MedWorm: Occupational Therapy

Redefining failure: phenomenology and meaning

Australian Occupational Therapy Journal — Mon, 25 Aug 2008 04:00:00 +0100

(Source: Australian Occupational Therapy Journal)

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Interrater reliability of the personal care participation assessment and resource tool (pc-part) in a rehabilitation setting

Australian Occupational Therapy Journal — Mon, 25 Aug 2008 04:00:00 +0100

Background: The Personal Care Participation Assessment and Resource Tool (PC-PART), formerly the Handicap Assessment and Resource Tool (HART), assesses the domains of clothing, hygiene, nutrition, mobility, safety, residence and supports.Aim: To examine the interrater reliability of the PC-PART in a rehabilitation setting.Methods: Assessments made by the researcher were compared to the interdisciplinary rehabilitation team. The research and standard assessments occurred within three working days. Raters were blind to each other's scores. Sample participants were a consecutive case-series of rehabilitation clients with varied diagnoses, activity limitations and participation restrictions. Of 66 consecutive patients seen during the a priori determined enrolment period, 25 were included in the study (nine males and 16 females, aged 44[ndash]85 years). The remaining 41 patients did not meet the inclusion criteria.Conclusion: The PC-PART has good interrater reliability. Clinicians, administrators and researchers can be reassured about this aspect of the validity of the tool. (Source: Australian Occupational Therapy Journal)

Reliability of the perceive, recall, plan and perform system of task analysis: a criterion-referenced assessment

Australian Occupational Therapy Journal — Mon, 25 Aug 2008 04:00:00 +0100

Objective: To conduct preliminary examination of the rater and test-reliability of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis, an ecological measure designed to assess task-embedded information processing capacity during occupational therapy assessment of confused and agitated adults following traumatic brain injury.Methods: Occupational therapists observed and scored client performance using the PRPP System of Task Analysis. Correlational analysis and measures of agreement were performed to determine interrater and intrarater reliability. Test procedures were examined for reliability and internal consistency.Results: Interrater and test reliability considered three factors: therapists, clients and tasks. A moderate level of interrater reliability was achieved between trained therapists (intraclass correlation coefficient (ICC) = 0.60). Test procedures were highly reliable (ICC = 0.88). Across two measurement occasions, therapists showed a tendency towards harder rating on the second test occasion ([dmacr] [ndash]4.5%; 95% confidence interval for [dmacr]: [ndash]10.67%[rarr] 3.17%).Conclusion: The findings of this study support the use of criterion-referenced tests in the area of occupational performance measurement. Occupational therapists achieved moderate interrater reliability when measuring the performance of adults with brain injury on various activities of daily living. Test procedures were found to be highly reliable in measuring the occupational performance of adults demonstrating confusion and agitation typical to the stage of post-traumatic amnesia following head injury. (Source: Australian Occupational Therapy Journal)

Employer-sponsored occupational therapy professional development in a multicampus facility: a quality project

Australian Occupational Therapy Journal — Mon, 25 Aug 2008 04:00:00 +0100

Aim: To critically assess and develop recommendations for professional development (PD) for occupational therapists in a multisite specialist cerebral palsy occupational therapy service.Method: Quality improvement project based on principles of participatory action research: audit of PD resources/activity; stakeholder consultations and literature review.Results: The PD program goal, resources, strategies, activities and evaluations conducted at the centre were identified and described. Areas for improvement were identified by critically considering the PD program in the context of reviewed literature. There was an assumption that personal change through PD would help attain the organisational goal of clinically competent practitioners who use evidence-based practice in a family-centred context.Recommendations: Future PD plans and evaluations need to explicitly address this assumption. The use of structured reflection and the 'clinical reasoning' conceptual framework was recommended as one way to help personal change from PD to have workplace impact. This project provides a precedent and guide to occupational therapy PD planners regarding a whole-of-organisation approach to developing and maintaining competence through PD. (Source: Australian Occupational Therapy Journal)

Why occupational therapy needs evidence of participation in continuing professional development

Australian Occupational Therapy Journal — Mon, 25 Aug 2008 04:00:00 +0100

(Source: Australian Occupational Therapy Journal)

Use of three-dimensional kinematic analysis following upper limb botulinum toxin a for children with hemiplegia

European Journal of Neurology — Fri, 22 Aug 2008 04:00:00 +0100

Background and purpose: To examine whether three-dimensional (3-D) kinematic analysis can detect changes in upper limb tasks (reach and hand-to-mouth) in children with hemiplegia, following upper limb botulinum toxin A injections. Methods: Ten children with hemiplegic cerebral palsy (7 males, 3 females, aged 9[ndash]17 years). Subjects received botulinum toxin A (Botox) injections into elbow forearm muscles combined with 6 weeks of occupational therapy. Participants completed a 3-D kinematic analysis of two upper limb tasks, Melbourne Assessment of Unilateral Upper Limb Function and modified Ashworth scores measured at baseline, 2, 6 and 12 weeks post-injection. Results: Post-injections, elbow flexor muscle tone was reduced for 12 weeks (p < 0.05). Group differences in active range of motion during 3-D analysis tasks could not be demonstrated at any time post-intervention. However, individual analyses found that at 2 weeks post-injection, three subjects had >15 degrees increases in active elbow extension and six subjects showed an increase of >25 degrees in forearm supination during performance of the reach and hand-to-mouth tasks, respectively. Conclusions: 3-D kinematics can detect changes in active movements during functional tasks following botulinum toxin A injections, suggesting this could be a potential objective outcome measure in a clinical trial. (Source: European Journal of Neurology)

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Cognitive orientation to (daily) occupational performance (co-op) with children with asperger's syndrome who have motor-based occupational performance goals

Australian Occupational Therapy Journal — Tue, 19 Aug 2008 04:00:00 +0100

Background/aim: Motor difficulties associated with Asperger's syndrome (AS) are commonly reported, despite these not being diagnostically significant. Cognitive Orientation to daily Occupational Performance (CO-OP) is a verbal problem-solving intervention developed for use with children with developmental coordination disorder to address their motor-based difficulties. This paper reports on two case studies of children with AS illustrating the outcomes of CO-OP to address motor-based occupational performance goals.Methods: A case study approach was used to document how two children with AS engaged in 10 weekly sessions of CO-OP addressing child-chosen motor-based occupational performance goals and the outcomes of this intervention.Results: Pre and post-intervention assessment using the Canadian Occupational Performance Measure, Vineland Adaptive Behaviour Scales and the Performance Quality Rating Scale indicated that both children were able to engage in CO-OP intervention to successfully improve their occupational performance.Conclusions: Further research into the application of CO-OP with children with AS is warranted based on preliminary positive findings regarding the efficacy of this intervention to address motor-based performance difficulties in two children with AS. (Source: Australian Occupational Therapy Journal)

Belonging to a community-based football team: an ethnographic study

Australian Occupational Therapy Journal — Tue, 19 Aug 2008 04:00:00 +0100

Purpose: This study considered the benefits derived from participation in a community-based Australian Rules Football league in Melbourne, Australia. The RecLink league deliberately tackles the social and occupational disadvantages associated with mental illness, addictions, unemployment and homelessness. Methods: An ethnographic methodology was used to study one team from the RecLink football league throughout an entire season. Fieldnotes were written following participant observation at training, games and events, and five in-depth interviews were conducted and transcribed. A constant comparative approach to data analysis was adopted.Results: Three major themes were identified: a spirit of inclusion, team-building and meaning of team involvement. The first describes how members were accepted, welcomed and given the opportunity for team involvement, with the expectation that they 'had a go', and 'tried their best'. The second illustrates how the team collectively fostered a culture of friendship, cooperation and support. The third examines the significance of being part of the team, incorporating personal contributions and gains, and meanings attributed to team involvement.Conclusions: These findings demonstrated how football can be used as non-clinical, community-based occupational therapy: enabling participation in a personally meaningful and culturally valued occupation. Occupational therapists are challenged to explore further how such community-based sports programs may complement existing clinical and welfare-based approaches to social disadvantage. (Source: Australian Occupational Therapy Journal)

Knowledge generation and utilisation in occupational therapy: towards epistemic reflexivity

Australian Occupational Therapy Journal — Tue, 19 Aug 2008 04:00:00 +0100

Aim: The purpose of this article is to consider the ways in which theory generation, and hence knowledge generation, in occupational therapy is a complex social process, and therefore carries (often hidden) responsibilities for those who are part of our epistemic community. An epistemic community is a knowledge-producing community, who apply their standards of credibility, and epistemic values, to theory choice. In occupational therapy this community is comprised of a worldwide group of scholars and practitioners.Methods: We propose that epistemic reflexivity can be used to critique and contribute to our disciplinary knowledge and to critically consider 'who' makes epistemological choices in our profession, and the consequent implications for the theories we adopt. The purpose of this article is to make these relations explicit so that scholars and therapists can become increasingly conscious and empowered with respect to their contributions to occupational therapy's epistemic community. To demonstrate an application of epistemic reflexivity, we critically consider a theoretical construction that has been widely adopted by the international occupational therapy community: evidence-based practice.Results: As authors, we engage in epistemic reflexivity to critically consider the challenge posed by evidence-based practice. We propose a conception of practice knowledge that is informed by evidence yet based on a conception of wise practice.Conclusion: Our intention is to stimulate discussion and debate in occupational therapy's epistemic community, a number of approaches for fostering epistemic reflexivity in occupational therapy are suggested. (Source: Australian Occupational Therapy Journal)

Retracted: development of an education programme for caregivers of people aging with multiple sclerosis

Occupational Therapy International — Mon, 18 Aug 2008 04:00:00 +0100

The article from Occupational Therapy International, Development of an Education Program for Caregivers of People Aging with Multiple Sclerosis (DOI: 10.1002/OTI.245) by Marcia Finlayson, Jennifer Garcia and Katharine Preissner, published online on 5 February 2008 in Wiley InterScience (www.interscience.wiley.com), has been retracted by John Wiley & Sons, Ltd. The retraction has been agreed due to dual publication of this article. Copyright ? 2008 John Wiley & Sons, Ltd. (Source: Occupational Therapy International)

Representation of physical therapy and occupational therapy in cnpq

Revista Brasileira de Fisioterapia — Sun, 17 Aug 2008 16:32:42 +0100

(Source: Revista Brasileira de Fisioterapia)

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Students' learning experiences from interprofessional collaboration on a training ward in municipal care

Learning in Health and Social Care — Tue, 05 Aug 2008 04:00:00 +0100

One way to offer students pursuing health and social care programmes realistic experiences of teamwork is interprofessional training wards where students from different educational programmes learn teamwork by working together. In the present study, a training ward in municipal care for older people was evaluated. Students from occupational therapy, nursing and social work programmes worked together on the ward for 3 weeks to learn with, from and about each other. The aim of the study was to compare students' attitudes towards practice on a training ward before and after and to evaluate goal fulfilment after 3 weeks' interprofessional education on a training ward. An attitude questionnaire was distributed to all students before and after their time on the ward, supplemented with a retrospective goal-fulfilment questionnaire afterwards. The results show that the collaborative, social experience the training ward offers was appreciated by the students and in most respects, met the learning goals set up for the course. The most important learning experience was working together in a real-life setting. However, there are some issues to take into consideration when planning and developing training wards. The setting needs to be realistic and relevant in relation to future roles for all of the student groups involved. The value and purpose of engaging together in basic patient care needs to be the subject of further investigation. When it comes to fostering competent team-workers, training wards seem to be one way forward. But to fully understand the challenges and difficulties involved in planning these wards, the learning achieved must be understood in the context of the setting as a whole, in all its aspects. (Source: Learning in Health and Social Care)

Article: community supports after surviving extremely low-birth-weight, extremely preterm birth: special outpatient services in early childhood

Archives of Pediatrics — Mon, 04 Aug 2008 04:00:00 +0100

Objective To determine special outpatient services (SOS) use, need, associated factors, and neurodevelopmental and functional outcomes among extremely preterm infants at 18 to 22 months' corrected age. Design Retrospective analysis. Setting National Institute of Child Health and Human Development (NICHD) Neonatal Research Network. Participants Infants younger than 28 weeks' gestational age who had been born weighing less than 1000 g at an NICHD Neonatal Research Network center from January 1, 1997, to December 31, 2000, and who were receiving follow-up at 18 to 22 months' corrected age. Interventions Questionnaires were administered at the 18- to 22-month follow-up visit regarding SOS use since hospital discharge and the current need for SOS (social work, visiting nurse, medical specialty, early intervention, speech and language services, occupational therapy and physical therapy, and neurodevelopmental and behavioral services). Main Outcome Measures The use of and need for SOS were analyzed by gestational age. Logistic regression analysis identified factors independently associated with the use of more than 5 services and with the need for any services. Results Of 2315 infants, 54.7% used more than 3 SOS by 18 to 22 months, and 19.1% used 6 to 7 SOS. The need for any SOS was reported by approximately 37%. The following variables that were commonly associated with adverse neurodevelopmental outcomes were also associated with the use of more than 5 SOS: sepsis, birth weight, postnatal corticosteroid use, bronchopulmonary dysplasia, and cystic periventricular leukomalacia or grade 3 or 4 intraventricular hemorrhage. Male sex was associated with the need for any SOS. Although high SOS use was more likely among children with adverse neurodevelopmental outcomes, a reported need for SOS was common even among those with mild developmental impairment (39.7%) and mild cerebral palsy (42.2%). Conclusions High SOS use is common, has identifiable neonatal risk factors, and is associated with neurodevelopmental impairment. Extremely preterm survivors have substantial need for community supports regardless of their impairment level. Efforts to improve comprehensive delivery of family-centered community-based services are urgently needed. (Source: Archives of Pediatrics)

Feasibility of a classification system for physical therapy, occupational therapy, and sports therapy interventions for mobility and self-care in spinal cord injury rehabilitation.

Archives of Physical Medicine and Rehabilitation — Fri, 01 Aug 2008 04:00:00 +0100

Feasibility of a classification system for physical therapy, occupational therapy, and sports therapy interventions for mobility and self-care in spinal cord injury rehabilitation.

Arch Phys Med Rehabil. 2008 Aug;89(8):1454-9

Authors: van Langeveld SA, Post MW, van Asbeck FW, Postma K, Leenders J, Pons K

OBJECTIVE: To test the feasibility of a classification system developed to record the contents of treatment sessions intended to improve mobility and self-care by persons with a spinal cord injury (SCI) in clinical rehabilitation. DESIGN: Descriptive study. SETTING: Three Dutch SCI facilities. PARTICIPANTS: Participants (N=36) as well as physical therapists (n=20), occupational therapists (n=14), and sports therapists (n=2). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Questionnaires to assess the clarity of the classification system, time needed to record 1 treatment session, and the distribution of categories and interventions. The classification system consisted of 28 categories at 3 levels of functioning: basic functions (eg, muscle power), basic activities (eg, transfers), and complex activities (eg, walking and moving around outside). RESULTS: Therapists used 1625 codes to record 856 treatment sessions of 142 patients. For 93% of the treatment sessions, the coding caused little or no doubt. The therapists were able to classify 86.3% of the treatment sessions within 3 minutes. The classification system was rated as useful and easy to use. CONCLUSIONS: The findings support the suitability of our classification system as a tool to record the contents of SCI treatment sessions in different settings and by different therapists.

PMID: 18674980 [PubMed - in process]

(Source: Archives of Physical Medicine and Rehabilitation)

Recovery from disablement: what functional abilities do rehabilitation professionals value the most?

Archives of Physical Medicine and Rehabilitation — Fri, 01 Aug 2008 04:00:00 +0100

Recovery from disablement: what functional abilities do rehabilitation professionals value the most?

Arch Phys Med Rehabil. 2008 Aug;89(8):1600-6

Authors: Rist PM, Freas DW, Maislin G, Stineman MG

OBJECTIVE: To determine whether rehabilitation clinicians representing different therapeutic disciplines would choose to recover from profound disability differently. DESIGN: Applying recovery preference exploration as a data-collection tool, clinicians imagined recovery from complete disability in each of the 18 activities assessed on the FIM instrument. We hypothesized that recovery-choice pathways would vary among the disciplines because of differences in training and practice focus. We compared each clinician's preference for imagined recovery of the ability to perform each FIM activity relative to the other 17. Item-level preferences were explored by discipline. The mean absolute difference (MAD) in the medians of the 18 FIM recovery preference values between each of the disciplines was used to quantify overall differences. SETTING: Inpatient rehabilitation unit within a larger tertiary care urban hospital of an academic medical center. PARTICIPANTS: Ninety-three clinicians actively providing care to patients in an inpatient rehabilitation setting classified into 5 groups anticipated to have similar types of practices: physicians and medical students (physician group), nurses, occupational and recreational therapists (occupational therapy [OT] group), physical therapists (physical therapy [PT] group), and neuropsychologists and social workers (psychology group). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Relative recovery preferences in 18 FIM activities. RESULTS: The MAD value between the 2 groups with the least similar recovery values (physician and psychology groups) was 1.78 times larger than the MAD value between the 2 groups with the most similar recovery values (PT and OT groups). CONCLUSIONS: There were subtle differences in recovery choice pathways that may logically relate to differences in the cognitive processes used in clinical decision making among the therapeutic discipline groups.

PMID: 18597736 [PubMed - indexed for MEDLINE]

(Source: Archives of Physical Medicine and Rehabilitation)

[therapeutics] occupational therapy is cost-effective for older people with dementia and their caregivers

Evidence-Based Mental Health — Thu, 31 Jul 2008 04:00:00 +0100

(Source: Evidence-Based Mental Health)

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Use of the perceive, recall, plan and perform system of task analysis for persons with schizophrenia: a preliminary study

Australian Occupational Therapy Journal — Sun, 13 Jul 2008 04:00:00 +0100

Background/aim: Task analysis that targets information processing skills is an essential tool to understanding difficulties encountered by people with schizophrenia in their daily activities. The purpose of this preliminary study was to explore the use of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis for this clientele. The specific objectives were to describe information processing difficulties as measured by the PRPP and to examine preliminary evidence of construct validity and interrater reliability.Methods: In the first part of this study, 10 participants with schizophrenia living in the community were assessed using the PRPP during both a simple and a complex meal preparation task. Community functioning was measured using the Independent Living Skills Survey. In the second part, interrater reliability was appraised using three trained raters, who scored 15 participants preparing the complex meal preparation task.Results: Analysis of performance demonstrates that people with schizophrenia have difficulties especially in the Perceive and Plan quadrants of the PRPP and are more challenged in the complex task. The PRPP total score for the complex task is strongly related to the community functioning score. Results indicate good interrater reliability for the PRPP total score and moderate interrater reliability for the quadrant scores.Conclusion: Despite the small sample size, results from this preliminary study support the use of the PRPP System of Task Analysis to further explore the impact cognitive deficits have on daily task performance and thus on community functioning in people with schizophrenia. (Source: Australian Occupational Therapy Journal)

Trilogy opens cincinnati health campus

bizjournals.com Health Care:Hospitals headlines — Fri, 11 Jul 2008 14:50:04 +0100

Trilogy Health Services LLC announced that it has acquired Paragon Rehabilitation Inc., a Nashville, Tenn.-based contract physical and occupational therapy provider. (Source: bizjournals.com Health Care:Hospitals headlines)

Trilogy acquires nashville rehab company, opens cincinnati health campus

bizjournals.com Health Care:Hospitals headlines — Thu, 10 Jul 2008 15:49:41 +0100

Trilogy Health Services LLC announced Thursday that it has acquired Paragon Rehabilitation Inc., a Nashville, Tenn.-based contract physical and occupational therapy provider. (Source: bizjournals.com Health Care:Hospitals headlines)

Handwriting speed: duration of testing period and relation to socio-economic disadvantage and handedness

Occupational Therapy International — Thu, 10 Jul 2008 04:00:00 +0100

In the course of norm-referencing the Handwriting Speed Test (HST) for 8- to 18-year-olds in the Irish education system, the authors examined the issue of the duration of the handwriting test period, the relation of handwriting speed to socio-economic disadvantage and the comparative handwriting speed of left- and right-handed students. The literature reports some concerns about the generalizability of results from a short-duration handwriting speed test, some evidence that children from poorer backgrounds are less proficient at handwriting, and conflicting results on the relation of handedness to speed of handwriting. The results of this study suggest that the addition of a further 9-minute test to the 3-minute test of the HST would improve its ability to predict handwriting speed problems in everyday extended writing tasks, such as examinations, and would also identify some children who are wrongly classified as slow writers on the 3-minute test. The results also indicate a markedly lower-than-average handwriting speed for children attending designated disadvantaged schools. The results suggest that neither left- nor right-handed children have a consistent advantage in handwriting speed. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Occupational Therapy International)

A retrospective audit exploring the use of relaxation as an intervention in oncology and palliative care

European Journal of Cancer Care — Thu, 10 Jul 2008 04:00:00 +0100

The benefits of relaxation in cancer care have been well documented within the literature, with the majority of research being undertaken by nursing professionals. However, evidence of the effectiveness of relaxation interventions by occupational therapists is lacking. Occupational therapists are in an ideal situation to provide information and practical relaxation sessions. Athough in numerical terms, the outcome of relaxation interventions is small, functional outcome related to quality of life and independence in activities of daily living is immeasurable. This article reports the findings of a retrospective audit exploring relaxation-specific referrals to occupational therapy, and identifies effectiveness of a variety of different techniques currently employed within this specific programme. Patients with a primary diagnosis of breast cancer were the most frequently seen, and this prevalence is reflected in current national statistics. Similarly, those between 50 and 59 years of age comprised the largest group. Guided visualization was the most commonly used technique, although there appeared to be very little change in perceived tension between all the techniques. Further study of the impact relaxation has on occupational performance would be worthwhile. (Source: European Journal of Cancer Care)

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Escalating levels of access to in-hospital care and stroke mortality.

Stroke — Thu, 10 Jul 2008 04:00:00 +0100

Escalating Levels of Access to In-Hospital Care and Stroke Mortality.

Stroke. 2008 Jul 10;

Authors: Saposnik G, Fang J, O'Donnell M, Hachinski V, Kapral MK, Hill MD,

BACKGROUND AND PURPOSE: Organized stroke care is an integrated approach to managing stroke to improve stroke outcomes by ensuring that optimal treatment is offered. However, limited information is available comparing different levels of organized care. Our aim was to determine whether escalating levels of organized care can improve stroke outcomes. METHODS: Cohort study including patients with acute ischemic stroke between July 2003 and March 2005 in the Registry of the Canadian Stroke Network (RCSN). The RCSN is the largest clinical database of patients with acute stroke patients seen at selected acute care hospitals in Canada. As stroke unit admission does not automatically imply receipt of comprehensive care, we created the organized care index to represent different levels of access to organized care ranging from 0 to 3 as determined by the presence of occupational therapy/physiotherapy, stroke team assessment, and admission to a stroke unit. The primary end point was early stroke mortality. Secondary end points include 30-day and 1-year mortality. RESULTS: Overall, 3631 ischemic stroke patients were admitted to 11 hospitals. Seven day stroke mortality was 6.9% (249/3631), 30-day stroke mortality was 12.6% (457/3631), and 1-year stroke mortality was 23.6% (856/3631). Risk-adjusted 7-day mortality was 2.0%, 3.2%, 7.8%, and 22.5% for organized care index of 3, 2, 1, and 0. Higher level of care was associated with lower adjusted mortality (for organized care index 3, OR 0.03, 95% CI 0.02 to 0.07 for 7-day mortality; OR 0.09, 95% CI 0.05 to 0.17 for 30-day mortality; and OR 0.40, 95% CI 0.25 to 0.64 for 1-year mortality). CONCLUSIONS: Higher level of access to care was associated with lower stroke mortality rates. Establishing a well-organized and multidisciplinary system of stroke care will help improve the quality of service delivered and reduce the burden of stroke.

PMID: 18617667 [PubMed - as supplied by publisher]

(Source: Stroke)

Robotic therapy and botulinum toxin type a: a novel intervention approach for cerebral palsy.

Medical Physics — Wed, 09 Jul 2008 04:00:00 +0100

Robotic Therapy and Botulinum Toxin Type A: A Novel Intervention Approach for Cerebral Palsy.

Am J Phys Med Rehabil. 2008 Jul 9;

Authors: Fasoli SE, Fragala-Pinkham M, Hughes R, Krebs HI, Hogan N, Stein J

Fasoli SE, Fragala-Pinkham M, Hughes R, Krebs HI, Hogan N, Stein J: Robotic therapy and botulinum toxin type A: a novel intervention approach for cerebral palsy. Am J Phys Med Rehabil 2008;87:000-000.The combined effects of robotic therapy and botulinum toxin type A (BTX-A) on upper-limb movement and function were studied in an 8(1/2)-yr-old child with hemiplegic cerebral palsy. Robotic therapy comprising repetitive, goal-directed reaching tasks was administered two times per week for 8 wks. Clinical measures included the Modified Ashworth Scale, the Quality of Upper Extremity Skills Test, and the Fugl-Meyer Assessment (upper-limb section). Improvements in upper-limb coordination and quality of motor performance were apparent throughout the robotic therapy trial. The observed gains are comparable with those attained from conventional occupational therapy combined with BTX-A. A parent questionnaire indicated that the amount of paretic arm use also improved during daily activities at home. This preliminary study indicates that robotic therapy may be a useful clinical tool when combined with BTX-A injections for improving upper-limb coordination and quality of motor performance in children with cerebral palsy.

PMID: 18617860 [PubMed - as supplied by publisher]

(Source: Medical Physics)

Role of occupational therapy after stroke

Annals of Indian Academy of Neurology — Tue, 08 Jul 2008 08:09:02 +0100

Rowland Tennille J, Cooke Deirdre M, Gustafsson Louise AAnnals of Indian Academy of Neurology 2008 11(5):99-107 (Source: Annals of Indian Academy of Neurology)

A firm persuasion in our work. mentors i have known (and loved).

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

A firm persuasion in our work. Mentors I have known (and loved).

Am J Occup Ther. 2008 Jul-Aug;62(4):487-90

Authors: Gillette N

PMID: 18712012 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

Concepts in clinical scholarship. research literature in occupational therapy, 2001-2005.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Concepts in clinical scholarship. Research literature in occupational therapy, 2001-2005.

Am J Occup Ther. 2008 Jul-Aug;62(4):480-6

Authors: Case-Smith J, Powell CA

One method to determine trends in occupational therapy research is to survey the literature published in occupational therapy journals. This study describes the types and topics of articles published in five prominent occupational therapy journals over a 5-year span. Feature articles published between 2001 and 2005 were analyzed to determine the types of articles and research and subject areas. The percentage of research articles published between 2001 and 2005 increased from 65% to 78% of all articles published and is higher than previous reports. More than 70% of the research articles used designs that substantially contribute to the evidence base for occupational therapy (defined by Kielhofner, Hammel, Finlayson, Helfrich, & Taylor [2004] as correlational-comparison, experimental, qualitative, and meta-analysis). Of the research articles, 60% addressed pediatric, physical disability, and rehabilitation topics. The 5-year period showed a trend of increasing frequency of geriatric and pediatric topics in research reports. Scholars should emphasize research designs that build the evidence for occupational therapy approaches and practices and focus on research topics of highest value to society.

PMID: 18712011 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

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Augmenting occupational therapy treatment of upper-extremity spasticity with botulinum toxin a: a case report of progress at discharge and 2 years later.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Augmenting occupational therapy treatment of upper-extremity spasticity with botulinum toxin A: a case report of progress at discharge and 2 years later.

Am J Occup Ther. 2008 Jul-Aug;62(4):473-9

Authors: Denham SP

This case report summarizes occupational therapy services provided to a participant after botulinum toxin A (BTA) injections and her improvements 2 years later. The injections were performed to neutralize spasticity in the left upper extremity after a stroke. Along with BTA, the participant received occupational therapy for 12 weeks, using neurodevelopmental and biomechanical approaches and an activity-based home program. Spasticity decreased from a 4 to a 1 on the Modified Ashworth Scale (MAS) immediately after the injections. Two years after the injections, the MAS score ranged between 1 and 1+. Initially, the participant demonstrated functional limitations in areas of splint application, dressing, toileting, and bathing. Following BTA injections and occupational therapy, the participant demonstrated increased independence in all deficit areas. For this participant, BTA, combined with functional, activity-based occupational therapy interventions, was associated with neurological change and greater functional use of the spastic limb.

PMID: 18712010 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

Task-specific, patient-driven neuroprosthesis training in chronic stroke: results of a 3-week clinical study.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Task-specific, patient-driven neuroprosthesis training in chronic stroke: results of a 3-week clinical study.

Am J Occup Ther. 2008 Jul-Aug;62(4):466-72

Authors: Hill-Hermann V, Strasser A, Albers B, Schofield K, Dunning K, Levine P, Page SJ

OBJECTIVE: We examined the efficacy of a clinically based regimen in which a woman 16 months' poststroke participated in daily practice sessions of valued activities of daily living (ADLs). A unique aspect of this intervention was that it was largely patient driven, with the patient practicing ADLs while wearing an electrical stimulation neuroprosthesis. METHOD: The Fugl-Meyer Assessment (FM), Action Research Arm Test (ARA), Arm Motor Activity Test (AMAT), and Canadian Occupational Performance Measure (COPM) were administered before intervention. Therapy consisted of 3-hr ADL training sessions every weekday during a 3-week period using a neuroprosthesis featuring functional electrical stimulation during treatment sessions. One week after the end of the treatment phase, the FM, ARA, AMAT, and COPM were again administered. RESULTS: The patient exhibited reduced impairment (FM score change from 31 to 35), decreased time needed to complete AMAT tasks (from 998 s to 558 s), and increased ARA score (from 27 to 31). CONCLUSIONS: Clinically meaningful changes were realized with distant or minimal therapist supervision, making this regimen a practical and efficacious alternative.

PMID: 18712009 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

Effects of task instructions and target location on reaching kinematics in people with and without cerebrovascular accident: a study of the less-affected limb.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Effects of task instructions and target location on reaching kinematics in people with and without cerebrovascular accident: a study of the less-affected limb.

Am J Occup Ther. 2008 Jul-Aug;62(4):456-65

Authors: Lin KC, Wu CY, Lin KH, Chang CW

OBJECTIVE: We investigated how verbal instructions and target location interacted to influence reaching movement of the less-affected limb in participants with and without unilateral cerebrovascular accidents (CVAs). METHOD: Using a counterbalanced repeated-measures design, 26 people with CVA and 24 age-matched healthy people performed the reaching tasks under 4 conditions formed by the crossing of verbal instructions (speed and accuracy emphasis) and target locations (ipsilateral and contralateral to the performing hand). RESULTS: In the control groups, speeded instructions and ipsilateral reaches elicited significantly more preprogrammed movements than did accuracy instruction and contralateral reaches, respectively. Similar patterns of performance in response to task constraints were found in the CVA groups except for movement initiation in the right CVA group. CONCLUSION: Instruction and locations interacted to constrain reaching movements in both control and CVA groups. The combination of speeded instruction and ipsilateral reach may optimize movement performance of the less-affected limb in stroke patients.

PMID: 18712008 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

Reliability, validity, and clinical utility of the executive function performance test: a measure of executive function in a sample of people with stroke.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Reliability, validity, and clinical utility of the Executive Function Performance Test: a measure of executive function in a sample of people with stroke.

Am J Occup Ther. 2008 Jul-Aug;62(4):446-55

Authors: Baum CM, Connor LT, Morrison T, Hahn M, Dromerick AW, Edwards DF

This study examined the reliability and validity of the Executive Function Performance Test (EFPT). The EFPT assesses executive function deficits in the performance of real-world tasks. It uses a structured cueing and scoring system to assess higher-level cognitive functions, specifically initiation, organization, sequencing safety and judgment, and task completion. Seventy-three participants with mild to moderate stroke and 22 age- and education-matched controls completed the 4 EFPT tasks (cooking, using the telephone, managing medications, and paying bills). Significant differences were found between participants with mild and moderate stroke and healthy control participants. The EFPT can help occupational therapists determine the level of support needed by people with cognitive impairments to perform complex instrumental tasks. Objective information derived from this assessment is an essential part of the process of determining whether the person can live independently and helping families understand how to support the performance of their family members at home.

PMID: 18712007 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

Effect of wearing a static wrist orthosis on shoulder movement during feeding.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Effect of wearing a static wrist orthosis on shoulder movement during feeding.

Am J Occup Ther. 2008 Jul-Aug;62(4):438-45

Authors: May-Lisowski TL, King PM

OBJECTIVE: This study compares the effect of wrist immobilization with non-immobilization on shoulder abduction, shoulder flexion, and shoulder rotation during feeding. METHOD: Twenty right-hand-dominant participants with no upper-extremity dysfunction performed a controlled feeding activity under 2 separate wrist conditions: (1) while wearing a static wrist orthosis and (2) with the wrist not immobilized (free wrist). A Motion Monitor system using small magnetic sensors was used to measure range of motion. Data analysis included paired ttests to compare the 2 conditions. RESULTS: Statistically significant results were found for shoulder flexion and shoulder abduction, indicating increased movement at the shoulder while feeding when the wrist was immobilized. No significant difference was found in shoulder internal rotation. CONCLUSIONS: Wearing a wrist orthosis while feeding may alter normal movement patterns at the shoulder. Future research should examine the effects of wrist splinting on shoulder movement.

PMID: 18712006 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

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Modified constraint-induced movement therapy for a 12-month-old child with hemiplegia: a case report.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Modified constraint-induced movement therapy for a 12-month-old child with hemiplegia: a case report.

Am J Occup Ther. 2008 Jul-Aug;62(4):430-7

Authors: Cope SM, Forst HC, Bibis D, Liu XC

OBJECTIVE: This case report describes the use of modified constraint-induced movement therapy (CIMT) to improve upper-limb function in a 12-month-old child with right hemiplegia. It also describes parent concerns about CIMT and documents the short- and long-term effects of modified CIMT. METHOD: The participant was assessed 5 times over a 7.5-month period using the Peabody Developmental Motor Scales-2, Pediatric Motor Activity Log, Toddler Amount of Use Test, and Knox Parent Questionnaire. CIMT included a nonremovable cast worn on the unaffected arm and approximately 8 hr per week of occupational and physical therapy for 2 weeks. RESULTS: Benefits of improved upper-limb function measured immediately after CIMT were sustained at 6 months' follow-up. No adverse events related to cast use were reported. DISCUSSION: The findings from this case report suggest that CIMT was a safe intervention associated with improving upper-limb function for this young child with hemiplegia.

PMID: 18712005 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

Evidence-based review of interventions for autism used in or of relevance to occupational therapy.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Evidence-based review of interventions for autism used in or of relevance to occupational therapy.

Am J Occup Ther. 2008 Jul-Aug;62(4):416-29

Authors: Case-Smith J, Arbesman M

Occupational therapy practitioners are among the professionals who provide services to children and adults with autism spectrum disorder (ASD), embracing both leadership and supportive roles in service delivery. The study's primary aims were as follows: (1) to identify, evaluate, and synthesize the research literature on interventions for ASD of relevance to occupational therapy and (2) to interpret and apply the research literature to occupational therapy. A total of 49 articles met the authors' criteria and were included in the review. Six categories of research topics were identified, the first 3 of which are most closely related to occupational therapy: (1) sensory integration and sensory-based interventions; (2) relationship-based, interactive interventions; (3) developmental skill-based programs; (4) social cognitive skill training; (5) parent-directed or parent-mediated approaches; and (6) intensive behavioral intervention. Under each category, themes supported by research evidence and applicable to occupational therapy were defined. The findings have implications for intervention methods, communication regarding efficacious practices to professionals and consumers, and future occupational therapy research.

PMID: 18712004 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

Children's perceptions of play experiences and play preferences: a qualitative study.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Children's perceptions of play experiences and play preferences: a qualitative study.

Am J Occup Ther. 2008 Jul-Aug;62(4):407-15

Authors: Miller E, Kuhaneck H

This qualitative study investigated the perceptions of play experiences and rationales for play choices of 6 boys and 4 girls between the ages of 7 and 11 years. Individual in-depth interviews were completed and then transcribed, and the transcripts were coded and analyzed using grounded theory methodology. Fun emerged from the data as the core category explaining the choice of specific play activities for children, and 4 additional categories of characteristics surfaced as contributors to the children's perception of fun: relational, activity, child, and contextual. The relationships among the core category, the 4 characteristics categories, and the development of play preference and meaningfulness are illustrated in the Dynamic Model for Play Choice. Included is a discussion of the usefulness of the model in supporting the careful consideration of factors that will increase the perception of fun during therapeutic activities and facilitate client-centered pediatric practice.

PMID: 18712003 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

Pilot study of the sensory over-responsivity scales: assessment and inventory.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Pilot study of the Sensory Over-Responsivity Scales: assessment and inventory.

Am J Occup Ther. 2008 Jul-Aug;62(4):393-406

Authors: Schoen SA, Miller LJ, Green KE

This article describes 3 stages of construction of the Sensory Over-Responsivity (SensOR) Scales: instrument development, reliability and validity analyses, and cross-validation on a new sample. The SensOR Scales include the SensOR Assessment, an examiner-administered performance evaluation, and the SensOR Inventory, a caregiver self-rating scale. Both scales measure sensory overresponsivity in 7 sensory domains. Data were collected from 2 samples consisting of participants who were typically developing (ns = 60 and 44, respectively) and participants with sensory overresponsivity (ns = 65 and 48, respectively), ages 3 to 55. In developing the research edition, items on the pilot version were reviewed for their internal consistency reliability, discriminant validity, and construct validity. Data from both samples on the research edition revealed high internal consistency reliability for domains and the total test and significant discrimination between the overresponsive and the typically responsive groups (p < .05). The preliminary psychometric integrity of the scales, along with continued research efforts, is an important contribution to evidence-based practice.

PMID: 18712002 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

Reliability and validity of the test of in-hand manipulation in children ages 5 to 6 years.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Reliability and validity of the Test of In-Hand Manipulation in children ages 5 to 6 years.

Am J Occup Ther. 2008 Jul-Aug;62(4):384-92

Authors: Pont K, Wallen M, Bundy A, Case-Smith J

The Test of In-Hand Manipulation (TIHM; Case-Smith, 2000) is a five-task test that uses a 9-hole pegboard to examine 2 key components of in-hand manipulation: rotation and translation with stabilization. The authors used Rasch modeling to examine the TIHM's construct validity, interrater reliability, and test-retest reliability in 45 typically developing children ages 5.5 years to 6.5 years. A version of the test, revised using Rasch modeling, was found to have evidence for adequate construct validity and excellent interrater reliability. However, test-retest reliability over a 2-week retest period was not supported. The TIHM demonstrates potential as a clinically useful assessment of in-hand manipulation. The test does not examine all aspects of in-hand manipulation, however, and it may have limited sensitivity to the performance of finger-to-palm and palm-to-finger translation. Further validation of the test is needed before the TIHM can confidently be used in occupational therapy practice.

PMID: 18712001 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

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Establishing validity of a modified melbourne assessment for children ages 2 to 4 years.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Establishing validity of a modified Melbourne Assessment for children ages 2 to 4 years.

Am J Occup Ther. 2008 Jul-Aug;62(4):373-83

Authors: Randall M, Imms C, Carey L

BACKGROUND: The Melbourne Assessment of Unilateral Upper Limb Function is a valid tool for measuring quality of upper-limb movement in children ages 5 to 15 with cerebral palsy. This study presents the first phase in establishing the validity of a modified version of the assessment for children ages 2 to 4. OBJECTIVE: We sought to determine whether children without neurological impairment scored within the top 5% on the modified assessment, to investigate compliance with test demands, and to investigate the relationship between the modified tool and the Quality of Upper Extremity Skills Test. METHOD: The test was modified and administered to 32 children without neurological impairment ages 2 to 4. RESULTS: All children ages 2.5 to 4 scored as expected and were compliant with test demands. CONCLUSION: The Modified Melbourne Assessment may be used with children ages 2.5 to 4 without neurological impairment. Investigation with children with neurological impairment is now indicated.

PMID: 18712000 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

Welcome from the new editor-in-chief.

The American Journal of Occupational Therapy — Tue, 01 Jul 2008 04:00:00 +0100

Welcome from the new editor-in-chief.

Am J Occup Ther. 2008 Jul-Aug;62(4):371-2

Authors: Gutman SA

PMID: 18711999 [PubMed - in process]

(Source: The American Journal of Occupational Therapy)

What causes idiopathic intracranial hypertension?

PediatricEducation.org — Mon, 30 Jun 2008 07:00:00 +0100

Patient Presentation A 14-year-old female came to the emergency room with a 3 week history of tinnitus that resolved 3 days prior to admission. She had persistent blurred vision in her left eye and 2 days ago developed it in her right eye. She also complains of some neck pain and a headache that she was taking ibuprofen for. She denied any trauma. The past medical history showed attention deficit disorder on methylphenidate and mild acne that was controlled with benzoyl peroxide. The family history was negative for any hematological, neurological or ophthalmological disorders. The review of systems showed no fever, nausea, vomiting, cough, diarrhea, difficulties walking, writing or speaking. The pertinent physical exam showed vital signs of blood pressure = 145/105, pulse = 98, respiratory rate = 20, was afebrile, with a mini-mental status evaluation showing her to be alert and oriented x 3. Her weight was > 95% for age with a body mass index of 35 kg/m2. Eye examination showed decreased light perception bilaterally, with papilledema and her venous pulsations could not be determined. Extraocular muscles were intact. Neurologically cranial nerves III-XII were intact, deep tendon reflexes were normal, strength and tone were normal. She had normal sensation and was able to walk but had problems because of her vision. She had no obvious ataxia. The work-up included an emergency consultation with ophthalmology and neurology that confirmed decreased vision, papilledema and no venous pulsations. She was taken to the pediatric intensive care unit, given intravenous Diamox®, Lasix® and Solumedrol®. Magnetic resonance imaging revealed the diagnosis of a non-occulsive venous sinus thrombosis in the right transverse sinus, but it was questioned whether or it this alone could be the cause of her idiopathic intracranial hypertension. A lumbar puncture was normal. The patient's clinical course showed her to have a continued decrease in her vision over the next day and therefore a lumboperitoneal shunt was placed to decrease the intracranial pressure. This stopped the visual decline but at discharge she had not regained her prior vision and had a discharge acuity of 20/150 in her right eye and 20/180 in her left eye. The diuretics were stopped and she was to continue prednisone, tapering it over 1 month. During her admission she was evaluated for her hypertension and her idiopathic hypertension was being controlled on propranolol at discharge. She had a hematological evaluation for a hypercoagulable state that was negative, but would have repeated Protein C and Protein S levels drawn later as acute levels may not be accurate. She was placed on aspirin prophylaxis. She was discharged to home with daily occupational therapy and physical therapy. She was to follow up with a local nutritionist for her obesity, with her local physician within the week and other specialists within the month. http://www.pediatriceducation.org/pictures/viewer$282 Figure 63 - Axial (left) and sagittal (right) T1-weighted magnetic resonance images of the brain demostrate a relatively small bright (seen here as white) signal abnormality in the right transverse sinus, concerning for venous sinus thrombosis. Figure 64 - 06-30-08 - Magnetic resonance venogram obtained with contrast demonstrates some irregularity in the contour of the right transverse sinus, but it is still patent and there is flow within it, demonstrating the thrombus is non-occlusive. Discussion Papilledema is described as congestion and elevation of the optic nerve head, blurring of the optic nerve disc margin, obliteration of the physiological optic cup, venous congestion with loss of spontaneous venous pulses, peripapillary splinter hemorrhages and edema of the peripapillary retina. An image of papilledema from EyeRounds.org can be seen by clicking here. Papilledema is a neurological emergency and needs prompt evaluation by specialists. The causes of papilledema include: Cataracts Demyelinating diseases Drugs Glaucoma Hypertension Iridocyclitis Meningo-encelphalitis Optic atrophy Tumor Retinitis pigmenotosa Idiopathic intracranial hypertension (IIH) is the proper term but many other terms are used such as benign intracranial hypertension or pseudotumor cerebri which is the term used by the National Library of Medicine. IIH is defined as elevated intracranial pressure but no clinical laboratory or radiographic evidence of hydrocephalus, infection, tumor or vascular abnormality. IIH has papilledema, normal or small cerebral ventricular system on radiographic imaging, no intracranial mass and normal cerebrospinal fluid. The pathogenesis of IIH is not complete understood. Proposed mechanisms include increased cerebral blood volume, increased cerebrospinal fluid secretion, increased venous sinus pressure and decreased cerebrospinal fluid absorption. All or combinations of these problems can lead to intracranial hypertension. IIH occurs from childhood (with an increasing incidence in adolescence) to adulthood. Infants and neonates usually do not have it. In younger children there is an equal gender distribution of patients, but as age increases female predominate. Patients often come to attention because of headache, nausea and/or vomiting, blurred vision or diplopia, dizziness, tinnitus and stiff neck. Other presentations include anorexia, increasing head size, pain behind the orbit, photophobia, head tilt and preference for knee-chest position. Patients can also be asymptomatic with papilledema noticed incidentally on physical examination. The papilledema in IIH is usually bilateral but may be unilateral or asymmetric. Treatment to decrease the intracranial pressure and to maintain vision include stopping possible causative drugs, diuretics (i.e. acetazolamide, furosemide), serial lumbar punctures, and operative procedures such as optic nerve sheath fenestration or placement of a lumboperitoneal shunt. With prompt treatment, visual loss can be completely reversible, but some visual loss is reported in up to 17% of patients. Recurrence rate is between 6-12% Learning Point Causes and possible associations with IIH include: Cardiovascular Heart murmur Mitral valve prolapse Heart transplant* Collagen Vascular Behçet disease Panuveitis Polyangiitis overlap syndrome Systemic lupus erythematosus Drugs Amiodarone Antibiotics - minocycline and tetracycline Chemotherapy - cytarabine Contraceptives, oral and implantable Danazol Desmopressin Human growth hormone Steroids or steroid withdrawal Lithium Mesalamine Nalidixic acid Nitrofurantoin Vitamin A, retinoic acid and similar drugs Endocrine Addison disease Cushing disease Hypocalcemia Hypo or hyperthyroidism Ovarian dysfunction Vitamin D-dependent rickets Vitamin A excess or deficiency Gastrointestinal Crohn's disease Genetic Guillain-Barré Galactosemia Miller-Fisher variant Hematologic Severe anemia Hypercoagulable states* Polycythemia vera Wiskott-Aldrich syndrome Infectious Disease Illness with fever Lyme disease* Measles Otitis media Roseola Sinusitis Streptococcal B pharyngitis Tonsillitis Upper respiratory tract infection Viral disease Varicella Pulmonary Asthma Chronic lung disease Cystic fibrosis* Renal Renal failure* Renal transplant* Surgical/Trauma Appendectomy Head trauma* Tonsillectomy and adenoidectomy Miscellaneous Malnutrition Obesity Postvaccination Refeeding Note: one paper (Rangwala and Liu, see To Learn More below) reviewed other reports which may not meet the standard criteria for IIH. This paper cites the following as possibly not meeting criteria for IIH: cystic fibrosis, head trauma, heart transplantation, hypercoagulable states, Lyme disease, renal failure and renal transplantation. Questions for Further Discussion 1. What radiographic imaging tests should be performed to evaluate papilledema? 2. What disease processes are considered neurological emergencies? 3What disease processes are considered opthalmological emergencies? Related Cases Disease Idiopathic Intracranial Hypertension Pseudotumor cerebri Benign Tumors Blood and Blood Disorders Eye Diseases High Blood Pressure Venous Sinus Thrombosis Symptom/Presentation Bleeding and Bruising Blurred Vision Hypertension Neck Stiffness Tinnitus Visual Field Defects Specialty Ophthalmology Neurology / Neurosurgery Radiology / Nuclear Medicine / Radiation Oncology Pharmacology / Toxicology Age Teenager To Learn More To view pediatric review articles on this topic from the past year check PubMed. Information prescriptions for patients can be found at MedlinePlus for this topic: (Source: PediatricEducation.org)

Comparison of time use, role participation and life satisfaction of older people after stroke with a sample without stroke

Australian Occupational Therapy Journal — Sat, 28 Jun 2008 04:00:00 +0100

Background/aims: This study investigated the time use, role participation and life satisfaction of older Australians (aged 65 years and older) who were 1[ndash]3 years post-stroke and living in the community. The results of this study were compared with a published study on the time use, role participation and life satisfaction of older Australians who had not experienced stroke.Methods: Twenty-three participants with stroke (mean age 74.2 years, 69.6% men) were interviewed using measures of time use, role participation and life satisfaction.Results: Participants with stroke spent most of their time in sleep (7.2 h/day), solitary leisure (7.0 h/day), social leisure (3.0 h/day), and basic activities of daily living (2.9 h/day). Compared to the sample without stroke, participants with stroke spent significantly less time in sleep, instrumental activities of daily living, and volunteer work, and significantly more time at home, with others, and engaged in solitary leisure. Similar to the sample without stroke, the most common roles for participants with stroke were family member, friend, and home maintainer. Participants with stroke engaged in fewer roles than participants without stroke. Unlike the sample without stroke, role loss was not correlated with life satisfaction for participants with stroke; however, having more roles was correlated with greater life satisfaction.Conclusion: Experiencing a stroke can affect the configuration of older people's time use and reduce their role participation. Facilitation of older people's role participation after stroke may enhance their life satisfaction. (Source: Australian Occupational Therapy Journal)

Coaching parents to enable children's participation: an approach for working with parents and their children

Australian Occupational Therapy Journal — Sat, 28 Jun 2008 04:00:00 +0100

In this paper, Occupational Performance Coaching (OPC) is presented as a means whereby occupational therapists can support parents in achieving goals for themselves and their children. OPC is a coaching intervention that assists parents to recognise and implement social and physical environment changes that support more successful occupational performance for themselves and their children. OPC utilises collaborative problem-solving within a coaching relationship in which parents are guided towards identifying and implementing effective, autonomous solutions to occupational performance dilemmas. OPC is described in relation to the principles of contemporary practice; in particular that intervention is both family- and occupation-centred, and leads, as directly as possible, to the enablement of children's participation at home and in the community. Tentative empirical support for coaching parents draws on the supporting evidence for similar interventions in cognate disciplines. The unique features of OPC, namely, overt collaborative analysis of performance with parents and parent-initiated solution finding, are highlighted and their potential contributions to interventions currently employed by therapists are outlined. Recommendations are advanced as to how further research can support the adoption of this intervention strategy. (Source: Australian Occupational Therapy Journal)

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Clinical reasoning in neurology: use of the repertory grid technique to investigate the reasoning of an experienced occupational therapist

Australian Occupational Therapy Journal — Sat, 28 Jun 2008 04:00:00 +0100

Background/aim: The aim of this paper is to describe the use of a structured interview methodology, the repertory grid technique, for investigating the clinical reasoning of an experienced occupational therapist in the domain of upper limb hypertonia as a result of brain injury.Method: Repertory grid interviews were completed before and after exposure to a protocol designed to guide clinical reasoning and decision-making in relation to upper limb neurological rehabilitation. Data were subjected to both qualitative and quantitative analyses.Results: Qualitative analysis focussed on clinical reasoning content. Common themes across the pre- and post-exposure interviews were the use of theoretical frameworks and practice models, the significance of clinical expertise, and discrimination of 'broad' and 'specific' aspects, as well as differentiation between 'therapist and client-related' aspects of the clinical situation. Quantitative analysis indicated that for both pre- and post-exposure repertory grids, clinical reasoning was structured in terms of two main concepts. In the pre-exposure grid, these were related to the therapist's role, and to the 'scope' of practice tasks (either broad or specific). In the post-exposure grid the two main concepts were upper limb performance, and client-centred aspects of the therapy process.Conclusions: The repertory grid technique is proposed as an effective tool for exploring occupational therapy clinical reasoning, based on its capacity for accessing personal frames of reference, and elucidating both the meaning and the structure supporting clinical reasoning. (Source: Australian Occupational Therapy Journal)

The tree theme method as an intervention in psychosocial occupational therapy: client acceptability and outcomes

Australian Occupational Therapy Journal — Sat, 28 Jun 2008 04:00:00 +0100

Background/aim: The Tree Theme Method (TTM) is an intervention in which the client paints trees representing certain periods in his/her life. The intervention comprises five sessions, using trees as a starting point to tell one's life story. This study, which is part of an implementation project, aimed to examine the therapeutic alliance and client satisfaction, in relation to perceptions of everyday occupations and health-related factors, with clients going through a TTM intervention.Methods: Nine occupational therapists recruited 35 clients, at general outpatient mental health care units, for the TTM intervention. Self-rating instruments, targeting therapeutic alliance (HAq-II), different aspects of daily occupations (Canadian Occupational Performance Measure, Satisfaction with Daily Occupations), health-related factors (Sense of Coherence measure, Mastery Scale, Symptom Checklist-90-R) and client satisfaction (Client Satisfaction Questionnaire), were administrated before and after the intervention.Results: A good initial therapeutic alliance, experienced by both therapists and clients, was correlated to increased changes regarding occupational performance and self-mastery. According to the therapists' ratings, a good initial therapeutic alliance was correlated to increased sense of coherence and a decreased level of psychiatric symptoms. The results showed positive significant changes in occupational performance and health-related factors. High ratings of the therapeutic alliance by the therapists were also related to high client satisfaction.Conclusions: The TTM seemed to function well in psychosocial occupational therapy, but there is a need for further implementation studies to deepen our understanding of the treatment process, comprising both technique and formation of the therapeutic alliance. (Source: Australian Occupational Therapy Journal)

Silver rings to treat arthritis symptoms validated

NaturalNews.com — Mon, 23 Jun 2008 07:00:00 +0100

(NaturalNews) Research by academics at the University of Southampton in collaboration with occupational therapy clinicians into the effectiveness of wearing a particular type of silver ring to alleviate symptoms of arthritis has found some benefits to their use.The research, which was carried out by academics from the University's School of Health Professions and Rehabilitation Sciences and the School of Electronics and Computer Science in conjunction with Occupational Therapy at Royal Hampshire County Hospital, Winchester, found that silver ring splints are effective in controlling hyperextension deformity of finger joints, which is common in individuals with rheumatoid arthritis.These silver ring splints are elegant rings, which have replaced bulky, plastic ones and are worn to give joints back their stability. Many patients think they look better than the plastic ones and they are also stronger and more durable.The paper, Three Dimensional Function Motion Analysis of Silver Ring Splints in Rheumatoid Arthritis, which was awarded the Arthritis Research Campaign Silver Medal at the British Society of Rheumatology's annual meeting, was honoured for its interdisciplinary approach.The research work was funded by a grant awarded by Wessex Medical Research. The research team consisted of Dr. Cheryl Metcalf, an engineer at the University of Southampton's School of Electronics and Computer Science, Caroline Spicka studying for her MSc at the University and Dr. Jo Adams Professional Lead for Occupational Therapy at the University, and a clinical occupational therapist from Royal Hampshire County Hospital.Silver Rings Splints can be purchased without prescriptions. I found one company, Silver Ring Splint Company, that specializes only in Silver Rings Splints and can be found at (http://www.silverringsplint.com/index.html) .Journal reference:Jo Adams et al. (http://rheumatology.oxfordjournals.org/cgi/reprint/47/suppl_2/ii151) Three Dimensional Functional Motion Analysis Of Silver Ring Splints In Rheumatoid Arthritis. Rheumatology, 47: ii151-ii157 DOI: 10.1093/rheumatology/kem530Source:University of Southampton (2008, June 4) (http://www.soton.ac.uk/)About the authorLeslee Dru Browning is a 6th generation Medical Herbalist and Nutritionist from the ancestral line of Patty Bartlett Sessions; Pioneer Mid-Wife and Herbalist. Leslee practiced Medical Herbalism and Nutritional Healing for over 25 years and specialized in Cancer Wellness along with Chronic Illness. She now devotes her career to teaching people, through her writing, about Natural Healing from An Herbal Perspective. (Source: NaturalNews.com)

The tree theme method as an intervention in psychosocial occupational therapy: client acceptability and outcomes

Australian Occupational Therapy Journal — Fri, 20 Jun 2008 18:46:12 +0100

Australian Occupational Therapy Journal, Volume 0, Issue 0, Page ???, September 2003. Background/aim: The Tree Theme Method (TTM) is an intervention in which the client paints trees representing certain periods in his/her life. The intervention comprises five sessions, using trees as a starting point to tell one's life story. This study, ... (Source: Australian Occupational Therapy Journal)

Use of the perceive, recall, plan and perform system of task analysis for persons with schizophrenia: a preliminary study

Australian Occupational Therapy Journal — Fri, 20 Jun 2008 08:44:15 +0100

Australian Occupational Therapy Journal, Volume 0, Issue 0, Page ???, September 2003. Background/aim: Task analysis that targets information processing skills is an essential tool to understanding difficulties encountered by people with schizophrenia in their daily activities. The purpose of this preliminary study was to explore the use ... (Source: Australian Occupational Therapy Journal)

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Coaching parents to enable children's participation: an approach for working with parents and their children

Australian Occupational Therapy Journal — Fri, 20 Jun 2008 08:44:11 +0100

Australian Occupational Therapy Journal, Volume 0, Issue 0, Page ???, September 2003. In this paper, Occupational Performance Coaching (OPC) is presented as a means whereby occupational therapists can support parents in achieving goals for themselves and their children. OPC is a coaching intervention that assists parents to recognise and ... (Source: Australian Occupational Therapy Journal)

Clinical reasoning in neurology: use of the repertory grid technique to investigate the reasoning of an experienced occupational therapist

Australian Occupational Therapy Journal — Fri, 20 Jun 2008 08:44:11 +0100

Australian Occupational Therapy Journal, Volume 0, Issue 0, Page ???, September 2003. Background/aim: The aim of this paper is to describe the use of a structured interview methodology, the repertory grid technique, for investigating the clinical reasoning of an experienced occupational therapist in the domain of upper limb hypertonia as ... (Source: Australian Occupational Therapy Journal)

Comparison of time use, role participation and life satisfaction of older people after stroke with a sample without stroke

Australian Occupational Therapy Journal — Fri, 20 Jun 2008 08:44:10 +0100

Australian Occupational Therapy Journal, Volume 0, Issue 0, Page ???, September 2003. Background/aims: This study investigated the time use, role participation and life satisfaction of older Australians (aged 65 years and older) who were 1–3 years post-stroke and living in the community. The results of this study were compared with a ... (Source: Australian Occupational Therapy Journal)

Rheumatology education for undergraduate nursing, physiotherapy and occupational therapy students in the uk: standards, challenges and solutions

Rheumatology — Mon, 16 Jun 2008 04:00:00 +0100

Objectives. Rheumatological conditions are common, thus nurses (Ns) occupational therapists (OTs) and physiotherapists (PTs) require at least basic rheumatology knowledge upon qualifying. The aim of this study was to develop a core set of teaching topics and potential ways of delivering them. Methods. A modified Delphi technique was used for clinicians to develop preliminary core sets of teaching topics for each profession. Telephone interviews with educationalists explored their views on these, and challenges and solutions for delivering them. Inter-professional workshops enabled clinicians and educationalists to finalize the core set together, and generate methods for delivery. Results. Thirty-nine rheumatology clinicians (12N, 14OT, 13PT) completed the Delphi consensus, proposing three preliminary core sets (N71 items, OT29, PT26). Nineteen educationalists (6N, 7OT, 6PT) participated in telephone interviews, raising concerns about disease-specific vs generic teaching and proposing many methods for delivery. Three inter-professional workshops involved 34 participants (clinicians: N12, OT9, PT5; educationalists: N2, OT3, PT2; Patient 1) who reached consensus on a single core set comprising six teaching units: Anatomy and Physiology; Assessment; Management and Intervention; Psychosocial Issues; Patient Education; and the Multi-disciplinary Team, recommending some topics within the units receive greater depth for some professions. An innovative range of delivery options was generated plus two brief interventions: a Rheumatology Chat Show and a Rheumatology Road Show. Conclusions. Working together, clinicians and educationalists proposed a realistic core set of rheumatology topics for undergraduate health professionals. They proposed innovative delivery methods, with collaboration between educationalists, clinicians and patients strongly recommended. These potential interventions need testing. (Source: Rheumatology)