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Journal: The American journal of occupational therapy : official publication of the American Occupational Therapy Association

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OBJECTIVE. To determine how safe-patient-handling (SPH) equipment is used in rehabilitation and how it affects therapists, patients, and therapy practice. METHOD. We used a qualitative, instrumental case study design. Thirty-five occupational and physical therapist practitioners from three facilities participated in the study. RESULTS. Therapists reported a broad range of applications for equipment (e.g., functional mobility and neuromusculoskeletal function). They reported that SPH equipment increased treatment options for therapists and increased participation options for patients, although equipment limitations exist. Three themes emerged from the analysis: choice, potential, and safety. CONCLUSION. SPH equipment has therapeutic applications in rehabilitation, especially for medically complex or bariatric patients. Therapists in this study engaged in a highly individualized, complex process of decision making when selecting and using SPH devices in rehabilitation. More research to refine and test therapeutic uses is necessary.

Concepts: Scientific method, Medicine, Therapy, Decision theory, Decision making software, Qualitative research, Case study, Dative case

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PURPOSE. To understand the medication routines used by older adults taking four or more medications daily. METHOD. One hundred forty-nine community-dwelling older adults were interviewed about the individual routines, storage locations, equipment, and assistance that enabled their adherence to a medication regimen. A subsample of 84 older adults was observed completing one medication routine in their home environments. FINDINGS. Medication habits were embedded in mealtime, wake-up, and sleep routines for 91% of the sample. Participants developed unique, individualized behaviors for taking medications that were choreographed within broader daily routines. The primary locations for storing medications were the kitchen and bathroom. Equipment used to promote adherence was primarily pillboxes or self-made adaptations. More than 50% of the entire sample required some type of assistance related to medication adherence. IMPLICATIONS. Findings support the role of occupational therapists in collaborating with clients to develop individualized medication routines to promote medication adherence.

Concepts: Pharmacology, Prescription drug, Medicine, Sampling, Pharmaceutical drug, Subroutine, Occupational therapy

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This single-case, mixed-method study explored the feasibility of self-administered, home-based SMART (sensorimotor active rehabilitation training) Arm training for a 57-yr-old man with severe upper-limb disability after a right frontoparietal hemorrhagic stroke 9 mo earlier. Over 4 wk of self-administered, home-based SMART Arm training, the participant completed 2,100 repetitions unassisted. His wife provided support for equipment set-up and training progressions. Clinically meaningful improvements in arm impairment (strength), activity (arm and hand tasks), and participation (use of arm in everyday tasks) occurred after training (at 4 wk) and at follow-up (at 16 wk). Areas for refinement of SMART Arm training derived from thematic analysis of the participant’s and researchers' journals focused on enabling independence, ensuring home and user friendliness, maintaining the motivation to persevere, progressing toward everyday tasks, and integrating practice into daily routine. These findings suggest that further investigation of self-administered, home-based SMART Arm training is warranted for people with stroke who have severe upper-limb disability.

Concepts: Participation, Stroke, Training, Activity

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Research regarding sensory processing and adults with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) is limited. This study aimed to compare sensory processing patterns of groups of higher education students with ADHD or ASD and to explore the implications of these disorders for their college life.

Concepts: Attention, Educational psychology, Attention-deficit hyperactivity disorder, Hyperactivity

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The purpose of this study was to estimate the effect of Cognitive Orientation to Daily Occupational Performance (CO-OP) compared with usual occupational therapy on upper-extremity movement, cognitive flexibility, and stroke impact in people less than 3 mo after stroke. An exploratory, single-blind randomized controlled trial was conducted with people referred to outpatient occupational therapy services at two rehabilitation centers. Arm movement was measured with the Action Research Arm Test, cognitive flexibility with the Delis-Kaplan Executive Function System Trail Making subtest, and stroke impact with subscales of the Stroke Impact Scale. A total of 35 participants were randomized, and 26 completed the intervention. CO-OP demonstrated measurable effects over usual care on all measures. These data provide early support for the use of CO-OP to improve performance and remediate cognitive and arm movement impairments after stroke over usual care; however, future study is warranted to confirm the effects observed in this trial.

Concepts: Effect, Randomized controlled trial, Effectiveness, Affect, Cognition, Cognitive science, Test method, Occupational therapy

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Some people without independent mobility are candidates for powered mobility but are unable to use a traditional power wheelchair joystick. This proof-of-concept study tested and further developed an innovative method of driving power wheelchairs for people whose impairments prevent them from operating commercial wheelchair controls. Our concept, Self-referenced Personal Orthotic Omni-purpose Control Interface (SPOOCI), is distinguished by referencing the control sensor not to the wheelchair frame but instead to the adjacent proximal lower-extremity segment via a custom-formed orthosis. Using a descriptive case-series design, we compared the pre-post functional power wheelchair driving skill data of 4 participants, measured by the Power Mobility Program, using descriptive analyses. The intervention consisted of standard-care power wheelchair training during 12 outpatient occupational or physical therapy sessions. All 4 participants who completed the 12-wk intervention improved their functional power wheelchair driving skills using SPOOCI, but only 3 were deemed safe to continue with power wheelchair driving.

Concepts: Skill, Disability, Programming language, Wheelchair, Power, Mobility device, Wheelchairs, Mobility scooter

24

The Functional Loewenstein Occupational Therapy Cognitive Assessment (FLOTCA) was developed to assess integrative higher cognitive abilities in people with traumatic brain injury (TBI). The FLOTCA measures performance on three tasks: navigating on a map, organizing a toolbox, and planning a daily schedule. This study assessed the psychometric properties of the FLOTCA with a sample of 25 participants with TBI ages 18-49 and 25 matched healthy participants. The FLOTCA showed high interrater reliability (intraclass correlation = .996) and internal consistency reliability for the total score (α = .82). Construct validity was supported for the total score, t (48) = -5.48, d = 1.52, and the separate tasks. Moderate ecological validity was obtained with the combined FIM™ and Functional Assessment Measure, r (19) = .44, p < .05. The results indicate that the FLOTCA can be used to assess higher cognitive abilities in functioning and can serve as the basis for intervention planning.

Concepts: Brain, Traumatic brain injury, Assessment, Educational psychology, Psychometrics, Thought, Validity, Reliability

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Limited information is available regarding use of the Frazier free water protocol (FWP) with hospitalized patients who have dysphagia and have survived a critical illness with compromised pulmonary status. This pilot study used a two-group nonequivalent comparison group design to evaluate the FWP in 15 adults admitted to a respiratory care unit (RCU) with dysphagia concerns. Inclusion criteria included recommendation for a modified diet with thickened liquids by a dysphagia therapist and ability to follow the specific free water guidelines. The 15 control participants were chosen from a retrospective chart review of consecutive RCU admissions that met the same inclusion criteria. The intervention group for whom the free water guidelines were implemented did not differ significantly from the control group in rate of development of aspiration pneumonia, χ²(30) = .01, p = 1.00.

Concepts: Controlling for a variable, Scientific control, Pneumonia, Retrospective, Sociology, Aspiration pneumonia, Dysphagia, Compromise

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Research measuring sensory processing in children with autism spectrum disorder (ASD) has shown variability in terms of measures used and participant ages, contributing to difficulty in interpreting and summarizing the findings of these studies. In an attempt to clarify the status of the literature, we conducted a systematic review of studies that focused on participation in daily occupations and evaluated sensory processing in children with ASD aged 5-13 yr using Dunn’s sensory processing framework. Evidence from 7 studies shows that sensory processing has a significant impact on participation in daily life of children with ASD. Included studies demonstrated medium and low levels of evidence. Additional research using more robust scientific methods is needed.

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More is known about the experience of occupational therapists than the experience of patients during the profession’s early years. We examined soldiers' experiences of occupational therapy in American Base Hospital 9 in France during World War I through analysis of a 53-line poem by Corporal Frank Wren contained in the unpublished memoir of occupational therapy reconstruction aide Lena Hitchcock.

Concepts: Medicine, Therapy, Physician, Experience, Knowledge, World War II, Procedural knowledge, Occupational therapy