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Nielsen SS, Skou ST, Larsen AE, Polianskis R, Arendt-Nielsen L, Østergaard AS, Kjær-Staal Petersen K, Vægter HB, Søndergaard J, Christensen JR. Changes in pain, daily occupations, lifestyle, and health following an occupational therapy lifestyle intervention: a secondary analysis from a feasibility study in patients with chronic high-impact pain. Scand J Pain 2024; 24:sjpain-2023-0043. [PMID: 38037749 DOI: 10.1515/sjpain-2023-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES This study explored changes in pain-related parameters, occupational function, occupational balance, lifestyle factors, and self-perceived health status in adults with chronic high-impact pain participating in an occupational therapy lifestyle intervention. METHODS This one-group longitudinal feasibility study was performed in three continuous feasibility rounds. The occupational therapists-led intervention targeted meaningful occupations, regular physical activity, and a healthy diet. The intervention contained individual and group sessions and was added to the standard multidisciplinary chronic pain treatment. Outpatients (n=40, 85 % females, 46.6 ± 10.9 years old) participated in the study between April 2019 and December 2021. The analysis includes data for 31 participants. Analysis of pre-post changes assessed after each feasibility round were performed for the outcomes: pain intensity, pain sensitivity and pain modulation (pressure pain threshold and tolerance, temporal summation of pain and conditioned pain modulation), pain self-efficacy, pain catastrophizing, motor and process skills, occupational balance, daily wake-time movement, daily walking steps, body mass index, waist circumference, blood pressure, and self-perceived health status. RESULTS Improvements in motor skills (assessment of motor and process skills score=0.20 (1.37; 1.57), 95 % CI 0.01; 0.38) and temporal summation of pain (-1.19 (2.86; -1.67), 95 % CI -2.16; -0.22), but a decrease in pain tolerance (-7.110 (54.42; 47.32), 95 % CI -13.99; -0.22) were observed. Correlation analysis suggested moderate-to-very strong statistically significant relationships in several outcomes related to pain, health, pain coping, occupational balance, occupational functioning, body anthropometrics, and pain sensitivity. CONCLUSIONS This study suggested that the lifestyle intervention would benefit motor skills while effects on other outcomes were unclear in adults with chronic pain. To confirm the findings, a randomized trial evaluating effectiveness is needed. Ethical committee number: SJ-307 Reg. Clinicaltrials.gov: NCT03903900.
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Affiliation(s)
- Svetlana Solgaard Nielsen
- Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved, Slagelse & Ringsted Hospitals, Slagelse, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved, Slagelse & Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anette Enemark Larsen
- Department of Therapy and Midwifery Studies, Faculty of Health Sciences, University College Copenhagen, Copenhagen, Denmark
| | - Romanas Polianskis
- Multidisciplinary Pain Centre, Department of Anesthesiology, Naestved Hospital, Naestved, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Skov Østergaard
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Henrik Bjarke Vægter
- Pain Research Group/Pain Centre, Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- Research Unit of General Practice, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- User Perspectives, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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Walsh S, Ransohoff Brisson A, Flaherty R, Geller D, Tokash J, Kim G. Application of the ICF and OTPF-4 to Conceptualize the Dual Diagnosis of COVID-19 and Stroke: Implications for Occupational Therapy Practice in Acute and Inpatient Rehabilitation. Occup Ther Health Care 2023; 37:576-594. [PMID: 35659394 DOI: 10.1080/07380577.2022.2081753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
There is mounting evidence that the vascular manifestations associated with COVID-19 are linked to ischemic strokes. The emergence of patients with both COVID-19 and cerebrovascular accidents (COV-CVA) has created a need to adjust occupational therapy service delivery for inpatients with this dual diagnosis. This clinical perspective paper conceptualizes COV-CVA as a health condition using the International Classification of Functioning, Disability and Health Framework (ICF). The Occupational Therapy Practice Framework-4 was used to guide clinical considerations and recommendations for the evaluation, intervention, and discharge planning of patients with COV-CVA.
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Affiliation(s)
- Siobhan Walsh
- Department of Occupational Therapy, Visiting Nurse Association of Staten Island, Staten Island, NY, USA
| | | | - Raechel Flaherty
- Department of Occupational Therapy, Bellevue Hospital Center, New York, NY, USA
| | - Daniel Geller
- Department of Rehabilitation and Regenerative Medicine, Vagelos College of Physicians and Surgeons, Programs in Occupational Therapy, Columbia University, New York, NY, USA
| | - Jennifer Tokash
- Master's of Science in Occupational Therapy Program, Pace University, New York, NY, USA
| | - Grace Kim
- School of Culture, Department of Occupational Therapy, New York University Steinhardt, New York, NY, USA
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Yang CL, Connell LA, Eng JJ. Evaluating the Dissemination and Implementation Impact of a Rehabilitation Intervention: The Graded Repetitive Arm Supplementary Program (GRASP). Physiother Can 2023; 75:105-117. [PMID: 37736384 PMCID: PMC10510554 DOI: 10.3138/ptc-2022-0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 09/23/2023]
Abstract
Purpose To evaluate the dissemination and implementation impacts of a rehabilitation intervention. Methods Systematic evaluation of data sources including academic publishing metrics, publications, and surveys was used to describe the dissemination and implementation impact of the graded repetitive arm supplementary program (GRASP). Three categories in the Payback Framework were evaluated: knowledge production and dissemination, benefits to future research and research use, and real-world uptake and implementation. Results In the Knowledge production and dissemination category, seven publications, authored by the GRASP research team, were associated with the GRASP, and there were approximately 17,000 download counts of GRASP manuals from the website from 120 countries. In the Benefits to future research and research use category, 15 studies and 8 registered clinical trials, authored by researchers outside of the GRASP team, have used GRASP as an intervention. In the real-world uptake and implementation category, GRASP has informed recommendations in 2 clinical guidelines and 20 review papers, and had high implementation uptake (e.g., 35% [53/154] of UK therapists surveyed had used GRASP; 95% [649/681] who downloaded GRASP had used it). More than 75% of those who had used GRASP identified that GRASP provides more intensity in upper extremity rehabilitation, is evidence-based and easy to implement, and the equipment and manual are easy to obtain. Conclusion The Payback Framework is useful to evaluate the dissemination and implementation impacts of a rehabilitation intervention. GRASP has been implemented extensively in clinical practice and community in a relatively short time since it has been developed.
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Affiliation(s)
- Chieh-ling Yang
- From the:
Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Louise A. Connell
- School of Sport & Health Sciences, University of Central Lancashire, Preston, United Kingdom
- East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada
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4
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Geller D, Winterbottom L, Goldberg C, Nilsen DM, Mahoney D, Gillen G. Exercise for Adults With Stroke to Improve ADL and/or Functional Mobility Performance (2012-2019). Am J Occup Ther 2023; 77:24093. [PMID: 37093617 DOI: 10.5014/ajot.2023.77s10004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on interventions to improve activities of daily living (ADL) and functional mobility performance for people with stroke. This theme reports on exercise interventions.
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Affiliation(s)
- Daniel Geller
- Daniel Geller, EdD, MPH, OTR/L, is Assistant Professor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Lauren Winterbottom
- Lauren Winterbottom, MS, OTR/L, is Research Occupational Therapist, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center; and Instructor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Carly Goldberg
- Carly Goldberg, MS, OTR/L, is Advanced Clinician, Inpatient Rehabilitation Unit, New York Presbyterian-Columbia University Irving Medical Center; and Instructor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Dawn M Nilsen
- Dawn M. Nilsen, EdD, OTR/L, FAOTA, is Professor and Interim Program Director, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center; and Per Diem Occupational Therapist, New York Presbyterian-Columbia University Irving Medical Center
| | - Danielle Mahoney
- Danielle Mahoney, OTD, OTR/L, is Assistant Professor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Glen Gillen
- Glen Gillen EdD, OTR/L, FAOTA, is Professor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
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Geller D, Nilsen DM, Quinn L, Van Lew S, Bayona C, Gillen G. Home mirror therapy: a randomized controlled pilot study comparing unimanual and bimanual mirror therapy for improved arm and hand function post-stroke. Disabil Rehabil 2022; 44:6766-6774. [PMID: 34538193 DOI: 10.1080/09638288.2021.1973121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To compare home-based unimanual mirror therapy (UMT) and bimanual mirror therapy (BMT) for upper limb recovery in subacute/chronic stroke individuals with moderate-to-severe arm impairment. METHOD Twenty-two participants were randomized into 1 of 3 groups: UMT, BMT or traditional occupational therapy (TOT) home-based programs. The intervention was 6-weeks and consisted of OT 2 days a week, weekly sessions with the research OT, and 30-minutes of the home-based program 5 days a week, according to group allocation. The Action Research Arm Test (ARAT), ABILHAND, Fugl-Meyer Assessment (FMA), grip strength, and Stroke Impact Scale (SIS) were used for outcome measures. RESULTS All groups significantly improved over time on all outcome measures and adhered to the prescribed dosage regardless of group (p<0.05). While there were no between-group differences, effect size and 95% confidence interval data suggest a clinical significance in favor of UMT as compared to the other groups. CONCLUSIONS All participants, regardless of home-based program, adhered to the prescribed dosage and significantly improved over time. Despite no between-group differences, effect size and 95% confidence interval data suggest that UMT may be more beneficial for individuals with moderate-to-severe arm impairment as compared to BMT or TOT. ClinicalTrials.gov: #NCT02780440Implications for RehabilitationHome-based unimanual mirror therapy (UMT), bimanual mirror therapy (BMT), and traditional occupational therapy (TOT), when administered in conjunction with outpatient OT, are helpful for improving upper limb recovery post-stroke.Home-based UMT may be more beneficial than BMT or TOT for improvement in upper limb motor function and activities of daily living of patients with moderate to severe arm impairment post-stroke.
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Affiliation(s)
- Daniel Geller
- Department of Occupational Therapy, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA.,Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Dawn M Nilsen
- Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Lori Quinn
- Department of Behavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Stephen Van Lew
- Department of Occupational Therapy, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA
| | - Claribell Bayona
- Department of Occupational Therapy, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA
| | - Glen Gillen
- Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Hensel L, Lange F, Tscherpel C, Viswanathan S, Freytag J, Volz LJ, Eickhoff SB, Fink GR, Grefkes C. Recovered grasping performance after stroke depends on interhemispheric frontoparietal connectivity. Brain 2022; 146:1006-1020. [PMID: 35485480 PMCID: PMC9976969 DOI: 10.1093/brain/awac157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/19/2022] [Accepted: 04/14/2022] [Indexed: 01/11/2023] Open
Abstract
Activity changes in the ipsi- and contralesional parietal cortex and abnormal interhemispheric connectivity between these regions are commonly observed after stroke, however, their significance for motor recovery remains poorly understood. We here assessed the contribution of ipsilesional and contralesional anterior intraparietal cortex (aIPS) for hand motor function in 18 recovered chronic stroke patients and 18 healthy control subjects using a multimodal assessment consisting of resting-state functional MRI, motor task functional MRI, online-repetitive transcranial magnetic stimulation (rTMS) interference, and 3D movement kinematics. Effects were compared against two control stimulation sites, i.e. contralesional M1 and a sham stimulation condition. We found that patients with good motor outcome compared to patients with more substantial residual deficits featured increased resting-state connectivity between ipsilesional aIPS and contralesional aIPS as well as between ipsilesional aIPS and dorsal premotor cortex. Moreover, interhemispheric connectivity between ipsilesional M1 and contralesional M1 as well as ipsilesional aIPS and contralesional M1 correlated with better motor performance across tasks. TMS interference at individual aIPS and M1 coordinates led to differential effects depending on the motor task that was tested, i.e. index finger-tapping, rapid pointing movements, or a reach-grasp-lift task. Interfering with contralesional aIPS deteriorated the accuracy of grasping, especially in patients featuring higher connectivity between ipsi- and contralesional aIPS. In contrast, interference with the contralesional M1 led to impaired grasping speed in patients featuring higher connectivity between bilateral M1. These findings suggest differential roles of contralesional M1 and aIPS for distinct aspects of recovered hand motor function, depending on the reorganization of interhemispheric connectivity.
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Affiliation(s)
- Lukas Hensel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Fabian Lange
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Caroline Tscherpel
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Shivakumar Viswanathan
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Jana Freytag
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Lukas J Volz
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Simon B Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany,Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - Gereon R Fink
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Christian Grefkes
- Correspondence to: Christian Grefkes Institute of Neuroscience and Medicine - Cognitive Neuroscience (INM-3) Research Centre Juelich, Juelich, Germany E-mail:
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7
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Yu CH, Mathiowetz VG, Zieffler A, Tomlin GS. Efficacy of a Forearm Rotation Orthosis for People With a Hemiparetic Arm. Am J Occup Ther 2021; 75:23074. [PMID: 34792542 DOI: 10.5014/ajot.2021.043455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Insufficient voluntary forearm movements are associated with ineffective and inefficient functional performance among people poststroke. Although evidence supports the application of the occupational therapy task-oriented (OTTO) approach for this population, the training protocol does not explicitly address the role of forearm rotation movements. In addition, a need exists for theoretical support for orthotic interventions for people poststroke. Objective: To examine the efficacy of (1) a forearm rotation orthosis, (2) the OTTO approach, and (3) the combination of the two with people poststroke with a hemiparetic arm. DESIGN Stratified, randomized, two-group, single-blinded, repeated-measures design. SETTING Rehabilitation clinic. PARTICIPANTS Participants (N = 14) with a diagnosis of stroke and at least 10° of voluntary shoulder and elbow movement. INTERVENTION Participants were stratified into three groups by motor function (mild, moderate, severe) and randomly assigned either to 6 wk of no treatment followed by 6 wk of OTTO or to 6 wk of orthotic intervention followed by 6 wk of orthosis plus OTTO. Outcomes and Measures: Primary outcome measures were the Canadian Occupational Performance Measure (COPM), Wolf Motor Function Test (WMFT), and Motor Activity Log (MAL), administered at baseline (Week 1), at the end of Phase 1 (Week 7), and at the end of Phase 2 (Week 15) by blinded evaluators. RESULTS Both groups showed clinically important improvements on the COPM. No significant differences were found on the WMFT or MAL. CONCLUSIONS AND RELEVANCE The OTTO intervention provides clinically important benefits in self-perceived functional performance to people poststroke. What This Article Adds: The OTTO approach is an occupation-focused intervention that aims at functional performance and emphasizes clients' active engagement throughout the process. The findings suggest that the protocol of the OTTO intervention and its efficacy are appropriate for clinical practice.
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Affiliation(s)
- Chih-Huang Yu
- Chih-Huang Yu, PhD, OTR/L, is Assistant Professor, School of Occupational Therapy, Pacific University, Hillsboro, OR;
| | - Virgil G Mathiowetz
- Virgil G. Mathiowetz, PhD, OTR/L, FAOTA, is Associate Professor, Program in Occupational Therapy, University of Minnesota, Minneapolis
| | - Andrew Zieffler
- Andrew Zieffler, PhD, is Senior Lecturer, Department of Educational Psychology, University of Minnesota, Minneapolis
| | - George S Tomlin
- George S. Tomlin, PhD, OTR/L, FAOTA, is Professor, School of Occupational Therapy, University of Puget Sound, Tacoma, WA
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Donoso Brown EV, Eskander J, Wallace SE, Mull J. Effects of Preferred Music Listening on Adherence to Upper Extremity Home Programs. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2020.1865500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Elena V. Donoso Brown
- Department of Occupational Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Joanna Eskander
- Department of Occupational Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Sarah E. Wallace
- Department of Speech Language Pathology, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Jessica Mull
- Department of Music Education & Music Therapy, Mary Pappert School of Music, Pittsburgh, Pennsylvania, USA
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Smith MA, Tomita MR. Combined effects of Telehealth and Modified Constraint-Induced Movement Therapy for Individuals with Chronic Hemiparesis. Int J Telerehabil 2020; 12:51-62. [PMID: 32983368 PMCID: PMC7502810 DOI: 10.5195/ijt.2020.6300] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Telehealth use allows improved access to services and results in potential cost savings. The purpose of this study was to examine the effectiveness of a combined modified Constrained Induced Movement Therapy (mCIMT) program using telehealth and in-person sessions, for participants with higher (Group 1) and lower (Group 2) functional ability of the hemiparetic upper extremity. Using a pre-experimental design with a 6-week intervention, 28 participants were assessed twice on use of upper extremity via subjective and objective measures. For the Motor Activity Log, the amount of use and quality of use were significant for Groups 1 and 2. Significant improvements were shown on the Wolf Motor Function Test (WMFT), the Fugl-Meyer UE, and the Functional Independence Measure (FIM) for both groups except for the strength subtest on the WMFT and the timed portion for Group 1. Percentages of attendance for telehealth and in-person sessions were also compared. Telehealth sessions had a higher attendance rate (84.5%) than in-person sessions (75.3%) (p=.004). The combined mCIMT program of telerehabilitation and in-person group sessions was effective in improving functional ability after a stroke.
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Affiliation(s)
- Mary Ann Smith
- University of St. Augustine for Health Sciences, Austin, TX, USA
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10
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Zhu MH, Zeng M, Shi MF, Gu XD, Shen F, Zheng YP, Jia YP. Visual feedback therapy for restoration of upper limb function of stroke patients. Int J Nurs Sci 2020; 7:170-178. [PMID: 32685613 PMCID: PMC7355201 DOI: 10.1016/j.ijnss.2020.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 04/05/2020] [Accepted: 04/05/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To investigate the effects of mirror neuron theory-based visual feedback therapy (VFT) on restoration of upper limb function of stroke patients and motor-related cortical function using functional magnetic resonance imaging (fMRI). Methods Hemiplegic stroke patients were randomly divided into two groups: a VFT group and a control (CTL) group. Sixteen patients in the VFT group received conventional rehabilitation (CR) and VFT for 8 weeks, while 15 patients in the CTL group received only CR. The Barthel Index (BI) was used to assess the activities of daily living at baseline and the 8th week of the recovery training period. The Fugl–Meyer assessment (FMA) scale, somatosensory evoked potential (SEP), and fMRI were used to evaluate the recovery effect of the training therapies. The latencies and amplitudes of N9 and N20 were measured. Before recovery training, fMRI was performed for all patients in the VFT and CTL groups. In addition, 17 patients (9 in the VFT group and 8 in the CTL group) underwent fMRI for follow-up 2 months after treatment. Qualitative data were analyzed using the χ2 test. The independent sample t-test was used to compare normally distributed data among different groups, the paired sample t-test was used to compare data between groups, and the non-parametric test was used to comparing data without normal distribution among groups. Results There were no significant differences between the VFT and CTL group in all indexes. However, after 8 weeks of recovery training, these indexes were all significantly improved (P < 0.05). As compared with the CTL group, the FMA scores, BI, and N9/N20 latencies and amplitudes of SEP in the VFT group were significantly improved (P < 0.05). Two months after recovery training, fMRI showed that the degree of activation of the bilateral central anterior gyrus, parietal lobe, and auxiliary motor areas was significantly higher in the VFT group than the CTL group (P < 0.05). Conclusions VFT based on mirror neuron theory is an effective approach to improve upper extremity motor function and daily activity performance of stroke patients. The therapeutic mechanism promotes motor relearning by activating the mirror neuron system and motor cortex. SEP amplitudes increased only for patients who participated in visual feedback. VFT promotes sensory-motor plasticity and behavioral changes in both the motor and sensory domains.
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Wall A, Borg J, Palmcrantz S. Self-perceived functioning and disability after randomized conventional and electromechanically-assisted gait training in subacute stroke: A 6 months follow-up. NeuroRehabilitation 2019; 45:501-511. [PMID: 31868699 DOI: 10.3233/nre-192929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Few previous studies have assessed self-perceived functioning, disability and recovery after electromechanically-assisted gait training (EAGT). OBJECTIVE To compare self-perceived functioning, disability and recovery after EAGT and after conventional gait training in the subacute stage after stroke, using the Stroke Impact Scale (SIS), and factors associated with self-perceived recovery, assessed at 6 months after stroke. METHODS Patients were randomized into two groups performing a 4-week intervention period of incorporated EAGT using the Hybrid Assistive Limb (HAL) or conventional physiotherapy only. RESULTS There were no significant differences in self-perceived strength, ADL, mobility, participation and percentage of recovery between intervention groups (p > 0.05). Self-perceived mobility was associated with improvements in objectively assessed walking speed/endurance and balance (R2 0.717, p = 0.002), and self-perceived recovery with self-perceived activities of daily living (ADL) ability (R2 0.34, p = 0.001). CONCLUSIONS This study indicates that EAGT and conventional gait training in the subacute stage after stroke have no differential impact on self-perceived functioning, disability and recovery at 6 months after stroke. Further, the study highlights the importance of interventions targeting ADL and self-care independence during stroke rehabilitation to enhance self-perceived recovery and clinical aspects to be targeted to enhance perceived mobility.
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Affiliation(s)
- Anneli Wall
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
| | - Jörgen Borg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
| | - Susanne Palmcrantz
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
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12
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Zhang B, Kan L, Dong A, Zhang J, Bai Z, Xie Y, Liu Q, Peng Y. The effects of action observation training on improving upper limb motor functions in people with stroke: A systematic review and meta-analysis. PLoS One 2019; 14:e0221166. [PMID: 31469840 PMCID: PMC6716645 DOI: 10.1371/journal.pone.0221166] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 07/31/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Action observation training (AOT) has been used as a new intervention for improving upper limb motor functions in people with stroke. This systematic review and meta-analysis aims to investigate the effects of AOT on improving upper limb motor functions in people with stroke. METHODS We searched ten electronic databases to identify randomized controlled trials (RCTs) about the effects of AOT on upper limb motor functions in stroke survivors. Methodological quality of included studies was assessed by the Risk of Bias Tool in the Cochrane Handbook for Systematic Reviews of Interventions. A random-effects meta-analysis was performed by pooling the standardized mean difference (SMD) of upper limb motor outcomes. RESULTS Seven studies of 276 participants with stroke were included. Meta-analysis showed a significant effect favoring AOT on improving upper limb motor functions in patients with stroke [SMD = 0.35, 95% confidence interval [CI], 0.10 to 0.61, I2 = 10.14%, p = 0.007]. CONCLUSIONS AOT appears to be an effective intervention for improving the upper limb motor functions in people after stroke. Further studies need to investigate the neural mechanism underlying the effects of AOT.
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Affiliation(s)
- Bingbing Zhang
- Department of Rehabilitation Medicine, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Laidi Kan
- Department of Rehabilitation Medicine, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Anqin Dong
- Department of Rehabilitation Medicine, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- * E-mail:
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zhongfei Bai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Occupational Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Yi Xie
- Department of Rehabilitation Engineering, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qianhao Liu
- Department of Rehabilitation Medicine, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yuzhong Peng
- Department of Rehabilitation Medicine, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Stefanello JL, Mendes GC, Moser ADDL, Nohama P. Ludic-activities-based therapeutic suitcase for rehabilitation of people with stroke. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: The rehabilitation of people who suffered a stroke depends on patient commitment, rehabilitation strategies and technologies employed. Objective: To develop a suitcase with rehabilitation activities using devices that provide functional exercises in a fun and motivating way. Method: The main motor and sensory functions lost due to the stroke were identified and a set of three boards was modeled, providing activities with adequate structure and strategies to conduct rehabilitation exercises. A pilot experiment was performed with a subject with poststroke sequelae. Results: The suitcase has three boards containing devices for exercises of proprioception, motor coordination, grasping and reeducation to decrease agnosia, to increase muscle strength and for cognitive training. Conclusion: The suitcase fulfilled its functional reeducation purpose via a playful method; it provides improvements in the ability to fit parts, differentiate colors, recognize shapes and textures, and increase the strength.
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Affiliation(s)
| | | | | | - Percy Nohama
- Pontifícia Universidade Católica do Paraná, Brazil; Universidade Tecnológica Federal do Paraná, Brazil
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14
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Wallace SE, Donoso Brown EV, Saylor A, Lapp E. Participants' perceptions of an aphasia-friendly occupational therapy home program. Top Stroke Rehabil 2018; 25:1-11. [PMID: 30296202 DOI: 10.1080/10749357.2018.1517492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Upper extremity impairments post-stroke impact participation in valued occupations. Home programs are used to extend the frequency and amount of upper extremity practice for people post-stroke, but novel ways of increasing adherence to these programs is needed to ensure intense repetitive practice. OBJECTIVES The purpose of this process evaluation, was to examine the perceptions of people with aphasia as it relates to modifications to home programs that could influence participation, specifically listening to music and aphasia-friendly adaptations of written materials. METHODS Seven people with chronic aphasia completed an upper extremity home program that included the use of music and aphasia-friendly modified materials (ClinicalTrials.gov ID:2016/06/18). After the home program, participants completed semi-structured interviews to understand their perceptions of the program and the modifications. RESULTS Five themes were identified including (1) music, (2) activities, (3) instructions, (4) logistics, and (5) progress. Most participants perceived music as helpful, but a few reported it being distracting. Participants found the variety of activities helpful as well as specific characteristics of the instructions such as photographs and images. Some participants expressed elements of the home program to be barriers to practice such as using the activity monitors and logbook, which required assistance at times. Finally, participants noted their own progress resulting from the program and liked that they could adjust the intensity of the program as they progressed. CONCLUSIONS Overall participants in this study with aphasia perceived the modifications to home programs including aphasia friendly written instructions and music to facilitate successful home practice.
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Affiliation(s)
- Sarah E Wallace
- a Department of Speech-Language Pathology , Duquesne University , Pittsburgh , USA
| | | | - Anna Saylor
- c Department of Speech-Language Pathology , Duquesne University , Pittsburgh , USA
| | - Erica Lapp
- c Department of Speech-Language Pathology , Duquesne University , Pittsburgh , USA
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15
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Radomski MV, Anheluk M, Arulanantham C, Finkelstein M, Flinn N. Implementing evidence-based practice: A context analysis to examine use of task-based approaches to upper-limb rehabilitation. Br J Occup Ther 2018. [DOI: 10.1177/0308022617752068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Statement of contextMany occupational therapists experience challenges in implementing evidence-based practice, which may be best approached as a context-specific enterprise.Critical reflection on practiceThis practice analysis article reports the results of analyzing 24 home programs that occupational therapists issued to rehabilitation inpatients with stroke upon their discharge home. Home programs did not reflect a task-based approach to upper-limb recovery, even though this is supported by established evidence. Examination of contextual factors provides a framework to facilitate evidence implementation.Implications for practiceOccupational therapists may optimize evidence-based practice implementation by first evaluating and addressing practice-specific contextual factors.
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Affiliation(s)
| | - Mattie Anheluk
- Occupational Therapist, Courage Kenny Rehabilitation Institute, Minneapolis, USA
| | | | - Marsha Finkelstein
- Senior Scientific Advisor, Courage Kenny Research Center, Minneapolis, USA
| | - Nancy Flinn
- Senior Scientific Advisor, Courage Kenny Research Center, Minneapolis, USA
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16
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Simpson EK, Ramirez NM, Branstetter B, Reed A, Lines E. Occupational Therapy Practitioners' Perspectives of Mental Health Practices With Clients in Stroke Rehabilitation. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2018; 38:181-189. [PMID: 29495909 DOI: 10.1177/1539449218759627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Following a stroke, depression and anxiety may negatively affect recovery and decrease quality of life. Occupational therapy (OT) practitioners are distinctly qualified to address both the physical and psychosocial sequelae of a stroke, including clients' mental and emotional health. This study explored the ways in which OT practitioners address the mental health needs of clients post stroke. A sequential explanatory mixed-methods design was used to collect both survey and focus group data. In all, 754 OT practitioners across the United States completed an online survey, and 10 practitioners participated in focus groups. Practitioners considered their clients' mental health needs to be a priority (68.17%); however, only 56.64% were satisfied with the care they provided related to mental and emotional health. They identified barriers that included limited time, increased productivity standards, expectations related to physical recovery, and poor educational preparation. Practitioners are motivated to improve their provision of mental health services to clients post stroke. To address the conflict between practice realities and professional values, education programs should better integrate curricular components that focus on physical and mental health.
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Affiliation(s)
| | | | | | - Aileen Reed
- 1 Midwestern University, Downers Grove, IL, USA
| | - Evan Lines
- 1 Midwestern University, Downers Grove, IL, USA
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17
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Patients' and Health Professionals' Experiences of Using Virtual Reality Technology for Upper Limb Training after Stroke: A Qualitative Substudy. Rehabil Res Pract 2018; 2018:4318678. [PMID: 29593910 PMCID: PMC5822914 DOI: 10.1155/2018/4318678] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/16/2018] [Indexed: 12/20/2022] Open
Abstract
Background In recent years, virtual reality (VR) therapy systems for upper limb training after stroke have been increasingly used in clinical practice. Therapy systems employing VR technology can enhance the intensity of training and can also boost patients' motivation by adding a playful element to therapy. However, reports on user experiences are still scarce. Methods A qualitative investigation of patients' and therapists' perspectives on VR upper limb training. Semistructured face-to-face interviews were conducted with six patients in the final week of the VR intervention. Therapists participated in two focus group interviews after the completion of the intervention. The interviews were analyzed from a phenomenological perspective emphasizing the participants' perceptions and interpretations. Results Five key themes were identified from the patients' perspectives: (i) motivational factors, (ii) engagement, (iii) perceived improvements, (iv) individualization, and (v) device malfunction. The health professionals described the same themes as the patients but less positively, emphasizing negative technical challenges. Conclusion Patients and therapists mainly valued the intensive and motivational character of VR training. The playful nature of the training appeared to have a significant influence on the patients' moods and engagement and seemed to promote a "gung-ho" spirit, so they felt that they could perform more repetitions.
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18
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Lin SH, Dionne TP. Interventions to Improve Movement and Functional Outcomes in Adult Stroke Rehabilitation: Review and Evidence Summary. J Particip Med 2018; 10:e3. [PMID: 33052128 PMCID: PMC7434068 DOI: 10.2196/jopm.8929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/02/2017] [Indexed: 12/30/2022] Open
Abstract
Background Patients who have had a stroke may not be familiar with the terminology nor have the resources to efficiently search for evidence-based rehabilitation therapies to restore movement and functional outcomes. Recognizing that a thorough systematic review on this topic is beyond the scope of this article, we conducted a rapid review evidence summary to determine the level of evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Objective The objective of this study was to find evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Methods Medline Complete, PubMed, CINAHL Complete, Cochrane Database, Rehabilitation and Sports Medicine Source, Dissertation Abstracts International, and National Guideline Clearinghouse, from 1996 to April of 2016, were searched. From 348 articles, 173 met the following inclusion criteria: (1) published systematic reviews or meta-analyses, (2) outcomes target functional movement or motor skills of the upper and lower limbs, (3) non-pharmacological interventions that are commonly delivered to post-stroke population (acute and chronic), (4) human studies, and (5) English. Evidence tables were created to analyze the findings of systematic reviews and meta-analyses by category of interventions and outcomes. Results This rapid review found that the following interventions possess credible evidence to improve functional movement of persons with stroke: cardiorespiratory training, therapeutic exercise (ie, strengthening), task-oriented training (task-specific training), constraint-induced movement therapy (CIMT), mental practice, and mirror therapy. Neuromuscular electrical stimulation (NMES) (ie, functional electrical stimulation) shows promise as an intervention for stroke survivors. Conclusions Most commonly delivered therapeutic interventions to improve motor recovery after a stroke possess moderate quality evidence and are effective. Future research recommendations, such as optimal timing and dosage, would help rehabilitation professionals tailor interventions to achieve the best outcomes for stroke survivors.
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Affiliation(s)
- Susan Hamady Lin
- Institute of Health Professions, Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, United States
| | - Timothy P Dionne
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, United States
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19
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McNair K, Lutjen M, Langhamer K, Nieves J, Hreha K. Comprehensive, technology-based, team approach for a patient with locked-in syndrome: A case report of improved function & quality of life. Assist Technol 2017; 31:53-58. [PMID: 28750192 DOI: 10.1080/10400435.2017.1352052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
One of the most severe types of stroke is locked-in syndrome (LIS) due to the loss of almost all voluntary motor functions and a high mortality rate. The majority of the literature regarding LIS is based on case reports that utilized multidisciplinary interventions focused on improving functional communication and respiratory care with minimal focus on motor retraining. These reports were neither dynamic nor multi-sensory, and the only technology utilized was in the form of augmentative communication. There are additional types of technology frequently used in the general stroke population that can address similar motor deficits that occur in the LIS population. This case report explains an interdisciplinary approach using motor and communication interventions that are multisensory, progressive, multi-modal, and technology- based. The length of stay was 153 days in acute rehabilitation, after which the patient returned home making significant gains in overall function. In this patient, the FIM changes in motor (+42), cognitive (+29) and total change score of (+71) surpassed what was determined to be a minimal clinically important difference. These results suggest that this treatment program and approach may be a key reason why this patient was able to achieve significant functional gains and report improved quality of life.
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Affiliation(s)
- Keara McNair
- a Kessler Institute for Rehabilitation , West Orange , New Jersey , USA
| | - Madeline Lutjen
- a Kessler Institute for Rehabilitation , West Orange , New Jersey , USA
| | - Kara Langhamer
- a Kessler Institute for Rehabilitation , West Orange , New Jersey , USA
| | - Jeremiah Nieves
- a Kessler Institute for Rehabilitation , West Orange , New Jersey , USA.,b Rutgers Medical School , Newark , New Jersey , USA
| | - Kimberly Hreha
- a Kessler Institute for Rehabilitation , West Orange , New Jersey , USA.,c Kessler Foundation , West Orange , New Jersey , USA
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20
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Skubik-Peplaski C, Custer M, Powell E, Westgate PM, Sawaki L. Comparing Occupation-Based and Repetitive Task Practice Interventions for Optimal Stroke Recovery: A Pilot Randomized Trial. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2017. [DOI: 10.1080/02703181.2017.1342734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Camille Skubik-Peplaski
- Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond, Kentucky, USA
| | - Melba Custer
- Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond, Kentucky, USA
| | - Elizabeth Powell
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky, USA
| | - Philip M. Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Lumy Sawaki
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky, USA
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21
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Nagayama H, Tomori K, Ohno K, Takahashi K, Nagatani R, Izumi R, Moriwaki K, Yamauchi K. Cost effectiveness of the occupation-based approach for subacute stroke patients: result of a randomized controlled trial. Top Stroke Rehabil 2017; 24:337-344. [PMID: 28198661 DOI: 10.1080/10749357.2017.1289686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE The cost effectiveness of occupational therapy for subacute stroke patients is unclear in the extant literature. Consequently, this study determined the cost effectiveness of the occupation-based approach using Aid for Decision-Making in Occupation Choice (ADOC) for subacute stroke patients compared with an impairment-based approach. METHODS We conducted an economic evaluation from a societal perspective alongside a pilot randomized controlled trial, with a single blind assessor for participants in 10 subacute rehabilitation units in Japan. The intervention group received occupation-based goal setting using ADOC, with interventions focused on meaningful occupations. The control group received an impairment-based approach focused on restoring capacities. For both groups, occupational-therapy intervention was administered more than five times per week, for over 40 min each time, and they received physical and speech therapy prior to discharge. The main outcomes were quality-adjusted life years (QALYs) and total costs. Further, sensitivity analyses were performed to examine the influence of parameter uncertainty on the base case results. RESULTS The final number of participants was 24 in each of the two groups. In terms of QALYs, the intervention group is significantly higher than the control group (p = 0.001, difference 95% CI: 0.002-0.008) and total costs are not statistically significant. Applying a willingness-to-pay threshold of JPY 5 million/QALY, the probability of the occupation-based approach using ADOC being cost effective was estimated to be 65.3%. CONCLUSIONS The results show that the occupation-based approach is associated with significantly improved QALYs and has potential cost effectiveness, compared with the impairment-based approach.
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Affiliation(s)
- Hirofumi Nagayama
- a Department of Occupational Therapy , Kanagawa University of Human Services , Yokosuka , Japan.,g Graduate School of Health Management , Keio University , Fujisawa , Japan
| | - Kounosuke Tomori
- b Unit of Rehabilitation Sciences , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Kanta Ohno
- c IMS Itabashi Rehabilitation Hospital , Itabashi , Japan
| | - Kayoko Takahashi
- d Department of Occupational Therapy, School of Allied Health Sciences , Kitasato University , Sagamihara , Japan
| | - Ryutaro Nagatani
- a Department of Occupational Therapy , Kanagawa University of Human Services , Yokosuka , Japan
| | - Ryota Izumi
- e Department of Occupational Therapy , Seirei Christopher University , Hamamatsu , Japan
| | - Kensuke Moriwaki
- f Department of Medical Statistics , Kobe Pharmaceutical University , Kobe , Japan
| | - Keita Yamauchi
- g Graduate School of Health Management , Keio University , Fujisawa , Japan
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22
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The Influence of Speech-Language-Hearing Therapy Duration on the Degree of Improvement in Poststroke Language Impairment. Rehabil Res Pract 2017; 2017:7459483. [PMID: 28168056 PMCID: PMC5266857 DOI: 10.1155/2017/7459483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/21/2016] [Accepted: 12/08/2016] [Indexed: 11/18/2022] Open
Abstract
Background. The relevance of speech-language-hearing therapy (ST) duration to language impairment remains unclear. Objective. To determine the effect of ST duration on improvement in language impairment as a stroke sequela and to compare the findings with those for occupational therapy (OT) and physical therapy (PT). Methods. Data regarding patients with stroke sequelae who were registered in the Japanese Association of Rehabilitation Medicine database were analyzed. Propensity scores for ST, OT, and PT duration were calculated using logistic regression, followed by inverse probability weighting in generalized estimating equations to examine the odds ratio for improvement in the Functional Independence Measures scores for comprehension, expression, and memory. Analyses stratified by age and dementia severity were also conducted. Results. Compared with short-duration ST, long-duration ST was significantly associated with improved scores for comprehension and expression in the overall study population and in some groups, with higher benefit especially for younger participants (<64 years) and those with more severe dementia. A significant but less pronounced effect was also observed for OT and PT. Conclusion. Long-duration ST is more effective than long-duration OT or PT for improving language impairment occurring as stroke sequela. However, these effects are limited by age and severity of dementia.
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Almhdawi KA, Mathiowetz VG, White M, delMas RC. Efficacy of Occupational Therapy Task-oriented Approach in Upper Extremity Post-stroke Rehabilitation. Occup Ther Int 2016; 23:444-456. [DOI: 10.1002/oti.1447] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 09/04/2016] [Accepted: 09/21/2016] [Indexed: 01/16/2023] Open
Affiliation(s)
- Khader A. Almhdawi
- Department of Rehabilitation Sciences; Jordan University of Science and Technology; Irbid Jordan
| | - Virgil G. Mathiowetz
- Department of Rehabilitation Science; University of Minnesota; Minneapolis MN USA
| | - Matthew White
- Abbott Northwestern Hospital; Courage Kenny Rehabilitation Institute; Minneapolis MN USA
| | - Robert C delMas
- Department of Educational Psychology; University of Minnesota; Minneapolis MN USA
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24
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Grattan ES, Lang CE, Birkenmeier R, Holm M, Rubinstein E, Van Swearingen J, Skidmore ER. Examining the Feasibility, Tolerability, and Preliminary Efficacy of Repetitive Task-Specific Practice for People With Unilateral Spatial Neglect. Am J Occup Ther 2016; 70:7004290020p1-8. [PMID: 27294994 DOI: 10.5014/ajot.2016.019471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined the feasibility, tolerability, and preliminary efficacy of repetitive task-specific practice for people with unilateral spatial neglect (USN). METHOD People with USN ≥6 mo poststroke participated in a single-group, repeated-measures study. Attendance, total repetitions, and satisfaction indicated feasibility and pain indicated tolerability. Paired t tests and effect sizes were used to estimate changes in upper-extremity use (Motor Activity Log), function (Action Research Arm Test), and attention (Catherine Bergego Scale). RESULTS Twenty participants attended 99.4% of sessions and completed a high number of repetitions. Participants reported high satisfaction and low pain, and they demonstrated small, significant improvements in upper-extremity use (before Bonferroni corrections; t = -2.1, p = .04, d = .30), function (t = -3.0, p < .01, d = .20), and attention (t = -3.4, p < .01, d = -.44). CONCLUSION Repetitive task-specific practice is feasible and tolerable for people with USN. Improvements in upper-extremity use, function, and attention may be attainable.
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Affiliation(s)
- Emily S Grattan
- Emily S. Grattan, PhD, OTR/L, is Postdoctoral Scholar, Department of Health Science and Research, Medical University of South Carolina, Charleston;
| | - Catherine E Lang
- Catherine E. Lang, PT, PhD, is Professor, Program in Physical Therapy and Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Rebecca Birkenmeier
- Rebecca Birkenmeier, OTD, OTR/L, is Assistant Professor, Program of Occupational Therapy, Maryville University, St. Louis, MO
| | - Margo Holm
- Margo Holm, PhD, OTR/L, is Professor Emerita, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Elaine Rubinstein
- Elaine Rubinstein, PhD, is Lecturer, Department of Psychology, Chatham University, and Senior Service Fellow, Office of Mine Safety and Health Research, Bruceton Research Center, National Institute for Occupational Safety and Health, Pittsburgh, PA
| | - Jessie Van Swearingen
- Jessie Van Swearingen, PT, PhD, is Associate Professor, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Elizabeth R Skidmore
- Elizabeth R. Skidmore, PhD, OTR/L, is Associate Professor and Chair, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
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Mirela Cristina L, Matei D, Ignat B, Popescu CD. Mirror therapy enhances upper extremity motor recovery in stroke patients. Acta Neurol Belg 2015; 115:597-603. [PMID: 25850528 DOI: 10.1007/s13760-015-0465-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/23/2015] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to evaluate the effects of mirror therapy program in addition with physical therapy methods on upper limb recovery in patients with subacute ischemic stroke. 15 subjects followed a comprehensive rehabilitative treatment, 8 subjects received only control therapy (CT) and 7 subjects received mirror therapy (MT) for 30 min every day, five times a week, for 6 weeks in addition to the conventional therapy. Brunnstrom stages, Fugl-Meyer Assessment (upper extremity), the Ashworth Scale, and Bhakta Test (finger flexion scale) were used to assess changes in upper limb motor recovery and motor function after intervention. After 6 weeks of treatment, patients in both groups showed significant improvements in the variables measured. Patients who received MT showed greater improvements compared to the CT group. The MT treatment results included: improvement of motor functions, manual skills and activities of daily living. The best results were obtained when the treatment was started soon after the stroke. MT is an easy and low-cost method to improve motor recovery of the upper limb.
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Affiliation(s)
- Luca Mirela Cristina
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, 9-13 Kogalniceanu Street, 700454, Iasi, Romania
| | - Daniela Matei
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, 9-13 Kogalniceanu Street, 700454, Iasi, Romania.
| | - Bogdan Ignat
- Department of Neurology, Faculty of General Medicine, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Str.Universitatii NR.16, 700115, Iasi, Romania
| | - Cristian Dinu Popescu
- Department of Neurology, Faculty of General Medicine, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Str.Universitatii NR.16, 700115, Iasi, Romania
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Van Lew S, Geller D, Feld-Glazman R, Capasso N, Dicembri A, Zipp GP. Development and Preliminary Reliability of the Functional Upper Extremity Levels (FUEL). Am J Occup Ther 2015; 69:6906350010. [PMID: 26565105 DOI: 10.5014/ajot.2015.016006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The Functional Upper Extremity Levels (FUEL) is a new classification tool to assess a person's upper-extremity functional and physical performance after sustaining a stroke. The aim of this preliminary study was to develop the tool and determine its content validity and interrater reliability. METHOD Forty-four licensed occupational therapists ranging in years of experience from 6 mo to 16 yr participated in this study. A two-phase study was conducted: (1) constructing the FUEL and determining its content validity and (2) ascertaining its interrater reliability. RESULTS We found that the FUEL had initial content validity and substantial interrater reliability (Fleiss κ = .754). CONCLUSION The FUEL can be a useful clinical and research tool in occupational therapy for the assessment and classification of upper-extremity function for people after stroke. Further studies with larger samples and comparison studies with other similar tools are required to support the tool's reliability and validity.
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Affiliation(s)
- Stephen Van Lew
- Stephen Van Lew, MS, OTR/L, is Director of Occupational Therapy, New York University Langone Medical Center, New York, NY;
| | - Daniel Geller
- Daniel Geller, MS, MPH, OTR/L, is Occupational Therapy Research Clinical Specialist, New York University Langone Medical Center, New York, NY
| | - Rachel Feld-Glazman
- Rachel Feld-Glazman, MS, OTR/L, is Occupational Therapy Program Director, Burke Rehabilitation Hospital, White Plains, NY
| | - Nettie Capasso
- Nettie Capasso, MS, OTR/L, is Occupational Therapy Assistant Supervisor, New York University Langone Medical Center, New York, NY
| | - Adrienne Dicembri
- Adrienne Dicembri, MPH, OTR/L, is Occupational Therapy Supervisor, New York University Langone Medical Center, New York, NY
| | - Genevieve Pinto Zipp
- Genevieve Pinto Zipp, EdD, PT, is Professor, Interprofessional Health Sciences and Health Administration Department, and Director, Center for Interprofessional Education in Health Sciences, Seton Hall University, South Orange, NJ
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Kim K. Action observation for upper limb function after stroke: evidence-based review of randomized controlled trials. J Phys Ther Sci 2015; 27:3315-7. [PMID: 26644700 PMCID: PMC4668191 DOI: 10.1589/jpts.27.3315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/06/2015] [Indexed: 11/27/2022] Open
Abstract
[Purpose] The purpose of this study was to suggest evidenced information about action
observation to improve upper limb function after stroke. [Methods] A systematic review of
randomized controlled trials involving adults aged 18 years or over and including
descriptions of action observation for improving upper limb function was undertaken.
Electronic databases were searched, including MEDLINE, CINAHL, and PEDro (the
Physiotherapy Evidence Database), for articles published between 2000 to 2014. Following
completion of the searches, two reviewers independently assessed the trials and extracted
data using a data extraction form. The same two reviewers independently documented the
methodological quality of the trials by using the PEDro scale. [Results] Five randomized
controlled trials were ultimately included in this review, and four of them (80%) reported
statistically significant effects for motor recovery of upper limb using action
observation intervention in between groups. [Conclusion] This review of the literature
presents evidence attesting to the benefits conferred on stroke patints resulting from
participation in an action observation intervention. The body of literature in this field
is growing steadily. Further work needs to be done to evaluate the evidence for different
conditions after stroke and different duration of intervention.
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Affiliation(s)
- KyeongMi Kim
- Department of Occupational Therapy, College of Biomedical Sciences and Engineering, Inje University, Republic of Korea
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Flor H. Lost in Translation: Psychologische Mechanismen und Psychotherapie. VERHALTENSTHERAPIE 2015. [DOI: 10.1159/000430829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Arbesman M, Lieberman D, Berlanstein DR. Method for the Evidence-Based Reviews on Occupational Therapy and Stroke. Am J Occup Ther 2014; 69:6901180020p1-5. [DOI: 10.5014/ajot.2015.013524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Evidence-based reviews of the literature relevant to adults with stroke are important to the practice of occupational therapy. We describe the four questions that served as the focus for the evidence-based reviews of the effectiveness of occupational therapy interventions for adults with stroke. The questions include occupation- and activity-based interventions to improve occupational performance and social participation after stroke, as well as interventions for motor, cognitive, and psychological and emotional impairments after stroke. We include the background for the reviews; the process followed for addressing each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each evidence-based review; a summary of the themes of the results; the strengths and limitations of the findings; and implications for practice, education, and research are presented.
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Affiliation(s)
- Marian Arbesman
- Marian Arbesman, PhD, OTR/L, is Consultant, Evidence-Based Practice Project, American Occupational Therapy Association, Bethesda, MD; President, ArbesIdeas, Inc., Williamsville, NY; and Adjunct Assistant Professor, Department of Rehabilitation Science, University at Buffalo, Buffalo, NY;
| | - Deborah Lieberman
- Deborah Lieberman, MSHA, OTR/L, FAOTA, is Program Director, Evidence-Based Practice Project, and Staff Liaison to the Commission on Practice, American Occupational Therapy Association, Bethesda, MD
| | - Debra R. Berlanstein
- Debra R. Berlanstein, MLS, AHIP, is Associate Director, Hirsh Health Sciences Library, Tufts University, Medford, MA
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