Posts Tagged adults

[Abstract] Efficacy of Telerehabilitation for Adults With Traumatic Brain Injury: A Systematic Review


Objective: To identify and appraise studies evaluating the efficacy of telerehabilitation for adults with traumatic brain injury (TBI).

Methods: A systematic search of Cochrane Library, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases was conducted from January 1980 to April 23, 2017, for studies evaluating the efficacy of telerehabilitation for adults with TBI. Two reviewers independently assessed articles for eligibility and rated methodological quality using 16 criteria related to internal validity, descriptive, and statistical characteristics.

Results: The review yielded 13 eligible studies, including 10 randomized controlled trials and 3 pre-/postgroup studies (n ≥ 10). These evaluated the feasibility and/or efficacy of telephone-based (10 studies) and Internet-based (3 studies) interventions. Overall, the evidence of efficacy was somewhat mixed. The most common study design evaluated the efficacy of telephone-based interventions relative to usual care, for which 4 of 5 randomized controlled trials reported positive effects at postintervention (d = 0.28-0.51). For these studies, improvements in global functioning, posttraumatic symptoms and sleep quality, and depressive symptoms were reported. The feasibility of Internet-based interventions was generally supported; however, the efficacy could not be determined because of insufficient studies.

Conclusions: Structured telephone interventions were found to be effective for improving particular outcomes following TBI. Controlled studies of Internet-based therapy and comparisons of the clinical and cost-effectiveness of in-person and telerehabilitation formats are recommended for future research.

via Efficacy of Telerehabilitation for Adults With Traumatic Bra… : The Journal of Head Trauma Rehabilitation

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[VIDEO] FAQs about CIMT for adults –  Constraint Induced Movement Therapy

Source: FAQs | CIMT | Constraint Induced Movement Therapy

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[WEB SITE] Fine Motor Skills for Adults – The Ultimate Collaborative List  

I am always looking for new fine motor skills ideas, specifically when working with adults. I tend to resort to my “old favorites” that I know work well, along with specific activities that are important to my patients.

But when I am working with a patient long term, where I need to grade the activity or trying to look for activities that are fun and new, I can get stuck.

So I asked 27 Occupational therapists –  What are your favorite fine motor control exercises when working with adults?

Below are the great ideas (and video!) we came up with – read, print and enjoy!

Get some new ideas with this HUGE list of fine motor activities when working with adults | #OT #geriatricOTNuts and bolts, lacing beads, using clothespins to pick up Pom pons to paint or just sort, buttons, zippers, snaps, putting marbles or rubber balls on golf tees, making small balls with putty or play doh, sorting jewelry, squeezing water out of sponges or towels, using different types of tongs to pick up small objects – Paula Bradley

Drawing a picture graded by changing the size of the paper. Bring in different materials stampers, finger paint, etc – Richard Brown

Folding clothes (wash cloths, socks), ADL board (button, zippers bra hooks etc), opening containers (toothpaste, lotion), clothes pins, rainbow rings for crossing midline, velcro board, keys and locks, theraputty, digiflex, beading craft – Jasmine Sohrakoff

My bin of various empty grocery containers is my go-to for FMC to open/close, and having pts reach for them in cabinets/refrigerators/shelves of various heights is one of my favorite GMC activities. – Sarah Stromsdorfer from

I take them straight to the kitchen and do bathroom stuff! I get them to open their make up containers, shampoo/conditioner bottles, wearing weights while organizing shelves in the bathroom and or kitchen…make meatballs, bread, pies for meal prep…opening different containers of milk, using the manual can opener. Sorting dry a bag of dry beans for meal prep…decorating cookies and cupcakes. – India Leah Davis

Theraband activities or squeezing a ball. – Noreena Ishtiaq


I had a patient who had a stroke that was a retired banker. I brought in all sorts of coins/dollars he really enjoyed sorting them into various piles, placing them in stacks, etc. – Samantha Kaufman

One easy fine motor activity I really like is to take a piece of paper and using one hand, make it into a ball, then spread it out flat.

Click here to see this exercise in action on the SeniorsFlourish Facebook page. 

But Rachel Hall, had a suggestion to take it one step farther to grade it by starting with the paper on table then raise it up once in the hand so no “cheating.”

My patient cleaned a tray table of shaving cream and told me she liked doing a functional task. – Sharon Leary

Graded puzzles (larger piece sizes to smaller); grooming/hygiene tasks – open/close/apply toothpaste, lotion, lipstick; sort through a purse or bag to retrieve a specified item; pulling out a Kleenex or paper towel; open/close food and kitchen storage containers; buttons and zippers; play checkers or arrange on the board; handle money; turn pages of a book or magazine; pull silverware from a dish rack, separate them, and put into silverware tray; spray and wash a window or mirror; turn faucets on/off or light switches. Anything functional! – Monica Heltemes from

I’d love to try origami – Ruby Kopenski

We use a weightwell for strengthening and grip (graded). We also have a woodwork and arts and crafts area at work which enables meaningful engagement. – Charlotte Parry

I like those fleece blankets you tie together… they can give it to someone. One of my ladies was expecting a great granddaughter – so she was able to give her something she made. She was so excited. – Tonya Gladden

HUGE list of fine motor activities when working with adults | #OT #geriatricOTMaking salt dough and using cookie cutters to make shapes. End product is endless – tags for gifts, place cards, add essential oils to dough and make hanger for closet. Stringing beads for tree decorations at Xmas and Mardi Gras.

Weaving on a simple table loom – make scarves, placemats, etc. Card making with dye cuts. Silkscreening. Puzzles with the pieces hidden in rotini pasta/beans/black eye peas all dry and uncooked. Adult coloring books. – Jane Ryan

Pony bead necklaces and bracelets, flower pens, sorting beans in a weekday pill tray, letting the patient show you how to crochet if you don’t know how, lacing boards. – Natalie Nunyabiz

We removed the line, cleaned, oiled and put a new line on a fishing rod. Box of various nuts and bolts, pennies in piggy bank, placing lots of washers on a long bolt, various locks and keys, buttoning small buttons on a shirt. Have had ladies cut coupons and make cards. – Tammy Lane

Therapy apron which has all sorts of buttons, zips, Velcro, buckles and ties. Even typing or musical instrument playing. – Bec Rourke

I’ll find out their interests. ADL (example: dressing board), IADL (example: cooking, money management like picking coin) or leisure (gardening, word finding-using pen or computer base). – Vicneas Veloo

The game “Topple” is great for fine motor. – TerriAnne Zocco Ragonese

I love to use cards games and board games: checkers, chess, Sorry, Yahtzee, Jenga, BananaGrams, Sour Apples, Chinese Checkers. Jewelry making. Cooking tasks, like that are related to holiday themes and decorating them by hand with candy decorations and frosting bags. napping fresh green beans, teaching some of the basic sign language letters. Working on the computer. Handwriting, letter writing or card writing and have them address the envelopes as well. Crochet/knit/hook rugs. Have women put on make up or do nail care and have them paint their nails. Put together models of cars or even miniture furniture. – Julie Clark Spuhler

I use culturally relevant activity prescription such as cooking. – Jouyin Teoh

Making bread and cookies. Model planes, cars and boats. Lego kits and designs. – Sandy Hanebrink

It’s always fun to bring a nostalgic type of games as long as they understand why were doing the particular task.  jacks, string games (“Cat’s Cradle”), etc. Simple sport games on the Ipad or Iphone like “swim meet” and “tennis.” – Ylisa Gabay Young

I have used woodwork projects and model airplanes – sanded and then painted projects to display in their rooms at the SNF. – Michelle Stoermer


If you are looking for a few more activity ideas for your patients, check out Domino Match Game for Patients with Low Level Dementia or Occupation Based Kit Ideas for Your Rehab Department

<< Visit Site for the Link to free PDF of this ENTIRE list in an easy, quick reference chart organized by fine motor activity type >>

Source: Fine Motor Skills for Adults – The Ultimate List | Seniors Flourish

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[Abstract] Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015


Stroke rehabilitation is a progressive, dynamic, goal-orientated process aimed at enabling a person with impairment to reach their optimal physical, cognitive, emotional, communicative, social and/or functional activity level.

After a stroke, patients often continue to require rehabilitation for persistent deficits related to spasticity, upper and lower extremity dysfunction, shoulder and central pain, mobility/gait, dysphagia, vision, and communication.

Each year in Canada 62,000 people experience a stroke. Among stroke survivors, over 6500 individuals access in-patient stroke rehabilitation and stay a median of 30 days (inter-quartile range 19 to 45 days). The 2015 update of the Canadian Stroke Best Practice Recommendations: Stroke Rehabilitation Practice Guidelines is a comprehensive summary of current evidence-based recommendations for all members of multidisciplinary teams working in a range of settings, who provide care to patients following stroke.

These recommendations have been developed to address both the organization of stroke rehabilitation within a system of care (i.e., Initial Rehabilitation Assessment; Stroke Rehabilitation Units; Stroke Rehabilitation Teams; Delivery; Outpatient and Community-Based Rehabilitation), and specific interventions and management in stroke recovery and direct clinical care (i.e., Upper Extremity Dysfunction; Lower Extremity Dysfunction; Dysphagia and Malnutrition; Visual-Perceptual Deficits; Central Pain; Communication; Life Roles).

In addition, stroke happens at any age, and therefore a new section has been added to the 2015 update to highlight components of stroke rehabilitation for children who have experienced a stroke, either prenatally, as a newborn, or during childhood.

All recommendations have been assigned a level of evidence which reflects the strength and quality of current research evidence available to support the recommendation. The updated Rehabilitation Clinical Practice Guidelines feature several additions that reflect new research areas and stronger evidence for already existing recommendations.

It is anticipated that these guidelines will provide direction and standardization for patients, families/caregiver(s), and clinicians within Canada and internationally.

Source: Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015

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[Abstract] Play-based interventions improve physical function for people with adult-acquired brain injury: a systematic review and meta-analysis of randomised controlled trials [with consumer summary] – PEDro 

Saywell N, Taylor N, Rodgers E, Skinner L, Boocock M

Clinical Rehabilitation 2016 Feb 11:Epub ahead of print

systematic review


OBJECTIVE: To undertake a systematic review and meta-analysis of the effectiveness of play-based interventions compared to traditional therapy in rehabilitation of adults with adult-acquired brain injury.

DATA SOURCES: The search was performed using Medline; CINAHL Plus; Health Source (Nursing/Academic Edition); Psychology and Behavioural Sciences Collection; Biomedical Reference Collection (Basic).

REVIEW METHODS: Studies included were randomised controlled trials that investigated the effect of play-based interventions on physical function of adults with adult acquired brain injury. Two independent reviewers identified eligible studies and assessed methodological quality using a modified Downs and Black. Meta-analysis compared standardised differences in means, to determine effect sizes for grouped functional outcome measures. The GRADE scoring system was used to determine the level of clinical evidence.

RESULTS: Thirty studies met the inclusion criteria, 13 were considered high quality and 17 moderate quality. Studies predominantly involved post-stroke participants, with only three studies including participants with traumatic brain injury. When compared to traditional therapy, dose-matched studies of play-based interventions showed a significant effect on independence (effect size (ES) 0.6) and physical performance (ES 0.43), as measured using the Fugl-Meyer. For non-dose matched studies, play-based interventions showed a significant improvement for balance (ES 0.76) compared with traditional therapy. In all studies that measured participant enjoyment, play-based therapy was rated as more enjoyable than traditional therapy.

CONCLUSION: Play-based interventions for people with adult acquired brain injury are more effective in improving balance and independence, which may be due to them being more enjoyable than traditional therapy.

Full text (sometimes free) may be available at these link(s):


Source: PEDro – Search Detailed Search Results


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[REVIEW] A review of postoperative cognitive dysfunction: Diagnostic and rehabilitation – Full Text PDF


Postoperative cognitive dysfunction is a very common event after cardiac surgery, especially in elder patients and with lower education levels. The prevention of POCD should be done using a few simple features before surgery and during surgery, such as corticosteroids before surgery to reduce inflammation of the brain, which affect cognition. When possible, the anesthetic technique must be performed using the bispectral index (BIS) for controlling the length and depth of surgical anesthesia. The use of anesthetics that cause less damage in cognition in relation to other drugs that are already established as POCD trigger can also be the best way. The use of imaging tests that facilitate the research of cognitive disorders such as the use of structural and functional MRI or EEG for the accuracy of the survey brain region affected and that affected functions are good resources for cognitive rehabilitation. The cognitive rehabilitation techniques are very diversified as the use of digital games and activities that stimulate neuropsychological functions. The use of direct electrical current stimulation (tDCS) or of other electrical stimulation techniques can help the patient on rehabilitation of cognitive functions during the postoperative period.

Full Text PDF

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