Effects of the CO-OP Approach in Addressing the Occupational Performance of Adults With Stroke: A Systematic Review.

BACKGROUND: Stroke is the third leading cause of permanent disability worldwide. It is associated with difficulties in occupational performance, an area targeted by the Cognitive Orientation to daily Occupational Performance (CO-OP). OBJECTIVE: To investigate the evidence available for the effectiveness of the CO-OP in addressing adults' performance of activities of daily living. DATA SOURCES: Randomized controlled trials (RCTs) or pilot RCTs of the CO-OP written in English and published through December 2021 were retrieved from PubMed, SCOPUS, ScienceDirect, OTseeker, and EBSCO. STUDY SELECTION AND DATA COLLECTION: The studies' participants were adults with stroke, evaluated on occupational performance before and after CO-OP administration. The American Occupational Therapy Association Evidence-Based Practice Project methodology was followed. Quality appraisal was conducted using the Cochrane Collaboration's Risk of Bias 2 tool. RESULTS: Four RCTs and 3 pilot RCTs met the inclusion criteria. Inconsistent results are presented for trained and untrained goals, with the last ones being scarcely investigated. LIMITATIONS: The limited number of studies, combined with the methodological limitations observed, did not allow for definite conclusions to be reached. CONCLUSIONS AND RELEVANCE: The CO-OP is a promising client-centered, occupation-based approach, but future adequately powered studies addressing the potential for generalization are needed. Plain-Language Summary: The Cognitive Orientation to daily Occupational Performance is a relatively new treatment method that uses cognitive techniques to guide patients into discovering ways to perform activities of daily living independently. This systematic review presents the available evidence regarding CO-OP's effectiveness when used with adults after stroke. The findings showed that CO-OP has a positive impact in this population, but further research is needed to reach more concrete conclusions. Stroke patients may benefit from CO-OP because it can be a cost-effective, short-duration, task-oriented treatment.

Development of the Refugees and Asylum Seekers Occupational Satisfaction (RASOS) Assessment Tool.

The objective of this study was to develop an occupation-centered and client-centered assessment tool for refugees and asylum seekers. A preliminary tool outline was produced based on a literature review, while considering previous published tools' strengths and limitations. A qualitative study was undertaken via focus groups to improve on the tool's design and adequacy for its purpose, resulting in the creation of a pilot version of the tool. Convenience sampling included 8 Greek and Cypriot professional and student occupational therapists with experience in the field, 8 international expert occupational therapists, 4 laypeople, 4 humanitarian professionals, and 5 refugees and asylum seekers. Basic qualitative content and thematic analysis led to topics regarding tool modifications that concerned categorization, formation/structure, wording, administration, and assessment scale. Corresponding tool revisions ensued. This study led to the development of the pilot version of the Refugees and Asylum Seekers Occupational Satisfaction (RASOS), which can also be used to identify underlying personal and environmental factors that contribute to self-perceived low satisfaction. A future quantitative study is required to establish the psychometric properties of the tool.

An Exploration of the Effectiveness of Different Intensity Protocols of Modified Constraint-Induced Therapy in Stroke: A Systematic Review.

Purpose: To examine the effectiveness of different modified Constraint-Inuced Therapy (mCIMT) protocol intensities on upper extremity motor function in adults with hemiplegia. Methods: A search was conducted in PubMed, Scopus, EBSCO, and Cochrane Library for articles published between April 2010 and December 2021. Only randomized controlled trials (RCTs) were included. Studies were excluded if they used a sample of less than five, mCIMT in combination with other therapy, and/or if they were not written in English. Methodologic quality was assessed using the Cochrane collaboration risk of bias tool-2. Results: Thirty-six RCTs with a total of 721 participants were included. Most researchers followed a moderate to low protocol intensity in terms of total treatment time and moderate to high intensity with regard to restriction time. Almost all of the upper limb motor function measures showed statistically significant improvements (p < .05) after mCIMT, irrespective of the protocol's intensity, but there was lack of high-quality studies. Statistically significant improvements did not always translate to clinical importance. Conclusions: Low-intensity CIMT protocols may result in comparable improvements to more intensive ones but caution has to be taken when drawing conclusions due to high risk of bias studies.

A Hand Motion Tracker Supporting Home-Based Rehabilitation for People with Hemiplegia due to Stroke.

Modern Wearable Medical Devices (WMDs), implement capabilities that have contributed significantly to patient outcomes, as well as quality of life. Using such devices can be beneficial for many patients, especially during the time of the pandemic where everyone had to isolate at home. This paper presents a proof of concept of a new low-cost technology-based approach to support home-based rehabilitation for people with hemiplegia aiming to assess the effectiveness of their home-based exercises thus making telerehabilitation sessions more effective.

Internationalization at Home: An Occupational Therapy Synchronous Collaboration Between Cyprus and the United States.

IMPORTANCE: Designing, implementing, and measuring the effectiveness of sustainable Internationalization at Home programs will support the development of cultural competence among occupational therapy students. OBJECTIVE: To explore potential sustainable, effective methods for enhancing cultural competence in occupational therapy students through cross-cultural online collaborations. DESIGN: Pretest-posttest, parallel mixed-methods design. SETTING: An online collaboration using video conferencing technology and classrooms at the European University Cyprus and the University of St. Augustine for Health Sciences. PARTICIPANTS: Bachelor of science and master of occupational therapy students at the European University Cyprus and the University of St. Augustine for Health Sciences, respectively. INTERVENTION: Online video conferencing collaboration between occupational therapy students in which students discussed their perspectives and experiences regarding social injustice and occupational therapy's role in working with vulnerable populations. OUTCOMES AND MEASURES: Each campus participated in focus groups, and students completed individual reflections. Themes were derived from the qualitative information gathered. Quantitative data were collected using the Cultural Awareness Scale for Occupational Therapy Students (CASOTS). RESULTS: CASOTS did not reflect changes in cultural awareness. The qualitative measures identified students' desire to participate in more frequent and culturally diverse experiences. Challenges included length of preparation and actual communication time. Inclusion of prior asynchronous sessions and methods to overcome the language barrier was suggested for future implementation. CONCLUSION: Synchronous cross-cultural collaborations may enhance occupational therapy student's cultural awareness and may be more attractive than traditional in-class teaching. Further development is necessary to overcome challenges. WHAT THIS ARTICLE ADDS: Documenting the benefits and barriers of implementing Internationalization at Home experiences will allow academic institutions to create sustainable methods for enhancing occupational therapy students' cultural competence. Recommendations to further enhance Internationalization at Home experiences provide opportunities for increased cultural collaboration.

Home-Based Training Support for Stroke Patients Using the Leap Motion and StandInExercise Stand.

Rehabilitation aims at brain rewiring through intensive practice following brain injury. This paper presents a new supportive mechanism that will be used to isolate wrist movement and in combination to the use of serious games, to act as a motivational tool to improve adherence during home-based practice. The paper describes the proposed methodology employed to carry out the home-based programme while leap motion is used to monitor and evaluate these exercises.

Development of a Robotic System for Enhancing Children's Motivation in Constraint Induced Movement Therapy (CIMT).

This paper presents a novel robotic system, which aims to enhance children's motivation through the gamification of the CIMT process. The system offers adjustability of the required movement skills, ensuring children will put increasingly more effort to achieve the rehabilitation goal, while keeping the task fun and engaging.

Modified Constraint-Induced Movement Therapy as a Home-Based Intervention for Children With Cerebral Palsy.

PURPOSE: This study was designed to investigate the benefit to upper limb function of a home-based version of pediatric constraint-induced movement therapy, which was delivered across 2 months. METHODS: Nine children (mean age: 6 years, 9 months) with hemiplegic cerebral palsy participated in this A1-B-C-A2 design, where A1 and A2 were nonintervention phases. In phases B and C, participants wore a splint on the unaffected hand. In phase C, motivating feedback through a computer game was added. RESULTS: The Melbourne Assessment of Unilateral Upper Limb Function and the Quality of Upper Extremity Skills Test scores were significantly higher at the end of phases B (P = .037 and P = .006, respectively) and C (P = .001 and P = .001, respectively). Melbourne scores remained higher at the end of phase A2 (P = .001). CONCLUSIONS: A nonintensive form of home-based constraint-induced movement therapy was found to be effective. Improvements were larger after the second month of intervention.

Forced use as a home-based intervention in children with congenital hemiplegic cerebral palsy: choosing the appropriate constraint.

PURPOSE: The purpose of this study was (1) to identify the most appropriate splint from children's and parents' perspective as reflected by effectiveness and adherence to home-based forced use therapy (FUT). (2) To provide guidance in the development of a practical and effective protocol based on forced use principles. METHOD: A crossover design with a convenience sample of children with hemiplegic cerebral palsy and their parents was used to test three types of splint (mitt, short splint and long splint) during home-based FUT. Children wore the splints for a minimum of 1 h/ day during physical activity. Outcome measures included a daily log and a questionnaire (completed by parents), an actometer worn on the affected hand to quantify movement and video recordings to inform quality of movement. RESULTS: The short splint was found to be the most effective and acceptable restraining device. Wearing devices for more than 1 h per day was not considered acceptable by either parents or children. CONCLUSION: A short splint, worn for 1 h per day was found to be the most acceptable protocol.