Differences in awareness between persons with left and right hemispheric stroke

Community Rehabilitation Outcomes for Different Stroke Diagnoses: An Observational Cohort Study

Objective

To determine the differences in functional and cognitive rehabilitation gains made in community-based rehabilitation following a stroke based on stroke diagnosis (left or right hemisphere, hemorrhagic, or ischemic).

Design

A 12-month follow-up observational retrospective cohort study.

Setting

Staged community-based brain injury rehabilitation.

Participants

Clients (N=61) with hemorrhagic left brain stroke (n=10), hemorrhagic right brain stroke (n=8), ischemic left brain stroke (n=27), or ischemic right brain stroke (n=16) participating in rehabilitation for at least 12 months.

Intervention

Not applicable.

Main Outcome Measures

The Mayo-Portland Adaptability Inventory-4 (MPAI-4) was completed at admission and 12 months post admission to staged community-based brain injury rehabilitation by consensus of a multidisciplinary team.

Results

After 12 months in staged community-based brain injury rehabilitation, the study population made significant gains in Total (P<.001) and across Ability (P<.001) and Participation (P<.001) subscales of the MPAI-4. All diagnostic groups made significant gains in Participation T-scores, and no groups made significant gains in Adjustment. The ischemic left and right hemisphere stroke groups also made significant gains in Ability and Total T-scores from admission to 12 months. Clients with ischemic left hemisphere stroke had more severe limitations in motor speech (P<.05) than clients with right hemisphere stroke at admission and/or review and were also more impaired in verbal communication (P<.01) than the hemorrhagic right hemisphere group at admission.

Conclusions

There are some differences in outcomes on presentation to rehabilitation based on type of stroke; there are also differences in rehabilitation gains. Improvement in physical ability does not always translate to improvement in social participation and independence; those with right brain stroke need further assistance to translate physical gains into participatory outcomes.

How is carer strain related to the recovery of stroke survivors with right hemisphere dysfunction? Implications for practice

Aim: Right hemisphere strokes are associated with neuro-behavioural impairments including hemi-inattention, impulsiveness and anosognosia, which can impede stroke recovery and adversely affect carer health. This study explored the impact of associated impairments on carer strain and depression through a mixed methods approach.Method: Fifty-one carer-survivor dyads were recruited from inpatient rehabilitation units and followed-up for 6 months. Validated measures assessed survivors' physical and cognitive function and carers' strain and depression levels. Survey methods captured qualitative experiences of the caring role. Data collection occurred at baseline, discharge, 6 weeks post-discharge and 6 months. Multilevel-modelling and thematic data analysis, were employed.Results: Carer strain median scores were within normal ranges of the Caregiver Strain Index scale. Carer strain was positively linked to carer depression, number of carers' concerns reported and survivors' anosognosia levels. Carer strain was negatively linked to the survivors' functional and cognitive abilities. Carers' experiences differed qualitatively with caring concerns increasing over time.Conclusion: Carer strain worsens with increases in significant concerns about the rehabilitation process and poor survivor functioning skills, which potentially increase risk of depression in carers. Consequently, improving right-hemisphere stroke survivors' recovery and nurturing the carer-survivor relationship are likely to enhance overall outcomes and caring experiences.IMPLICATIONS FOR REHABILITATIONIn the context of right hemisphere stroke: Carer assessment should be comprehensive and include a measure of perceived ability to care.Less strained carers tend to report fewer caring concerns and have lower depression levels.Education, training and practical support should be tailored to carer identified needs, abilities and the caring context.

Integrating Occupational Therapy Specific Assessments in Practice: Exploring Practitioner Experiences

BACKGROUND

Occupational therapists sometimes find it challenging to integrate client-centered and occupational therapy specific assessments in practice. The aim of this study was to explore the use of occupational therapy specific assessments such as the Assessment of Motor and Process Skills (AMPS) among occupational therapists in Sweden and Japan.

METHODS

Interviews and qualitative thematic analyses were utilized.

FINDINGS

Four themes are reported: (1) use it or lose it, (2) simply no space until after hours, (3) biggest barriers can be colleagues, and (4) being more specific: communication.

CONCLUSION

In keeping with previous studies, occupational therapists often find it challenging to implement client-centered and occupation-based assessment tools into practice. However, more work is needed to understand how best practices can be incorporated into a changing occupational therapy daily practice.

Evaluation of Activities of Daily Living Ability and Awareness among Clients in a Forensic Psychiatry Evaluation Unit in Sweden

Introduction:

The aim of this exploratory study was to investigate activities of daily living (ADL) functioning for clients in a forensic psychiatry evaluation unit and also to investigate the relationship between ADL functioning and awareness of their ability to perform ADL.

Method:

The sample consisted of 35 participants at a forensic psychiatry evaluation unit in Sweden. ADL was investigated using the Assessment of Motor and Process Skills (AMPS) and awareness of ability was investigated using the Assessment of Awareness of Ability (A3).

Results:

The ADL mean motor ability for the participants was 1.68 logits and the process ability showed an ADL mean value of 0.83 logit. The mean value of awareness was 0.60 logit. A majority of the participants demonstrated ability measures below the cut-off criteria in the AMPS, which indicates that they might need support to function in the community. There was also a significant relationship between awareness of ability and ADL motor ability (rho = 0.49, p<0.01) and ADL process ability (rho = 0.77, p<0.01).

Conclusion:

Clients in forensic psychiatry demonstrate limited ability in ADL, associated with a limited awareness. Clients in forensic psychiatry may also need assistance to live in the community, which suggests that occupational therapy may be offered to these clients in order to prepare them to manage in the community.