Comparison of performance in materials-based occupation, imagery-based occupation, and rote exercise in nursing home residents

Haptic-Enabled Hand Rehabilitation in Stroke Patients: A Scoping Review

There is a plethora of technology-assisted interventions for hand therapy, however, less is known about the effectiveness of these interventions. This scoping review aims to explore studies about technology-assisted interventions targeting hand rehabilitation to identify the most effective interventions. It is expected that multifaceted interventions targeting hand rehabilitation are more efficient therapeutic approaches than mono-interventions. The scoping review will aim to map the existing haptic-enabled interventions for upper limb rehabilitation and investigates their effects on motor and functional recovery in patients with stroke. The methodology used in this review is based on the Arksey and O’Malley framework, which includes the following stages: identifying the research question, identifying relevant studies, study selection, charting the data, and collating, summarizing, and reporting the results. Results show that using three or four different technologies was more positive than using two technologies (one technology + haptics). In particular, when standardized as a percentage of outcomes, the combination of three technologies showed better results than the combination of haptics with one technology or with three other technologies. To conclude, this study portrayed haptic-enabled rehabilitation approaches that could help therapists decide which technology-enabled hand therapy approach is best suited to their needs. Those seeking to undertake research and development anticipate further opportunities to develop haptic-enabled hand telerehabilitation platforms.

Including the Consumer and Environment in Occupational Therapy Treatment Planning

This study was designed to examine the extent to which occupational therapists include the consumer and the environment in treatment planning. Twenty-nine registered occupational therapists who subscribe to the Mental Health Specialty Interest Section or the Physical Disabilities Specialty Interest Section completed treatment plans based on a single case study. The treatment plans were analyzed based on goal setting and treatment activities. Data indicated therapists frequently identified goals not addressed by the consumer and demonstrated limited consideration of the context in the selection of treatment activities. Therapists identified as many short-term goals not related to the consumer's stated goal as they identified goals that were related to the consumer's goal. T-test comparisons indicated that therapists significantly more often selected simulated over real activities and activities aimed at changing the person over activities aimed at changing the environment. These preliminary results from a small, self-selected sample suggest that current occupational therapy treatment planning is not consistent with consumer-oriented practice models.

Comparing Materials-Based Occupation, Imagery-Based Occupation, and Rote Movement through Kinematic Analysis of Reach

This replication research of Wu, Trombly, and Lin (1994) compared the kinematics of reach in materials-based occupationally embedded movement (OEM), imagery-based OEM, and rote movement. Three-dimensional motion analysis equipment was used to test one of the basic premises of occupational therapy: OEM is qualitatively different from movements performed under artificial circumstances. The sample consisted of 60 healthy college women with a mean age of 21.6 years (SD = 1.63). A randomized counterbalanced design was used so that each subject participated in 3 trials of each of the following conditions: reaching for a pencil in a pencil holder, imagining reaching for a pencil in a pencil holder, and rote reaching. Materials-based OEM resulted in quicker reaction time (P = .009), more rapid movement time (P < .001), smoother movement (with fewer movement units) (P < .001), more direct movement (less displacement) (P < .001), and lower peak velocity (P = .001) than the other two conditions. In some ways the imagery-based OEM resembled rote movement; in other ways it resembled materials-based OEM. The findings support the main results reported by Wu et al. (1994) and enhance occupational therapy's research base by demonstrating the distinctiveness of materials-based OEM.

Materials-Based Occupation versus Imagery-Based Occupation versus Rote Exercise: A Replication and Extension

Historically, occupational therapists have embedded exercise within occupation to enhance performance. In a recent study Lang, Nelson, and Bush (1992) compared the effects of materials-based occupation (kicking a balloon), imagery-based occupation (imagining kicking a balloon), and rote exercise on the number of exercise repetitions performed. This study extends that study by measuring the vertical distance and speed of the movement by means of Motion Analysis, Inc. digitization of videotape, in addition to exercise repetitions. The subjects included 24 women and 4 men between 76 and 98 years of age residing in residential facilities. All of the subjects experienced the three conditions but in different orders. After a statistically significant analysis of variance across the three conditions (p<.001), the Tukey procedure determined that the materials-based occupation condition elicited significantly more repetitions than the other two conditions. The difference between the imagery-based occupation and rote exercise was not statistically significant. Analyses of variance indicated no significant difference between conditions for both the vertical distance variable ( p=.074) and the speed variable ( p=.61).

Enhancing Occupational Performance through Occupationally Embedded Exercise: A Meta-Analytic Review

Occupation or purposeful activity is the unique historical root of occupational therapy and is thought to enhance health and prevent disability. Nelson's (1988) recent conceptual framework of occupation consolidates the beliefs of occupational therapy. One focus for empirical research and theoretical inquiry is the relationship between occupational form and occupational performance. This article critically analyzes this important part of the Nelson model and meta-analytically summarizes findings of the empirical studies that have examined this relationship. Results of the meta-analysis showed a substantial relationship of occupational form to occupational performance (weighted mean effect size r=0.50) in support of the proposition of the Nelson model that occupation can be analyzed in terms of the relationship between occupational form and occupational performance. The impact of potential moderators on the study findings is explored. Implications for occupational therapy theory and practice are discussed.

Perceived Risk and its Effects on Quality of Movement in Occupational Performance of Well-Elderly Individuals

The purpose of this study was to determine whether elderly individuals would demonstrate differences in quality of movement when completing a water-pouring task under different levels of perceived risk (i.e., pouring hot water vs. pouring cold water during beverage preparation). Fifty individuals over the age of 65 (M=72.1 years, SD=6.3) participated in the repeated measures, counterbalanced design. Results indicated that participants used less efficient movement dynamics when pouring hot water (higher risk) than when pouring cold water (lower risk). Elders tended to take longer and make more adjustments when pouring hot water than when pouring cold water. Occupational therapists can use this information to better understand the movement dynamics needed during everyday occupations and design therapeutic interventions that appropriately challenge clients.

Occupational Embeddedness during a Reaching and Placing Task with Survivors of Cerebral Vascular Accident

This study examined the effects of enhanced occupational embeddedness on the upper extremity movement dynamics in survivors of a cerebral vascular accident (CVA). Seventeen persons who survived a CVA participated in this repeated measures study with two conditions. The occupationally embedded (OE) condition involved three labeled soup cans; the nonoccupationally embedded (NOE) condition involved three nonrepresentational clay masses. The task consisted of moving the objects from a kitchen counter to the cabinet with each limb. Movement dynamics were recorded using an electronic goniometer that was attached to each elbow. Dependent variables were movement time, displacement, movement units, peak velocity, and percentage of movement time at which the peak velocity occurred. It was hypothesized that the OE condition would result in significantly different movement dynamics than the NOE condition. It was also hypothesized that the movement dynamics of the affected limb would be significantly different than those of the unaffected limb. During the OE condition, there were significantly fewer movement units and smaller movement times. No significance was found with displacement, peak velocity, or percentage of movement time to peak velocity. Further, there were no significant differences between the two limbs' movement dynamics. The results of this study support the concept that greater occupational embeddedness can promote enhanced motor performance. Specifically, this study suggests that occupationally embedded occupational forms can enhance performance of movement units and movement time in a reaching and placing task with individuals who survived a stroke. Additionally, OE occupational forms do not appear to influence the affected limb differently than the unaffected limb.

Reality, virtual reality, and imagery: Quality of movement in novice dart players

Introduction

Meaning and purpose have been tenets of occupational therapy since the profession’s inception. Therefore, it is important to understand how to best employ these central concepts in practice. One way to do this is to study the “same” task under materials-based, imagery-based, and virtual reality conditions.

Method

Participants included 34 adult novice dart players, each of whom experienced all three conditions in a randomized order. Motion capture technology was used to evaluate the quality of motion during the three conditions.

Results

Similarities between the materials-based and imagery-based condition ( p > 0.0167) suggest participants utilized preconceived concepts of throwing real darts during these two conditions. Differences between the virtual reality and imagery-based conditions ( p < 0.0167) suggest that the virtual reality condition utilized a different motor performance, focusing less on perceptions of throwing darts and more on achieving successes within the virtual environment.

Conclusion

Implications are that utilizing materials-based occupations may be more efficient than imagery-based to enhance development of a skill; imagery-based performance is more similar to the materials-based performance than the virtual reality performance. Virtual reality occupations can be utilized should the patient find meaning and purpose in virtual reality occupations or if the patient cannot engage in a materials-based counterpart.

Becoming occupation-based: a case study

This descriptive case study illustrates the experiences of a 55-year-old male with a chronic disability resulting from a stroke, living in the community and a clinician's trial using occupation-based interventions predominately in a rehabilitation setting. The participant engaged in occupation-based interventions three times a week for 5 weeks guided by the Canadian Occupational Performance Measure (COPM). Data were collected through semi-structured interviews during the intervention sessions and journal entries made by the therapist. Results suggested occupation-based interventions facilitated a transformation for both the client and the therapist by enhancing the participant's occupational performance and the ability to resume previous roles. The therapist's belief in the power and value of occupation-based practice was reinforced and validated, particularly in the rehabilitation of an individual with chronic stroke.

Toward a physical environmental continuum for occupational intervention in a rehabilitation hospital

ABSTRACT A study was conducted to explore occupational therapists' perceptions of rehabilitation environments and the influence of these perceptions on practice and occupational interventions. Traditionally, inpatient occupational therapists have a choice of intervention environments, ranging from a gym-like to a more home-like setting. Choosing to provide interventions in these different environments can have an impact on occupational performance. In this qualitative exploration, 21 occupational therapists participated in focus groups designed to explore their perceptions of practice environments. Analysis of the transcribed data revealed that therapists felt rehabilitation environments should offer choices and be flexible, that environments influenced intervention strategies, and that the practice environment had an impact on professional identity. On the basis of this data, a conceptual matrix of the intersection of environmental setting and occupation-based interventions is presented to highlight the importance of these two aspects of therapy. Future research in this understudied area is needed to transform this matrix into a clinically useful model.

Application of motor learning principles with stroke survivors

The purpose of this study was to determine the relationship between type of task and type of environment on retention and transfer of motor skills when applied to stroke survivors, as measured by time to complete the task and the number of errors. It was expected that those performing a purposeful task in a familiar environment (home) would demonstrate greater retention and transfer of the motor task; however, data was inconclusive.

Physical rehabilitation for older people in long-term care

BACKGROUND

The worldwide population is progressively ageing, with an expected increase in morbidity and demand for long-term care. Physical rehabilitation is beneficial in older people, but relatively little is known about effects on long-term care residents. This is an update of a Cochrane review first published in 2009.

OBJECTIVES

To evaluate the benefits and harms of rehabilitation interventions directed at maintaining, or improving, physical function for older people in long-term care through the review of randomised and cluster randomised controlled trials.

SEARCH METHODS

We searched the trials registers of the following Cochrane entities: the Stroke Group (May 2012), the Effective Practice and Organisation of Care Group (April 2012), and the Rehabilitation and Related Therapies Field (April 2012). In addition, we searched 20 relevant electronic databases, including the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2009, Issue 4), MEDLINE (1966 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), AMED (1985 to December 2009), and PsycINFO (1967 to December 2009). We also searched trials and research registers and conference proceedings; checked reference lists; and contacted authors, researchers, and other relevant Cochrane entities. We updated our searches of electronic databases in 2011 and listed relevant studies as awaiting assessment.

SELECTION CRITERIA

Randomised studies comparing a rehabilitation intervention designed to maintain or improve physical function with either no intervention or an alternative intervention in older people (over 60 years) who have permanent long-term care residency.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed risk of bias and extracted data. We contacted study authors for additional information. The primary outcome was function in activities of daily living. Secondary outcomes included exercise tolerance, strength, flexibility, balance, perceived health status, mood, cognitive status, fear of falling, and economic analyses. We investigated adverse effects, including death, morbidity, and other events. We synthesised estimates of the primary outcome with the mean difference; mortality data, with the risk ratio; and secondary outcomes, using vote-counting.

MAIN RESULTS

We included 67 trials, involving 6300 participants. Fifty-one trials reported the primary outcome, a measure of activities of daily living. The estimated effects of physical rehabilitation at the end of the intervention were an improvement in Barthel Index (0 to 100) scores of six points (95% confidence interval (CI) 2 to 11, P = 0.008, seven studies), Functional Independence Measure (0 to 126) scores of five points (95% CI -2 to 12, P = 0.1, four studies), Rivermead Mobility Index (0 to 15) scores of 0.7 points (95% CI 0.04 to 1.3, P = 0.04, three studies), Timed Up and Go test of five seconds (95% CI -9 to 0, P = 0.05, seven studies), and walking speed of 0.03 m/s (95% CI -0.01 to 0.07, P = 0.1, nine studies). Synthesis of secondary outcomes suggested there is a beneficial effect on strength, flexibility, and balance, and possibly on mood, although the size of any such effect is unknown. There was insufficient evidence of the effect on other secondary outcomes. Based on 25 studies (3721 participants), rehabilitation does not increase risk of mortality in this population (risk ratio 0.95, 95% CI 0.80 to 1.13). However, it is possible bias has resulted in overestimation of the positive effects of physical rehabilitation.

AUTHORS' CONCLUSIONS

Physical rehabilitation for long-term care residents may be effective, reducing disability with few adverse events, but effects appear quite small and may not be applicable to all residents. There is insufficient evidence to reach conclusions about improvement sustainability, cost-effectiveness, or which interventions are most appropriate. Future large-scale trials are justified.

Use of mental practice to improve upper-limb recovery after stroke: a systematic review

OBJECTIVE

We sought to determine whether mental practice is an effective intervention to improve upper-limb recovery after stroke.

METHOD

We conducted a systematic review of the literature, searching electronic databases for the years 1985 to February 2009. We selected studies according to specified criteria, rated each study for level of evidence, and summarized study elements.

RESULTS

Studies differed with respect to design, patient characteristics, intervention protocols, and outcome measures. All studies used imagery of tasks involving movement of the impaired limb. The length of the interventions and number of practice hours varied. Results suggest that mental practice combined with physical practice improves upper-limb recovery.

CONCLUSION

When added to physical practice, mental practice is an effective intervention. However, generalizations are difficult to make. Further research is warranted to determine who will benefit from training, the dosing needed, the most effective protocols, whether improvements are retained, and whether mental practice affects perceived occupational performance.

Rehabilitation for older people in long-term care

BACKGROUND

Examination of demographic trends indicates that the worldwide population is progressively ageing. It is expected that such longevity will be associated with an increase in morbidity and demand for long-term residential care. This review examines whether there is evidence that physical rehabilitation benefits older people in long-term care.

OBJECTIVES

To evaluate physical rehabilitation interventions directed at improving physical function among older people in long-term care.

SEARCH STRATEGY

We searched the trials registers of the following Cochrane entities: Stroke Group (searched March 2008), Effective Practice and Organisation of Care Group (searched August 2006) and the Rehabilitation and Related Therapies Field, (searched August 2006). In addition, we searched 17 relevant electronic databases including the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3), MEDLINE (1966 to 1 October 2007), EMBASE (1980 to 1 October 2007), CINAHL (1982 to 1 October 2007), AMED (1985 to 1 October 2007), PsycINFO (1967 to 1 October 2007) and PEDro (searched 1 October 2007). We also searched trials and research registers and conference proceedings, checked reference lists, and contacted authors and researchers in the field and other relevant Cochrane entities.

SELECTION CRITERIA

Randomised studies comparing a rehabilitation intervention designed to maintain or improve physical function with either no intervention or an alternative intervention in older people aged 60 years or over who have permanent long-term care residency.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information.

MAIN RESULTS

Forty-nine trials involving 3611 participants were included. On average, 74 (range 12 to 468) participants were randomised into trials at baseline. Of studies which reported age, the overall mean age was 82 years (range of 69 to 89). Most interventions lasted less than 20 weeks, and comprised approximately three 30 to 45-minute group sessions per week. Twelve trials conducted post-intervention follow up (maximum one year). Most often a 'usual care' control group was used, but social activity and alternative interventions also featured. The primary outcome, daily activity restriction, was reported by 38 trials. A range of secondary outcomes are also reported.

AUTHORS' CONCLUSIONS

Provision of physical rehabilitation interventions to long-term care residents is worthwhile and safe, reducing disability with few adverse events.Most trials reported improvement in physical condition. However, there is insufficient evidence to make recommendations about the best intervention, improvement sustainability and cost-effectiveness.

Kontrollierte Studien zur Wirksamkeit von Ergotherapie bei �lteren

OBJECTIVE

To identify the evidence for the efficacy of occupational therapy on prioritized diseases and disabilities of the elderly.

METHOD

Reviews, meta-analyses and clinical trials with control group design regarding "occupational therapy" were identified by an electronic search of pubmed and reviewed based on the CONSORT-Statement. The study results were summarised in regard to diseases and commented considering further literature.

RESULTS

A total of 31 studies were identified: 10 on stroke, 6 on dementia, 5 on prevention of falls, growing loneliness or inactivity, 4 on need of nursing care, and 6 on other diseases or disabilities. There is evidence for a positive efficacy of occupational therapy on the level of several controlled trials or reviews.

CONCLUSION

Especially in Germany, further research specific to occupational therapy is needed in the fields of depression, diabetes mellitus and nursing care in the community.

Occupation reconsidered

The current article delineates the need for the profession of occupational therapy to maintain relevance and be responsive to current trends. As part of such responsivity, this article proposes a reconsideration of the concept of occupation as an 'adaptive response' to the current societal need for clarification regarding occupational therapy. Reconsideration of what is meant by occupation for general use is discussed and illustrated by the ambiguous use of the term occupation as both a means and an end. Although occupational therapists are comfortable with such ambiguous use because of their apparent ease with complexity, use of the term in an ambiguous manner makes it harder for society to understand what is meant by occupation. Related to this, an annotation of literature on the definitions of occupation is presented in summary form. Furthermore, the political need to reconsider the term occupation is argued in light of the revision of International Classification of Functioning, Disability and Health (ICF), which includes the use of the word activity. Finally, this article proposes that occupation should be considered as the process of doing with meaning, and that activity should be the outcome. Such reconsideration renders us consistent with ICF and paves the way to reduce ambiguity in the use of the term occupation with the general public.

Physical therapy and occupational therapy: partners in rehabilitation for persons with movement impairments

SUMMARY The professions of physical therapy and occupational therapy have legitimate roles in the restoration of human movement in the rehabilitation process. This paper first presents a physical therapy perspective on changing trends in therapeutic exercise. Recent trends in physical therapy reflect a shift away from isolating patterns of movement and open kinetic chain exercises toward a new emphasis on functional patterns of movement and closed kinetic chain exercises. Rehabilitation of persons with hip fracture is used as an example of these shifting trends. Next, the paper presents an occupational therapy perspective. Occupational therapy's historical emphasis on the use of naturalistic occupations as the context for therapeutic exercise is described. Theoretical advantages of occupationally embedded movement are listed, and recent research in support of naturalistic occupations is summarized. Physical therapy and occupational therapy are distinct professions with autonomous outlooks and terminologies, but the responsibilities of physical therapists and occupational therapists potentially overlap in the restoration of movement. Suggestions are made for interdisciplinary teamwork whereby the holistically considered welfare of the patient is always the primary concern of all therapists.

Directing attention to movement effects enhances learning: a review

Studies investigating the influence of the learner's focus of attention, induced by instructions or feedback, on motor skill learning are reviewed. In general, directing performers' attention to the effects of their movements (external focus of attention) appears to be more beneficial than directing their attention to their own movements (internal focus of attention). Preliminary evidence is presented indicating that an internal attentional focus constrains the motor system by interfering with natural control processes, whereas an external focus seems to allow automatic control processes to regulate the movements. Support for the view that actions are controlled by their anticipated effects comes from research demonstrating functional variability in motor control, as well as the benefits of purposeful activity in occupational therapy. We explain these results in terms of the ideomotor principle of human actions (James, 1890) and its more modern derivatives (Hommel, 1996; Prinz, 1990, 1997).

A kinematic study of contextual effects on reaching performance in persons with and without stroke: influences of object availability

OBJECTIVE

To examine the effects of context on reaching performance in neurologically impaired and intact populations. Context was varied by the presence or absence of objects used to complete a task.

DESIGN

A counterbalanced repeated-measures design.

SETTING

A motor control laboratory in a university setting.

PARTICIPANTS

Fourteen persons with stroke and 25 neurologically intact adults.

INTERVENTIONS

Each participant was tested under two conditions: the presence of the object, in which the participant reached forward with the impaired arm (or corresponding arm) to scoop coins off the table into the other hand; and the absence of the object, in which the participant reached forward to the place where the coins would be placed in the condition of object present.

MAIN OUTCOME MEASURES

Kinematic Variables of movement time, total displacement, peak velocity, percentage of reach where peak velocity occurs, and movement units (derived from acceleration data) for reaching tasks.

RESULTS

The condition of using real objects elicited kinematically better performance of reaching movements than the condition of performing movements without relevant objects present. Better performance was reflected by shorter movement time, less total displacement, higher peak velocity, greater percentage of reach where peak velocity occurs, and fewer movement units.

CONCLUSION

The results of this study showed that the condition of object present elicited better performance of movements represented by kinematic variables than the condition of object absent. The clinical implication is that the use of real and functional objects might be an effective way of facilitating efficient, smooth, and coordinated movement with the impaired arm in persons with stroke. This study, however, should be replicated and extended to confirm the validity of its findings and to allow for generalization in various functional activities.

What is the quality of the reporting of research ethics in publications of nursing home research?

OBJECTIVE

To assess the quality of reporting of research ethics in published clinical research that involves a particularly vulnerable population: nursing home residents.

DESIGN

A structured review of publications researched from 1992 to 1996 that involve nursing home residents. The review instrument assessed each publication's compliance with four common standards for research that involves nursing home residents or the cognitively impaired: justification of the use of nursing home residents, Institutional Review Board (IRB) review, nursing home committee review, and informed consent. For each publication, these results were summed into a quality score. The research ethics requirements contained in the journals' instructions for authors that corresponded with each publication were categorized in order to compare whether an association exists between the average quality score for each category and the detail of its research ethics instructions.

RESULTS

Forty-five publications were identified. The four quality measures of research ethics showed that (1) all 45 publications reported justification of use of nursing home residents, (2) 36 publications reported that informed consent was obtained or waived, (3) 18 publications reported IRB review, and (4) six publications reported nursing home committee review. Of the 35 publications reporting informed consent was obtained, 16 reported assessing subjects' decisional capacity, and 24 reported whether cognitively impaired subjects were included (19) or excluded (5). The research ethics requirements of each publication's instructions for authors ranked it in one of four categories: (A) None (9); (B) Less than "Uniform Requirements (UR) for Manuscripts Submitted to Biomedical Journals" (7); (C) UR (24); (D) UR plus Additional Instructions (5). A positive association exists between the detail of a research ethics instructions category and the average research ethics quality score for each category (Kruskal-Wallis chi2 = 11.2, P = .01). That is, the more detailed the instructions, the greater the quality score.

CONCLUSION

In publications of research that involves nursing home residents, basic standards of research ethics are not typically reported. However, the positive association between research ethics instructions category and research ethics quality score suggests that a journal's instructions for authors or other features of peer review and editing can affect the quality of reporting research ethics.