American Journal of Occupational Therapy最新文献

Importance: Occupational therapy practitioners use yoga in practice to achieve holistic care, and the American Occupational Therapy Association has provided guidance on the use of yoga in occupational therapy. For people with acquired brain injury (ABI), however, it is unknown whether yoga affects occupational performance.

Objective: To explore the perceived impact of an adapted yoga intervention on occupational performance using the Occupational Therapy Practice Framework: Domain and Process (4th ed.; OTPF-4) for participants with ABI.

Design: Qualitative descriptive study using virtual, semistructured interviews. An inductive, holistic, open-coding process, followed by a deductive process to map open codes to the OTPF-4.

Participants: Nine individuals with ABI were recruited from a yoga intervention study.

Results: The theme generated from the data-"Yoga participants with ABI realized that they could still do quite a bit"-was supported by two major categories from the OTPF-4: Occupations and Performance Skills. Participants described improvements in their functional performance (i.e., motor skills, process skills) and how these factors were synergistically connected to their occupational performance (i.e., self-care, leisure).

Conclusions and relevance: This study provides novel insight into how functional performance improved so participants could "still do things," such as engaging in occupations. When participants described improved performance skills, they simultaneously described re-engagement with their meaningful occupations. Participants also perceived an improvement in their mind-body connection, which should be further explored in future studies. This study generated original findings about participants' perceptions of an adapted yoga intervention as they relate to the OTPF-4. Plain-Language Summary: This study reports individuals' perceptions of their re-engagement with occupations and changes in occupational performance skills after participating in an adaptive yoga intervention. We highlight the distinct contribution that adaptive yoga-an intervention modality that can be used by occupational therapy practitioners-may have, using the OTPF-4 to connect the participants' perceptions about their improvements in occupational performance.

Importance: Interventions for improving upper extremity (UE) recovery have become a priority in stroke rehabilitation because UE disability can undermine a person's capacity to perform daily activities after stroke. A better understanding of the use of activity-based task-oriented training (TOT) will inform the development of more effective UE interventions in stroke rehabilitation.

Objective: To examine the effectiveness of activity-based TOT in improving the UE recovery of adults with stroke.

Data sources: CINAHL Plus, MEDLINE, and PubMed.

Study selection and data collection: Inclusion criteria included quantitative studies published between June 2012 and December 2022 that reported UE recovery as an outcome, including measurements of motor function, motor performance, and performance of activities of daily living (ADLs); a sample age ≥18 yr, with stroke in all phases; and interventions that incorporated real-world daily activities. We assessed articles for inclusion, quality, and risk of bias following Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Findings: Sixteen studies (692 participants, Level 1-4 evidence) were included. Strong to moderate evidence supported the effectiveness of activity-based TOT in UE motor function, motor performance, and ADL performance for adults with stroke. Strong evidence supported the effectiveness of hospital-based TOT, and moderate evidence supported the effectiveness of home-based TOT.

Conclusions and relevance: The results not only showed the value of activity-based TOT as an effective UE intervention in stroke rehabilitation but also supported the occupational therapy philosophy of using functional and meaningful activities in practice. Further research on home-based TOT is needed. Plain-Language Summary: This systematic review shows the effectiveness and value of using real-life activities in task-oriented training approaches for adult survivors of stroke. The authors found strong evidence for hospital-based task-oriented training interventions and moderate evidence for home-based interventions for improving upper extremity recovery. This review shows the value of upper extremity task-oriented training as an effective intervention in stroke rehabilitation. The review also supports the occupational therapy philosophy of using functional and meaningful activities in practice as well as the profession's use of evidence-based practice in stroke rehabilitation.

Importance: Research on the functional and motor performance impact of virtual reality (VR) as an intervention tool for children with cerebral palsy (CP) is limited.

Objective: To understand whether VR is an effective intervention to improve upper extremity (UE) function and motor performance of children diagnosed with CP.

Data sources: Databases used in the search were EBSCOhost, One Search, PubMed, Cloud Source, CINAHL, SPORTDiscus, and Google Scholar.

Study selection and data collection: Studies published from 2006 to 2021 were included if children had a diagnosis of CP and were age 21 yr or younger, VR was used as an intervention, and measures of UE function and motor performance were used.

Findings: Twenty-one studies were included, and the results provided promising evidence for improvements in areas of UE function, motor performance, and fine motor skills when VR is used as an intervention. To yield noticeable UE improvements in children with CP, VR should be implemented for 30 to 60 min/session and for at least 360 min over more than 3 wk. Additional areas of improvement include gross motor skills, functional mobility, occupational performance, and intrinsic factors.

Conclusions and relevance: The use of VR as an intervention for children with CP to improve UE function and motor performance is supported. More randomized controlled trials with larger sample sizes focusing on similar outcomes and intervention frequencies are needed to determine the most effective type of VR for use in clinical occupational therapy. Plain-Language Summary: This systematic review explains how virtual reality (VR) has been used as an intervention with children with cerebral palsy (CP). The review synthesizes the results of 21 research studies of children who had a diagnosis of CP and who were 21 years old or younger. The findings support using VR to improve upper extremity performance, motor performance, and fine motor skills. The findings also show that occupational therapy practitioners should use a VR intervention at a minimum frequency of 30 to 60 minutes per session and for at least 360 minutes over more than 3 weeks to yield noticeable improvements in upper extremity, motor performance, and fine motor skills for children with CP.

The articles in this Special Issue on Recovery of Function After Neurological Injury include an impressive range of clinical diagnoses, scientific approaches, and theoretical frameworks that demonstrate the breadth and depth of occupational therapy in the restoration of function after neurological injury. An emerging theme throughout is the need for the profession of occupational therapy to identify and use more efficient methods for diagnosing and treating people with neurological injuries to improve their quality of life and the impact of care.

Importance: Impaired self-awareness (SA) of deficits after an acquired brain injury (ABI) severely affects patients' independence in activities of daily living (ADLs). However, any assessment tool permits an exhaustive evaluation of SA in the context of ADLs.

Objective: To study the validity of the Breakfast and Dressing Conflict Task (BD Conflict Task) to assess online SA (awareness of performance in the context of a given task) in patients with ABI; to study its interactions with offline SA (general awareness); and to test the validity of a simplified measure of performance monitoring, the ADL Conflict-Monitoring Index.

Design: Convergent validity and correlational study.

Setting: Research laboratory, hospitals, and homes.

Participants: Thirty patients with ABI and 28 neurologically healthy controls.

Outcomes and measures: Using the BD Conflict Task, measures of emergent awareness, self-regulation, anticipatory awareness, and self-evaluation were assessed and their convergent validity and relationship with offline SA were analyzed. The ADL Conflict-Monitoring Index was calculated, and its convergent validity was tested.

Results: The online SA variables of the BD Conflict Task showed convergent validity with traditional online SA measures. Offline SA correlated with emergent and anticipatory awareness in the Breakfast Task. The ADL Conflict-Monitoring Index proved to be a valid measure of patients' performance monitoring.

Conclusions and relevance: These preliminary findings suggest that the BD Conflict Task is a valid tool to assess online SA in patients with ABI and provide further understanding of the online SA-offline SA interaction. Furthermore, the ADL Conflict-Monitoring Index may be a valid and easy-to-use monitoring measure in clinical settings. Plain-Language Summary: Patients with acquired brain injury (ABI) and reduced awareness of their cognitive deficits face problems performing activities of daily living (ADLs) and may show signs of unsafe behaviors. Being aware of one's own abilities involves anticipating problems before starting a task, detecting and correcting errors during the task, and evaluating performance afterward. This study provides preliminary validity for the Breakfast and Dressing Conflict Task, a new tool that assesses aspects of self-awareness simultaneously in the context of familiar and significant ADLs. Furthermore, the tool simplifies the assessment of detecting and correcting errors with an easy-to-use index, making it suitable for use in clinical settings.

Importance: Spinal cord stimulation (SCS) is a neuromodulation technique that can improve paresis in individuals with spinal cord injury. SCS is emerging as a technique that can address upper and lower limb hemiparesis. Little is understood about its effectiveness with the poststroke population.

Objective: To summarize the evidence for SCS after stroke and any changes in upper extremity and lower extremity motor function.

Data sources: PubMed, Web of Science, Embase, and CINAHL. The reviewers used hand searches and reference searches of retrieved articles. There were no limitations regarding publication year.

Study selection and data collection: This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The inclusion and exclusion criteria included a broad range of study characteristics. Studies were excluded if the intervention did not meet the definition of SCS intervention, used only animals or healthy participants, did not address upper or lower limb motor function, or examined neurological conditions other than stroke.

Findings: Fourteen articles met the criteria for this review. Seven studies found a significant improvement in motor function in groups receiving SCS.

Conclusions and relevance: Results indicate that SCS may provide an alternative means to improve motor function in the poststroke population. Plain-Language Summary: The results of this study show that spinal cord stimulation may provide an alternative way to improve motor function after stroke. Previous neuromodulation methods have targeted the impaired supraspinal circuitry after stroke. Although downregulated, spinal cord circuitry is largely intact and offers new possibilities for motor recovery.

Importance: Persons living with and beyond cancer (PLWBC) are rarely referred to occupational therapy services despite their functional difficulties. An understanding of the barriers to and facilitators of occupational therapy referrals from the perspective of cancer health care professionals could help minimize referral gaps.

Objective: To explore cancer health care professionals' perspectives on and knowledge of occupational therapy's role in cancer care, identify the barriers, and explore solutions to optimize referrals.

Design: Multiexplanatory qualitative case study.

Setting: Community and hospital cancer clinics in Israel.

Participants: Six in-person focus groups of cancer care Israeli nurses and social workers, totaling 28 participants.

Results: Two main themes were identified: (1) barriers to occupational therapy referrals and (2) partial facilitators of occupational therapy referrals. The four barriers subthemes were (1) gaps in knowledge about symptoms' effects on daily functioning, (2) gaps in knowledge regarding occupational therapy's role in cancer care, (3) bureaucratic and organizational barriers, and (4) unavailability of occupational therapy services. The two facilitators subthemes were (1) collaborations and communication with occupational therapists and (2) awareness of occupational therapy services. Participants suggested practical solutions for improving occupational therapy referrals, interdisciplinary collaboration and communication, and integrating occupational therapy into cancer care.

Conclusions and relevance: Barriers to referrals included gaps in participants' knowledge that link side effects to functional difficulties indicating a need for referral to occupational therapy. Participants' suggestions to bolster referrals can be implemented by occupational therapists to reduce patients' unmet needs and bridge existing gaps in cancer care. Plain-Language Summary: This research helped to identify barriers and facilitators regarding insufficient knowledge about occupational therapy's role in cancer care and adds a better understanding of gaps in referrals to occupational therapy. In addition, cancer health care professionals who participated in the study suggested practical solutions for reducing barriers and maximizing support for referral. With these nuances, occupational therapy practitioners can work with medical cancer care units (i.e., acute care hospitals, medical cancer centers, and community health care clinics) to target the use of strategies that work for their units to ensure that persons living with and beyond cancer receive needed occupational therapy services.

Importance: Driving and community mobility (DCM) is key to supporting independence in teens and young adults (TYA) with autism spectrum disorder (ASD).

Objective: To determine whether an intervention focused on DCM can effectively improve DCM knowledge and skills in TYA.

Design: A pretest-posttest design using the same intervention and outcome measures.

Setting: University research setting.

Participants: Thirty-eight participants with ASD completed the program (M age = 17.76 yr, SD = 3.58). Twenty-six (68%) were male, and 12 (32%) were female.

Intervention: A 5-day intensive intervention using group and individualized strategies, including driving simulation, focused on improving performance skills needed for DCM.

Outcome and measures: Total and category scores of the Performance Analysis of Driving Ability (P-Drive) were analyzed using a repeated-measures analysis of variance measuring time (pretest vs. posttest), gender, and year of intervention. Paired t tests were used to determine the outcomes of the Canadian Occupational Performance Measure (COPM), anxiety measure and perception survey.

Results: Results indicated a significant main effect for time (p < .001) and year (p < .036), but not gender (p < .26), with no significant interaction effects, supporting the fidelity of the intervention. The COPM showed significant changes (p ≤ .001) in both performance and satisfaction, as well as a reduction in anxiety (p = .008).

Conclusions and relevance: Outcomes suggest that the intervention successfully improved DCM knowledge and skills for TYA. This adds new evidence that an occupational therapy intervention specific to TYA with ASD is effective in developing independence in DCM. Plain-Language Summary: Driving is the primary mode of community mobility in North America and other Western countries. Adults with autism spectrum disorder (ASD) who have a means of community mobility have a chance of employment that is 5 times greater than that for those who do not. Driving and community mobility are key to supporting independence among teens and young adults with ASD. However, teens and young adults with ASD have significantly lower rates of getting a driver's license. The results of this study show that occupational therapy practitioners can play a critical role in addressing driving and community mobility. Occupational therapy interventions that are specifically designed for and unique to each teen and young adult with ASD can effectively improve driving and community mobility skills and increase independence.

Importance: Youths with autism spectrum disorder (ASD) have challenges with executive function (EF). However, there are few measures to objectively assess EF, such as time management and prioritization. The Weekly Calendar Planning Activity (WCPA) is a promising performance-based EF measure that has rarely been used with youths with ASD.

Objective: To characterize the performance of youths with ASD on the WCPA and the association of WCPA performance with caregiver-rated EF.

Design: Observational and summary data obtained during a baseline evaluation for a research study.

Setting: Middle school.

Participants: Thirty-nine adolescents with ASD and without an intellectual disability.

Method: Youth were administered the WCPA; caregivers completed EF ratings. Descriptive statistics characterized WCPA performance. Correlations between WCPA scores and age, IQ, and EF ratings were computed.

Results: The majority of youth performed poorly on the WCPA and lacked insight into their poor performance. Many struggled to enter appointments. Appointment accuracy was <30%. The most common errors were location errors. Appointment accuracy and planning time were moderately associated with IQ but not with caregiver-rated EF or age.

Conclusions and relevance: Overall, the WCPA was cognitively demanding for youths with ASD without an intellectual disability. These results have implications for using evidence-based strategies to teach adolescents with ASD how to manage their time and plan and prioritize homework assignments, upcoming tests or quizzes, and extracurricular activities. Plain-Language Summary: Youths with autism spectrum disorder have significant problems with executive function, particularly organization, prioritization, time management, and planning. There are few objective, performance-based measures of executive function, especially those that can be used with autistic youths. To our knowledge, this study is the first to use the Weekly Calendar Planning Activity (WCPA) with autistic adolescents who do not have an intellectual disability. The WCPA captured their deficits related to executive function and could be a useful tool for assessment and treatment planning.