to enabling occupation, are in a strong position to help stroke survivors improve their participation. To demonstrate effectiveness, occupational therapists must be able to provide evidence of post-treatment changes in participation.

Objective:

The objective of this paper was to identify participation measures that have been developed for, or tested with, individuals who have experienced a stroke and to review them for use as occupational therapy outcome measures.

Method:

A literature review was carried out to locate relevant tools. These tools were then rated for psychometric and clinical properties that are critical for clinical outcome measurement. In addition, the theoretical fit of each evaluation with occupational therapy's commitment to client-centredness was considered.

Results:

Ten evaluations were identified and rated. These ratings were designed to assist occupational therapists to choose a participation measure for their practice.

Conclusion:

Selection and use of such a measure will help occupational therapists to document its effectiveness in improving participation among stroke survivors.

Impact of Stroke on Return to Work

Stroke has a marked impact on the ability to return to work. However, the stroke and its residual cognitive, physical and language deficits do not fully explain return-to-work success. While those with very severe deficits are less likely to return to work, and presence of disability is important, other extrinsic and intrinsic factors, such as having a job to go back to, beliefs and attitudes about work, job markets and the benefits system all play an important part. Vocational rehabilitation services developed with the stroke service user in mind are scarce in the United Kingdom. However, recent government interest in vocational rehabilitation and a recognition that evidence to support poststroke vocational rehabilitation is lacking have prompted efforts to develop new vocational rehabilitation services. People with stroke need specialist vocational rehabilitation services delivered by those who have an in-depth understanding of stroke and its effects. Service developers need to acknowledge and address factors that enable or impede return to work after stroke in service design. Research is needed to evaluate vocational rehabilitation interventions aimed specifically at the needs of stroke patients.

Implementing the Model of Human Occupation across a Mental Health Occupational Therapy Service: Communities of Practice and a Participatory Change Process

The implementation of evidence-based change in practice settings is complex and far reaching, but only limited research has been undertaken in this area. This participatory action research study investigated the implementation of the Model of Human Occupation (MOHO) across a mental health occupational therapy service.

Method:

The study involved preparatory workshops and 12 months of team-based, monthly group reflective supervision sessions, facilitated by a colleague from academia, with follow-up contact for a further 12 months.

Findings:

The main findings emphasise the importance of developing a critical learning space, or ‘community of practice’, and identify that barriers to theory implementation can be overcome by collective effort with a shared dialectic. The successful development of a community of practice required the careful consideration of a number of interconnected influences, including those of self, peer and facilitator, and contextual and theoretical relationships.

Conclusion:

The study concluded that the community of practice was central in supporting the effective implementation of MOHO and its associated assessment tools. A key output of the study is a Participatory Change Process, which illustrates the key steps undertaken and interrelated factors affecting theory uptake. The process requires further testing, but has potential to guide theory implementation in other settings.

Best practise use in stroke rehabilitation: from trials and tribulations to solutions!

PURPOSE

This article explores the use of best practises among stroke rehabilitation professionals, salient barriers that influence their knowledge uptake/application and effective knowledge translation (KT) strategies that meet the needs of this clinician group.

METHOD

Relevant literature on evidence-based practise in stroke rehabilitation and the use of KT strategies among rehabilitation professionals is summarised and discussed.

RESULTS

Although adherence to rehabilitation guidelines translates into improved patient outcomes, best practises are not routinely applied by clinicians when treating individuals with a stroke. Lack of protected work time to search and appraise the research literature is by far the largest organisational barrier to knowledge uptake/application. Personal barriers, such as the lack of confidence and skills to interpret, synthesise and apply research findings, also limit clinicians' uptake of best practises. Studies involving rehabilitation professionals found that active KT strategies were more effective than passive strategies to produce change in their evidence-based knowledge and practise behaviours. As such, interactive e-learning resources are likely to be a relevant KT solution to meet rehabilitation professionals' specific learning needs, guide their clinical decision-making and ultimately increase their best practise behaviours.

CONCLUSION

We have the knowledge of best practises in stroke rehabilitation, a means to disseminate that knowledge internationally through interactive e-learning resources, and information about effective KT interventions. With these opportunities in place, rehabilitation professionals can expand their capacity by adopting stroke best practises and producing better outcomes for patients.

Normal Movement and Functional Approaches to Rehabilitate Lower Limb Dressing following Stroke: A Pilot Randomised Controlled Trial

Dressing difficulties are common following stroke. However, specific interventions lack evidence. This pilot single-blind randomised controlled trial investigated normal movement and functional approaches to rehabilitate lower limb dressing, given to four eligible stroke inpatients. The Nottingham Stroke Dressing Assessment, Rivermead Motor Assessment and Canadian Occupational Performance Measure were taken at baseline, discharge and 8 weeks. The small sample lacked power. Preliminary results indicated that while all patients improved with occupational therapy, approaches may differ in rates of motor recovery, independence and treatment duration. A total sample of 30 is required for more conclusive research to inform lower limb dressing interventions.

Equipment Provision by Local Authority Occupational Therapy Teams Using the Fair Access to Care Services Eligibility Framework: A Vignette and Interview Study

Purpose:

In April 2003, the first national eligibility framework for adult services, Fair Access to Care Services (FACS), was implemented by local authorities in England. The intention was to ensure equity in the provision of adaptive equipment. This study examined how the criteria were being used by local authority occupational therapy teams and if equity was being achieved.

Procedure:

Five vignettes or hypothetical case histories were used to capture the experiences of a purposefully selected group of 12 employees from three local authority occupational therapy teams in the Midlands. Semi-structured interviews were then conducted to explore the themes raised by responses to the vignettes. Interviews were recorded and transcribed. Thematic analysis was independently conducted by two of the authors.

Findings:

There are inconsistencies in the access to services and the use of eligibility criteria, particularly at the point of entry to the service and for those people who are classified as having ‘low’ level needs. However, there is consistency within professional practice and evidence that staff prioritise client need.

Conclusion:

The implementation of FACS has been inconsistent and has not resulted in equity of provision. Some occupational therapy staff appear to prioritise the needs of clients above organisational policies.

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

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

Social Services Occupational Therapists' View of Practice and Integration with Health: A Survey

There is little known about social services occupational therapy provision within Scotland and England. This information is important when planning strategically for the future.

The aim of this study was to understand the views of social services occupational therapists on their practice and integration with health services. Systematic random sampling of social work/social services departments was completed (n = 10) and 57 occupational therapists within these departments received a mailed questionnaire. There was a 72% response rate.

The therapists received ‘on average 40 referrals' each month and 98% of the therapists retained the client for over 4 weeks, within which they had 3–6 contacts of 45–90 minutes each. Ninety-five per cent of the referrals were perceived to be appropriate and the clients benefited from the occupational therapy services. Fifty-four per cent of the therapists focused on self-care, equipment/adaptations and discussion with family/carers for more than half of their time, with 76% stating that they did not address all the clients' occupational needs. Eighty-eight per cent stated that there was an overlap with health service occupational therapists in the areas of assessment, equipment provision and family/carer advice. Forty-four per cent stated that there were some changes towards integration with health; however, 98% felt that more integration would benefit clients. The article sets out recommendations for consideration.