Participation after acquired brain injury: Associations with everyday technology and activities in daily life

Background: The development of the information society has led to increased use of everyday technology and changed the conditions for participation. Enabling participation in everyday life situations is an important rehabilitation goal after acquired brain injury (ABI). Identifying factors associated with individuals’ experienced participation and problems therein is therefore essential. Objective: This study aimed at exploring the relationship between perceived difficulty in everyday technology use, perceived ability in the activities of daily living (ADL), and perceived participation, and participation problems in persons with ABI. Methods: Eighty-one persons with ABI participated in the study and were assessed by the Impact on Participation and Autonomy questionnaire, the Everyday Technology Use Questionnaire, and the ADL taxonomy. Results: Findings showed that the combined model of difficulty in everyday technology (ET) use, ADL ability, and the interaction between them explained both participation in various domains of everyday life, and also overall level of perceived participation and the perceived problems. Conclusions: The findings underscore the importance of evaluating individuals’ ability in both ET use and ADL after ABI to increase the probability of explaining these persons’ participation in desired everyday life situations and, also, for rehabilitation design.     

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.     

Response actions to difficulties in using everyday technology after acquired brain injury

Abstract

Purpose: People with acquired brain injury (ABI) have difficulties using everyday technology (ET) in daily tasks at home and in society. To support them in managing the demands imposed by using ET, knowledge is needed concerning their response actions to the difficulties. The aim of this study was to explore and describe what characterizes response actions to difficulties using ET, their conditions, and how they influence the experiences of tasks in daily life among people with ABI. Methods: Interviews and observations were undertaken with 13 persons with an ABI. Data were analysed qualitatively using the constant comparative method. Results: The participants' response actions were categorized as (i) deliberate and organized planning, (ii) random and inflexible repeating (iii), re-evaluating tasks, (iv) explaining difficulties related to others, and (iv) proving and protecting capability. Certain conditions were decisive for the different response actions to be applied and also for their effectiveness in enabling engagement in tasks in daily life. Each participant used several types of response actions and the same action could be applied in several situations. Conclusion: To support people with an ABI to manage the demands imposed by using ET, it is important to identify the uniqueness of each client and his or her response actions to difficulties using ET and thereafter adjust the interventions accordingly.     

Dynamic pronation splint in high level spinal cord injury: A case study

Maintaining pronation of the forearm is difficult for patients with high level quadriplegia. Where partial innervation to, or weakness within, specific muscles of the upper limb occurs, the arm tends to be held in a flexed, supinated position. This position prevents the successful performance of many activities of daily living. The dynamic splint outlined in this paper is based on the Roylan Dynamic Pronation/Supination Kit with adaptions to enable elbow flexion. The application of this splint in a patient with incomplete quadriplegia below C5 cord segment has been described. This splint was introduced during the rehabilitation phase of treatment, and enabled the forearm to be positioned in pronation, so that the patient could perform functional activities such as feeding, typing, writing and using the telephone. Following discharge from hospital, the patient used the splint to help achieve goals such as returning to work and playing the piano.     

Elderly persons with disabilities in Sweden: their experiences of everyday life

The aim of this study was to describe the everyday life experiences of 22 elderly persons with physical disabilities in Sweden. The participants were aged between 65 and 91 years. Interviews were conducted and analysed according to a qualitative research approach. Disengagement in activities and social contacts resulted in feelings of resignation and dejection for some participants, while others delegated tasks as a satisfactory alternative. Participants also described how activities and social contacts continued, albeit in a different way, and being active and socializing gave feelings of pleasure and a sense of belonging. While receiving help was experienced as valuable, it also increased the fear of becoming dependent. Occupational therapy intervention should be directed at increasing social contacts and engagements in meaningful activities, as well as strengthening the individual's autonomy. The transferability of the study can be questioned as the sample only included elderly persons with physical disabilities from urban areas. Further research is needed to address the impact of occupational therapy interventions on life satisfaction.     

中国听力残疾老年人生活自理能力影响因素分析

目的分析中国听力残疾老年人生活自理能力现状及其影响因素。方法运用2006年第二次全国残疾人抽样调查数据,以≥60岁单纯听力残疾者为研究对象,对听力残疾的老年人基础性生活自理能力现状进行描述性分析,运用多因素logistics回归对听力残疾的老年人生活自理能力相关因素进行分析。结果中国≥60岁听力残疾老年人生活不能自理率为23.62%。多因素logistics回归分析结果显示,年龄越高听力障碍残疾等级越高(极重度OR=2.97,95%CI=2.68~3.29)、家庭人均户收入低于等于国家平均水平听力障碍老年人发生生活不能自理的风险越高(OR=1.17,95%CI=1.08~1.28);居住在农村(OR=0.86,95%CI=0.79~0.95)、所在地为东部(OR=0.59,95%CI=0.55~0.63)、受教育程度高(高中及以上OR=0.62,95%CI=0.53~0.72)听力障碍老年人发生生活不能自理的风险越低。结论个体因素和环境因素构成的情境因素与听力残疾老年人活动受限密切相关,影响其日常生活功能。     

脑损伤患者门诊康复治疗对日常生活活动能力的影响

目的通过观察住院康复治疗出院后继续在门诊接受康复治疗的脑损伤患者情况,探讨门诊康复治疗对巩固疗效、提高生活质量的作用和意义。方法将74例脑损伤患者分为门诊治疗组(A)、自行康复组(B),每组37例,两组患者住院期间接受相同的一级和二级康复治疗。出院后,门诊治疗组患者坚持每周5 d来门诊继续接受系统康复治疗,自行康复组患者出院时给予康复指导,交待注意事项,自行在家或社区进行康复训练,分别在相应的时间点进行评定。结果两组患者经过3个月康复治疗,出院时均有改善,3项评分相似。出院后3个月及9个月时评估,两组神经功能缺损程度、运动功能及日常生活活动能力亦均有所改善,但门诊治疗组改善更明显(P0.05)。结论脑损伤康复治疗不仅需要规范的三级康复治疗体系,而且要遵循持之以恒的康复治疗原则,持续进行规范系统的康复治疗(如有条件坚持门诊康复治疗),才能巩固脑损伤患者康复治疗的疗效,提高日常生活活动能力。     

Agreement Between Occupational Therapists and Clients with Stroke on Three Outcome Measures

In recent years, the occupational therapy profession has been under increased pressure to document the outcomes of interventions in order 10 improve the quality of client care and to provide evidence of the effectiveness and efficiency of services to recipients and sponsors. The literature to date has focused primarily on establishing therapy outcomes from a therapist perspective. However, attention must also be paid to the views of our consumers regarding the outcomes of therapy. The purpose of this study was to determine whether clients and therapists agree regarding client scores on three outcome measures. The study included 4 occupational therapists and 20 clients with stroke who rated clients' status in terms of personal activities of daily living, instrumental activities of daily living and quality of life, at admission of clients as well as discharge from rehabilitation. The results indicated that there was generally only moderate agreement between therapists' and clients' ratings at both admission and discharge. These findings suggest that therapists should continue to spend time exploring client status with their clients so that both parties have the best possible understanding of the clients' capabilities, and the outcome of therapy. The findings also suggest the need to administer client outcome assessments as well as to utilize client self-reports.     

Perceived difficulties using everyday technology after acquired brain injury: Influence on activity and participation

Abstract

Using everyday technology (ET) is a prerequisite for activities and participation at home and in the community. It is well known that persons with an acquired brain injury (ABI) can have limitations in activities of daily living but our knowledge of their difficulties using ET is not known. Thirty-six persons (27 men and 9 women, mean age 44 years, age range 26–60) with an ABI (2–10 years post injury) were interviewed, using the Everyday Technology Use Questionnaire (ETUQ), about their perceived difficulties using ET and how these difficulties influenced their everyday activities and their possibilities to participate at home and in the community. A majority (78%) of the persons reported difficulties using ET. The most common difficulties were related to the use of telecommunication and computers. Despite these difficulties, a majority still used most objects and services independently. Twenty-six participants (72%) perceived that their difficulties using ET influenced their everyday activities and their possibility to participate at home and in the community. The results indicate that rehabilitation following an ABI should consider whether clients' use of ET influences their activity and participation and adopt interventions accordingly. The results also indicate that difficulties using ET need to be considered in the design of community services to prevent societal barriers.     

Computer-assisted cognitive rehabilitation for adults with traumatic brain damage: Four case studies

The purpose of the study was to investigate the value of computer-assisted activities for four individuals with brain damage. Individuals were trained in cognitive functions in their homes to compensate for cognitive impairment, assisted in work activities and helped in leisure time occupations. The four people received individually adapted computers and peripheral equipment, and the environment was changed to accommodate their needs. Each person received guidance and instruction from an occupational therapist once or twice a week for 12–18 weeks. The goals for each person were achieved according to evaluation with Goal Attainment Scaling.     

Differences in awareness between persons with left and right hemispheric stroke

Abstract

Aim: The aim of this study was to investigate whether there are any differences in awareness of ability between persons with left and right hemispheric stroke. Methods: The sample consisted of data from the Assessment of Awareness of Ability (A³) database, primarily consisting of clients admitted to occupational therapy services. In total the study included 183 data records from clients, 78 with left and 105 with right hemispheric stroke. Awareness of ability was assessed using the Assessment of Awareness of Ability (A³). Differences in awareness were investigated using t-tests, CI, effect size, and differential item functioning. Results: No significant overall mean difference (t-test = 1.31, p = 0.19) in awareness between left and right hemispheric stroke was identified. However, significant differences (p < 0.05) were identified on three specific items included in the A³. In these cases, persons with right hemispheric stroke showed a more limited awareness. Conclusion: Persons with right hemispheric stroke have more pronounced problems with being aware of limitations in specific ADL performance skills compared with persons with left hemispheric stroke.     

Occupational Therapy Intervention: Effects on Self-Care,Performance, Satisfaction,Self-Esteem/Self-Efficacy,and Role Functioning of Older Hispanic Females with Arthritis

ABSTRACT

The purpose of this pilot study was to compare the effectiveness of occupation-based and enabling/preparatory interventions on self-care, perceived performance, satisfaction, self-efficacy, and role function among older Hispanic females with arthritis. A pre- and post-outcome measures design with semi-structured interview and questionnaire/rating scales was used with matched participants assigned to one of two intervention groups or a control, non-intervention group. For measures of task-specific functioning and self-efficacy, there were no statistically significant differences in average gain scores between the two interventions. Average gain scores were higher for the enabling/preparatory intervention than for the control group. For the occupational intervention, the scores were higher than for the control group for self-care/activities of daily living (ADL) functioning and self-esteem/self-efficacy. The results suggest that client-centered occupational therapy intervention provided within the home environment is beneficial for occupational performance, participation, role competence, and quality of life.     

Difficulties in using everyday technology after acquired brain injury: a qualitative analysis

Abstract

The aim of this study was to identify and describe the characteristics of the difficulties using everyday technology in persons with an aquired brain injury (ABI), and their experiences of how these difficulties influenced their life. Thirteen persons with an ABI were interviewed about their difficulties in using everyday technology and were observed in their use of technology. Data were analysed qualitatively with a constant comparative method. The results showed that the persons' experiences formed two categories: “A variety of combinations of difficulties in the use of everyday technology” and “Restrictions in life”. The difficulties identified were related not only to everyday technology itself but also to the interaction between the technology, the task, the person, and the environment. These difficulties influenced their experiences of restrictions in occupational performance, personal identification, and participation in society. The results emphasize that occupational therapists who design interventions for people with an ABI need to accommodate both the technology and other interacting aspects in order to overcome difficulties in using everyday technology.     

The Assessment of Motor and Process Skills as a measure of ADL ability in schizophrenia

Background: Functional impairments in schizophrenia are substantial, complex, and persistent. Objective measurement of ADL ability, functional capacity and performance is needed for effective intervention planning and outcome evaluation. Objective: To evaluate ADL ability in people with schizophrenia using the Assessment of Motor and Process Skills (AMPS) and to determine the utility of using the AMPS to predict levels of assistance required for successful community living. Method: In a retrospective audit, AMPS ADL measures of a consecutive sample of 64 people with schizophrenia admitted to a mental health facility were compared with normative data and with recommended “cut-off” measures for competency to live independently in the community. Results: Substantial difficulties were measured in both ADL motor (mean z = –1.5) and ADL process ability (mean z = –2.1). AMPS ability measures did not predict problems with independent living for 62.5% of the patients. Conclusion: People with schizophrenia admitted to an inpatient rehabilitation facility experienced significant difficulty performing ADL tasks. AMPS is a useful measure of ADL ability but should be used in conjunction with measures of functional performance in order to plan interventions and supports for people with schizophrenia that reflect the complexity of factors affecting community functioning.     

Community-based Occupational Therapy: A Study of Elderly People with Home Help in a Social-Welfare District in Stockholm

Since 1992 the local authorities in Sweden have been responsible for the rehabilitation of elderly people living at home. Few studies of this relatively new form of rehabilitation have been reported. The aim of this study was to describe the type of occupational- therapy interventions received by elderly people over the age of 65 living in an urban area. Another aim was to describe the patterns in the performances of 648 elderly people. The study demonstrated that most of the elderly people who received occupational therapy also received home help several times a day. indicating that these elderly people had severe problems in the activities of daily living (ADL) in the area of self-care. Home-making activities and activities outside the home were the most problematic activities. The elderly also wanted to engage in more activities than they were judged to have the capacity for and or the environmental support to do. The implications of the results for community-base, occupational-therapy programs are discussed.