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Bonn MM, Dickey JP, Moran B, McGuire S, Graham L. Completing an interdisciplinary outpatient intervention improves patient rehabilitation goals following a mild traumatic brain injury. Physiother Theory Pract 2023; 39:310-316. [PMID: 35001810 DOI: 10.1080/09593985.2021.2022046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Individualized and interdisciplinary rehabilitation programs are recommended following a mild traumatic brain injury (mTBI), but often have long waitlists. Accordingly, innovative evidence-based programs are needed. OBJECTIVES The first objective of this study was to determine the number and types of rehabilitation goals chosen by individuals completing an interdisciplinary outpatient rehabilitation intervention (BrainEx90) for persisting symptoms following an mTBI. The second objective was to investigate whether completing BrainEx90 or choosing specific types of goals influenced performance and satisfaction ratings of these goals. METHODS 217 individuals (44.4 ± 13.5 years old) with persisting symptoms following an mTBI completed BrainEx90, a 16-session interdisciplinary group outpatient rehabilitation intervention at Parkwood Institute between November 2013 and September 2019. Performance and satisfaction ratings of self-identified goals before and after BrainEx90 were assessed using the Canadian Occupational Performance Measure, and changes in ratings were analyzed using a linear mixed effects model. RESULTS 1008 goals were identified and categorized as: productivity (45%); leisure (37%); and self-care (18%). Satisfaction ratings were significantly higher for all goal types following BrainEx90. Satisfaction with self-care goals improved significantly more than leisure [t(151) = 3.24, p < .01] and productivity [t(144) = 2.97, p < .01] goals. Performance ratings were also significantly greater following BrainEx90 [2.4, 95% CI [2.27, 2.53], p < .01)]. CONCLUSION Performance and satisfaction of self-identified rehabilitation goals significantly improved following BrainEx90. Satisfaction with self-care goals demonstrated the greatest improvements, yet the most identified goal type was productivity.
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Affiliation(s)
- Marquise M Bonn
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - James P Dickey
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Becky Moran
- Regional Acquired Brain Injury Outpatient Program, Parkwood Institute, London, ON, Canada
| | - Shannon McGuire
- Regional Acquired Brain Injury Outpatient Program, Parkwood Institute, London, ON, Canada
| | - Laura Graham
- Lawson Health Research Institute, London, ON, Canada.,School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
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2
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Song YH, Lee HM. Effect of Immersive Virtual Reality-Based Bilateral Arm Training in Patients with Chronic Stroke. Brain Sci 2021; 11:brainsci11081032. [PMID: 34439651 PMCID: PMC8391150 DOI: 10.3390/brainsci11081032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 12/04/2022] Open
Abstract
Virtual reality (VR)-based therapies are widely used in stroke rehabilitation. Although various studies have used VR techniques for bilateral upper limb training, most have been only semi-immersive and have only been performed in an artificial environment. This study developed VR content and protocols based on activities of daily living to provide immersive VR-based bilateral arm training (VRBAT) for upper limb rehabilitation in stroke patients. Twelve patients with chronic stroke were randomized to a VRBAT group or a normal bilateral arm training (NBAT) group and attended 30-min training sessions five times a week for four weeks. At the end of the training, there was a significant difference in upper limb function in both groups (p < 0.05) and in the upper limb function sensory test for proprioception in the NBAT group (p < 0.05). There was no significant between-group difference in upper limb muscle activity after training. The relative alpha and beta power values for electroencephalographic measurements were significantly improved in both groups. These findings indicate that both VRBAT and NBAT are effective interventions for improving upper limb function and electroencephalographic activity in patients with chronic stroke.
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Affiliation(s)
- Yo-Han Song
- Department of Physical Therapy, Seoyeong University, Gwangju 61268, Korea;
| | - Hyun-Min Lee
- Department of Physical Therapy, Honam University, Gwangju 62399, Korea
- Correspondence:
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3
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Kronberg J, Tierney E, Wallisch A, Little LM. Early Intervention Service Delivery via Telehealth During COVID-19: A Research-Practice Partnership. Int J Telerehabil 2021; 13:e6363. [PMID: 34345340 PMCID: PMC8287712 DOI: 10.5195/ijt.2021.6363] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Coaching has been identified as a best practice for early intervention (EI) services provided through the Individuals with Disabilities Education Act (IDEA) Part C. The current study describes the establishment and progress of a research-relationship partnership to deliver coaching via telehealth during the COVID-19 pandemic. Community-based EI providers implemented 9-weeks of telehealth coaching and evaluated the extent to which child and caregiver outcomes differed between families that had previously received in-person services versus telehealth only. Four EI providers completed the intervention with n=17 families of children aged 6-34 months during the pandemic (April-August 2020). We used the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) to collect outcomes on caregiver identified goals; we used Wilcoxon Signed Rank Tests to examine pre- to post-intervention data. Results showed significant improvements in parent satisfaction, child performance, and goal attainment (all p<.01). Findings suggest that telehealth coaching procedures implemented by community-based EI providers resulted in improvements in caregiver identified goals for young children.
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Affiliation(s)
| | | | - Anna Wallisch
- Juniper Gardens Children's Project, University of Kansas, Kansas City, Kansas, USA
| | - Lauren M Little
- Department of Occupational Therapy, Rush University Medical Center, Chicago, Illinois, USA
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4
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Hoepner JK, Sievert A, Guenther K. Joint Video Self-Modeling for Persons With Traumatic Brain Injury and Their Partners: A Case Series. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:863-882. [PMID: 33784468 DOI: 10.1044/2021_ajslp-20-00074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Individuals with traumatic brain injury (TBI) experience impairments to self-regulation and social communication that strain relationships. Video self-modeling (VSM) provides visible and audible, tangible evidence of what they do well and what could improve. Conducting such training in the context of authentic exchanges with their everyday partners may support positive change in social communication. The present investigation sought to evaluate indices of improved social communication. Method A mixed-methods design was employed for this case series investigation. Quantitative measures include pre- and postoutcomes on goal attainment scales (GASs) and measures of conversational effectiveness. Qualitative measures include responsiveness to video-supported prompts, conversational behaviors, and metacognitive statements. Results Participants perceived gains on GAS of 3-4 SDs, as well as perceived improvements on the La Trobe Communication Questionnaire. Those gains were validated by gains on the adapted Measure of Participation in Conversation and Measure of Skill in Supported Conversation. Individuals with TBI and their partners reached consensus on most goals and postintervention La Trobe Communication Questionnaire ratings. Participants made accurate judgments about their behaviors at a high rate, given video review. Conversational behaviors and use of metacognitive statements varied across participants and conversational contexts. Field notes and session transcripts provide evidence that both dyads increased internalization of VSM goals and purpose. Conclusions Joint VSM shows promise as a method for eliciting accurate self-assessments among individuals with TBI and their close partners. Both dyads perceived positive gains in interactions within and outside their dyads. Furthermore, joint VSM and GAS appear to improve self-awareness and internalization of VSM goals and purpose.
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Affiliation(s)
- Jerry K Hoepner
- Department of Communication Sciences and Disorders, University of Wisconsin-Eau Claire
| | - Alexis Sievert
- Department of Communication Sciences and Disorders, University of Wisconsin-Eau Claire
| | - Kaitlin Guenther
- Department of Communication Sciences and Disorders, University of Wisconsin-Eau Claire
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5
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Clare L, Kudlicka A, Oyebode JR, Jones RW, Bayer A, Leroi I, Kopelman M, James IA, Culverwell A, Pool J, Brand A, Henderson C, Hoare Z, Knapp M, Morgan-Trimmer S, Burns A, Corbett A, Whitaker R, Woods B. Goal-oriented cognitive rehabilitation for early-stage Alzheimer's and related dementias: the GREAT RCT. Health Technol Assess 2020; 23:1-242. [PMID: 30879470 DOI: 10.3310/hta23100] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cognitive rehabilitation (CR) is an individualised, person-centred intervention for people with mild to moderate dementia that addresses the impact of cognitive impairment on everyday functioning. OBJECTIVES To determine whether or not CR is a clinically effective and cost-effective intervention for people with mild to moderate Alzheimer's disease or vascular or mixed dementia, and their carers. DESIGN This multicentre randomised controlled trial compared CR with treatment as usual (TAU). Following a baseline assessment and goal-setting to identify areas of everyday functioning that could be improved or better managed, participants were randomised (1 : 1) via secure web access to an independent randomisation centre to receive either TAU or CR and followed up at 3 and 9 months post randomisation. SETTING Community. PARTICIPANTS Participants had an International Classification of Diseases, Tenth Edition, diagnosis of Alzheimer's disease or vascular or mixed dementia, had mild to moderate cognitive impairment (Mini Mental State Examination score of ≥ 18 points), were stable on medication if prescribed, and had a family carer who was willing to contribute. The exclusion criteria were people with a history of brain injury or other neurological disorder and an inability to speak English. To achieve adequate power, we needed 350 people to complete the trial, with 175 people in each trial arm. INTERVENTION Cognitive rehabilitation consisted of 10 therapy sessions over 3 months, followed by four maintenance sessions over 6 months, delivered in participants' homes. The therapists were nine occupational therapists and one nurse. OUTCOME MEASURES The primary outcome was self-reported goal attainment at 3 months. Goal attainment was also assessed at 9 months. Carers provided independent ratings of goal attainment at both time points. The secondary outcomes were participant quality of life, mood, self-efficacy and cognition, and carer stress, health status and quality of life. The assessments at 3 and 9 months were conducted by researchers who were blind to the participants' group allocation. RESULTS A total of 475 participants were randomised (CR arm, n = 239; TAU arm, n = 236), 427 participants (90%) completed the trial and 426 participants were analysed (CR arm, n = 208, TAU arm, n = 218). At 3 months, there were statistically significant large positive effects for participant-rated goal attainment [mean change in the CR arm: 2.57; mean change in the TAU arm: 0.86; Cohen'sd = 0.97, 95% confidence interval (CI) 0.75 to 1.19], corroborated by carer ratings (Cohen'sd = 1.11, 95% CI 0.89 to 1.34). These effects were maintained at 9 months for both the participant ratings (Cohen's d = 0.94, 95% CI 0.71 to 1.17) and the carer ratings (Cohen's d = 0.96, 95% CI 0.73 to 1.20). There were no significant differences in the secondary outcomes. In the cost-utility analyses, there was no evidence of cost-effectiveness in terms of gains in the quality-adjusted life-years (QALYs) of the person with dementia (measured using the DEMentia Quality Of Life questionnaire utility score) or the QALYs of the carer (measured using the EuroQol-5 Dimensions, three-level version) from either cost perspective. In the cost-effectiveness analyses, by reference to the primary outcome of participant-rated goal attainment, CR was cost-effective from both the health and social care perspective and the societal perspective at willingness-to-pay values of £2500 and above for improvement in the goal attainment measure. There was no evidence on the cost-effectiveness of the self-efficacy measure (the Generalized Self-Efficacy Scale) from either cost perspective. LIMITATIONS Possible limitations arose from the non-feasibility of using observational outcome measures, the lack of a general measure of functional ability and the exclusion of people without a carer or with rarer forms of dementia. CONCLUSIONS Cognitive rehabilitation is clinically effective in enabling people with early-stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy sessions. FUTURE WORK Next steps will focus on the implementation of CR into NHS and social care services and on extending the approach to people with rarer forms of dementia. TRIAL REGISTRATION Current Controlled Trials ISRCTN21027481. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Aleksandra Kudlicka
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Jan R Oyebode
- School of Dementia Studies, University of Bradford, Bradford, UK
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Antony Bayer
- Division of Population Medicine, University Hospital Llandough, Cardiff University, Cardiff, UK
| | - Iracema Leroi
- Department of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Michael Kopelman
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, St Thomas' Hospital, King's College London, London, UK
| | - Ian A James
- Centre of the Health of the Elderly, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alison Culverwell
- Kent and Medway NHS and Social Care Partnership Trust, St Martin's Hospital, Canterbury, UK
| | | | - Andrew Brand
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Catherine Henderson
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | | | - Alistair Burns
- Department of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Anne Corbett
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | | | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
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6
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Jenkin T, Anderson V, D'Cruz K, Collins A, Muscara F, Scheinberg A, Knight S. Engaging children and adolescents with acquired brain injury and their families in goal setting: The clinician perspective. Neuropsychol Rehabil 2020; 32:104-130. [PMID: 32811301 DOI: 10.1080/09602011.2020.1801470] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper explored clinicians' experiences of the goal setting process with children and adolescents with acquired brain injuries (ABI) and their families in paediatric neurorehabilitation. Semi-structured interviews were conducted with 13 clinicians, all members of an interdisciplinary paediatric rehabilitation service, who work with children and adolescents with ABI and their families. Interview transcripts and additional data were analysed using constructivist grounded theory methods. Three main themes and sub-themes were developed: (1) Seeing the bigger picture: Goals change over time; Families set bigger picture goals; Need-to-dos: Goals that the child/adolescent needs to achieve; and Want-to-dos: Goals that the child/adolescent wants to achieve; (2) Collaborating as a team: Everyone needs to be on the same page; Hearing the child's/adolescent's voice; and Parents as advocates; and (3) Recognizing and navigating challenges: Child-/adolescent- and family-related challenges and Time as a service-related challenge. Participants perceived the clinician's role during goal setting as that of an active collaborator, enabling children and adolescents with ABI and their families to generate meaningful goals. These findings demonstrate insights into goal setting in paediatric ABI neurorehabilitation from clinicians' perspectives, and highlight the importance of collaboration, flexibility and anticipation of challenges in facilitating children's, adolescents' and families' involvement in this process.
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Affiliation(s)
- Taylor Jenkin
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | | | - Alana Collins
- Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Frank Muscara
- Murdoch Children's Research Institute, Melbourne, Australia.,Psychology Service, Royal Children's Hospital, Melbourne, Australia
| | - Adam Scheinberg
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Knight
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Australia
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7
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Colquhoun HL, Islam R, Sullivan KJ, Sandercock J, Steinwender S, Grimshaw JM. Behaviour Change Domains Likely to Influence Occupational Therapist Use of the Canadian Occupational Performance Measure. Occup Ther Int 2020; 2020:3549835. [PMID: 32508548 PMCID: PMC7245666 DOI: 10.1155/2020/3549835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/06/2020] [Accepted: 04/18/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Occupational therapists have shown low adoption rates for many evidence-based practices. One such practice is the limited uptake of standardized outcome measures such as the Canadian Occupational Performance Measure. Use of this measure has not consistently translated into practice despite decades of encouragement. Theory-based approaches to understanding healthcare provider behaviour change are needed if we are to realize the goal of attaining practice that is in keeping with evidence. This study utilized the Theoretical Domains Framework, a theory-based approach for understanding barriers to evidence-based practice, in order to increase our understanding of the limited uptake of the Canadian Occupational Performance Measure in occupational therapy practice. METHODS Theoretical Domains Framework methods were followed. First, primary data was collected from occupational therapists through semistructured interviews that focused on key behaviour change domains as they related to the use of the Canadian Occupational Performance Measure. Two independent researchers coded interview data into domains, derived belief statements from the data, and used belief strength, conflict, and frequency to determine the more and less influential domains for using the Canadian Occupational Performance Measure. RESULTS Interviews with 15 practicing occupational therapists across a range of practice areas yielded six key behaviour change domains for increasing the use of the Canadian Occupational Performance Measure. The more relevant domains were Social influences, Social professional role and identity, Beliefs about consequences, Beliefs about capabilities, Skills, and Behavioural regulation). The other eight domains were found to be less relevant. CONCLUSION We identified important domains and beliefs that influence the use of the Canadian Occupational Performance Measure by occupational therapists. Results inform our understanding of the use of this measure in practice and identify potential targets for behaviour change interventions.
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Affiliation(s)
- Heather L. Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Rafat Islam
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Ottawa, Ontario, K1H 8L6, Canada
| | - Katrina J. Sullivan
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Ottawa, Ontario, K1H 8L6, Canada
| | - Jane Sandercock
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Sandy Steinwender
- University of Western Ontario, PhD Candidate Health Information Science, Health Sciences, London, Ontario, N6A 5B9, Canada
| | - Jeremy M. Grimshaw
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Ottawa, Ontario, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
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8
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Fernández-Solano AJ, Del Baño-Aledo ME, Rodríguez-Bailón M. Results of an occupational self-analysis program in people with acquired brain injury. A pilot study. Brain Inj 2019; 34:253-261. [PMID: 31730407 DOI: 10.1080/02699052.2019.1689576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: The aim of this study was to evaluate the benefits of an occupational self-analysis program in people with acquired brain injury (ABI) in the areas of subjective health perception and occupational participation.Material and Method: This study explored the benefits of an occupational self-analysis program in people with ABI. The intervention group comprised 7 participants; the control group included 5 participants. Outcomes were measured using the SF-36 Health Survey and the Role Checklist. The contents of solicited participant diaries and a focus group discussion were also analyzed.Results: Compared to the control group, the intervention group showed statistically significant improvements in the SF-36 energy/fatigue subscale. The qualitative analysis revealed that participants in the intervention group increased their occupational participation in activities of daily living (ADL), social involvement, and leisure.Conclusion: The program helped participants improve their health perception and increase their occupational participation through learning about their supports and barriers for engaging in meaningful activities.
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9
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Goal statements in brain injury rehabilitation: A cohort study of client-centredness and relationship with goal outcome. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Currently, there is increasing recognition of the need to use a client-centred approach to goal setting in rehabilitation. However, there is limited research to guide practice with community-dwelling clients with acquired brain injury. An understanding of the characteristics of client-centred goals and the extent to which client-centeredness influences goal outcomes is required.Objective:To examine the relationships between the client-centredness of goals and their characteristics, content, recall and outcomes of client-centred goals in brain injury rehabilitation.Methods:A prospective cohort design study was employed. Participants were 45 clients with brain injury receiving outpatient rehabilitation, who completed measures of client-centredness after goal setting. Each goal was classified according to whether it was specific, measurable, non-jargonistic, and participation-focussed, included a timeframe and was recalled by participants.Results:Participants set 223 goals with 20 clinicians from multiple disciplines. Levels of client-centredness did not differ according to the characteristics, content and recall of goals, with the exception of goal specificity (p< 0.01). Client-centredness was significantly and positively correlated with goal outcomes (p< 0.05).Conclusions:The use of client-centred goals is recommended for improved rehabilitation outcomes. Applying goal documentation criteria does not necessarily mean that goals will be client-centred, and highly specific goal statements may not reflect what is important and meaningful to clients.
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10
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Williams MW, Rapport LJ, Hanks RA, Parker HA. Engagement in rehabilitation therapy and functional outcomes among individuals with acquired brain injuries. Disabil Rehabil 2019; 43:33-41. [PMID: 31099267 DOI: 10.1080/09638288.2019.1613682] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Purpose : The purpose was to examine the role of therapy engagement as a potential mediator for the relationship between neuropsychological performance and functional outcomes. Materials and method : Participants were 94 adults with medically documented ABI recruited from three outpatient rehabilitation clinics at the start of occupational therapy. Participants (57% men) ranged from 18 to 82 in age, with the majority (81%) having completed 12 or more years of education. They completed a comprehensive neuropsychological assessment at baseline. Separately, occupational therapists (OTs) assessed functional independence and disability at baseline and follow up. The OTs also rated the participants' therapy engagement. Results : Therapy engagement predicted functional outcomes and mediated the relationship between neuropsychological performance and outcomes. Moreover, therapy engagement accounted for unique variance in functional outcome, even after accounting for education, comorbid health conditions, emotional distress, apathy, and baseline functional ability. Conclusions : Engagement in therapy is a crucial patient characteristic in successful rehabilitation outcome. Cognitive deficits associated with ABI undermine full engagement in rehabilitation therapy, which in turn diminishes potential gains made in therapy and functional recovery. Neuropsychological assessment can enhance rehabilitation outcomes by identifying characteristics that underlie therapy engagement, which can ultimately be used to maximize the effectiveness of individualized treatment plans. Implications for rehabilitation Neuropsychological assessment can identify cognitive abilities that are strongly related to functional outcomes during occupational therapy for acquired brain injury. Therapy engagement is an important pathway by which neuropsychological impairment predicts functional outcomes after acquired brain injuries.
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Affiliation(s)
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Robin A Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA.,Rehabilitation Institute of Michigan, Detroit, MI, USA
| | - Hillary A Parker
- Department of Psychology, Wayne State University, Detroit, MI, USA
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11
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Hagelskjær V, Krohn M, Christensen PS, Christensen JR. Canadian Occupational Performance Measure Supported by Talking Mats: An Evaluation of the Clinical Utility. Occup Ther Int 2019; 2019:9367315. [PMID: 30804725 PMCID: PMC6362486 DOI: 10.1155/2019/9367315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Some clients with cognitive and communicative impairments after a brain injury are unable to participate in the Canadian Occupational Performance Measure (COPM) without support. The study originates from an assumption that some of these clients are able to participate independently in the COPM interview by using a visual material. AIM The aim was to investigate the clinical utility of COPM supported by Talking Mats (TM) for community-based clients with cognitive and communicative impairments. METHODS Six clients (51-60 years) were included. After matching the visual material of TM to COPM, the COPM interview was administered twice with an interval of 10 days, once using TM and once without. Interviews were videotaped and studied by six evaluators. RESULTS The most obvious benefits of using TM as a supportive tool in the COPM interview were related to the first two steps of the COPM interview. CONCLUSION Using TM in the COPM interview with clients with cognitive and communicative impairments after a brain injury is recommended as the basis for goal setting. The present study demonstrates a possibility to include a COPM interview to clients who had not been able to complete a COPM interview and thus start a rehabilitation process in a client-centered manner.
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Affiliation(s)
- Vita Hagelskjær
- VIA University College, Gl. Struervej 1, 7500 Holstebro, Denmark
| | - Mette Krohn
- VIA University College, Gl. Struervej 1, 7500 Holstebro, Denmark
| | | | - Jeanette Reffstrup Christensen
- The Research Initiative for Activity Studies and Occupational Therapy, Research Unit for General Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, 5000 Odense, Denmark
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12
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Coe Á, Martin M, Stapleton T. Effects of An Occupational Therapy Memory Strategy Education Group Intervention on Irish Older Adults' Self-Management of Everyday Memory Difficulties. Occup Ther Health Care 2019; 33:37-63. [PMID: 30620222 DOI: 10.1080/07380577.2018.1543911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An occupational therapy memory strategy education group (MSEG) was developed to assist clients with varying levels of memory impairment to adopt strategies to manage memory impairment in their daily lives. Participants were healthy older adults presenting with subjective memory complaints (SMC, n = 14), mild cognitive impairment (MCI, n = 33), or early stages of dementia (n = 13). Clients and their caregivers attended a one-hour session each week for six weeks. Outcome measures were taken at baseline, two weeks post completion of the group, and at a 3-month follow-up for 47 participants. Statistically significant improvements post-program were scored on the Rivermead Behavioural Memory Test (p = 0.001) and a dementia quality of life measure (p = 0.02), with increased use of external memory aids (p < 0.001) and significant improvements in participants' self-ratings of performance (p < 0.001) and satisfaction with their performance (p < 0.001) using the Canadian Occupational Performance Measure. Findings suggest positive outcomes that were maintained at 3-month follow-up and thus, support the role of occupational therapy in delivering occupation-focused memory strategy programs.
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Affiliation(s)
- Áine Coe
- a Department of Occupational Therapy, Naas General Hospital , Naas , Co. Kildare , Ireland
| | - Mary Martin
- b Department of Medicine , Naas General Hospital , Naas , Co. Kildare , Ireland
| | - Tadhg Stapleton
- c Department of Occupational Therapy, School of Medicine , University of Dublin , Trinity College , Dublin , Ireland
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13
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Turcotte S, Vallée C, Vincent C. [Occupational therapy and community integration of adults with neurological conditions: A scoping review]. The Canadian Journal of Occupational Therapy 2019; 85:365-377. [PMID: 30599776 DOI: 10.1177/0008417418813399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND. Although community integration (CI) is the ultimate goal of rehabilitation, it is rarely achieved in clinical settings. PURPOSE. The purpose of this study was to (a) synthesize the state of occupational therapy knowledge related to CI for people with neurological issues and to (b) illustrate how CI is conceptualized within the literature. METHOD. A scoping review was completed using two reviewers, resulting in the selection of 47 articles pertaining to four study populations. Themes common across all client populations were identified through content analysis, and an iterative synthesis was used to analyse the evolution of knowledge. FINDINGS. The selected articles covered craniocerebral trauma ( n = 21, 9 experimental categories [EXP]), medullar injuries ( n = 11, 4 EXP), cerebrovascular injuries ( n = 9, 4 EXP), and multiple sclerosis ( n = 4, 1 EXP). CI was used interchangeably with the term social participation. Fifty-one percent of the articles defined CI solely as part of a measurement tool, and 10% did not provide a definition of CI. The physical dimension of CI had been studied more frequently than the social and psychological dimensions. IMPLICATIONS. Innovative practices should work to enable community inclusion and full citizenship to support the long-term enablement.
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Abstract
Research has shown that patients who are mechanically ventilated or immobile for greater than 7 days are at increased risk for deconditioning and muscle atrophy. Immobility impacts length of stay as well as patients' ability to return to their prior level of function. As part of the safe patient-handling initiative created at Michigan Medicine, a special team of nurses and therapists was assembled to adapt an adult mobility framework for the pediatric population. The pediatric mobility model determines each patient's specific mobility "phase" based on detailed criteria. Clinical staff can then implement strategies aimed at preventing deconditioning and hospital-acquired weakness. At C.S. Mott Children's Hospital, a multidisciplinary team is available to support this pediatric mobility model. Specific equipment utilized during the different phases of mobility has been reviewed and discussed in this article.
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Meth MZ, Bernstein JPK, Calamia M, Tranel D. What types of recommendations are we giving patients? A survey of clinical neuropsychologists. Clin Neuropsychol 2018; 33:57-74. [DOI: 10.1080/13854046.2018.1456564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Molly Z. Meth
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University and Veterans Affairs Medical Center, Providence, RI, USA
| | | | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Daniel Tranel
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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16
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Alaniz ML, Rosenberg SS, Beard NR, Rosario ER. The Effectiveness of Aquatic Group Therapy for Improving Water Safety and Social Interactions in Children with Autism Spectrum Disorder: A Pilot Program. J Autism Dev Disord 2017; 47:4006-4017. [PMID: 28864911 DOI: 10.1007/s10803-017-3264-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Drowning is the number one cause of accidental death in children with Autism Spectrum Disorder (ASD). Few studies have examined the effectiveness of swim instruction for improving water safety skills in children with moderate to severe ASD. This study examines the feasibility and effectiveness of an aquatic therapy program on water safety and social skills in children with mild to severe ASD (n = 7). Water safety skills were evaluated using the Aquatics Skills Checklist and social skills were measured using the Social Skills Improvement Scale. We provide preliminary evidence that children with ASD can improve water safety skills (p = 0.0002), which are important for drowning prevention after only 8 h of intervention. However, social skills did not respond to intervention (p = 0.6409).
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Affiliation(s)
- Michele L Alaniz
- Children's Services Center, Casa Colina Hospital and Centers for Healthcare, 255 E. Bonita Ave., P.O. Box 6001, Pomona, CA, 91769, USA.
| | - Sheila S Rosenberg
- Children's Services Center, Casa Colina Hospital and Centers for Healthcare, 255 E. Bonita Ave., P.O. Box 6001, Pomona, CA, 91769, USA.,Casa Colina's Research Institute, Pomona, CA, USA
| | - Nicole R Beard
- Children's Services Center, Casa Colina Hospital and Centers for Healthcare, 255 E. Bonita Ave., P.O. Box 6001, Pomona, CA, 91769, USA.,Curative New Berlin Therapies, New Berlin, WI, USA.,Children's Services Center, University of Southern California, Los Angeles, CA, USA
| | - Emily R Rosario
- Children's Services Center, Casa Colina Hospital and Centers for Healthcare, 255 E. Bonita Ave., P.O. Box 6001, Pomona, CA, 91769, USA.,Casa Colina's Research Institute, Pomona, CA, USA
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Juengst SB, Kumar RG, Wagner AK. A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges. Psychol Res Behav Manag 2017; 10:175-186. [PMID: 28652833 PMCID: PMC5476717 DOI: 10.2147/prbm.s113264] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Depression is one of the most common conditions to emerge after traumatic brain injury (TBI), and despite its potentially serious consequences it remains undertreated. Treatment for post-traumatic depression (PTD) is complicated due to the multifactorial etiology of PTD, ranging from biological pathways to psychosocial adjustment. Identifying the unique, personalized factors contributing to the development of PTD could improve long-term treatment and management for individuals with TBI. The purpose of this narrative literature review was to summarize the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management. Overall, PTD has an estimated point prevalence of 30%, with 50% of individuals with moderate to severe TBI experiencing an episode of PTD in the first year after injury alone. PTD has significant implications for health, leading to more hospitalizations and greater caregiver burden, for participation, reducing rates of return to work and affecting social relationships, and for quality of life. PTD may develop directly or indirectly as a result of biological changes after injury, most notably post-injury inflammation, or through psychological and psychosocial factors, including pre injury personal characteristics and post-injury adjustment to disability. Current evidence for effective treatments is limited, although the strongest evidence supports antidepressants and cognitive behavioral interventions. More personalized approaches to treatment and further research into unique therapy combinations may improve the management of PTD and improve the health, functioning, and quality of life for individuals with TBI.
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Affiliation(s)
- Shannon B Juengst
- Department of Physical Medicine and Rehabilitation
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, TX
| | - Raj G Kumar
- Department of Physical Medicine and Rehabilitation
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation
- Department of Neuroscience
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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18
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Fisher S. The Canadian Occupational Performance Measure: Does it Address the Cultural Occupations of Ethnic Minorities? Br J Occup Ther 2016. [DOI: 10.1177/030802260506800506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study is the first to examine the cultural sensitivity of the Canadian Occupational Performance Measure (COPM), as reported by occupational therapists who have used it with people from an ethnic minority background. The research was conducted as part of a Master's degree, held in Boston, USA, and funded by the Elizabeth Casson Trust, UK. Twenty-five practising occupational therapists from North America answered an emailed survey and, from this sample, three were interviewed by telephone. The findings showed that the practitioners perceived the COPM as able to address the cultural occupations of ethnic minorities; however, they felt that including examples of cultural occupations and children's occupations and modifying the rating scales would improve the tool. Two of the three therapists interviewed worked with children and, because of this, there was a focus on children's occupations that was only revealed in the second part of the research. The nature of the tool, its ability to focus on occupation and the therapist's interview skills were identified as the reasons that the COPM is effective in addressing the cultural occupations of ethnic minorities. Additional research is needed using a larger sample to validate these findings.
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19
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Cognitive Intervention for Attention and Executive Function Impairments in Children With Traumatic Brain Injury: A Pilot Study. J Head Trauma Rehabil 2016; 31:407-418. [DOI: 10.1097/htr.0000000000000200] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Lee S, Kim Y, Lee BH. Effect of Virtual Reality-based Bilateral Upper Extremity Training on Upper Extremity Function after Stroke: A Randomized Controlled Clinical Trial. Occup Ther Int 2016; 23:357-368. [PMID: 27419927 DOI: 10.1002/oti.1437] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 11/08/2022] Open
Abstract
In the present study, we aimed to investigate the effect of virtual reality-based bilateral upper extremity training (VRBT) on paretic upper limb function and muscle strength in patients with stroke. Eighteen stroke survivors were assigned to either the VRBT group (n = 10) or the bilateral upper limb training group (BT, n = 8). Patients in the VRBT group performed bilateral upper extremity exercises in a virtual reality environment, whereas those in the BT group performed conventional bilateral upper extremity exercises. All training was conducted for 30 minutes day-1 , 3 days a week, for a period of 6 weeks. Patients were assessed for upper extremity function and hand strength. Compared with the BT group, the VRBT group exhibited significant improvements in upper extremity function and muscle strength (p < 0.05) after the 6-week training programme. The Box and Block test results revealed that upper extremity function and elbow flexion in hand strength were significantly improved in terms of group, time and interaction effect of group by time. Furthermore, the VRBT group demonstrated significant improvements in upper extremity function, as measured by the Jebsen Hand Function Test and Grooved Pegboard test, and in the hand strength test, as measured by elbow extension, grip, palmar pinch, lateral pinch and tip pinch, in both time and the interaction effect of group by time. These results suggest that VRBT is a feasible and beneficial means of improving upper extremity function and muscle strength in individuals following stroke. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Suhyun Lee
- Graduate School of Physical Therapy, Sahmyook University, Seoul, Korea
| | - Yumi Kim
- Graduate School of Physical Therapy, Sahmyook University, Seoul, Korea
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
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21
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Speicher SM, Walter KH, Chard KM. Interdisciplinary residential treatment of posttraumatic stress disorder and traumatic brain injury: effects on symptom severity and occupational performance and satisfaction. Am J Occup Ther 2016; 68:412-21. [PMID: 25005504 DOI: 10.5014/ajot.2014.011304] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE. This study examined outcomes of an 8-wk residential treatment program for veterans with posttraumatic stress disorder (PTSD) and a history of traumatic brain injury (TBI). METHOD. Twenty-six veterans completed the Canadian Occupational Performance Measure, Clinician-Administered PTSD Scale, Beck Depression Inventory-2nd Edition, and PTSD Checklist before and after treatment. RESULTS. Veterans demonstrated significant improvements in occupational performance and satisfaction with their performance, as well as in PTSD and depression symptom severity after residential PTSD/TBI treatment. Additionally, improvements in occupational performance and satisfaction were associated with decreases in depression symptom severity. CONCLUSION. Although preliminary, results suggest that veterans with PTSD and a history of TBI experienced significant decreases in PTSD and depression symptom severity and improvement in self-perception of performance and satisfaction in problematic occupational areas. Changes in occupational areas and depression symptom severity were related, highlighting the importance of interdisciplinary treatment.
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Affiliation(s)
- Sarah M Speicher
- Sarah M. Speicher, MOT, OTR, is Occupational Therapist, Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH
| | - Kristen H Walter
- Kristen H. Walter, PhD, is Clinical Psychologist and Independent Clinical Evaluator, Veterans Medical Research Foundation and Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Kathleen M Chard
- Kathleen M. Chard, PhD, is Director, Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, 1000 South Fort Thomas Avenue, Fort Thomas, KY 41075, and Professor of Psychiatry and Behavioral Neuroscience, Department of Psychiatry, University of Cincinnati Medical School, Cincinnati, OH;
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22
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Prescott S, Fleming J, Doig E. Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: A systematic scoping review. Brain Inj 2015; 29:1515-29. [DOI: 10.3109/02699052.2015.1075152] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Yoo C, Yong MH, Chung J, Yang Y. Effect of computerized cognitive rehabilitation program on cognitive function and activities of living in stroke patients. J Phys Ther Sci 2015; 27:2487-9. [PMID: 26355244 PMCID: PMC4563296 DOI: 10.1589/jpts.27.2487] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The objective of this study was to examine the effect of cognitive
rehabilitation using a computer on cognitive function and activities of daily living in
stroke patients presenting impairment of cognitive function. [Subjects] Forty-six stroke
patients were divided into two groups (a training group and control group) through random
assignment. [Methods] The training group received rehabilitation therapy and an additional
computerized cognitive rehabilitation program using The RehaCom software 30 minutes/day, 5
times/week for 5 weeks. The control group received only rehabilitation therapy including
physical and occupational therapy. A comparative analysis on all subjects was conducted
before and after the experiment using a cognitive test and activities of daily living
test. [Results] After 5 weeks of therapy, the training group presented statistically
significant improvement in cognitive function assessment items of digit span, visual span,
visual learning, auditory continuous performance, visual continuous performance, and
others compared with the control group but did not present statistically significant
improvement in activities of daily living. [Conclusion] It was revealed through this study
that computerized cognitive rehabilitation with the RehaCom program results in improvement
in cognitive function and can be used as a treatment tool beneficial to stroke patients
presenting cognitive impairment.
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Affiliation(s)
- Chanuk Yoo
- Department of Occupational Therapy, Hanlyo University, Republic of Korea
| | - Mi-Hyun Yong
- Department of Occupational Therapy, College of Health, Kyungwoon University, Republic of Korea
| | - Jaeyeop Chung
- Department of Occupational Therapy, Kyongbuk Science College, Republic of Korea
| | - Yeongae Yang
- Department of Occupational Therapy, College of Biomedical Sciences and Engineering, Inje University, Republic of Korea
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24
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Hunt AW, Le Dorze G, Trentham B, Polatajko HJ, Dawson DR. Elucidating a Goal-Setting Continuum in Brain Injury Rehabilitation. QUALITATIVE HEALTH RESEARCH 2015; 25:1044-1055. [PMID: 26187534 DOI: 10.1177/1049732315588759] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
For individuals with brain injury, active participation in goal setting is associated with better rehabilitation outcomes. However, clinicians report difficulty engaging these clients in goal setting due to perceived or real deficits (e.g., lack of awareness). We conducted a study using grounded theory methods to understand how clinicians from occupational therapy facilitate client engagement and manage challenges inherent in goal setting with this population. Through constant comparative analysis, a goal-setting continuum emerged. At one end of the continuum, therapists embrace client-determined goals and enable clients to decide their own goals. At the other, therapists accept preset organization-determined goals (e.g., "the goal is discharge") and pay little attention to client input. Although all participants aspired to embrace client-determined goal setting, most felt powerless to do so within perceived organizational constraints. Views of advocacy and empowerment help to explain our findings and inform more inclusive practice.
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Affiliation(s)
- Anne W Hunt
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | | | | | | | - Deirdre R Dawson
- University of Toronto, Toronto, Ontario, Canada Baycrest Hospital, Toronto, Ontario, Canada
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25
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Levack WMM, Weatherall M, Hay‐Smith EJC, Dean SG, McPherson K, Siegert RJ. Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation. Cochrane Database Syst Rev 2015; 2015:CD009727. [PMID: 26189709 PMCID: PMC8941379 DOI: 10.1002/14651858.cd009727.pub2] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Goal setting is considered a key component of rehabilitation for adults with acquired disability, yet there is little consensus regarding the best strategies for undertaking goal setting and in which clinical contexts. It has also been unclear what effect, if any, goal setting has on health outcomes after rehabilitation. OBJECTIVES To assess the effects of goal setting and strategies to enhance the pursuit of goals (i.e. how goals and progress towards goals are communicated, used, or shared) on improving health outcomes in adults with acquired disability participating in rehabilitation. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trials registers to December 2013, together with reference checking, citation searching and contact with study authors to identify additional studies. We did not impose any language or date restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs evaluating the effects of goal setting or strategies to enhance goal pursuit in the context of adult rehabilitation for acquired disability. DATA COLLECTION AND ANALYSIS Two authors independently reviewed search results for inclusion. Grey literature searches were conducted and reviewed by a single author. Two authors independently extracted data and assessed risk of bias for included studies. We contacted study authors for additional information. MAIN RESULTS We included 39 studies (27 RCTs, 6 cluster-RCTs, and 6 quasi-RCTs) involving 2846 participants in total. Studies ranged widely regarding clinical context and participants' primary health conditions. The most common health conditions included musculoskeletal disorders, brain injury, chronic pain, mental health conditions, and cardiovascular disease.Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting. These studies provide very low quality evidence that including any type of goal setting in the practice of adult rehabilitation is better than no goal setting for health-related quality of life or self-reported emotional status (8 studies; 446 participants; standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.17 to 0.88, indicative of a moderate effect size) and self-efficacy (3 studies; 108 participants; SMD 1.07, 95% CI 0.64 to 1.49, indicative of a moderate to large effect size). The evidence is inconclusive regarding whether goal setting results in improvements in social participation or activity levels, body structure or function, or levels of patient engagement in the rehabilitation process. Insufficient data are available to determine whether or not goal setting is associated with more or fewer adverse events compared to no goal setting.Fourteen studies compared structured goal setting approaches, with or without strategies to enhance goal pursuit, to 'usual care' that may have involved some goal setting but where no structured approach was followed. These studies provide very low quality evidence that more structured goal setting results in higher patient self-efficacy (2 studies; 134 participants; SMD 0.37, 95% CI 0.02 to 0.71, indicative of a small effect size) and low quality evidence for greater satisfaction with service delivery (5 studies; 309 participants; SMD 0.33, 95% CI 0.10 to 0.56, indicative of a small effect size). The evidence was inconclusive regarding whether more structured goal setting approaches result in higher health-related quality of life or self-reported emotional status, social participation, activity levels, or improvements in body structure or function. Three studies in this group reported on adverse events (death, re-hospitalisation, or worsening symptoms), but insufficient data are available to determine whether structured goal setting is associated with more or fewer adverse events than usual care.A moderate degree of heterogeneity was observed in outcomes across all studies, but an insufficient number of studies was available to permit subgroup analysis to explore the reasons for this heterogeneity. The review also considers studies which investigate the effects of different approaches to enhancing goal pursuit, and studies which investigate different structured goal setting approaches. It also reports on secondary outcomes including goal attainment and healthcare utilisation. AUTHORS' CONCLUSIONS There is some very low quality evidence that goal setting may improve some outcomes for adults receiving rehabilitation for acquired disability. The best of this evidence appears to favour positive effects for psychosocial outcomes (i.e. health-related quality of life, emotional status, and self-efficacy) rather than physical ones. Due to study limitations, there is considerable uncertainty regarding these effects however, and further research is highly likely to change reported estimates of effect.
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Affiliation(s)
- William MM Levack
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - Mark Weatherall
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - E. Jean C Hay‐Smith
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - Sarah G Dean
- University of ExeterUniversity of Exeter Medical SchoolVeysey BuildingSalmon Pool LaneExeterDevonUKEX2 4SG
| | - Kathryn McPherson
- Auckland University of TechnologySchool of Rehabilitation and Occupation StudiesPrivate Bag 92006AucklandNew Zealand1020
| | - Richard J Siegert
- Auckland University of TechnologySchool of Rehabilitation and Occupation StudiesPrivate Bag 92006AucklandNew Zealand1020
- Auckland University of TechnologySchool of Public Health and Psychosocial StudiesAucklandNew Zealand
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Haley KL, Womack J, Helm-Estabrooks N, Lovette B, Goff R. Supporting Autonomy for People with Aphasia: Use of the Life Interests and Values (LIV) Cards. Top Stroke Rehabil 2015; 20:22-35. [DOI: 10.1310/tsr2001-22] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kim K, Kim YM, Kim EK. Correlation between the Activities of Daily Living of Stroke Patients in a Community Setting and Their Quality of Life. J Phys Ther Sci 2014; 26:417-9. [PMID: 24707096 PMCID: PMC3976015 DOI: 10.1589/jpts.26.417] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/10/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The present study aimed to determine the correlation between the activities of
daily living and the quality of life (QOL) of patients with chronic stroke. [Subjects and
Methods] The study subjects were 68 patients with stroke. Three questionnaires were
distributed by visiting the subjects. [Results] All the items and total scores of the
functional independence measure (FIM) showed a high correlation with the QOL total score.
The relationship between the activities of daily living and the total QOL score showed a
significant positive correlation. Among the FIM items, mobility and social cognition
showed the most significant effects. The modified r2 value was 0.67, mobility
and social cognition explained approximately 67% of the change in the QOL. [Conclusion]
The activities of daily living of the patients with chronic stroke and their QOL showed a
high correlation. Among the FIM items, mobility (transfers) and social cognition had the
largest effects on the total QOL score.
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Affiliation(s)
- Kyung Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Young Mi Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Eun Kyung Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
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28
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Lee D, Lee M, Lee K, Song C. Asymmetric training using virtual reality reflection equipment and the enhancement of upper limb function in stroke patients: a randomized controlled trial. J Stroke Cerebrovasc Dis 2014; 23:1319-26. [PMID: 24468068 DOI: 10.1016/j.jstrokecerebrovasdis.2013.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/03/2013] [Accepted: 11/07/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Asymmetric movements with both hands contributed to the improvement of spatially coupled motion. Thus, the aim of this study was to investigate the effects of an asymmetric training program using virtual reality reflection equipment on upper limb function in stroke patients. METHODS Twenty-four stroke patients were randomly allocated to an experimental group (n=12) or a control group (n=12). Both groups participated in conventional physical therapy for 2×30 min/d, 5 d/wk, for 4 weeks. The experimental group also participated in an asymmetric training program using virtual reality reflection equipment, and the control group participated in a symmetric training program. Both asymmetric and symmetric programs were conducted for 30 min/d, 5 d/wk, for 4 weeks. To compare upper limb function before and after intervention, the Fugl-Meyer Assessment (FMA), the Box and Block Test (BBT), grip strength, range of motion (ROM), and spasticity were assessed. RESULTS Both groups showed significant increases in upper limb function, excepting spasticity, after intervention (P<.05, 1-way repeated-measures analysis of variance [ANOVA]). A significant group-time interaction was demonstrated only for shoulder/elbow/wrist items of FMA, BBT, grip strength, and ROM of wrist flexion, extension, and ulnar deviation (P<.05, 2-way repeated-measures ANOVA). CONCLUSIONS This study confirms that the asymmetric training program using virtual reality reflection equipment is an effective intervention method for improving upper limb function in stroke patients. We consider that an additional study based on a program using virtual reflection, which is more functional than performing simple tasks, and consisting of tasks relevant to the activities of daily living be conducted.
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Affiliation(s)
- DongJin Lee
- Department of Physical therapy, Graduate School of Sahmyook University, Seoul, Republic of Korea
| | - MyungMo Lee
- Department of Physical therapy, Graduate School of Sahmyook University, Seoul, Republic of Korea
| | - KyoungJin Lee
- Department of Physical therapy, Graduate School of Sahmyook University, Seoul, Republic of Korea
| | - ChangHo Song
- Department of Physical therapy, Graduate School of Sahmyook University, Seoul, Republic of Korea.
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29
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Dawson DR, Anderson ND, Binns MA, Bottari C, Damianakis T, Hunt A, Polatajko HJ, Zwarenstein M. Managing executive dysfunction following acquired brain injury and stroke using an ecologically valid rehabilitation approach: a study protocol for a randomized, controlled trial. Trials 2013; 14:306. [PMID: 24053695 PMCID: PMC3849520 DOI: 10.1186/1745-6215-14-306] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 09/02/2013] [Indexed: 11/12/2022] Open
Abstract
Background We have been investigating an ecologically valid strategy-training approach to enable adults with executive dysfunction to attain everyday life goals. Here, we report the protocol of a randomized controlled trial of the effects of this training compared to conventional therapy in a sample of community-dwelling adults with acquired brain injury and/or stroke. Methods/design We will recruit 100 community-dwelling survivors at least six months post-acquired brain injury or stroke who report executive dysfunction during a telephone interview, confirmed in pre-training testing. Following pre-training testing, participants will be randomized to the ecologically valid strategy training or conventional therapy and receive two one-hour sessions for eight weeks (maximum of 15 hours of therapy). Post-testing will occur immediately following the training and three months later. The primary outcome is self-reported change in performance on everyday life activities measured using the Canadian Occupational Performance Measure, a standardized, semi-structured interview. Secondary outcomes are objective measurement of performance change from videotapes of treatment session, Performance Quality Rating Scale; executive dysfunction symptoms, Behavioural Rating Inventory of Executive Function – Adult; participation in everyday life, Mayo-Portland Adaptability Inventory Participation Index; and ability to solve novel problems, Instrumental Activities of Daily Living Profile. Discussion This study is of a novel approach to promoting improvements in attainment of everyday life goals through managing executive dysfunction using an ecologically valid strategy training approach, the Cognitive Orientation to daily Occupational Performance. This study compares the efficacy of this approach with that of conventional therapy. The approach has the potential to be a valuable treatment for people with chronic acquired brain injury and/or stroke. Trial registration clinicaltrials.gov, Trial Identification Number:
NCT01414348
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Affiliation(s)
- Deirdre R Dawson
- Rotman Research Institute, Baycrest, 3560 Bathurst Street, Toronto, ON M6A 2E1, Canada.
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Lexell EM, Flansbjer UB, Lexell J. Self-perceived performance and satisfaction with performance of daily activities in persons with multiple sclerosis following interdisciplinary rehabilitation. Disabil Rehabil 2013; 36:373-8. [PMID: 23735012 DOI: 10.3109/09638288.2013.797506] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess self-perceived performance and satisfaction with performance of daily activities in persons with multiple sclerosis (MS) on admission to and at discharge from interdisciplinary rehabilitation. METHOD A retrospective study with a pre-post design. Twenty-seven women and 16 men with MS (mean age 51 years; median EDSS 6.5) participated in an individualised, goal-oriented, interdisciplinary, rehabilitation programme (average length 4 weeks). The Canadian Occupational Performance Measure (COPM) was used on admission to rehabilitation and at discharge. RESULTS On admission, the persons prioritised 216 activities that they perceived difficult to perform (mean number 3, range 2-8). Of these, 136 (63%) were in the COPM area of self-care, 52 (24%) in productivity and 28 (13%) in leisure. The lowest mean ratings of performance were found in the subgroups active recreation, community management and socialisation, and for satisfaction in the subgroup socialisation. For about 60% of the 216 prioritised activities, ratings of COPM performance as well as satisfaction were higher at discharge than on admission. For 18 (42%) and 24 (56%) persons, respectively, the mean change scores of performance and of satisfaction were equal to or greater than 2.0 at discharge, indicating a clinically significant change. CONCLUSIONS Persons with MS can experience problems with all types of daily activities upon admission to rehabilitation, but also perceive improvements in their performance and satisfaction with performance in these activities at discharge from rehabilitation. Using patient-reported outcome measures, such as the COPM, may contribute to a broader understanding of the benefits of interdisciplinary rehabilitation in persons with MS. Implications for Rehabilitation Persons with MS can perceive problems with all types of daily activities which have to be considered during interdisciplinary rehabilitation. Following interdisciplinary rehabilitation, persons with MS can perceive improvements in their performance and satisfaction with performance in all types of daily activities. Patient-reported outcome measures can contribute to a broader understanding of the benefits of interdisciplinary rehabilitation in persons with MS.
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Clare L, Bayer A, Burns A, Corbett A, Jones R, Knapp M, Kopelman M, Kudlicka A, Leroi I, Oyebode J, Pool J, Woods B, Whitaker R. Goal-oriented cognitive rehabilitation in early-stage dementia: study protocol for a multi-centre single-blind randomised controlled trial (GREAT). Trials 2013; 14:152. [PMID: 23710796 PMCID: PMC3680175 DOI: 10.1186/1745-6215-14-152] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 05/16/2013] [Indexed: 12/12/2022] Open
Abstract
Background Preliminary evidence suggests that goal-oriented cognitive rehabilitation (CR) may be a clinically effective intervention for people with early-stage Alzheimer’s disease, vascular or mixed dementia and their carers. This study aims to establish whether CR is a clinically effective and cost-effective intervention for people with early-stage dementia and their carers. Methods/design In this multi-centre, single-blind randomised controlled trial, 480 people with early-stage dementia, each with a carer, will be randomised to receive either treatment as usual or cognitive rehabilitation (10 therapy sessions over 3 months, followed by 4 maintenance sessions over 6 months). We will compare the effectiveness of cognitive rehabilitation with that of treatment as usual with regard to improving self-reported and carer-rated goal performance in areas identified as causing concern by people with early-stage dementia; improving quality of life, self-efficacy, mood and cognition of people with early-stage dementia; and reducing stress levels and ameliorating quality of life for carers of participants with early-stage dementia. The incremental cost-effectiveness of goal-oriented cognitive rehabilitation compared to treatment as usual will also be examined. Discussion If the study confirms the benefits and cost-effectiveness of cognitive rehabilitation, it will be important to examine how the goal-oriented cognitive rehabilitation approach can most effectively be integrated into routine health-care provision. Our aim is to provide training and develop materials to support the implementation of this approach following trial completion. Trial registration Current Controlled Trials ISRCTN21027481
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Affiliation(s)
- Linda Clare
- School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK.
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Ng EMW, Polatajko HJ, Marziali E, Hunt A, Dawson DR. Telerehabilitation for addressing executive dysfunction after traumatic brain injury. Brain Inj 2013; 27:548-64. [PMID: 23472964 DOI: 10.3109/02699052.2013.766927] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To investigate the feasibility of implementing the Cognitive Orientation to daily Occupational Performance approach (CO-OP) in a telerehabilitation format and to examine its impact on community integration and executive dysfunction for adults with traumatic brain injury (TBI). RESEARCH DESIGN A pilot series of three case studies with 3-month follow-up was conducted. METHODS AND PROCEDURES Three adults (all males, >10 years post-TBI) and their significant others were recruited. The CO-OP intervention, a meta-cognitive approach, was delivered through videoconferencing via Internet to train three of five participant-identified goals. Two goals were not trained to allow examination of transfer. Outcome measures included the Canadian Occupational Performance Measure, the Mayo-Portland Adaptability Inventory-4 Participation Index, and the Dysexecutive Questionnaire. Descriptive statistical analysis was used. MAIN OUTCOMES AND RESULTS The CO-OP approach administered in a telerehabilitation format was found to be feasible. All participants indicated self-reported improvement in both trained and untrained goals. Trends toward fewer symptoms of executive dysfunction and greater community integration were demonstrated. All participants expressed satisfaction with the Internet delivery method. CONCLUSIONS Telerehabilitation shows promise as a way to deliver the CO-OP approach and may help promote community integration of individuals living with TBI. Further study is warranted.
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Affiliation(s)
- Edith M W Ng
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
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Lexell EM, Alkhed AK, Olsson K. The group rehabilitation helped me adjust to a new life: Experiences shared by persons with an acquired brain injury. Brain Inj 2013; 27:529-37. [DOI: 10.3109/02699052.2013.765598] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Levack WMM, Siegert RJ, Dean SG, McPherson K, Hay-Smith EJC, Weatherall MM. Goal setting and activities to enhance goal pursuit for adults with acquired disabilities participating in rehabilitation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Helm-Estabrooks N, Whiteside J. Use of Life Interests and Values (LIV) Cards for Self-Determination of Aphasia Rehabilitation Goals. ACTA ACUST UNITED AC 2012. [DOI: 10.1044/nnsld22.1.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The concepts of self-determination and autonomy are now recognized as powerful factors in the ways people respond to rehabilitation. In this paper, we define these concepts and demonstrate that when self-determination and autonomy are incorporated into treatment delivery approaches, patient compliance, outcomes, and satisfaction improve. Determining the rehabilitation goals of people with aphasia (PWA) is typically challenging, because their communication problems often interfere with valid responding to interviews and questionnaires. The Life Interest and Values (LIV) cards described in this paper were developed as a way to circumvent the linguistic problems of PWA and allow them to choose goals for rehabilitation. We also describe the use of the LIV cards in an intensive aphasia rehabilitation program, how the activities chosen by participants were established as reimbursable goals with measureable outcomes, and case studies illustrating this process.
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Affiliation(s)
- Nancy Helm-Estabrooks
- Western Carolina University Cullowee, NC
- University of North Carolina Chapel Hill, NC
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Radomski M, Finkelstein M, Hagel S, Masemer S, Theis J, Thompson M. A Pilot Wellness and Weight Management Program for Individuals with Spinal Cord Injury: Participants’ Goals and Outcomes. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1702-59] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Doig E, Fleming J, Kuipers P, Cornwell P, Khan A. Goal-directed outpatient rehabilitation following TBI: A pilot study of programme effectiveness and comparison of outcomes in home and day hospital settings. Brain Inj 2011; 25:1114-25. [DOI: 10.3109/02699052.2011.607788] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Doig E, Fleming J, Kuipers P, Cornwell PL. Clinical Utility of the Combined Use of the Canadian Occupational Performance Measure and Goal Attainment Scaling. Am J Occup Ther 2010; 64:904-14. [DOI: 10.5014/ajot.2010.08156] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kelly F, Nikopoulos CK. Facilitating independence in personal activities of daily living after a severe traumatic brain injury. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2010. [DOI: 10.12968/ijtr.2010.17.9.78037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims This study examined the effectiveness of two components of a treatment programme typically used by occupational therapists (OTs) in personal activities of daily living (PADL) rehabilitation. Methods A multiple baseline probe design across PADL tasks was used, one which is particularly suited to the examination of the effects of complex interventions on skill performance. The subjects were two male adults with severe brain injuries and cognitive impairments who were in the acute stages of recovery. The OT treatment program consisted of a combination of errorless learning and strategy training approaches. The impact of the program was measured by the number of steps completed independently in each of these tasks, the level and type of assistance required, and by administering the UK Functional Independence Measure and the Assessment of Motor and Process Skills. Findings Errorless learning and strategy training, as used within an OT programme, was demonstrated to be effective in reducing the amount of assistance both participants required to complete the targeted PADL tasks. Further, there was evidence of generalization of training effects among trained and untrained activities. Conclusions Selecting and combining treatment techniques based on detailed assessment of functional performance is an area of high clinical importance but with limited research; the current study stands as an attempt towards that direction.
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Affiliation(s)
- Fiona Kelly
- Neurosciences Clinical Lead Rehabilitation, Royal Free Hospital, Pond Street, London; and
| | - Christos K Nikopoulos
- Occupational Therapy, School of Health Sciences and Social Care, Mary Seacole Building, Brunel University, Uxbridge, UK
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Boman IL, Lindberg Stenvall C, Hemmingsson H, Bartfai A. A training apartment with a set of electronic memory aids for patients with cognitive problems. Scand J Occup Ther 2010; 17:140-8. [DOI: 10.3109/11038120902875144] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Richard LF, Knis-Matthews L. Are We Really Client-Centered? Using the Canadian Occupational Performance Measure to See How the Client's Goals Connect With the Goals of the Occupational Therapist. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/01642120903515292] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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McDougall J, Wright V. The ICF-CY and Goal Attainment Scaling: Benefits of their combined use for pediatric practice. Disabil Rehabil 2009; 31:1362-72. [DOI: 10.1080/09638280802572973] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jenkinson N, Ownsworth T, Shum D. Utility of the Canadian Occupational Performance Measure in community-based brain injury rehabilitation. Brain Inj 2009; 21:1283-94. [DOI: 10.1080/02699050701739531] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kosar S, Seelen HA, Hemmen B, Evers SM, Brink PR. Cost-effectiveness of an integrated 'fast track' rehabilitation service for multi-trauma patients involving dedicated early rehabilitation intervention programs: design of a prospective, multi-centre, non-randomised clinical trial. J Trauma Manag Outcomes 2009; 3:1. [PMID: 19183451 PMCID: PMC2646689 DOI: 10.1186/1752-2897-3-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 01/30/2009] [Indexed: 11/10/2022]
Abstract
Background In conventional multi-trauma care service (CTCS), patients are admitted to hospital via the accident & emergency room. After surgery they are transferred to the IC-unit followed by the general surgery ward. Ensuing treatment takes place in a hospital's outpatient clinic, a rehabilitation centre, a nursing home or the community. Typically, each of the CTCS partners may have its own more or less autonomous treatment perspective. Clinical evidence, however, suggests that an integrated multi-trauma rehabilitation approach ('Supported Fast-track multi-Trauma Rehabilitation Service': SFTRS), featuring: 1) earlier transfer to a specialised trauma rehabilitation unit; 2) earlier start of 'non-weight-bearing' training and multidisciplinary treatment; 3) well-documented treatment protocols; 4) early individual goal-setting; 5) co-ordination of treatment between trauma surgeon and physiatrist, and 6) shorter lengths-of-stay, may be more (cost-)effective. This paper describes the design of a prospective cohort study evaluating the (cost-) effectiveness of SFTRS relative to CTCS. Methods/design The study population includes multi-trauma patients, admitted to one of the participating hospitals, with an Injury Severity Scale score > = 16, complex multiple injuries in several extremities or complex pelvic and/or acetabulum fractures. In a prospective cohort study CTCS and SFTRS will be contrasted. The inclusion period is 19 months. The duration of follow-up is 12 months, with measurements taken at baseline, and at 3,6,9 and 12 months post-injury. Primary outcome measures are 'quality of life' (SF-36) and 'functional health status' (Functional Independence Measure). Secondary outcome measures are the Hospital Anxiety & Depression Scale, the Mini-Mental State Examination as an indicator of cognitive functioning, and the Canadian Occupational Performance Measure measuring the extent to which individual ADL treatment goals are met. Costs will be assessed using the PROductivity and DISease Questionnaire and a cost questionnaire. Discussion The study will yield results on the efficiency of an adapted care service for multi-trauma patients (SFTRS) featuring earlier (and condensed) involvement of specialised rehabilitation treatment. Results will show whether improved SFTRS logistics, combined with shorter stays in hospital and rehabilitation clinic and specialised early rehabilitation training modules are more (cost-) effective, relative to CTCS. Trial registration Current Controlled Trials register (ISRCTN68246661) and Netherlands Trial Register (NTR139).
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Affiliation(s)
- Sevginur Kosar
- Rehabilitation Foundation Limburg, Hoensbroek, The Netherlands.
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Kang DH, Yoo EY, Chung BI, Jung MY, Chang KY, Jeon HS. The application of client-centred occupational therapy for Korean children with developmental disabilities. Occup Ther Int 2008; 15:253-68. [DOI: 10.1002/oti.258] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Evans L, Brewis C. The efficacy of community-based rehabilitation programmes for adults with TBI. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2008. [DOI: 10.12968/ijtr.2008.15.10.31213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lizzie Evans
- Neuropsychiatry, Whitchurch Hospital. Cardiff and Vale NHS Trust
| | - Claire Brewis
- Occupational Therapy at the University of Teesside, Middlesbrough, UK
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The use of self-generation procedures facilitates verbal memory in individuals with seizure disorders. Epilepsy Behav 2008; 13:162-8. [PMID: 18343201 DOI: 10.1016/j.yebeh.2008.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 01/22/2008] [Accepted: 01/26/2008] [Indexed: 11/20/2022]
Abstract
The efficacy of a self-generation encoding procedure in facilitating the encoding and retrieval of verbal memories was compared with the didactic presentation of information in individuals with seizure disorders. Through a within-subject design, 87 patients (25 left temporal seizure onset, 29 right temporal, 8 frontal, and 25 psychogenic nonepileptic seizures) received a self-generation learning condition and a didactic learning condition and were subsequently tested for verbal paired associate free recall, cued recall, and recognition memory. All patient groups benefited from the use of the self-generation condition relative to the didactic condition. Better performance occurred with the self-generation procedure for cued recall and recognition memory test performance, but not free recall. Individuals with a left temporal seizure onset (patients with the poorest memory performance on the didactic condition) benefited the most from the self-generation condition. A memory encoding strategy that actively involves patient participation enhances memory performance.
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Turner BJ, Ownsworth TL, Turpin M, Fleming JM, Griffin J. Self-identified goals and the ability to set realistic goals following acquired brain injury: A classification framework. Aust Occup Ther J 2008; 55:96-107. [DOI: 10.1111/j.1440-1630.2007.00660.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Roberts AEK, James A, Drew J, Moreton S, Thompson R, Dickson M. Measuring occupational performance and client priorities in the community: The COPM. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2008. [DOI: 10.12968/ijtr.2008.15.1.27946] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- AEK Roberts
- Advanced Occupational Therapy, University of Plymouth
| | - A James
- Occupational Therapy, Devon PCT
| | | | | | | | - M Dickson
- Specialist Services Unit, Raigmore Hospital, Highland Acute NHS Trust, Scotland
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Holliday RC, Cano S, Freeman JA, Playford ED. Should patients participate in clinical decision making? An optimised balance block design controlled study of goal setting in a rehabilitation unit. J Neurol Neurosurg Psychiatry 2007; 78:576-80. [PMID: 17178823 PMCID: PMC2077947 DOI: 10.1136/jnnp.2006.102509] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The recent National Service Framework for Long Term Conditions recommends that patients participate more in decision making about their care. However, few protocols exist to support this. One potentially useful method is goal setting, but little has been done to evaluate the added value of increasing patient participation in this way. Therefore, this study examined the impact of an increased participation goal setting protocol in a neurorehabilitation setting. DESIGN The study was an AB optimised balance block design with each block lasting 3 months, over an 18 month period. SETTING AND PARTICIPANTS Patients (n = 201) were recruited from an inpatient neurological rehabilitation unit. INTERVENTIONS Patients (n = 100) recruited in phase A were involved in "usual practice" goal setting. Patients (n = 101) recruited in phase B were involved in "increased participation" goal setting, which included a protocol to help them define and prioritise their own goals. MAIN OUTCOME MEASURES Patients' perceptions of the relevance of goal setting and their autonomy within the process; the number, type and outcome of goals; and level of functional ability. RESULTS Phase B patients ("increased participation") set fewer goals, of which significantly more were participation related. These patients perceived the goals to be more relevant, and expressed greater autonomy and satisfaction with goal setting. There were no differences in functional outcomes between the groups. CONCLUSION This study has shown that patients prefer increased participation in the goal setting process over standard procedures, perceiving their goals as more relevant and rehabilitation more patient centred despite the absence of functional gains. Effective patient centred care can be realised by using structures that help support patients to identify and communicate their priorities. As such, our findings suggest patients would benefit from greater participation in this aspect of clinical decision making.
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