[Abstract+References] Development of a tool to facilitate real life activity retraining in hand and arm therapy

Successful recovery of upper extremity function after stroke is more likely when the affected limb is used regularly in daily life. We developed an iPad (Apple) application called the ‘Aid for Decision-Making in Occupation Choice for Hand’ to facilitate daily upper extremity use. This study examined the suitability of items and pictures in the Aid for Decision-Making in Occupation Choice for Hand, and tested a paper prototype of the application (which has since been produced).

We used a Delphi method with 10 expert occupational therapists to refine the items in the aid. Next, we prepared pictures of items in the aid and confirmed their suitability by testing them with 10 patients (seven stroke, three cervical spondylotic myelopathy). Nine occupational therapists conducted field tests with a paper prototype of the aid in clinical practice to examine its utility.

After four Delphi rounds, we selected 130 items representing activities of daily living, organized into 16 categories. Of 130 pictures, 128 were recognizable to patients as representing the intended activities. Based on testing of the paper prototype, we found the Aid for Decision-Making in Occupation Choice for Hand process was suitable for clinical practice, and could be organized into six steps.

The Aid for Decision-Making in Occupation Choice for Hand process may promote daily upper extremity use. This application, since developed, now needs to be clinically tested in its digital form.


Ally BA, Budson AE (2007) The worth of pictures: Using high density event-related potentials to understand the memorial power of pictures and the dynamics of recognition memory. NeuroImage 35(1): 378395. Google Scholar CrossRef, Medline
Ally BA, Gold CA, Budson AE (2009) The picture superiority effect in patients with Alzheimer’s disease and mild cognitive impairment. Neuropsychologia 47(2): 595598. Google Scholar CrossRef, Medline
Ally BA, Waring JD, Beth EH, (2008) Aging memory for pictures: Using high-density event-related potentials to understand the effect of aging on the picture superiority effect. Neuropsychologia 46(2): 679689. Google Scholar CrossRef, Medline
Atwal A, Money A, Harvey M (2014) Occupational therapists’ views on using a virtual reality interior design application within the pre-discharge home visit process. Journal of Medical Internet Research 16(12): e283. Google Scholar CrossRef, Medline
Barecca S, Bohannon RW, Charness AL, (2001) Management of the Post Stroke Hemiplegic Arm and Hand: Treatment Recommendations of the 2001 Consensus Panel, Ontario, Canada: Heart and Stroke Foundation of Ontario. Google Scholar
Bouvat L, Kangas AJ, Szczech Moser C (2014) iPad apps in early intervention and school-based practice. Journal of Occupational Therapy, Schools & Early Intervention 7(1): 115. Google Scholar CrossRef
Che Daud AZ, Yau MK, Barnett F, (2016) Integration of occupation based intervention in hand injury rehabilitation: A randomized controlled trial. Journal of Hand Therapy 29(1): 3040. Google Scholar CrossRef
Curran T, Doyle J (2011) Picture superiority doubly dissociates the ERP correlates of recollection and familiarity. Journal of Cognitive Neuroscience 23(5): 12471262. Google Scholar CrossRef, Medline
Elwyn G, O’Connor A, Stacey D, (2006) International Patient Decision Aids Standards (IPDAS) collaboration. Developing a quality criteria framework for patient decision aid: Online international Delphi consensus process. British Medical Journal 333(7565): 417419. Google Scholar CrossRef, Medline
Embree LM, Budson AE, Ally BA (2012) Memorial familiarity remains intact for pictures but not for words in patients with amnestic mild cognitive impairment. Neuropsychologia 50(9): 23332340. Google Scholar CrossRef, Medline
Fujiwara Y, Shinkai S, Amano H, (2003) Test–retest variation in the Tokyo Metropolitan Institute of Gerontology Index of Competence in community-dwelling older people independent in daily living toward individual assessment of functional capacity. [Nihon Koshu Eisei Zasshi] 50(4): 360367. Google Scholar Medline
Gowland C, Stratford P, Ward M, (1993) Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment. Stroke 24(1): 5863. Google Scholar CrossRef, Medline
Graham ID, Logan J, Bennett CL, (2007) Physicians’ intentions and use of three patient decision aids. BMC Medical Informatics and Decision Making 7(1): 20. Google Scholar CrossRef, Medline
Gummesson C, Atroshi I, Ekdahl C (2003) The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: Longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskeletal Disorders 4(1): 11. Google Scholar CrossRef, Medline
Gummesson C, Ward MM, Atroshi I (2006) The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): Validity and reliability based on responses within the full-length DASH. BMC Musculoskeletal Disorders 7: 44. Google Scholar CrossRef, Medline
Klein RM, Bell B (1982) Self-care skills: Behavioral measurement with Klein-Bell ADL scale. Archives of Physical Medicine and Rehabilitation 63(7): 335338. Google Scholar Medline
Kopp B, Kunkel A, Flor H, (1997) The Arm Motor Ability Test: Reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living. Archives of Physical Medicine and Rehabilitation 78(6): 615620. Google Scholar CrossRef, Medline
Kurimoto S (2007) Validity and Reliability of the Hand 20. [Nihon Tegeka Gakkai Zasshi] 24(2): 14. Google Scholar
Lawton MP and Brody EM (1969) Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist 9(3): 179–186.
Lorah ER, Tincani M, Dodge J, (2013) Evaluating picture exchange and the iPad™ as a speech generating device to teach communication to young children with autism. Journal of Developmental and Physical Disabilities 25(6): 637649. Google Scholar CrossRef
Morris DM, Taub E, Mark VW (2006) Constraint-induced movement therapy: Characterizing the intervention protocol. Europa Medicophysica 42(3): 257–268. Google Scholar
O’Connor AM, Bennett CL, Stacey D, (2009) Decision aids for people facing health treatment or screening decisions. Cochrane Database Systematic Review 3: CD001431. Google Scholar
Ottenbacher KJ, Hsu Y, Granger CV, (1996) The reliability of the functional independence measure: A quantitative review. Archives of Physical Medicine and Rehabilitation 77(12): 12261232. Google Scholar CrossRef, Medline
Pollock A, Farmer SE, Brady MC, (2014) Interventions for improving upper limb function after stroke. Cochrane Database Systematic Review 11: CD010820. Google Scholar
Saposnik G, Chow CM, Gladstone D, (2014) iPad technology for home rehabilitation after stroke (iHOME): A proof-of-concept randomized trial. International Journal of Stroke 9(7): 956962. Google Scholar Link
Shepard RN (1967) Recognition memory for words, sentences, and pictures. Journal of Verbal Learning and Verbal Behavior 6(1): 156163. Google Scholar CrossRef
Shi YX, Tian JH, Yang KH, (2011) Modified constraint-induced movement therapy versus traditional rehabilitation in patients with upper-extremity dysfunction after stroke: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation 92(6): 972982. Google Scholar CrossRef, Medline
Sumsion T (1998) The Delphi technique: An adaptive research tool. The British Journal of Occupational Therapy 61(4): 153156. Google Scholar Link
Takebayashi T, Amano S, Hanada K, (2015) A one-year follow-up after modified constraint-induced movement therapy for chronic stroke patients with paretic arm: A prospective case series study. Topics in Stroke Rehabilitation 22(1): 1825. Google Scholar CrossRef, Medline
Takebayashi T, Koyama T, Amano S, (2013) A 6-month follow-up after constraint-induced movement therapy with and without transfer package for patients with hemiparesis after stroke: A pilot quasi-randomized controlled trial. Clinical Rehabilitation 27(5): 418426. Google Scholar Link
Taub E, Uswatte G, King DK, (2006) A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke 37(4): 10451049. Google Scholar CrossRef, Medline
Taub E, Uswatte G, Mark VW, (2013) Method for enhancing real-world use of a more affected arm in chronic stroke: Transfer package of constraint-induced movement therapy. Stroke 44(5): 13831388. Google ScholarCrossRef, Medline
Tomori K, Nagayama H, Saito Y, (2015) Examination of a cut-off score to express the meaningful activity of people with dementia using iPad application (ADOC). Disability and Rehabilitation: Assistive Technology 10(2): 126131. Google Scholar CrossRef, Medline
Tomori K, Saito Y, Nagayama H, (2013) Reliability and validity of individualized satisfaction score in aid for decision-making in occupation choice. Disability and Rehabilitation 35(2): 113117. Google Scholar CrossRef, Medline
Tomori K, Uezu S, Kinjo S, (2012) Utilization of the iPad application: Aid for decision-making in occupation choice. Occupational Therapy International 19(2): 8897. Google Scholar CrossRef, Medline
Uswatte G, Taub E, Morris D, (2005) Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use. Stroke 36(11): 24932496. Google Scholar CrossRef, Medline
Watanabe T, Kinoshita S, Takahashi C (2010) Further investigation of validity of the Paralytic arm Participation Measure (PPM) and its level of difficulty with each item. [Sagyo Ryoho Journal] 44(6): 489494.Google Scholar
Whiting P, Rutjes AW, Reitsma JB, (2003) The development of QUADAS: A tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology 3(Suppl 1): 25. Google Scholar CrossRef, Medline

Source: Development of a tool to facilitate real life activity retraining in hand and arm therapy – Mar 28, 2017


, , , , , , ,

  1. Leave a comment

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: