Effectiveness of Occupational Therapy Interventions to Improve Performance and Participation in Instrumental Activities of Daily Living (IADL) Among Adult Stroke Survivors (2009-2019).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme and/or subthemes, related to a specific topic. This Systematic Review Brief summarizes findings from the systematic review on interventions to improve performance and participation in instrumental activities of daily living among adult stroke survivors. This theme reports on the effectiveness of virtual reality, exercise, vision rehabilitation, and community-based stroke empowerment group interventions.

Occupational Therapy and Activities of Daily Living Interventions to Improve Performance in Activities of Daily Living for Adults With Stroke (2012-2019).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings for occupational therapy and activities of daily living (ADL) interventions to improve ADL outcomes for adults with stroke.

Effectiveness of Task-Oriented Approaches and Occupation-Based Activities to Improve Performance and Participation in Instrumental Activities of Daily Living (IADL) Among Adult Stroke Survivors (2009-2019).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings for task-oriented/occupation-based approaches and augmenting task-oriented training with cognitive strategies to support performance in instrumental activities of daily living among adult stroke survivors.

Preparatory Interventions to Support ADL Performance for Adults With Stroke (2012-2019).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings for preparatory interventions to support performance in activities of daily living for adults with stroke, such as early mobilization, bilateral priming, passive range of motion, sensory retraining, and shoulder taping.

Task-Oriented Training With Cognitive Strategies for Adults With Stroke to Improve ADL and/or Functional Mobility Performance (2012-2019).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on interventions to improve activities of daily living and functional mobility performance for people with stroke. This theme reports on task-oriented training with cognitive strategies.

Technology-Related Interventions to Improve Performance in Activities of Daily Living for Adults With Stroke (2012-2019).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings for technology-related interventions to improve performance in activities of daily living for adults with stroke, such as virtual reality/gaming, biofeedback, robotics, electrical stimulation, and telerehabilitation.

Behavioral Interventions to Improve Performance in Activities of Daily Living for Adults With Stroke (2012-2019).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings for behavioral interventions to improve outcomes in activities of daily living for adults with stroke, including cognitive, self-management, falls prevention, psychosocial, and creative/recreation interventions.

Task Oriented Training Interventions for Adults With Stroke to Improve ADL and Functional Mobility Performance (2012-2019).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on interventions to improve activities of daily living (ADL) and functional mobility performance for people with stroke. This theme reports on task-oriented training interventions.

Exercise for Adults With Stroke to Improve ADL and/or Functional Mobility Performance (2012-2019).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on interventions to improve activities of daily living (ADL) and functional mobility performance for people with stroke. This theme reports on exercise interventions.

A Call to Shift to Competency-Based Education.

This column explores the concept of competency-based education (CBE). A shift to CBE is a key trend for the future of health care education. Health care professions that have adopted, or started to adopt, a CBE framework include physical therapy, speech-language pathology, social work, medicine, nursing, pharmacology, and dentistry. Internationally, many occupational therapy programs are in the process of shifting to, or have shifted to, a CBE model. This column discusses how although select occupational therapy programs in the United States may individually be considering shifting to, or have shifted to, a CBE framework, there is no national movement to explore adopting the model for occupational therapy or a consensus on defined outcomes for the profession.

Dual-Tasking in Daily Activities Among Adults With and Without Stroke.

IMPORTANCE: In laboratory settings, dual-tasking is a performance strategy affected by dominance and stroke. However, the volitional use of dual-tasking has not been examined during naturalistic performance of activities of daily living (ADLs). OBJECTIVE: To examine dual-tasking in the context of ADLs and identify whether dominance and stroke influence its use. DESIGN: Cross-sectional, observational. SETTING: Academic medical center. PARTICIPANTS: Forty-three participants with chronic stroke and upper extremity (UE) motor impairment and 19 control participants without stroke. OUTCOMES AND MEASURES: We identified dual-tasking as the performance of dual-object primitives (DOPs), a functional strategy to manage two objects simultaneously. We videotaped participants performing feeding and toothbrushing tasks and identified the initiation and frequency of DOPs. We assessed whether these outcomes were influenced by UE dominance or paresis and whether among participants with stroke these outcomes were influenced by motor impairment (using the Fugl-Meyer Assessment) or cognitive impairment (using the Montreal Cognitive Assessment). RESULTS: DOP initiation was reduced on the nondominant side of control UEs and in the paretic UE of participants with stroke. After DOPs were initiated, however, their frequency was not significantly related to dominance or paresis. Among participants with stroke, DOP initiation but not DOP frequency was influenced by motor impairment, and neither were influenced by cognitive impairment. CONCLUSIONS AND RELEVANCE: The initiation of dual-tasking is curtailed in the nondominant and paretic UEs, extending previous laboratory-based findings to a more naturalistic setting. These results may reflect a demand on neural resources that is exceeded when these limbs are used. What This Article Adds: DOPs, a functional strategy to simultaneously engage two objects during ADLs, could serve as a behavioral marker of dual-tasking in real-world activities, supporting their investigation more broadly. Practicing DOPs in rehabilitation could also train the integration of dual-tasking strategies in activity execution.

Assessing and Building Clinical Competence in Occupational Therapists Treating Patients with Neurodegenerative Disease: A Community of Practice Study.

Communities of practice (CoPs) can be an effective means by which to efficiently build skills, knowledge, and competence for occupational therapists. The objective of this study was to assess changes in clinical competence for occupational therapists treating patients with neurodegenerative diseases (NDD) after participating in a CoP. A cohort of home health occupational therapists was recruited to participate in a seven-week CoP focused on treating patients with NDD. A single group pretest posttest mixed methods design was used to measure changes in clinical competence of the participants through a validated self-report assessment tool and a qualitative analysis of treatment summaries. Thirteen occupational therapists participated in the study. There were significant changes in pretest and post-test knowledge, beliefs, and action scores, indicating a positive change in the participants' competence to treat patients with NDD. Qualitative findings support positive changes in clinical competence through increased knowledge, confidence, and use of interventions aimed at optimizing occupational performance for this population. In summary, the CoP was an effective method for building clinical competence for treating patients with NDD with this cohort of occupational therapists.

Effectiveness of interventions to improve occupational performance of people with motor impairments after stroke: an evidence-based review.

We conducted a review to determine the effectiveness of interventions to improve occupational performance in people with motor impairments after stroke as part of the American Occupational Therapy Association's Evidence-Based Practice Project. One hundred forty-nine studies met inclusion criteria. Findings related to key outcomes from select interventions are presented. Results suggest that a variety of effective interventions are available to improve occupational performance after stroke. Evidence suggests that repetitive task practice, constraint-induced or modified constraint-induced movement therapy, strengthening and exercise, mental practice, virtual reality, mirror therapy, and action observation can improve upper-extremity function, balance and mobility, and/or activity and participation. Commonalities among several of the effective interventions include the use of goal-directed, individualized tasks that promote frequent repetitions of task-related or task-specific movements.

Effectiveness of interventions to improve occupational performance of people with cognitive impairments after stroke: an evidence-based review.

This evidence-based review was conducted to determine which interventions are effective in improving occupational performance after stroke. Forty-six articles met the inclusion criteria and were examined. Interventions for the following impairments were reviewed: general cognitive deficits, executive dysfunction, apraxia, memory loss, attention deficits, visual field deficits (included because of their close relationship with neglect), and unilateral neglect. Evidence is available from a variety of clinical trials to guide interventions regarding general cognition, apraxia, and neglect. The evidence regarding interventions for executive dysfunction and memory loss is limited. There is insufficient evidence regarding impairments of attention and mixed evidence regarding interventions for visual field deficits. The effective interventions have some commonalities, including being performance focused, involving strategy training, and using a compensatory as opposed to a remediation approach. The implications of the findings for practice, research, and education are discussed.

Motor Learning Following Stroke: Mechanisms of Learning and Techniques to Augment Neuroplasticity.

Sensorimotor impairments are common after stroke requiring stroke survivors to relearn lost motor skills or acquire new ones in order to engage in daily activities. Thus, motor skill learning is a cornerstone of stroke rehabilitation. This article provides an overview of motor control and learning theories that inform stroke rehabilitation interventions, discusses principles of neuroplasticity, and provides a summary of practice conditions and techniques that can be used to augment motor learning and neuroplasticity in stroke rehabilitation.

Clinician perceptions of a novel wearable robotic hand orthosis for post-stroke hemiparesis.

PURPOSE: Wearable robotic devices are currently being developed to improve upper limb function for individuals with hemiparesis after stroke. Incorporating the views of clinicians during the development of new technologies can help ensure that end products meet clinical needs and can be adopted for patient care. METHODS: In this cross-sectional mixed-methods study, an anonymous online survey was used to gather clinicians' perceptions of a wearable robotic hand orthosis for post-stroke hemiparesis. Participants were asked about their clinical experience and provided feedback on the prototype device after viewing a video. RESULTS: 154 participants completed the survey. Only 18.8% had previous experience with robotic technology. The majority of participants (64.9%) reported that they would use the device for both rehabilitative and assistive purposes. Participants perceived that the device could be used in supervised clinical settings with all phases of stroke. Participants also indicated a need for insurance coverage and quick setup time. CONCLUSIONS: Engaging clinicians early in the design process can help guide the development of wearable robotic devices. Both rehabilitative and assistive functions are valued by clinicians and should be considered during device development. Future research is needed to understand a broader set of stakeholders' perspectives on utility and design.

Clinicians valued both assistive and rehabilitative uses of a wearable robotic hand orthosis designed for individuals with hemiparesis after stroke.Wearable robotic hand devices should have the capacity to engage in functional, real-world activities for both assistive and rehabilitative purposes.Pragmatic factors, such as set-up and training time, must be balanced with device complexity to enable implementation in clinical settings.Stakeholders, such as clinicians, play an important role in identifying design priorities for wearable robotic devices to ensure these devices can meet the needs of end-users.

Home mirror therapy: a randomized controlled pilot study comparing unimanual and bimanual mirror therapy for improved arm and hand function post-stroke.

PURPOSE: To compare home-based unimanual mirror therapy (UMT) and bimanual mirror therapy (BMT) for upper limb recovery in subacute/chronic stroke individuals with moderate-to-severe arm impairment. METHOD: Twenty-two participants were randomized into 1 of 3 groups: UMT, BMT or traditional occupational therapy (TOT) home-based programs. The intervention was 6-weeks and consisted of OT 2 days a week, weekly sessions with the research OT, and 30-minutes of the home-based program 5 days a week, according to group allocation. The Action Research Arm Test (ARAT), ABILHAND, Fugl-Meyer Assessment (FMA), grip strength, and Stroke Impact Scale (SIS) were used for outcome measures. RESULTS: All groups significantly improved over time on all outcome measures and adhered to the prescribed dosage regardless of group (p<0.05). While there were no between-group differences, effect size and 95% confidence interval data suggest a clinical significance in favor of UMT as compared to the other groups. CONCLUSIONS: All participants, regardless of home-based program, adhered to the prescribed dosage and significantly improved over time. Despite no between-group differences, effect size and 95% confidence interval data suggest that UMT may be more beneficial for individuals with moderate-to-severe arm impairment as compared to BMT or TOT. ClinicalTrials.gov: #NCT02780440Implications for RehabilitationHome-based unimanual mirror therapy (UMT), bimanual mirror therapy (BMT), and traditional occupational therapy (TOT), when administered in conjunction with outpatient OT, are helpful for improving upper limb recovery post-stroke.Home-based UMT may be more beneficial than BMT or TOT for improvement in upper limb motor function and activities of daily living of patients with moderate to severe arm impairment post-stroke.

Thumb Stabilization and Assistance in a Robotic Hand Orthosis for Post-Stroke Hemiparesis.

We propose a dual-cable method of stabilizing the thumb in the context of a hand orthosis designed for individuals with upper extremity hemiparesis after stroke. This cable network adds opposition/reposition capabilities to the thumb, and increases the likelihood of forming a hand pose that can successfully manipulate objects. In addition to a passive-thumb version (where both cables are of fixed length), our approach also allows for a single-actuator active-thumb version (where the extension cable is actuated while the abductor remains passive), which allows a range of motion intended to facilitate creating and maintaining grasps. We performed experiments with five chronic stroke survivors consisting of unimanual resistive-pull tasks and bimanual twisting tasks with simulated real-world objects; these explored the effects of thumb assistance on grasp stability and functional range of motion. Our results show that both active- and passive-thumb versions achieved similar performance in terms of improving grasp force generation over a no-device baseline, but active thumb stabilization enabled users to maintain grasps for longer durations.

Use of mental practice to improve upper-limb recovery after stroke: a systematic review.

OBJECTIVE: We sought to determine whether mental practice is an effective intervention to improve upper-limb recovery after stroke. METHOD: We conducted a systematic review of the literature, searching electronic databases for the years 1985 to February 2009. We selected studies according to specified criteria, rated each study for level of evidence, and summarized study elements. RESULTS: Studies differed with respect to design, patient characteristics, intervention protocols, and outcome measures. All studies used imagery of tasks involving movement of the impaired limb. The length of the interventions and number of practice hours varied. Results suggest that mental practice combined with physical practice improves upper-limb recovery. CONCLUSION: When added to physical practice, mental practice is an effective intervention. However, generalizations are difficult to make. Further research is warranted to determine who will benefit from training, the dosing needed, the most effective protocols, whether improvements are retained, and whether mental practice affects perceived occupational performance.

Motor imagery training in hemiplegic cerebral palsy: a potentially useful therapeutic tool for rehabilitation.

Converging evidence indicates that motor deficits in cerebral palsy (CP) are related not only to problems with execution, but also to impaired motor planning. Current rehabilitation mainly focuses on alleviating compromised motor execution. Motor imagery is a promising method of training the more 'cognitive' aspects of motor behaviour, and may, therefore, be effective in facilitating motor planning in patients with CP. In this review first we present the specific motor planning problems in CP followed by a discussion of motor imagery and its use in clinical practice. Second, we present the steps to be taken before motor imagery can be used for rehabilitation of upper limb functioning in CP. Motor imagery training has been shown to be a useful addition to existing rehabilitation protocols for poststroke rehabilitation. No such study has been conducted in CP. The age at which children can reliably use motor imagery, as well as the specific way in which motor imagery training needs to be implemented, must be researched before motor imagery training can be employed in children with CP. Based on the positive results for poststroke rehabilitation, and in light of the motor problems in CP, motor imagery training may be a valuable additional tool for rehabilitation in CP.