Effectiveness of Environment-Based Interventions That Address Behavior, Perception, and Falls in People With Alzheimer's Disease and Related Major Neurocognitive Disorders: A Systematic Review.

OBJECTIVE: This systematic review evaluated the effectiveness of environment-based interventions that address behavior, perception, and falls in the home and other settings for people with Alzheimer's disease (AD) and related major neurocognitive disorders (NCDs). METHOD: Database searches were limited to outcomes studies published in English in peer-reviewed journals between January 2006 and April 2014. RESULTS: A total of 1,854 articles were initially identified, of which 42 met inclusion criteria. CONCLUSION: Strong evidence indicates that person-centered approaches can improve behavior. Moderate evidence supports noise regulation, environmental design, unobtrusive visual barriers, and environmental relocation strategies to reduce problematic behaviors. Evidence is insufficient for the effectiveness of mealtime ambient music, bright light, proprioceptive input, wander gardens, optical strategies, and sensory devices in improving behavior or reducing wandering and falls. Although evidence supports many environment-based interventions used by occupational therapy practitioners to address behavior, perception, and falls in people with AD and related major NCDs, more studies are needed.

Effectiveness of Sensory Stimulation to Improve Arousal and Alertness of People in a Coma or Persistent Vegetative State After Traumatic Brain Injury: A Systematic Review.

OBJECTIVE: This systematic review evaluates the effectiveness of sensory stimulation to improve arousal and alertness of people in a coma or persistent vegetative state after traumatic brain injury (TBI). METHOD: Databases searched included Medline, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. The search was limited to outcomes studies published in English in peer-reviewed journals between 2008 and 2013. RESULTS: Included studies provide strong evidence that multimodal sensory stimulation improves arousal and enhances clinical outcomes for people in a coma or persistent vegetative state after TBI. Moderate evidence was also provided for auditory stimulation, limited evidence was provided for complex stimuli, and insufficient evidence was provided for median nerve stimulation. CONCLUSION: Interventions should be tailored to client tolerance and premorbid preferences. Bimodal or multimodal stimulation should begin early, be frequent, and be sustained until more complex activity is possible.

Effectiveness of environment-based interventions for people with Alzheimer's disease and related dementias.

A systematic review of evidence for the efficacy of environment-based interventions on the affect, behavior, and performance of people with Alzheimer's disease and related dementias was conducted as part of the American Occupational Therapy Association's Evidence-Based Literature Review Project. Thirty-three reports met inclusion criteria. Results suggest that ambient music, aromatherapy, and Snoezelen are modestly effective in reducingagitation but do not consistently have long-term effects. Visually complex environments that give the illusion of barriers deter people from wandering to unsafe places but do not reduce the urge to wander. Evidence that bright light therapy can aid in regulating mood and the sleep-wake cycle and thus help people remain awake during the day is preliminary. Montessori-based programming can be useful in matching activities to the person's remaining skills. Further research is needed to evaluate the long-term effect, contraindications, and best dosages of these interventions.

Effectiveness of interventions designed to modify the activity demands of the occupations of self-care and leisure for people with Alzheimer's disease and related dementias.

A systematic review of evidence for the effectiveness of modification of activity demands in the care of people with Alzheimer's disease (AD) was conducted as part of the American Occupational Therapy Association's Evidence-Based Literature Review Project. The review included 10 articles addressing occupations of self-care and leisure. No reports related to work and social participation were located. Results suggest that evidence for this intervention's effectiveness is strong. Four practice principles were derived from this appraisal: (1) Occupational therapy programs should be individualized to elicit the person's highest level of retained skill and interest, (2) cues used while assisting people with AD to complete tasks should be short and provide clear direction, (3) compensatory strategies in the form of environmental modifications and simple adaptive equipment should be specifically implemented on the basis of the unique needs of the person, and (4) caregiver training and involvement are essential in implementing individualized programs.

Effectiveness of interventions to prevent falls in people with Alzheimer's disease and related dementias.

A systematic review was conducted to determine the effectiveness of interventions to prevent falls in people with Alzheimer's disease (AD) and related dementias. Twelve research reports met inclusion criteria. Studies reported on three types of intervention: (1) exercise- and motor-based interventions, (2) nursing staff-directed interventions, and (3) multidisciplinary interventions. Strategies were offered as single or multifaceted intervention programs. All types of intervention resulted in benefit, although the evidence for effectiveness is tentative because of the studies' limitations. More research is needed to better understand appropriate dosages of intervention. No evidence was found for the effectiveness of prevention programs accessed as part of occasional respite care. Occupational therapy was seldom involved in the interventions researched. Because effective fall prevention programs are embedded in people's daily routines and encouraged participation in occupation, the contribution occupational therapy practitioners can make to the care of people with AD has yet to be fully realized.

Effect of educational and supportive strategies on the ability of caregivers of people with dementia to maintain participation in that role.

A systematic review of evidence of the effectiveness of educational and supportive strategies for enabling caregivers of people with Alzheimer's disease (AD) or related dementias to maintain participation in that role was conducted as part of the American Occupational Therapy Association's Evidence-Based Literature Review Project. Forty-three articles met inclusion criteria. Results suggest that interventions that jointly engage people with AD and their caregivers in education and training in the home setting are more successful than strategies that focus solely on people with AD. Greater carryover is noted when education and training are implemented at the time that the caregiver identifies concerns. Interventions should provide caregivers with problem solving, technical skills, support, simple home modification strategies, and referral to community resources. Interventions mediated by technology have a positive effect on the caregiver and are especially important for those who live in rural areas.

National status of the entry-level doctorate in occupational therapy (OTD).

A multifaceted survey was conducted to identify the factors that academic occupational therapy (OT) programs were considering in making decisions as to whether the entry-level clinical doctorate (OTD) is a viable alternative for their institutions. The survey was sent in the summer of 2004 to program directors of all (150) occupational therapy programs in the United States. Responses were received from 111 programs (response rate of 74%). Quantitative (demographic) and qualitative (factor identification) data were compiled and analyzed. Supporting factors for the development of entry-level OTD programs included (a) coexistence of physical therapy doctorate program, (b) enhanced preparation of graduates, and (c) improved student recruitment. Impeding factors included (a) limited resources, (b) philosophical objections, and (c) lack of demand. In addition, results suggested that overall there is greater support for the OTD as a postprofessional degree. The study provided a historical record of current decision making in occupational therapy academic programs. In addition, the results of the study suggest a need for the development of national consensus regarding the place of the OTD in occupational therapy education.

Clara: a phenomenology of disability.

A phenomenological approach was used to describe the lived experience of disability of a woman who sustained a head injury 21 years ago. Data were collected through 11 face-to-face interviews and 72 e-mail messages over the period of 11 weeks. An iterative, fluid process of questioning, information-giving, analysis, and verification was characteristic of the whole study, alternating between analysis of the particular and analysis of the general. Through a process of phenomenological reduction, each interview transcript and e-mail message was divided into meaning units that denoted shifts of meaning. Similar meaning units within a transcript or message were then grouped and summarized in a phrase or word. As new meaning units emerged, additional interviews and e-mail exchanges took place in order to obtain an exhaustive description of the experience of disability. All meaning units obtained from this iterative process finally were "horizonalized" into meaning clusters of nonrepetitive themes. The themes of nostalgia, abandonment, and hope emerged through this collaborative process. A shift in view of life was noted in the participant as the reflective process of this study unfolded, suggesting a phenomenological collaboration between patient and therapist may engender a more genuine connection in which personal meaning is authentically the cornerstone of occupation-centered treatment.

Educating Leaders for the AOTA Centennial Vision.

In order to make the Centennial Vision a reality the education of occupational therapists and occupational therapy assistants should be based on constructivism because this pedagogy emphasizes renewal, interdisciplinary collaboration, drawing strength from diversity, and a focus on transformation of practice.