Use of the Perceive, Recall, Plan and Perform System of Task Analysis for persons with schizophrenia: A preliminary study

Background/aim:  Task analysis that targets information processing skills is an essential tool to understanding difficulties encountered by people with schizophrenia in their daily activities. The purpose of this preliminary study was to explore the use of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis for this clientele. The specific objectives were to describe information processing difficulties as measured by the PRPP and to examine preliminary evidence of construct validity and interrater reliability.
Methods:  In the first part of this study, 10 participants with schizophrenia living in the community were assessed using the PRPP during both a simple and a complex meal preparation task. Community functioning was measured using the Independent Living Skills Survey. In the second part, interrater reliability was appraised using three trained raters, who scored 15 participants preparing the complex meal preparation task.
Results:  Analysis of performance demonstrates that people with schizophrenia have difficulties especially in the Perceive and Plan quadrants of the PRPP and are more challenged in the complex task. The PRPP total score for the complex task is strongly related to the community functioning score. Results indicate good interrater reliability for the PRPP total score and moderate interrater reliability for the quadrant scores.
Conclusion:  Despite the small sample size, results from this preliminary study support the use of the PRPP System of Task Analysis to further explore the impact cognitive deficits have on daily task performance and thus on community functioning in people with schizophrenia.     

Using the Perceive, Recall, Plan and Perform System to assess cognitive deficits in adults with traumatic brain injury: A case study

One role of occupational therapy in the rehabilitation of people with traumatic brain injury is to determine the impact of cognitive and perceptual deficits on client performance of occupational tasks. Existing methods that can be used to assess cognitive deficits include standardised instruments and observations of everyday task performance. Few of these assessment methods are able to adequately link problems of cognition with problems with self-maintenance, productivity and leisure tasks relative to a client's expected occupational roles. The Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis enables observation of performance of any functional task and allows therapists to identify the cognitive basis of disordered performance. The results of this assessment are then used to establish and evaluate client-centred goals and guide subsequent intervention. This article describes the PRPP System of Task Analysis and outlines how it can be used by occupational therapists involved in the management of adults with traumatic brain injury. Specifically, an in-depth case study illustrates how this innovative model of assessment has effectively been used to promote client learning of self-maintenance skills.     

Reliability of the Perceive, Recall, Plan and Perform System of Task Analysis: A criterion-referenced assessment

Objective:  To conduct preliminary examination of the rater and test-reliability of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis, an ecological measure designed to assess task-embedded information processing capacity during occupational therapy assessment of confused and agitated adults following traumatic brain injury.
Methods:  Occupational therapists observed and scored client performance using the PRPP System of Task Analysis. Correlational analysis and measures of agreement were performed to determine interrater and intrarater reliability. Test procedures were examined for reliability and internal consistency.
Results:  Interrater and test reliability considered three factors: therapists, clients and tasks. A moderate level of interrater reliability was achieved between trained therapists (intraclass correlation coefficient (ICC) = 0.60). Test procedures were highly reliable (ICC = 0.88). Across two measurement occasions, therapists showed a tendency towards harder rating on the second test occasion (      –4.5%; 95% confidence interval for     : –10.67%→ 3.17%).
Conclusion:  The findings of this study support the use of criterion-referenced tests in the area of occupational performance measurement. Occupational therapists achieved moderate interrater reliability when measuring the performance of adults with brain injury on various activities of daily living. Test procedures were found to be highly reliable in measuring the occupational performance of adults demonstrating confusion and agitation typical to the stage of post-traumatic amnesia following head injury.     

The Perceive,Recall, Plan and Perform (PRPP) system for persons with Parkinson’s disease: a psychometric study

Background: The Perceive, Recall, Plan &; Perform (PRPP) system of task analysis might be feasible to evaluate occupational performance and information processing strategies for persons with Parkinson’s disease (PD).

Aim: To evaluate: (1) the random error between raters (inter-rater study), (2) the random error within raters (intra-rater study), and (3) the internal consistency of the PRPP.

Materials and methods: (1) video-recorded performance of meaningful activities of 13 Dutch persons with PD, scored independently by 38 Dutch PRPP trained occupational therapists were included in the analysis. The random error between raters was analyzed with two-way random Intraclass Correlation Coefficients (ICC). (2) Four videos were scored twice by 30 raters (6 week time interval). The random error within raters was analyzed using one-way random ICC’s. (3) Internal consistency study: data of 190 persons with PD were analyzed using Cronbach’s alpha (α).

Results: Inter-rater reliability ranged from slight to moderate (ICC=?0.06–0.43). The mean intra-rater reliability ranged from moderate to almost perfect (ICC=?0.60–0.83). Internal consistency is good (α?=?0.60–0.86).

Conclusion: The limited inter-rater reliability but adequate intra-rater reliability and internal consistency show the feasibility of the PRPP when used for persons with PD. Implications for reliable clinical use are discussed.     

Task based exposure assessment in ergonomic epidemiology: a study of upper arm elevation in the jobs of machinists, car mechanics, and house painters

Aims: To explore the precision of task based estimates of upper arm elevation in three occupational groups, compared to direct measurements of job exposure.

Methods: Male machinists (n = 26), car mechanics (n = 23), and house painters (n = 23) were studied. Whole day recordings of upper arm elevation were obtained for four consecutive working days, and associated task information was collected in diaries. For each individual, task based estimates of job exposure were calculated by weighting task exposures from a collective database by task proportions according to the diaries. These estimates were validated against directly measured job exposures using linear regression. The performance of the task based approach was expressed through the gain in precision of occupational group mean exposures that could be obtained by adding subjects with task based estimates to a group of subjects with measured job exposures in a "validation" design.

Results: In all three occupations, tasks differed in mean exposure, and task proportions varied between individuals. Task based estimation proved inefficient, with squared correlation coefficients only occasionally exceeding 0.2 for the relation between task based and measured job exposures. Consequently, it was not possible to substantially improve the precision of an estimated group mean by including subjects whose job exposures were based on task information.

Conclusions: Task based estimates of mechanical job exposure can be very imprecise, and only marginally better than estimates based on occupation. It is recommended that investigators in ergonomic epidemiology consider the prospects of task based exposure assessment carefully before placing resources at obtaining task information. Strategies disregarding tasks may be preferable in many cases.

     

Improving quality of ADL performance after rehabilitation among people with acquired brain injury

The aim of this study was to evaluate whether people with brain injury show improvements in quality of performance of activities of daily living (ADL) after rehabilitation. A retrospective pre- and post-test design with no control group was used. Subjects received interdisciplinary rehabilitation consisting of restorative and compensatory strategies. Thirty-six adults with moderate to severe disability following acquired brain injury were evaluated using the Assessment of Motor and Process Skills (AMPS), an observational evaluation of the quality of ADL task performance. Paired t-tests revealed significant increase in ADL ability after intervention; effect sizes were medium. Improvements occurred across ages, within all diagnostic groups, and with no relation to time post-injury. It was concluded that people with moderate to severe disability following acquired brain injury improved in ADL ability after participating in an intensive, interdisciplinary rehabilitation programme. Although lack of a control group prevented a conclusively conclusion that the changes were due to the intervention provided, the fact that the subjects had shown slow spontaneous recovery and minimal improvements before the study was implemented supports the likelihood that their gains were largely the result of the intervention.     

Efficacy of Occupational Therapy Task‐oriented Approach in Upper Extremity Post‐stroke Rehabilitation

There is a need for more effective rehabilitation methods for individuals post‐stroke. Occupational Therapy Task‐Oriented (TO) approach has not been evaluated in a randomized clinical trial. The purpose of this study was to evaluate functional and impairment efficacies of TO approach on the more‐affected Upper Extremity (UE) of persons post‐stroke. A randomized single‐blinded cross‐over trial recruited 20 participants post‐stroke (mean chronicity = 62 months) who demonstrated at least 10° active more‐affected shoulder flexion and abduction and elbow flexion‐extension. Participants were randomized into immediate (n = 10) and delayed intervention (n = 10) groups. Immediate group had 6 weeks of 3 hr/week TO intervention followed by 6 weeks of no‐intervention control. Delayed intervention group underwent the reversed order. Functional measures included Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), and Wolf Motor Function Test (WMFT). Impairment measures included UE Active Range of Motion (AROM) and handheld dynamometry strength. Measurements were obtained at baseline, cross over, and end of the study. TO intervention showed statistically higher functional change scores. COPM performance and satisfaction scores were 2.83 and 3.46 units greater respectively (p < .001), MAL amount of use and quality of use scores were 1.1 and 0.87 units greater, respectively (p < .001), WMFT time was 8.35 seconds faster (p = .009). TO impairment outcomes were not significantly larger than control ones. TO approach appears to be an effective UE post‐stroke rehabilitation approach inducing clinically meaningful functional improvements. More studies are needed with larger samples and specific stroke chronicity and severity. Copyright © 2016 John Wiley & Sons, Ltd.     

Attentional and Affective Processing of Sexual Stimuli in Women with Hypoactive Sexual Desire Disorder

Hypoactive sexual desire disorder (HSDD) is the most common sexual problem in women. From an incentive motivation perspective, HSDD may be the result of a weak association between sexual stimuli and rewarding experiences. As a consequence, these stimuli may either lose or fail to acquire a positive meaning, resulting in a limited number of incentives that have the capacity to elicit a sexual response. According to current information processing models of sexual arousal, sexual stimuli automatically activate meanings and if these are not predominantly positive, processes relevant to the activation of sexual arousal and desire may be interrupted. Premenopausal U.S. and Dutch women with acquired HSDD (n = 42) and a control group of sexually functional women (n = 42) completed a single target Implicit Association Task and a Picture Association Task assessing automatic affective associations with sexual stimuli and a dot detection task measuring attentional capture by sexual stimuli. Results showed that women with acquired HSDD displayed less positive (but not more negative) automatic associations with sexual stimuli than sexually functional women. The same pattern was found for self-reported affective sex-related associations. Participants were slower to detect targets in the dot detection task that replaced sexual images, irrespective of sexual function status. As such, the findings point to the relevance of affective processing of sexual stimuli in women with HSDD, and imply that the treatment of HSDD might benefit from a stronger emphasis on the strengthening of the association between sexual stimuli and positive meaning and sexual reward.     

Neurocognitive Effects of Cocoa and Red-Berries Consumption in Healthy Adults

In recent decades, the elderly population has increased at higher rates than any other population group, resulting in an increase in age-related diseases such as neurodegenerative and cognitive impairment. To address this global health problem, it is necessary to search for new dietary strategies that can prevent the main neurocognitive problems associated with the ageing process. Therefore, the aim of the present study was to analyze the effect of cocoa flavanols and red berry anthocyanins on brain-derived neurotrophic factor (BDNF) and nerve growth factor receptor (NGF-R) and to stablish the possible improvement in cognitive performance by using a battery of neurocognitive tests that included the Verbal Learning Test Spain-Complutense, the Spatial Recall Test 10/36 BRB-N, the Wechsler Adult Intelligence Scale III and IV, the STROOP Task and the Tower of London Test. A randomized, double-blind, parallel-group study was performed in 60 healthy volunteers between 50 and 75 years old who consumed a cocoa powder, a red berries mixture or a combination of both for 12 weeks. After the intervention, we observed a reduction in the time needed to start (p = 0.031) and finish (p = 0.018) the neurocognitive test known as the Tower of London in all groups, but the decrease in time to finish the task was more pronounced in the intervention with the combination of cocoa-red berries group. We failed to show any significant difference in BDNF and NGF-R sera levels. However we found a negative correlation between BDNF and the number of movements required to finish the TOL in women (p = 0.044). In conclusion, our study showed an improvement in executive function, without any change in neurotrofin levels, for all intervention arms.     

Task-specific practice of dressing tasks in a hospital setting improved dressing performance post-stroke: a feasibility study

Background: Practise of personal activities of daily living, including dressing improves outcomes for people living at home after a stroke. Less is known about dressing outcomes for hospital inpatients. Aim: This study aimed to investigate the feasibility and outcomes of a group‐based, task‐specific dressing retraining programme for inpatients post‐stroke. Methods: A pre‐post single group study design was used. Retrospective data were collected for stroke inpatients admitted to one hospital between 2007 and 2009. Participants attended a one‐hour dressing group twice weekly during admission, supervised by occupational therapists. Each participant had one or more dressing goals. Scores on the Functional Independence Measure (FIM) upper and lower body dressing items were compared at baseline and at discharge. Results: Of 119 participants who received group‐based training, a mean improvement was found of 2.2 FIM points (95% CI 1.9–2.5, P = 0.0001) for upper body dressing (range 0–7), 2.7 FIM points (95% CI 2.3–3.1, P = 0.0001) for lower body dressing (range 0–7) and 5.2 FIM points (95% CI 4.5–6.0, P = 0.0001) for total dressing scores (range 0–14). Of 242 goals recorded, 48% focussed on shirt/upper body dressing, 35% on pants/shorts, 11% on socks and shoes and 13% involved buttons/fastenings. Conclusions: Task‐specific practice of dressing tasks in a group setting was feasible and made clinically significant differences to dressing performance during inpatient rehabilitation. More rigorous methods of investigation are required in future to minimise selection, measurement and intervention biases.     

Probiotic Mixture Containing Lactobacillus helveticus,Bifidobacterium longum and Lactiplantibacillus plantarum Affects Brain Responses to an Arithmetic Stress Task in Healthy Subjects: A Randomised Clinical Trial and Proof-of-Concept Study

Probiotics are suggested to impact physiological and psychological stress responses by acting on the gut-brain axis. We investigated if a probiotic product containing Bifidobacterium longum R0175, Lactobacillus helveticus R0052 and Lactiplantibacillus plantarum R1012 affected stress processing in a double-blinded, randomised, placebo-controlled, crossover proof-of-concept study ({"type":"clinical-trial","attrs":{"text":"NCT03615651","term_id":"NCT03615651"}}NCT03615651). Twenty-two healthy subjects (24.2 ± 3.4 years, 6 men/16 women) underwent a probiotic and placebo intervention for 4 weeks each, separated by a 4-week washout period. Subjects were examined by functional magnetic resonance imaging while performing the Montreal Imaging Stress Task (MIST) as well as an autonomic nervous system function assessment during the Stroop task. Reduced activation in regions of the lateral orbital and ventral cingulate gyri was observed after probiotic intervention compared to placebo. Significantly increased functional connectivity was found between the upper limbic region and medioventral area. Interestingly, probiotic intervention seemed to predominantly affect the initial stress response. Salivary cortisol secretion during the task was not altered. Probiotic intervention did not affect cognitive performance and autonomic nervous system function during Stroop. The probiotic intervention was able to subtly alter brain activity and functional connectivity in regions known to regulate emotion and stress responses. These findings support the potential of probiotics as a non-pharmaceutical treatment modality for stress-related disorders.     

Performance management in healthcare: Performance indicator development, task uncertainty, and types of performance indicators

In healthcare, performance indicators are increasingly used to measure and control quality and efficiency of care-providing teams. This article demonstrates that when controllability is emphasized during indicator development, the level of task uncertainty influences the type of resulting performance indicators. We report findings from a field study in a medical rehabilitation centre in The Netherlands, where four low task uncertain teams (‘hand trauma’, ‘heart failure’, ‘amputation’, ‘chronic pain’), and four high task uncertain teams (‘children with developmental coordination disorders (DCD)’, ‘parkinson's disease’, ‘young children (0–4 years) with developmental disorders’, and ‘acquired brain injuries’) participated in the development of performance indicators using the Productivity Measurement and Enhancement System (ProMES) method. Results show that teams higher on task uncertainty developed relatively more process indicators compared to outcome indicators, whereas the reverse was true for teams lower on task uncertainty. Additionally, process indicators developed by high task uncertain teams were more of a problem solving nature than process indicators developed by low task uncertain teams, which had a more procedural character. The study expands existing knowledge by providing a framework which explicates the task processes to be executed under different levels of task uncertainty, and in line with that appropriate performance indicators for healthcare teams.     

Effectiveness of workplace accommodations for a corporate telephone operator with a full left-arm prosthesis: A case study

A corporate telephone operator and voice mail programmer was involved in a serious automobile accident resulting in left-arm amputation and through rehabilitation received a full left-arm prosthesis. Upon returning to work in her previous job capacity, some work activities and work area configurations were identified as problematic during task performance. Work methods and work area configuration were evaluated regarding their appropriateness for supporting return to work and long-term accommodation. Job activity analysis determined all reaches, clearances, and forces and their compliance with recommended criteria. A body part comfort/discomfort survey (BPCDS) was administered pre- and post-accommodation to elicit information regarding workplace problem areas and provide a measure to assess accommodation effectiveness. Workstation, support equipment, work area, seating, task assignments, and work methods were modified to more appropriately support operator task performance. Comparison of pre- and post-accommodation BPCDS indicates a significant reduction in operator discomfort with residual discomfort associated with the orthopedic prosthesis. This case study illustrates the use of the principles and techniques of industrial ergonomics to develop workplace accommodations. The area of ergonomics, medical ergonomics,is an example of the development of reasonable accommodations for physically challenged workers in the spirit of compliance with the Americans with Disabilities Act (ADA).     

Client-centred ADL intervention after stroke: Significant others’ experiences

Background: Client-centredness is a prominent contemporary concept in rehabilitation. However, there is a lack of knowledge on if and how a client-centred rehabilitation approach is incorporated in the everyday life of significant others of people who receive such rehabilitation. Objective: Explore and describe if and how a client-centred ADL intervention (CADL) was integrated in the everyday lives of significant others of people with stroke. Materials and methods: Qualitative longitudinal design, with a grounded theory approach. Seven significant others, who cohabited with persons receiving a CADL intervention, were interviewed during the first year. Findings: One core category was identified: “Taking responsibility and achieving balance with respect to self-esteem in order to get on with everyday life”. The integration of the CADL was a process. A key aspect was that as the person with stroke acted upon his/her own desired activity goals the significant others were encouraged to act on their own needs. Conclusions: Enablement is important also for the significant others of people with stroke. One way of enabling significant others to maintain an active lifestyle and find respite in everyday life might be to enable people with stroke to formulate and act upon their desired activity goals.     

Carbon monoxide exposure and information processing during perceptual-motor performance

Summary This study examined the influence of exposure to ambient carbon monoxide resulting in final carboxyhemoglobin (COHb) levels of approximately 5.0% on the ability to process information during motor performance. Subjects (n=16) performed a primary reciprocal tapping task and a secondary digit manipulation task singly and/or concurrently during 2.5 h exposure to room air (0 ppm CO) or 100 ppm CO. Five levels of tapping difficulty and two levels of digit manipulation were employed. Tapping performance was unaffected when COHb levels were as high as 5%. However, at this level of COHb it was noted that CO exposure interacted with task difficulty of both tasks to influence reaction time on the digit manipulation task. It was concluded that motor performance was not influenced by exposure to CO leading to COHb concentrations of 5%. Task difficulty was a significant factor mediating behavioral effects of CO exposure.This work was supported in part by the U.S. Environmental Protection Agency under grant R808177010 and the U.S. National Institutes of Health under grant RR07099. (Although the research described in this article has been funded in part by the EPA through grant RR07099 to the Institute of Environmental Stress, it has not been subjected to the agency's required peer and policy review and therefore does not necessarily reflect the views of the angency and no official endorsement should be inferred.)     

Examination of the change in Assessment of Motor and Process Skills performance in patients with acquired brain injury between the hospital and home environment

Aim: The Assessment of Motor and Process Skills (AMPS) is a standardised, valid, reliable, observational assessment that is sensitive to change over time. This research aimed to examine the change in AMPS performance in patients discharged from a neurosurgical rehabilitation ward to a home‐based therapy programme over a four‐week time frame. Methods: A total of 15 individuals with acquired brain injury who were participating in rehabilitation were recruited to the study. The AMPS was conducted with each individual during the participant’s inpatient rehabilitation and again approximately four weeks later, while participating in home‐based rehabilitation. Assessment results were collated using the AMPS computer programme and entered into a statistics package from which data were analysed. Results: As a group, no statistically significant change in function was identified between the home and hospital environments; however, individual results did indicate a change in occupational performance for many of the participants. Conclusions: The AMPS was shown to reflect a change in occupational performance for many of the research participants. This research supports previous studies which indicate that some individuals’ motor and process skill abilities appear to be affected by the environment in which they perform. This suggests that occupational therapists wishing to know how an individual will perform activities of daily living should evaluate the individual’s performance in the environment in which they will be functioning.     

Precision and Recall of Search Strategies for Identifying Studies on Return-To-Work in Medline

Introduction The purpose of this study was to report on the qualities of various search strategies and keywords to find return to work (RTW) studies in the Medline bibliographic database. Methods We searched Medline for articles on RTW published in 2003, using multiple search strings, and hand searched 16 major periodicals of rehabilitation or occupational medicine. Among the retrieved articles, those considered to be relevant, were pooled in a Gold Standard Database. From this database, we identified candidate text words or MeSH terms for search strategies using a word frequency analysis of the abstracts and a MEDLINE categorization algorithm. According to the frequency of identified terms, searches were run for each term independently and in combination. We computed Recall, Precision, and number needed to read (NNR = 1/Precision) of each keyword or combination of keywords. Results Among the 8,073 articles examined, 314 (3.9%) were considered relevant and included in the Gold Standard Database. The search strings (“Rehabilitation, Vocational” [MeSH]), (“Return to work”[All]) and (“Back to work”[All]) had Recall/Precision ratio of 30.46/19.11, 59.55/87.38 and 3.18/90.91%, respectively. Their combination with the Boolean operator OR yielded to a Recall/Precision ratio of 73.89/58.44% and a NNR of 1.7. For the end user requiring comprehensive literature search, the best string was (“Return to work” OR “Back to work” OR “Rehabilitation, vocational”[MeSH] OR “rehabilitation”[Subheading]), with a Recall of 88.22% and a NNR of 18. Conclusions No single MeSH term is available to help the physician to identify relevant studies on RTW in Medline. Locating these types of studies requires the use of various MeSH and non-MeSH terms in combination to obtain a satisfactory Recall. Nevertheless, enhancing the Recall of search strategies may lead to lower Precision, and higher NNR, although with a non linear trend. This factor must be taken into consideration by the end user in order to improve the cost-effectiveness ratio of the search in Medline.