Posts Tagged Daily activities

[THESIS] Participation in everyday life after stroke : development and evaluation of f@ce – a team-based, person-centred rehabilitation intervention supported by information and communication technology


AIM: The general aim of this thesis was to generate knowledge about how Information and Communication technology (ICT) could be used in the rehabilitation process after stroke in order to develop and evaluate the feasibility of F@ce- a person-centred, team-based intervention, supported by ICT, to enable performance of daily activities and participation in everyday life for people after stroke. 

METHODS: Studies I and II were qualitative grounded theory studies that were performed to generate knowledge on people after stroke and health care professionals working with rehabilitation after stroke, regarding the experiences of using ICT. The third study was a secondary analysis of a previously performed randomised controlled trial, evaluating a client-centred activities of daily living (CADL) intervention, to analyse factors of importance for a positive outcome in participation after stroke. The knowledge generated in studies I-III combined with previous research was used to develop F@ce, a team-based, person-centred intervention for rehabilitation after stroke, that was supported by ICT. Study IV was an evaluation of the feasibility of using F@ce, and the study design, in terms of the recruitment process, outcome measures used, fidelity, adherence, acceptability and potential harms. 

RESULTS: People after stroke in study I described their drive to integrate ICT in their everyday lives after stroke. They used their mobile phones to feel safe, to stay connected to friends and family, and to improve physical and cognitive functions. They also used their computer for social networks, to manage daily occupations such as paying bills, online shopping and searching for information. The healthcare professionals in study II did not use ICT to any greater extent outside their office, however, they had a vision that ICT could be used as a platform for sharing information and collaboration within the rehabilitation process. The results from study III showed that within the control group (receiving usual ADL interventions) those with mild stroke and home-based rehabilitation had a better outcome in perceived participation compared to the intervention group, however, in the intervention group the difference between stroke severity and context of rehabilitation were not significant. This would indicate that the CADL intervention were specifically useful for those with moderate to severe stroke and those receiving rehabilitation at an in-patient unit. The feasibility testing of the newly developed F@ce intervention in study IV showed that it was feasible to use, and that the fidelity, adherence and acceptability of the intervention were good. The participants had positive outcomes in performance (n=4) and satisfaction with the performance (n=6) of daily activities according to Canadian Occupational Performance measure (COPM) and several participants had clinically significant improvements in different domains in the Stroke Impact Scale (SIS).

CONCLUSION: The studies within this thesis enabled the development and evaluation of a new rehabilitation intervention, F@ce, using ICT which is relevant in this time, with the rapid digitalization in the society, healthcare and rehabilitation. The knowledge from the previously developed CADL study, along with the experiences of people after stroke and healthcare professionals’ use of ICT, and the modelling of F@ce together with stakeholders created a strong foundation for the new intervention. Using a team-based, person-centred intervention with the support of ICT seemed to enable people to perform daily activities and thus increase their participation in everyday life.

List of papers: 
I.Martha Gustavsson, Charlotte Ytterberg, Mille Nabsen Marwaa, Kerstin Tham & Susanne Guidetti. Experiences of using information and communication technology within the first year after stroke – a grounded theory study. Disability and Rehabilitation. 2016 (40) 561-568 

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[BLOG POST] Occupational Therapy Month: The Role of OT – NARIC

April is Occupational Therapy Month.  Occupational therapy (OT) is a client-centered health profession that helps people across the lifespan to do the things they want and need to do through therapeutic use of daily activities (occupations).  Occupational therapists use a holistic approach that focuses on the individual and work together with their clients to enhance their ability to engage in the occupations they want, need, or are expected to do. Occupational therapists enable people of all ages to live life to its fullest by helping them promote health, and prevent—or live better with—injury, illness, or disability.

Occupational therapy helps people function in all of their environments (e.g., home, work, school, community) and addresses the physical, psychological, and cognitive aspects of their well-being through engagement in occupation.  Occupational therapists may be employed in a number of roles, including but not limited to, practitioner, academic, manager, advocate, consultant, and researcher.  OT services typically include:

  • An individualized evaluation, during which the client/family and occupational therapist determine the person’s goals,
  • customized intervention to improve the person’s ability to perform daily activities and reach the goals, and
  • an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan.

Additionally, OT services may include comprehensive evaluations of the client’s home and other environments (e.g., workplace, school), recommendations for modifications to these environments or for adaptive equipment and training in its use, and guidance and education for family members and caregivers.  The American Occupational Therapy Association (AOTA) website offers a wide variety of resources on OT for children and youthadults, and caregivers as well as professionals. AOTA offers fact sheets on a variety of conditions related to rehabilitation and disability including the role of occupational therapists in reintegration into the community, chronic disease management, and community mobility and driving, among other topics.

Occupational therapists undergo extensive undergraduate, graduate, and/or doctorial accredited educational programs; as well as entry-level mentored practice.  After completion of a qualified accredited program an individual may sit for the national certification exam administered by the National Board for Certification in Occupational Therapy.  More information on job and career resources including qualifications for becoming an occupational therapist is available on the AOTA website.


via Occupational Therapy Month:  The Role of OT | Collection Spotlight from the National Rehabilitation Information Center

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[WEB SITE] What we learned about mirror therapy from almost 2000 patients

What we learned about mirror therapy from almost 2000 patients

September 3, 2018

Stroke tends to affect one side more than the other. It can leave us feeling off-balance and weaker on one side. Sometimes, people may be unable to stand up straight, or even use their arm or leg on their affected side. Physical therapy and exercises bring you a long way on your recovery path. But is there something else that can help?

A creative way to use a mirror

Sometimes, people try a treatment called mirror therapy. Mirror therapy involves placing a mirror in a particular way so you can see the good side of your body reflected to represent your affected side. The mirror stands in line with the middle of your body. That way, you see the unaffected half reflected in it, as if its the affected side of your body. It creates the optical illusion that your weak hand or leg is moving normally again. Initially, this technique was meant for people suffering from chronic pain. Now, stroke patients can benefit from mirror therapy too. It’s pretty easy to set up, even if you might be severely disabled. You can also do it on your own at home!

Does mirror therapy work?

But, does it even work? German researchers took on the enormous task of looking at the 62 studies out there about mirror therapy and stroke. Compiling all these studies, a total of 1982 patients were included. The data showed that mirror therapy resulted in moderate improvement of motor function and daily activities. Mirror therapy also seemed to work well for people suffering from post-stroke complex regional pain syndrome, which is a chronic pain caused by damage to the nerves. However, authors couldn’t tell if mirror therapy helped with neglect, which is when people have a hard time noticing things in the visual field on their bad side.

Try it today with your regular therapy!

It looks like mirror therapy really can’t hurt you if you want to try it. But don’t think that it could replace the efforts of hard work and physical therapy! We shouldn’t use mirror therapy instead of these other standard therapies but as a supplement. Right now, we just don’t know if it is as good as other treatments. But it wouldn’t hurt to try it along with the training you do with your therapist!

The lead author of this study was Dr. Holm Thieme, the Erste Europäische Schule für Physiotherapie, Ergotherapie und Logopädie, Klinik Bavaria Kreischa, Kreischa,  Saxony, Germany.


via What we learned about mirror therapy from almost 2000 patients – Strokemark : Strokemark

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[ARTICLE] Feasibility Analysis Of Daily Activities Using Assistive Robotic Manipulators – Full Text


In the United States, more than 21.5 million people report a limitation in their self-care activities and independent living. Assistive robotic manipulators (ARMs) can provide assistance with daily tasks for people with upper extremity impairments. Previous studies have evaluated ARM efficacy in completing single and multiple action tasks. This paper presents the feasibility analysis of two sequential daily self-care activities, brushing teeth and preparing and then eating a simple meal. The two tasks were successfully completed by a well-trained investigator using the ARM. By analyzing the difficulties and failures in the testing, the ARM’s kinematic and dynamic limitations and the kinesthetic perceptions made it difficult to re-adjust motion planning before errors occurred. In addition, we provide an example to alleviate environmental limitations. Due to the differences between the ARM and human motions, some intuitive human motion plans were not applicable to the ARM motion. The results of this work may help researchers and clinicians develop appropriate accessories, make adequate environmental adjustments, and tailor training for ARM users.


In the United States, more than 21.5 million people report limitations in the self-care activities and independent living (Erickson, Lee, & von Schrader, 2014), such as dressing and eating and doing errands alone. In addition, a growing older adult population with moderate to severe disabilities is estimated to reach 24.6 million people in 2040 (Johnson, 2007). Assistive robot manipulators (ARMs) have emerged as a tool to assist with activities of daily living (ADLs) (Allin, Eckel, Markham, & Brewer, 2010). Commercial ARMs such as iARM by the Exact Dynamics (Dindom, The Netherlands) and JACO by Kinova (Montreal, Canada), were developed to assist people with upper extremity impairments with manipulation tasks in their daily living and increase their independence (Driessen, Evers, & Van Woerden, 2001; Maheu, Archambault, Frappier, & Routhier, 2011).

The adaptation of new assistive technologies requires not only a solid understanding of the interface but also new ways in performing tasks. For example, a new power wheelchair user has to learn not only the joystick control interface but also develop new strategies to move around places due to the limitation of the mobility device. Similarly, better ARM performance relies on both the efficient control interface and fluid motion planning. Studies evaluated the ARM control efficiency using various levels of ADL tasks: single action, multiple actions, and sequential tasks (Chung, Wang, & Cooper, 2013), shown in Table 1. These studies evaluated ARM performance using single or multiple action tasks, such as pick-and-place and pushing buttons and evaluated users’ abilities with different control interfaces. However, most ADL tasks are sequential, which are the combinations of successful completion of single and multiple actions in a suitable sequence. A complete eating sequence includes not only scooping of food and placing a spoon in the mouth but also applying different motion plans to collect food from different locations in the bowl.

Several studies (Chung, Hannan, Wang, Kelleher, & Cooper, 2014; Chung, Wang, Kelleher, & Cooper, 2013) were conducted to evaluate the ARM efficacy with standardized performance evaluation tools that can minimize environmental variability so that performance from different studies can be easily contrasted or compared. These studies revealed statistical differences in the efficacy of ARM performance across tasks. Noticeably, better performance on the standardized tools may lead to less errors and faster performance in the sequential tasks. However, most ARM studies were evaluated in lab settings. The feasibility using common objects within ordinary environments remains to be determined. Additionally, few studies have reported the limitations and challenges of ARM performance under real life situations.

Thus, in this study, we assessed the feasibility of two sequential self-care tasks, brushing teeth and preparing and then eating a simple meal. Successful motion planning in conjunction with the limitations and challenges under real life situations were examined to help researchers and clinicians develop appropriate accessories and make adequate environmental adjustments for ARM users.

Figure 1. Two sequential tasks (Left: brushing teeth, Right: preparing and then having a simple meal)

Continue —> Feasibility Analysis Of Daily Activities Using Assistive Robotic Manipulators

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[WEB SITE] Traumatic Brain Injury: Effects and Interventions – AOTA

Occupational Therapy: Skills for the Job of Living

Traumatic brain injury (TBI) is caused by an impact to the head from direct blows or sudden movements in other parts of the body, such as severe shaking. TBI can result in physical, cognitive, behavioral, or emotional difficulties. Injuries can range from minor to extremely severe and call for various levels of intervention and treatment.

People with TBI may experience short-term memory loss, have difficulty concentrating or paying attention, become easily disoriented, have impaired judgment, experience headaches or migraines, have slurred speech, experience seizures, become fatigued, depressed, or easily agitated, or experience increased anxiety and impulsive behaviors.

Occupational therapists can help people who have sustained a TBI. The type and duration of intervention depend on how severe the injury.

What can an occupational therapist do?

  • Evaluate the client engaging in daily activities at home, such as dressing and eating; at work; and during leisure activities, and facilitate the resumption of those activities.
  • Establish and restore (depending on the age of the client) endurance and strength so that a person with TBI can bathe, dress, and feed himself or herself.
  • Help the client minimize overstimulation and confusion in his or her environment.
  • Help the client perform simple tasks that are meaningful to the person’s life.
  • Implement weekly checklists of household chores.
  • Recommend equipment that can aid a person in performing daily life activities with greater independence, such as a tub or shower seat to allow bathing without standing when the client has poor balance and grab bars for greater safety when getting in or out of a tub or shower.
  • Teach a person with TBI to compensate for problems with thinking, such as memory impairments.

What can families and friends of a person with a TBI do?

  • Become educated about the recovery process of a family member with a TBI.
  • Provide long-term support to a family member with a TBI.
  • Learn techniques to help the person with a TBI manage cognitive and physical problems.
  • Help the person adapt his or her home to accommodate the effects of a TBI.

Need more information?

A person with traumatic brain injury and his or her family likely will need long-term assistance. If you would like to consult an occupational therapist, they are available through most hospitals, medical centers, and community clinics.

Occupational therapists and occupational therapy assistants are trained in helping adults and children with a broad range of issues in addition to traumatic brain injury, such as arthritis, stroke, and mood disorders. Practitioners also help clients develop wellness techniques that may prevent injury and disease.

via Traumatic Brain Injury: Effects and Interventions.

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