Occupational Therapy Practice in the Rehabilitation of Adults with Occupational Dysfunction following a Neurological Injury in Argentina: A Descriptive Study.

To describe aspects of occupational therapy practice in the rehabilitation of adults with occupational dysfunction following a neurological injury in Argentina, a cross-sectional, descriptive study was conducted. One hundred and sixty-seven occupational therapists completed an online, self-administered questionnaire. The preferred professional model was the Model of Human Occupation and the most frequently administered assessment was the Functional Independence Measure. The most frequent interventions were sitting balance, fine motor skills, and dressing. There is an inclination to work on neuromusculoskeletal functions, followed by training in activities of daily living. No statistically significant differences were found between the type of interventions and care method, type of sessions, and rehabilitation stage. Results indicate that although occupational therapists use a combination of practice approaches, the footprints of reductionism are still present in professional exercise.

Using Multicontext Approach to Improve Instrumental Activities of Daily Living Performance after a Stroke: A Case Report.

Cognitive deficits constitute one of the greatest challenges for independence achievement after a stroke. This paper provides an in depth view of the application of the Multicontext approach within routine Occupational Therapy care for a 41-year-old who demonstrated limited participation in activities of daily living as a consequence of executive function impairments and limited self-awareness. Results indicated improved online self-awareness, strategy use and functional performance, however, no changes were observed on a standard Awareness Questionnaire. This suggests that awareness within activities may be more important in contributing to effective strategy use and functional performance compared to verbal acknowledgment in an interview. Results also support the feasibility of the Multicontext approach within inpatient settings in Argentina.

A Spanish validation of the Coma Recovery Scale-Revised (CRS-R).

RESEARCH DESIGN: Analysis of inter-rater reliability and concurrent validity. OBJECTIVE: To determine measurement properties of a Spanish version of The Coma Recovery Scale-Revised (CRS-R). METHODS AND PROCEDURES: A sample of 35 in-patients with severe acquired brain injury. To test concurrent validity of the translated scale, the Glasgow Coma Scale (GSC) and Disability Rating Scale (DRS) were also administered. Two experts in the field were recruited to assess inter-rater agreement. RESULTS: Inter-rater reliability was good for total CRS-R scores (Cronbach α = 0.973, p = 0.001). Sub-scale analysis showed moderate-to-high inter-rater agreement. Total CRS-R scores correlated significantly (p < 0.05) with total GCS (r = 0.74) and DRS (r = 0.54) scores, indicating acceptable concurrent validity. CONCLUSIONS: The Spanish version of CRS-R can be administered reliably by trained and experienced examiners. CRS-R appears capable of differentiating patients in Emergence from Minimally Conscious State (EMCS) or in Minimally Conscious State (MCS) from those in a Vegetative State (VS).

Assessing level of consciousness and cognitive changes from vegetative state to full recovery.

Although investigations addressing cognitive recovery from the vegetative state have been reported, to date there have been no detailed studies of these patients combining both neuropsychology and functional imaging to monitor and record the recovery of consciousness. This paper describes the recovery of a specific vegetative state (VS) case. The patient (OG) remained in the vegetative state for approximately two months, increasing her level of awareness to a minimally conscious state, where she continued for approximately 70 days. In the course of the ensuing 18 months, she was able to reach an acceptable level of cognitive functioning, with partial levels of independence. Throughout this two year period, she received continuous cognitive evaluation, for which several different tools were applied including coma and low functioning scales, full cognitive batteries, and structural and functional magnetic resonance imaging (MRI). We present here preliminary data on fMRI using a word presentation paradigm before and after recovery; we also discuss the difficulty of how to determine level of consciousness using the tools currently available, and the subsequent improvement in different cognitive domains. We confirm that accurate diagnosis and proper cognitive assessment are critical for the rehabilitation of patients with disorders of consciousness.