Assistive Technology Addressing Safety Issues in Dementia: A Scoping Review.

Safety is an issue for older adults with dementia because they are at risk for various incidents. Intelligent assistive technology (IAT) may mitigate risks while promoting independence and reducing the impact on the caregiver of supporting a relative with dementia. The aim of this scoping review was to describe IATs and to identify factors to consider when selecting one. A systematic search was performed of the scientific and gray literature published between 2000 and 2015. A total of 31 sources were included. Four types of IATs were identified as addressing safety issues in dementia: monitoring technologies, tracking and tagging technologies, smart homes, and cognitive orthoses. Characteristics of the device and ethical considerations emerged as key factors to consider when selecting one. IATs yield promising results but pose various challenges, such as adapting to the evolution of dementia. Further research on their actual impact is needed.

Algo Used by Homecare Nonoccupational Therapists Selecting Bathing Assistive Technology: Enhancing Standardization by Exploring Clinical Reasoning.

Algo is a clinical decision algorithm developed to support nonoccupational therapists in establishing assistive technology recommendations to enable physically disabled adults to perform their hygiene at home. This study aimed to explore the in-depth clinical reasoning of nonoccupational therapists using Algo to pinpoint the items leading to disagreements regarding recommendations. A multiple-case study was conducted with eight nonoccupational therapists trained to use Algo and filmed while using it with six standardized clients. Explicitation interviews were conducted for the conflicting recommendations. Identifying the key reasoning skills to develop in Algo users has led to three recommendations to enhance standardization with seniors.

Interrater reliability of Algo used by non-occupational therapist members of homecare interdisciplinary teams.

PURPOSE: To determine if non-occupational therapists (non-OTs) with different job titles using Algo, a clinical algorithm for recommending bathroom modifications (e.g., bath seat) for community-dwelling elders in "straightforward" situations, will make clinically equivalent recommendations for standardized clients. METHOD: Eight non-OTs (three social workers, two physical rehabilitation therapists, two homecare aides and one auxiliary nurse) were trained on Algo and used it with six standardized clients. Bathroom adaptations recommended (one of nine options) by non-OTs were compared to assess interrater agreement using Fleiss adapted kappa. RESULTS: Estimated kappa was 0.43 [0.36; 0.49] qualified as a moderate agreement, according to Landis and Koch's arbitrary divisions, among the recommendations of non-OTs. However, clinical equivalence is reached, since safety and client needs were met when raters selected two different options (e.g., with or without a seat back). CONCLUSIONS: Non-OTs using Algo in the same simulated clinical scenarios recommend clinically equivalent bathroom adaptations, increasing the confidence regarding the interrater reliability of Algo used by non-OT members of homecare interdisciplinary teams Implications for Rehabilitation In homecare services, non-occupational therapists from different health care disciplines (e.g., homecare aides, social workers, physical rehabilitation therapists) may be asked to select assistive devices for the hygiene care of clients living at home. Algo was designed to guide non-occupational therapists in the selection of assistive devices when performed with clients in straightforward cases. This study indicates that non-occupational therapists using Algo recommend similar and acceptable bathroom adaptations to enhance client safety.

The influence of medical students' self-explanations on diagnostic performance.

CONTEXT: Skill in clinical reasoning is a highly valued attribute of doctors, but instructional approaches to foster medical students' clinical reasoning skills remain scarce. Self-explanation is an instructional procedure, the positive effects of which on learning have been demonstrated in a variety of domains, but which remain largely unexplored in medical education. OBJECTIVES: The purpose of this study was to investigate the effects of self-explanation on students' learning of clinical reasoning during clerkships and to examine whether these effects are affected by topic familiarity. METHODS: An experimental study with a training phase and an assessment phase was conducted with 36 Year 3 medical students, randomly assigned to one of two groups. In the training phase, students solved 12 clinical cases (four cases on a less familiar topic; four on a more familiar topic; four on filler topics), either generating self-explanations (n = 18) or not (n = 18). The self-explanations were generated after minimal instructions and no feedback was provided to students. One week later, in the assessment phase, students were requested to diagnose 12 different, more difficult cases, similarly distributed among the same more familiar topic, less familiar topic and filler topics, and their diagnostic performance was assessed. RESULTS: In the training phase the performance of the two groups did not differ. However, in the assessment phase 1 week later, a significant interaction was found between self-explanation and case topic familiarity (F(1,34) = 6.18, p < 0.05). Students in the self-explanation condition, compared with those in the control condition, demonstrated better diagnostic performance on subsequent clinical cases, but this effect emerged only for cases concerning the less familiar topic. CONCLUSIONS: The present study shows the beneficial influence of generating self-explanations when dealing with less familiar clinical contexts. Generating self-explanations without feedback resulted in better diagnostic performance than in the control group at 1 week after the intervention.

[Sexual citizenship education for people with mental health problems]. / L'éducation à la citoyenneté sexuelle des usagers de services en santé mentale.

This article addresses the sexuality of people with mental health problems. More specifically, the authors examine the issue of the sexual life of people with mental health problems in a perspective of sexual citizenship defined as a status that recognizes the sexual identity of individuals and their right to a sexual life of quality. They present an educational experience that allowed participants not only to gain confidence but also to create a social link that encourages them to become actors of their own sexuality and to exercise their rights as sexual citizens.

Adaptation process, participation and depression over six months in first-stroke individuals and spouses.

OBJECTIVE: To describe changes in the adaptation process (appraisal and coping) in the six months after a first stroke and identify domains of the adaptation process related to participation and depressive symptoms for both affected individuals and spouses. DESIGN: A short-longitudinal study where data of the two groups were collected at three times: in the first two weeks post stroke (T1), at three months (T2) and six months (T3) post stroke. SUBJECTS: Individuals with a first stroke and spouses. MAIN MEASURES: The Stress Appraisal Measure (SAM) for appraisal, Revised Ways of Coping Questionnaire (RWCQ) for coping strategies, Assessment of Life Habits (LIFE-H) for participation, and Beck Depression Inventory (BDI) for depressive symptoms. RESULTS: Mean (SD) ages of the stroke group (n = 88) and spouse group (n = 47) were 71.8 (10.8) and 69.2 (11.2) years respectively. The Threat, Challenge and Stressfulness scales of the SAM decreased significantly (P < 0.02) from T1 to T3 in both groups whereas perceived uncontrollability of the situation increased significantly (P = 0.003) for spouses in the first six months. RWCQ Rationalisation and Giving control to others scales decreased in the stroke group (P = 0.008 and 0.002 respectively) but not in the spouse group (P = 0.07 and 0.39 respectively). Several components of adaptation at T1 could explain between 18% and 27% of the variance observed in the LIFE-H and BDI at T3. CONCLUSION: Appraisal and coping strategies change over time. Initial adaptation could partially predict participation level and depressive symptoms six months post stroke for affected individuals as well as spouses.

Changes in participation level after spouse's first stroke and relationship to burden and depressive symptoms.

BACKGROUND: No comprehensive data are available on the impact of stroke on the spouse's participation level. The purpose of this study was to document changes in participation level over time and explore associations between changes in participation level, burden and depressive symptoms for spouses of people who had had a first stroke. METHODS: Participants were spouses recruited in the first 2 weeks after admission of individuals with a first stroke to acute care. Prestroke measures (T0) were collected at recruitment, simultaneously with the first measure (T1); further measures were collected 6 months after the stroke event (T2). Participation level was measured with the LIFE-H, perceived burden with the Caregiver Strain Index and depressive symptoms using the Beck Depression Inventory (BDI). RESULTS: Mean age of participants (n = 54) was 69 years (SD 10.9) and the majority were female (75.9%). Changes in participation include small but significant increases at T1 for the nutrition (effect size, ES, 0.34) and responsibilities (ES 0.22) domains, and large significant persistent decreases at T2 compared to T0 were found for personal relationships (ES 0.83), employment (ES 0.63) and recreation (ES 0.93). Changes in these last three participation domains are associated with a higher Caregiver Strain Index score (p < 0.01) but not with the BDI. CONCLUSIONS: Participation domains mostly affected for spouses after stroke were personal relationships, employment and recreation which could be addressed by clinicians in their provision of support.

Changes in participation after a mild stroke: quantitative and qualitative perspectives.

PURPOSE AND METHOD: This descriptive study is aimed at documenting changes in participation level (accomplishment of daily activities and social roles) from quantitative (n = 35) and qualitative (n = 5) perspectives in individuals who have had a first "mild" stroke compared to their prestroke level. With advances in technology (e.g., increased use of thrombolitic therapy), the prevalence of mild stroke is expected to increase. Yet these strokes are rarely referred to rehabilitation, and little is known about the consequences of stroke on patients' lives. CONCLUSION: Results of both methods confirmed significant impact of the stroke on participation level that is persistent even 6 months poststroke.

Long-term changes in participation after stroke.

BACKGROUND AND PURPOSE: People who have had a stroke may have difficulty resuming some of their previous activities, which leads to a decline in their participation in daily activities and social roles. The purposes of this study were to compare participation 6 months (T1) and between 2 and 4 years (T2) after discharge from a rehabilitation unit and to verify if any changes were associated with changes in personal and environmental factors. METHOD: Participation of people who had had a stroke was measured at T1 and T2 with the Assessment of Life Habits. RESULTS: A significant reduction (p < .001) in participation in daily activities was observed, specifically in the following categories: nutrition, p < .001; fitness, p = .004; personal care, p < .001; and housing, p = .001. However, participation in social roles was maintained during this period (p = .10). The increased perception of technology as a facilitator (environmental factor) over time explained a part of the decline in participation (R2 = 0.13). CONCLUSION: Factors associated with the reduction in participation in daily activities should be further studied in order to prevent this decline.

Adaptation and coping following a first stroke: a qualitative analysis of a phenomenological orientation.

Stroke can have consequences in all areas of a person's life. If not coped with optimally, this life event will have a deleterious effect on the quality of life. The aim of this study was to improve understanding of appraisal and coping, post-stroke. Ten individuals were purposely recruited upon admission for a first stroke to participate in this qualitative study. Participants were asked to share their personal experiences with regard to their efforts to deal with the consequences of the stroke. In-depth interviews were transcribed verbatim and the content was analyzed using a rigorous method, inspired by a phenomenological orientation. Seven themes related to appraisal (unpredictability, overwhelming, feeling out of control, threat, turning point, acceptance/resignation and future prospects) and five themes related to coping (active and passive compensation, escape, change how the situation is perceived and utilization of resources) emerged from the content analysis of the in-depth interviews. In conclusion, since returning to the previous life style and activities is rather improbable, changing how the situation is perceived appears to be the most effective way of coping, in order to reach a state of acceptance/resignation favourable to an optimal quality of life.

Predictors of long-term participation after stroke.

PURPOSE: (1) To explore factors that predict long-term participation after stroke (2-4 years after discharge from rehabilitation), and (2) to determine factors that predict both short- and long-term participation. METHODS: Biopsychosocial data of people who had had a stroke were measured at discharge from an intensive rehabilitation unit using valid instruments. Six months later (n=102) as well as 2-4 years later (n=66), social participation of the survivors was measured in their living environments. Participation was estimated with the Assessment of Life Habits (LIFE-H), which includes 12 categories of daily activities and social roles. RESULTS: From multivariate regression analyses, the best predictors of long-term participation after stroke appear to be age, comorbidity, motor coordination, upper extremity ability and affect. Age, comorbidity, affect and lower extremity coordination are the best predictors of participation after stroke at both measurement times. CONCLUSIONS: With the exception of age, these factors may be positively modified and thus warrant special attention in rehabilitation interventions.

Participation after stroke compared to normal aging.

OBJECTIVE: To examine the reduction in participation of people who have had a stroke compared with healthy people with normal aging. DESIGN: Participation of people who had a stroke was compared with participation of healthy subjects. SUBJECTS/PATIENTS: Forty-six people who had a stroke for 2-4 years and 46 healthy participants matched on age, sex and living environment. MEASUREMENTS: Participation was estimated with the Assessment of Life Habits (LIFE-H). The LIFE-H (short version 2.1) is composed of 58 daily activities and social roles associated to the 12 categories of the Disability Creation Process model. The LIFE-H gives separate scores for each category, for 2 main subsections "Daily activities" and "Social roles" and a total score. RESULTS: Scores of healthy subjects did not reach the maximum value (9/9) of the LIFE-H, their mean scores varying from 6.3 to 8.6, according to the categories. These scores are higher than of the participants with stroke for all categories (scores varying from 3.9 to 6.5; p-values from 0.002 to <0.001), except the interpersonal relationships category (score of 7.8 vs 8.0) where no difference was found (p=0.49). The disruption in participation after stroke varies according to the categories of the LIFE-H, but is more important in the daily activities categories. CONCLUSION: The comparison of the scores obtained by the 2 groups suggests that a part of the reduction in participation in daily activities and social roles after stroke is attributable to normal aging and not entirely to the stroke itself. It helps to focus interventions on activities and roles disruption domains that are really attributable to stroke.