Posts Tagged Occupational therapy

[Case Study] Improved functional independence measure facilitates return to home after paralyzed upper-limb training: a case report – Full Text PDF

Abstract.

[Purpose] We report a case in which rehabilitation that targeted the paralyzed side’s upper limb in a hemiplegic stroke patient remarkably accelerated the patient’s ability to perform activities of daily living, improved her Functional Independence Measure score, and facilitated the patient’s return to home.

[Subject and Methods] We provided rehabilitation training to a female patient who experienced a cerebral infarction at a nursing home for the elderly and was admitted to the Kaifukuki recovery phase rehabilitation ward in order to improve her activities of daily living and return home. An intensive rehabilitation program incorporating occupational therapy and physical training for upper-limb function on the affected side was instituted over 170 days.

[Results] At presentation, the patient had functional disorders and load-induced pain in both lower limbs requiring her to walk with a fixed-type walker. After the intensive rehabilitation program, her activities of daily living improved and she was able to return home.

[Conclusion] This case suggests that activities of daily living training and simultaneous active training of upper-limb function on the affected side in patients with functional disorders or lower-limb pain could effectively improve their Functional Independence Measure scores, promote functional recovery, and facilitate their return to home.

INTRODUCTION

Motor and cognitive impairments in stroke patients result in disability or dependence during activities of daily living (ADL) among the elderly. ADL performance requires optimal motor function in the trunk and upper and lower extremities. Self-reported disability measures, such as the Functional Independence Measure (FIM), are used to determine functional limitations1) . As it is more difficult to recover function in affected upper extremities than it is in the lower extremities, and since ADL can often be performed with only the unaffected side2, 3) , rehabilitation is aimed at improving function in the unaffected upper extremity4, 5) or switching hand dominance6) . Strategies are designed to improve FIM scores and reduce return-to-home times, as these measures are often also used to evaluate the productivity of rehabilitation clinics and determine budget- and reimbursement-related questions as well7) . In this setting where training to improve function in the affected upper extremity is seldom prioritized, we experienced a rare case wherein functional improvement in the affected dominant upper extremity greatly improved FIM scores and allowed the patient to return home.

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[BLOG POST] Study Compares Intento Device and Traditional Occupational Therapy  

The Intento device is designed to enable patients to control the functional electronic stimulation that they receive, to help patients regain mobility in arms weakened by a stroke.

The Intento device is designed to enable patients to control the functional electronic stimulation that they receive, to help them regain mobility in arms weakened by a stroke.

A device from Ecole Polytechnique Fédérale de Lausanne startup company Intento is designed to enable stroke patients to self-administer functional electrical stimulation to help regain mobility in their arms weakened by the stroke.

The system consists of electrode patches, a device the patients control using their working hand, and tablet software. The therapist selects one of several programmed movements on the tablet and loads it, with a single click, onto the device. The program shows where the electrodes need to be placed and automatically configures the electrical pulse settings to generate the desired movement. Patients then move their functioning hand to control the electrical stimulation needed.

The ultimate aim is for patients to eventually perform the movements without using the device, explains a media release from Ecole Polytechnique Fédérale.

Results from a study investigating Intento’s device were published recently in Archives of Physical Medicine and Rehabilitation.

In the study, researchers from Lausanne University Hospital (CHUV) compared the device to conventional occupational therapy among 11 patients who were severely paralyzed as the result of a stroke. These patients experienced the stroke more than 6 months prior to the study, and other therapies did not work for them.

Over a period of 10 days, the 11 patients underwent 1.5-hour sessions using the Intento device.

Their mobility results from using the device were then compared to the results following conventional occupational therapy conducted over the same amount of time. The patients’ mobility was measured before and after each type of treatment, according to the release.

The results suggest that 70% of the patients experienced significant improvement in their motor functions, versus only 30% of the patients with the conventional occupational therapy.

“Above and beyond the study’s findings, several of the patients told us a few weeks later that they were already using their arms more than before,” says Andrea Maesani, Intento’s CEO and other cofounder, in the release.

Patients were still making steady progress 6 months after the study was conducted, suggesting that the treatment produces long-term effects, according to the release.

The next step will be a clinical study on a larger group before marketing the device, the founders state in the release.

[Source(s): Ecole Polytechnique Fédérale, EurekAlert]

Source: Study Compares Intento Device and Traditional Occupational Therapy – Rehab Managment

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[BOOK] A Dictionary of Occupational Science and Occupational Therapy – Matthew Molineux – Google Books

Front Cover

A Dictionary of Occupational Science and Occupational Therapy

Matthew Molineux

Oxford University PressMar 23, 2017 – Medical – 512 pages
Including over 600 A to Z entries, this original dictionary provides clear and succinct definitions of the terms used in the related and developing fields of occupational science and occupational therapy. Entries cover a broad range of topics from activities of daily living and autonomy to task-oriented approach and work-life balance and have a clear occupational focus. They provide an overview of the complex nature of human occupation and the impact of illness on occupation and well-being. Descriptions and analysis are backed up by key theories from related areas such as anthropology, sociology, and medicine. This is an authoritative resource for students of occupational science and occupational therapy, as well as an accessible point of reference for practitioners from both subject areas.

Source: A Dictionary of Occupational Science and Occupational Therapy – Matthew Molineux – Google Books

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[Research Poster] Management of Visual Deficits with Neurological Etiology – Implications for Practice Patterns and Inter-professional Collaboration

To investigate and describe:

  1. occupational therapy practice patterns as it relates to low vision and visual dysfunction,
  2. what occupational therapy practitioners perceive as their level of competence in addressing vision and how competence is achieved,

  3. the importance of inter-professional management to provide comprehensive care and best practice for visual deficits,

  4. potential practice guidelines for the management of visual deficits resulting from neurological etiology.

Source: Management of Visual Deficits with Neurological Etiology – Implications for Practice Patterns and Inter-professional Collaboration – Archives of Physical Medicine and Rehabilitation

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[Abstract] Delivering occupational therapy hand assessment and treatment sessions via telehealth

Telehealth offers a solution to assist delivery of occupational therapy (OT) services for hand therapy in rural and remote locations. However, there is currently no evidence to validate this service model. The aim of this study was to examine the validity of clinical decisions made during hand therapy sessions conducted via telehealth compared to a traditional clinical model (TCM) assessment, and explore patient and clinician satisfaction.

Eighteen patients referred for hand therapy to a rural/remote hospital-based outpatient service were assessed simultaneously via telehealth and a TCM assessment. An allied health assistant supported data collection at the patient end. Hand function was assessed using a range of objective measures, subjective scales and patient reported information. Minimal level of percent exact agreement (PEA) between the telehealth OT (T-OT) and the TCM-OT was set at ≥80%.

Level of agreement for all objective measures (dynamometer and pinch gauge reading, goniometer flexion and extension, circumference in millimetres) ranged between 82% and 100% PEA. High agreement (>80% PEA) was also obtained for judgements of scar and general limb function, exercise compliance, pain severity and sensitivity location, activities of daily living and global ratings of change (GROC) scores. There was 100% PEA for overall recommendations. Minimal technical issues were experienced. Patient and clinician satisfaction was high.

Clinical decisions made via telehealth were comparable to the TCM and consumers were satisfied with telehealth as a service option. Telehealth offers the potential to improve access to hand therapy services for rural and remote patients.

Source: Delivering occupational therapy hand assessment and treatment sessions via telehealth – Feb 13, 2017

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[ARTICLE] Electromyographic Activity of the Upper Limb in Three Hand Function Tests – Full Text

Summary

Objective/Background

Occupational therapists usually assess hand function through standardised tests, however, there is no consensus on how the scores assigned to hand dexterity can accurately measure hand function required for daily activities and few studies evaluate the movement patterns of the upper limbs during hand function tests. This study aimed to evaluate the differences in muscle activation patterns during the performance of three hand dexterity tests.

Methods

Twenty university students underwent a surface electromyographic (sEMG) assessment of eight upper limb muscles during the performance of the box and blocks test (BBT), nine-hole peg test (9HPT), and functional dexterity test (FDT). The description and comparison of each muscle activity during the test performance, gender differences, and the correlation between individual muscles’ sEMG activity were analysed through appropriate statistics.

Results

Increased activity of proximal muscles was found during the performance of BBT (p < .001). While a higher activation of the distal muscles occurred during the FDT and 9HPT performance, no differences were found between them. Comparisons of the sEMG activity revealed a significant increase in the muscle activation among women (p = .05). Strong and positive correlations (r > .5; p < .05) were observed between proximal and distal sEMG activities, suggesting a coordinate pattern of muscle activation during hand function tests.

Conclusion

The results suggested the existence of differences in the muscle activation pattern during the performance of hand function evaluations. Occupational therapists should be aware of unique muscle requirements and its impact on the results of dexterity tests during hand function evaluation.

Introduction

Hand and upper extremity function is essential to humans as it allows for the performance of a wide range of self-care, productive, and leisure activities (Chan & Spencer, 2004). Due to its importance, impairments in the upper extremities lead to restrictions on activity performance and impacts participation in social activities and engagements in meaningful occupations, ultimately affecting overall wellbeing and quality of life (van de Ven-Stevens et al., 2016).

Treating patients with hand and upper limb injuries is a common situation for occupational therapists; hand and wrist lesions account for approximately 20% of all cases seen in hospital emergency departments (Dias & Garcia-Elias, 2006), with most patients presenting further limitations to upper extremity function due to a restricted range of motion, pain, oedema, and muscle weakness caused by the trauma (Ydreborg, Engstrand, Steinvall, & Larsson, 2015). In addition to acute situations, restricted hand function also represents one of the leading causes of limited participation in daily activities by patients with chronic diseases, such as rheumatoid arthritis (Andrade, Brandão, Pinto, & Lanna, 2016) and stroke (Dawson, Binns, Hunt, Lemsky, & Polatajko, 2013).

Although the cause of injury varies in different countries (Che Daud, Yau, Barnett, Judd, Jones, & Muhammad Nawawi, 2016), the majority of the upper limb trauma affects working adults aged between 20 years and 64 years (de Putter et al., 2016), thereby causing a significant economic impact. Studies completed in the past decade have estimated the healthcare and productivity costs of upper limb lesions to be US$ 410–740 million per year (de Putter et al., 2012 ;  de Putter et al., 2016), with increased absenteeism and early retirement age observed among patients (Shi et al., 2014 ;  Tiippana-Kinnunen et al., 2013).

Assessment procedures that allow occupational therapists to obtain accurate and reliable information regarding patients’ hand function are essential for setting realistic goals and measuring patients’ progression during the rehabilitation of upper limb injuries (Carrasco-Lopez et al., 2016). Amongst the several resources available, standardised manual tests are extensively used during the evaluations of hand function to assess the upper limb coordination and skill through a series of tasks involving the manipulation of objects in established patterns (Ekstrand et al., 2016; Srikesavan et al., 2015 ;  van de Ven-Stevens et al., 2016).

Despite focusing on the measurements of body functions and structures, standardised dexterity tests provide valid and reliable data that aids therapists in understanding the impact of hand injuries on patients’ activities of daily life. Commonly used standardised tests have high inter-rater and test-retest reliability, usually with an intraclass correlation coefficient (ICC) greater than 0.85 (Aaron and Jansen, 2003; Desrosiers et al., 1994 ;  Earhart et al., 2011).

However, given the existence of multiple standardised dexterity tests and an even greater variety of structured tasks involved in each assessment, there is no consensus on which test is more suitable for evaluating the entire function of upper extremities (van de Ven-Stevens et al., 2016). Moreover, there is an increasing concern regarding the way by which the scores assigned to hand dexterity can accurately measure hand function required for daily activities (Rallon and Chen, 2008; Rand and Eng, 2010 ;  van de Ven-Stevens et al., 2016).

The study of muscle activation through surface electromyography (sEMG) allows a real-time, noninvasive assessment of the activation pattern of muscles during the activity performance (Gurney et al., 2016). Although sEMG has been used to evaluate the muscle activation patterns in several self-care (Meijer et al., 2014), productivity (Almeida et al., 2013 ;  Ferrigno et al., 2009), and leisure activities (Donoso Brown, McCoy, Fechko, Price, Gilbertson, & Moritz, 2014), few studies have analysed the different recruitment of muscle fibres during the performances of different hand function tests (Brorsson et al., 2014 ;  Calder et al., 2011).

Considering the lack of studies describing the muscle activities of the upper extremities in standardised hand assessments, this study aimed to evaluate and compare the differences in muscle activation patterns during the performance of the box and blocks test (BBT), nine-hole peg test (9HPT), and functional dexterity test (FDT)—the three hand dexterity tests used by occupational therapists during hand function evaluation.

Continue —> Electromyographic Activity of the Upper Limb in Three Hand Function Tests

Experimental setting. (A) Box and blocks test; (B) Nine-hole peg test; (C) ...

Figure 1. Experimental setting. (A) Box and blocks test; (B) Nine-hole peg test; (C) functional dexterity test.

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[Abstract] Giving Them a Hand: Wearing a Myoelectric Elbow-Wrist-Hand Orthosis Reduces Upper Extremity Impairment in Chronic Stroke

Abstract

Objective

Determine the immediate impact of a portable, myoelectric elbow-wrist-hand orthosis (MEWHO) on paretic upper extremity (UE) impairment in chronic, stable, moderately impaired stroke survivors.

Design

Observational cohort study Setting: Outpatient rehabilitation clinic

Participants

18 participants exhibiting chronic, moderate, stable, post-stroke, UE hemiparesis.

Interventions

Subjects were administered a battery of measures testing UE impairment as well as UE function. They then donned a fabricated MEWHO and were again tested on the same battery of measures while wearing the device.

Main Outcome Measures

The primary outcome measure was the UE section of the Fugl-Meyer Impairment Scale (FM). Subjects were also administered a battery of functional tasks and the Box and Blocks test (BB).

Results

Subjects exhibited significantly reduced UE impairment while wearing the MEWHO (FM: t {17} = 8.56, p < .0001), and increased quality in performing all functional tasks while wearing the MEWHO, with three subtasks showing significant increases (Feeding {grasp}: Z=2.251, p=.024; Feeding {elbow}: Z=2.966, p=.003; Drinking {grasp}: Z= 3.187, p=.001). Additionally, subjects showed significant decreases in time taken to grasp a cup (Z=1.286, p=.016) and increased gross manual dexterity while wearing a MEWHO (BB: Z =3.42, p < .001).

Conclusion

Results suggest that UE impairment, as measured by the FM, is significantly reduced when donning a MEWHO and these changes exceeded the FM’s clinically important difference threshold. Further, utilization of a MEWHO significantly increased gross manual dexterity and performance of certain functional tasks. Future work will integrate education sessions to increase subjects’ ability to perform multi-joint functional movements and attain consistent functional changes.

Source: Giving Them a Hand: Wearing a Myoelectric Elbow-Wrist-Hand Orthosis Reduces Upper Extremity Impairment in Chronic Stroke – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Does a combined intervention program of repetitive transcranial magnetic stimulation and intensive occupational therapy affect cognitive function in patients with post-stroke upper limb hemiparesis? – Full Text HTML

 

Abstract

Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) to the contralesional hemisphere and intensive occupational therapy (iOT) have been shown to contribute to a significant improvement in upper limb hemiparesis in patients with chronic stroke. However, the effect of the combined intervention program of LF-rTMS and iOT on cognitive function is unknown. We retrospectively investigated whether the combined treatment influence patient’s Trail-Making Test part B (TMT-B) performance, which is a group of easy and inexpensive neuropsychological tests that evaluate several cognitive functions. Twenty-five patients received 11 sessions of LF-rTMS to the contralesional hemisphere and 2 sessions of iOT per day over 15 successive days. Patients with right- and left-sided hemiparesis demonstrated significant improvements in upper limb motor function following the combined intervention program. Only patients with right-sided hemiparesis exhibited improved TMT-B performance following the combined intervention program, and there was a significant negative correlation between Fugl-Meyer Assessment scale total score change and TMT-B performance. The results indicate the possibility that LF-rTMS to the contralesional hemisphere combined with iOT improves the upper limb motor function and cognitive function of patients with right-sided hemiparesis. However, further studies are necessary to elucidate the mechanism of improved cognitive function.

 

Introduction
Upper limb hemiparesis is reported to be observed in 55–75% of post-stroke patients, and affects the patient’s activities of daily living and quality of life (Nichols-Larsen et al., 2005; Wolf et al., 2006). Duncan et al. (1992) reported that dramatic recovery of motor function was completed by 1month post-stroke, and that recovery often plateaued by 6 months. In recent years, repetitive transcranial magnetic stimulation (rTMS) has attracted attention as a treatment technique for the sequelae of stroke. It is a non-invasive, painless method to stimulate regions of the cerebral cortex, in which a figure-8 or a round coil converts electrical current into a rapidly variable magnetic field that is orthogonal to the current. Eddy currents generated by the changes of the magnetic field directly affect neurons (Barker, 1999). In addition, it has been known that different stimulation frequencies have different effects on the activities of the cerebral cortex, with high-frequency (> 5 Hz) stimulation facilitating local neuronal excitability and low-frequency (< 1 Hz) stimulation showing inhibitory effects (Lefaucheur, 2006; Butler and Wolf, 2007). Low-frequency rTMS (LF-rTMS) aims at increasing the excitability of the ipsilesional hemisphere by exerting its effects on the disrupted interhemispheric inhibition following stroke and thereby providing inhibitory stimulation to the contralesional hemisphere. Meta-analyses of rTMS in patients with stroke indicate that LF-rTMS is recommended for stroke patients in the chronic phase (> 6 months post-stroke), showing a strong possibility of a significant improvement of their upper limb function (Hsu et al., 2012; Le et al., 2014). In the past, our research group implemented a 15-day treatment protocol consisting of LF-rTMS and an intensive individualized rehabilitation program for patients with upper limb hemiparesis following stroke, and demonstrated a significant improvement of upper limb hemiparesis (Kakuda et al., 2011, 2012, 2016). Furthermore, we investigated the effects of our treatment protocol on brain activity and demonstrated a significant increase in the fMRI laterality index, indicating increased neuronal activity in the ipsilesional hemisphere (Yamada et al., 2013). Our single photon emission computed tomography (SPECT) study also demonstrated a significant decrease in perfusion in the middle frontal gyrus (Brodmann area; BA6), precentralgyrus (BA4), and post central gyrus (BA3) of the contralesional hemisphere, as well as an increased perfusion in the insula (BA13) and precentral gyrus (BA44) of the ipsilesional hemisphere (Hara et al., 2013). Thus, we demonstrated changes in brain activity between pre- and post-treatment that combined LF-rTMS and an intensive occupational therapy (iOT) program.

In recent studies, rTMS was used not only in treating upper limb hemiparesis after stroke, but also for other conditions, including neurological and psychiatric disorders, pain, and Parkinson’s disease (Lefaucheur et al., 2014). Furthermore, some studies conducted neuropsychological examinations at the time of rTMS to evaluate its effect on cognitive function (Nardone et al., 2014; Drumond Marra et al., 2015). One study reported an improvement in cognitive function following rTMS in patients with mild cognitive impairment (Nardone et al., 2014). Drumond Marra et al. (2015) reported an improved performance on the Rivermead Behavioral Memory Test following high-frequency rTMS (HF-rTMS) to the left dorsolateral prefrontal cortex (DLPFC).

Furthermore, the effects of rTMS on cognitive function in addition to motor disorders, aphasia, and affective disorders have been attracting attention (Lefaucheur et al., 2014; Nardone et al., 2014; Drumond Marra et al., 2015). One study reported an improvement in Trail-Making Test part B (TMT-B) performance by HF-rTMS, while another study reported a lack of significant improvement relative to a control group (Moser et al., 2002; Mittrach et al., 2010). However, few studies have investigated the effects of LF-rTMS on cognitive function. As described earlier, LF-rTMS exerts an inhibitory stimulation to the side of administration and is considered to affect the contralateral cerebral cortices via a modulation of interhemispheric inhibition. Therefore, LF-rTMS possibly affects a broader region than that affected by HF-rTMS. Meta-analyses of rTMS in patients with stroke indicate that LF-rTMS is recommended for stroke patients in the chronic phase (> 6 months post-stroke).

Although previous studies indicate a possibility of positive effects of rTMS on cognitive function; however, to the best of our knowledge, there has been no report describing the effect of a combined intervention program of LF-rTMS and intensive occupational therapy (iOT) on cognitive function in post-stroke patients. Therefore, the present study aimed to explore the therapeutic effect of the combined intervention program on patients with post-stroke upper limb hemiparesis.

Continue —> Does a combined intervention program of repetitive transcranial magnetic stimulation and intensive occupational therapy affect cognitive function in patients with post-stroke upper limb hemiparesis? Hara T, Abo M, Kakita K, Masuda T, Yamazaki R – Neural Regen Res

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[Abstract] Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors

Abstract

Background/aim

Stroke is a leading cause of disability in developed countries. One of the most widespread techniques in clinical practice is mirror therapy (MT). To determine the effectiveness of MT over other methods of intervention in the recovery of upper limb function in people who have had a stroke.

Methods

A systematic review was conducted. The search string was established based on the last systematic review about MT that dated from 2009: “upper extremity” OR “upper limb “AND “mirror therapy” AND stroke. For this search Pubmed, Scopus and SciELO databases were used.

Results

Fifteen studies were included in the systematic review. Recovery of the upper limb, upper limb function and gross manual dexterity were frequently measured in these studies.

Conclusions

In the primary variables in promoting recovery, MT alone showed better results in acute and chronic stroke patients in upper limb functioning than either conventional rehabilitation (CR) or CR plus MT.

 

Source: Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors – Pérez-Cruzado – 2016 – Australian Occupational Therapy Journal – Wiley Online Library

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[Abstract] Home exercise programmes supported by video and automated reminders compared with standard paper-based home exercise programmes in patients with stroke: A randomized controlled trial

Abstract

Objective: To determine whether patients with stroke receiving rehabilitation for upper limb deficits using smart technology (video and reminder functions) demonstrate greater adherence to prescribed home exercise programmes and better functional outcomes when compared with traditional paper-based exercise prescription.

Design: Randomized controlled trial comparing upper limb home exercise programmes supported by video and automated reminders on smart technology, with standard paper-based home exercise programmes.

Setting: A community rehabilitation programme within a large metropolitan health service.

Subjects: Patients with stroke with upper limb deficits, referred for outpatient rehabilitation.

Interventions: Participants were randomly assigned to the control (paper-based home exercise programme) or intervention group (home exercise programme filmed on an electronic tablet, with an automated reminder). Both groups completed their prescribed home exercise programme for four weeks.

Main measures: The primary outcome was adherence using a self-reported log book. Secondary outcomes were change in upper limb function and patient satisfaction.

Results: A total of 62 participants were allocated to the intervention (n = 30) and control groups (n = 32). There were no differences between the groups for measures of adherence (mean difference 2%, 95% CI −12 to 17) or change in the Wolf Motor Function Test log transformed time (mean difference 0.02 seconds, 95% CI −0.1 to 0.1). There were no between-group differences in how participants found instructions (p = 0.452), whether they remembered to do their exercises (p = 0.485), or whether they enjoyed doing their exercises (p = 0.864).

Conclusions: The use of smart technology was not superior to standard paper-based home exercise programmes for patients recovering from stroke.

Source: Home exercise programmes supported by video and automated reminders compared with standard paper-based home exercise programmes in patients with stroke: A randomized controlled trial

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