Initial Validation of the Weekly Calendar Planning Activity With Adolescents With ABI.

The purpose of this study was to assess the validity of the Weekly Calendar Planning Activity Middle/High School (WCPA) in adolescents with acquired brain injuries (ABI). We recruited neurotypical controls (n = 27) and adolescents with ABI (n = 14) to complete a 90-min battery of cognitive tests. Adolescents with ABI were further divided into mild and severe groups by Glasgow Coma Scale Score and compared with controls. Mann-Whitney U tests revealed significant differences (p = .05) on the WCPA between groups in total time to complete and rules followed. Between the controls and severe group, a significant difference (p = .05) was found for total time spent, errors, rules followed, strategies used, and accurate appointments (p = .01). Moderate correlations were found between the WCPA and neuropsychological tests (ρ = .31-.45). The WCPA is a valid performance-based assessment of functional cognition that can be used to detect deficits in adolescents with severe ABI.

Cognitive oriented strategy training augmented rehabilitation (COSTAR) for ischemic stroke: a pilot exploratory randomized controlled study.

Purpose: To investigate the effect of adding cognitive strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared with TST on activity and participation for chronic stroke survivors in an outpatient occupational therapy settingMaterials and methods: We conducted an exploratory, single-blind, randomized controlled trial. Participants were randomized to TST or COSTAR protocol. Our primary outcomes measured activity and participation after stroke: the Stroke Impact Scale (SIS), Canadian Occupational Performance Measure (COPM), and Performance Quality Rating Scale (PQRS).Results: Forty-four participants were randomized. The COSTAR group had an attrition rate of 50% and an average of 9.8 of 12 sessions were completed; the TST group had an attrition rate of 25% and an average of 10.7 sessions were completed. Generally both groups improved on the majority of primary and secondary outcomes. There is little evidence to support a beneficial effect of COSTAR over TST for improvement of primary measures of activity performance or secondary measures.Conclusion: Negligible findings may be attributed to an inadvertent treatment group equivalency. Further, the research design did not allow for adequate measurement of the effect of each intervention on participants' ability to generalize learned skills.Implications for rehabilitationStroke rehabilitation is largely based upon the principles of task-specific training, which is associated with improvements in upper extremity motor performance; however, TST requires a heavy dosage and lacks generalization to untrained activities.Cognitive strategy use has been associated with improved generalization of treatment to untrained activities and novel contexts however, it is often not used in TST protocols.The results of this preliminary study found no clear advantage between task-specific training and strategy-adapted task-specific training on trained and untrained activities when both interventions targeted activity performance.Task-specific training, if focused at the activity performance level rather than the impairment reduction level, may have a stronger effect on improving in individual's ability to participate in everyday life activities even without the use of cognitive-strategies.Incorporating cognitive strategy-use into TST would likely produce the greatest effect on generalization and transfer of the treatment effects to other activities and contexts rather than solely on activity performance of trained activities.

Generalized Reflexive Responding and Cross-Modal Tactile Transfer of Stimulus Function in Children with Autism.

We sought to evaluate the efficacy of successive matching training for establishing generalized reflexive matching across 4 children with autism. In Experiment 1, differential reinforcement with delay fading was efficacious in establishing "yes" and "no" matching and nonmatching responses in 2 participants when 2 identical or nonidentical picture stimuli were presented. In addition, emergent visual-visual reflexive relational responses were observed using novel picture stimuli in a transfer test phase. In Experiment 2, differential reinforcement alone was efficacious in establishing matching and nonmatching responses in the other 2 participants when 2 identical or nonidentical objects were presented. Transfer to identical objects presented through touch (i.e., tactile discrimination) was additionally observed for both participants. Procedures in the study were adapted from the PEAK Relational Training System to aid in clinical replication, and the translational results have implications for language training with individuals with autism.

Interventions Within the Scope of Occupational Therapy Practice to Improve Activities of Daily Living, Rest, and Sleep for Children Ages 0-5 Years and Their Families: A Systematic Review.

IMPORTANCE: Research studies supporting occupational therapy interventions to address feeding, toileting, and sleep can be applied to practice in early intervention and preschool settings to improve the outcomes of young children and their families. OBJECTIVE: To examine the effectiveness of interventions within the scope of occupational therapy practice to improve activities of daily living, rest, and sleep for children ages 0-5 yr and their families. DATA SOURCES: Five databases (MEDLINE, PsycINFO, CINAHL, OTseeker, ERIC) and Evidence-Based Medicine Reviews, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, and Database of Abstracts of Reviews of Effectiveness were searched for studies published between January 2000 and March 2017. STUDY SELECTION AND DATA COLLECTION: Inclusion criteria were Levels I-III evidence, being within occupational therapy's scope of practice, including participants with a mean age younger than 6 yr, and addressing self-care, activities of daily living, and rest and sleep. FINDINGS: Forty articles were appraised, and three themes emerged: interventions to address feeding and eating, interventions to address toileting, and interventions to address rest and sleep. Additional subthemes of behavioral approaches, parent and caregiver education, and contextual intervention were revealed. CONCLUSIONS AND RELEVANCE: Occupational therapy practitioners should consider the use of interventions with moderate or strong evidence as described in this review. Limitations include risk of bias and limited evidence for several interventions. WHAT THIS ARTICLE ADDS: This article provides a broader perspective on evidence-based practice by examining studies within the scope of occupational therapy practice published outside of current occupational therapy publications. The review includes studies from nutrition, nursing, and psychology, which address interdisciplinary care, family coaching and education, and behavioral approaches within the professional scope of occupational therapy to improve the functional performance, routines, and quality of life for young children and their caregivers.

A Conceptual Framework of Social Communication: Clinical Applications to Pediatric Traumatic Brain Injury.

Social communication impairments are common following pediatric traumatic brain injury (TBI) and can lead to social isolation, and poor social outcomes. Social communication has been documented as a persistent area of need in terms of proper assessment and intervention; however, this is not consistently addressed in clinical practice. While there is a body of evidence regarding social communication impairments and pediatric TBI, this area is not yet fully understood and remains underrecognized. To meet this gap, we provide a conceptual framework of social communication from a neurodevelopmental perspective, which can be applied to better understand the social communication impairments associated with pediatric TBI. We propose a general model of social communication with component constructs and consideration of internal factors such as sex and gender. These can inform considerations, clinical applications, and future research in assessment and evidence-based interventions within the domain of social communication.

Rehabilitation Outcomes of an Occupational Therapy Student-Run Free Clinic for Individuals with Acquired Brain Injury.

BACKGROUND: Preliminary evidence shows the successes of student-run free clinics (SRFC) in improving patient health; however, continued research is required on the effectiveness of student-delivered occupational therapy (OT) for individuals with acquired brain injury (ABI). The purpose of this study was to evaluate the effectiveness of OT treatment on patient outcomes in a SRFC for ABI. METHODS: A single-group pre/post study examined the effect of a 12-week OT intervention for 26 individuals with ABI on seven outcome measures using Cohen's d and effect size r for non-normal samples. RESULTS: The intervention had a large effect (≥0.8) on upper extremity function, goal improvement, and functional balance, a medium effect (0.5 < x < 0.8) on self-perceived physical health and activity participation, and a small effect (0.2 < x < 0.5) on cognition and mood outcomes. CONCLUSIONS: This is the first study to show the effectiveness of an OT SRFC. Participation in this clinic had a positive effect on activity-based goals, physical, cognitive, health, and psychosocial outcomes of clients with ABI.

Evidence-based systematic review of cognitive rehabilitation, emotional, and family treatment studies for children with acquired brain injury literature: From 2006 to 2017.

This paper updates guidelines for effective treatments of children with specific types of acquired brain injury (ABI) published in 2007 with more recent evidence. A systematic search was conducted for articles published from 2006 to 2017. Full manuscripts describing treatments of children (post-birth to 18) with acquired brain injury were included if study was published in peer-reviewed journals and written in English. Two independent reviewers and a third, if conflicts existed, evaluated the methodological quality of studies with an Individual Study Review Form and a Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Strength of study characteristics was used in development of practice guidelines. Fifty-six peer-reviewed articles, including 27 Class I studies, were included in the final analysis. Established guidelines for writing practice recommendations were used and 22 practice recommendations were written with details of potential treatment limitations. There was strong evidence for family/caregiver-focused interventions, as well as direct interventions to improve attention, memory, executive functioning, and emotional/behavioural functioning. A majority of the practice standards and guidelines provided evidence for the use of technology in delivery of interventions, representing an important trend in the field.

Construct validity for the verbal associated pairs screen.

The present study introduces the Verbal Associated Pairs Screen (VAPS) as a new measure for assessing performance validity in pediatric populations. This study presents initial data on psychometric properties and establishes construct validity for the VAPS in a sample of 30 adolescent healthy controls and 206 youths with traumatic brain injury (TBI: moderate/severe, N = 30; mild, N = 176). The control group's age (M = 14.93, SD = 1.8) was significantly higher than the moderate/severe TBI (M = 13.9, SD = 2.8), t(68.508) = -3.038, p = .003, and mild TBI (mTBI) groups (M = 14, SD = 2.8), t(54.147) = 2.038, p = .046. The TBI groups were administered the VAPS in accord with other established performance validity tests (PVTs) and well-established  memory tests as part of routine clinical evaluations. The healthy control group was administered the VAPS only. VAPS score distributions for the control group were negatively skewed and highly kurtotic. VAPS scores from the moderate/severe TBI and control groups were indistinguishable for Trial 2 (U = 274, p < .01) and the Delay (U = 396, p = .218). In the mTBI group, convergent and divergent validity was established with other well-validated PVTs and memory tests, respectively. ROC curve analyses identified optimal cutoff scores for the VAPS Total Score, with acceptable sensitivity (55%) and excellent specificity (100%), as well as strong detectability (AUC = .829, 95% CI: 0.731 - 0.928, p < .001). Clinical applications, limitations, and directions for future research with the VAPS are discussed.

Teaching preschool children to report suspicious packages to adults.

Law enforcement agencies stress that public reporting of terror-related crime is the predominant means for disrupting these actions. However, schools may be unprepared because the majority of the populace may not understand the threat of suspicious materials or what to do when they are found on school grounds. The purpose of this study was to systematically teach preschool children to identify and report suspicious packages across three experiments. In the first experiment, we used multiple exemplar training to teach children to identify the characteristics of safe and unsafe packages. In the second experiment, we taught participants to identify the locations where packages should be considered unsafe. Finally, in the third experiment, we used behavioral skills training to teach participants to avoid touching unsafe packages, leave the area where they were located, and report their discovery to an adult. Results suggest the participants quickly developed these skills. Implications for safety skills in young school children are discussed.

Development and Alternate Form Reliability of the Complex Task Performance Assessment (CTPA) for People With Mild Stroke.

Cognitive impairment is a common consequence of mild stroke. Current performance-based assessments for mild stroke can detect mild impairments in executive function but lack alternate forms to be used as outcome measures. This study aimed to develop an alternate form of the Complex Task Performance Assessment (CTPA-Alt), a performance-based assessment of executive function, and to establish the alternate form reliability of the CTPA-Alt. A repeated-measures study was conducted with 26 community participants. Participants were screened for eligibility and administered both forms of the CTPA; administration order was alternated. Overall performance was significantly correlated (rs = .44, p = .03), but pattern of scoring differed by CTPA form and order of administration. Our results indicate that the CTPA forms were similar but that the specific tasks in each form were different. The CTPA may be used as an ecologically valid outcome assessment with further considerations.

The effect of self-management education following mild stroke: an exploratory randomized controlled trial.

BACKGROUND: Mild stroke comprises 53% of stroke hospital admissions; however, the majority of those with mild stroke patients receive little support to address chronic symptoms following stroke. OBJECTIVES: To evaluate the feasibility and preliminary effect of the Chronic Disease Self-Management Program (CDSMP) for use with individuals immediately post mild-stroke. METHODS: Single-blind, exploratory, randomized controlled trial with participants who sustained a mild stroke (NIHSS <6). Participants were randomized to either receive the CDSMP intervention or to an inactive control group. Primary outcomes were self-reported health and self-efficacy and were obtained at baseline, post-intervention (treatment group only), and at six months post-baseline. Wilcoxon Signed Rank Tests were used to compare change score differences for all participants and effect size was computed using effect size r for non-parametric data. RESULTS: There were no differences between groups in demographics or baseline data with the exception of how participants felt they are able to manage their health in general (p = 0.05). At follow-up, effect sizes ranged from 0 to 0.35 (no effect to medium effect); however, while the treatment group reported improvements in several areas of health at follow-up, the results are not compelling when compared to the control group over the same time period. CONCLUSIONS: The results did not identify a positive effect that would support the use of the CDSMP with individual's post-mild stroke; however, the generalizability of these results is limited secondary to several limitations in this exploratory study.

The reliability and validity of the Complex Task Performance Assessment: A performance-based assessment of executive function.

The objective of this study was to evaluate the inter-rater reliability, test-retest reliability, concurrent validity, and discriminant validity of the Complex Task Performance Assessment (CTPA): an ecologically valid performance-based assessment of executive function. Community control participants (n = 20) and individuals with mild stroke (n = 14) participated in this study. All participants completed the CTPA and a battery of cognitive assessments at initial testing. The control participants completed the CTPA at two different times one week apart. The intra-class correlation coefficient (ICC) for inter-rater reliability for the total score on the CTPA was .991. The ICCs for all of the sub-scores of the CTPA were also high (.889-.977). The CTPA total score was significantly correlated to Condition 4 of the DKEFS Color-Word Interference Test (p = -.425), and the Wechsler Test of Adult Reading (p = -.493). Finally, there were significant differences between control subjects and individuals with mild stroke on the total score of the CTPA (p = .007) and all sub-scores except interpretation failures and total items incorrect. These results are also consistent with other current executive function performance-based assessments and indicate that the CTPA is a reliable and valid performance-based measure of executive function.

The Feasibility of Using Metacognitive Strategy Training to Improve Cognitive Performance and Neural Connectivity in Women with Chemotherapy-Induced Cognitive Impairment.

OBJECTIVE: To evaluate the feasibility and preliminary effect of metacognitive strategy training (MCST) on cognitive performance and on neural connectivity in the frontoparietal network in women with chemotherapy-induced cognitive impairment (CICI) following treatment for breast cancer. METHODS: A single-group pre/post study was conducted. After completing the baseline assessment battery and neuroimaging, the participants completed a 12-session MCST intervention. Following the completion of the intervention, the subjects completed the same assessment battery and neuroimaging as was completed at baseline within 4 weeks after the intervention. The key inclusion/exclusion criteria for this study were: completed chemotherapy for treatment of breast cancer, no other neurological or psychiatric diagnoses, self-reported CICI, and no contraindications to the use of MRI. RESULTS: MCST had a small-to-large positive effect on all primary (cognitive) and secondary (quality of life and psychosocial) behavioral outcome measures (r = -0.12 to -0.88). There was also a positive change in functional connectivity in a frontoparietal cognitive control network connection in 6 of the 10 subjects, which was correlated to changes in the behavioral measures. CONCLUSIONS: This study found that MCST was associated with a positive effect on cognitive performance and neural connectivity in women with CICI following treatment for breast cancer.

Combined Cognitive-Strategy and Task-Specific Training Affects Cognition and Upper-Extremity Function in Subacute Stroke: An Exploratory Randomized Controlled Trial.

The purpose of this study was to estimate the effect of Cognitive Orientation to Daily Occupational Performance (CO-OP) compared with usual occupational therapy on upper-extremity movement, cognitive flexibility, and stroke impact in people less than 3 mo after stroke. An exploratory, single-blind randomized controlled trial was conducted with people referred to outpatient occupational therapy services at two rehabilitation centers. Arm movement was measured with the Action Research Arm Test, cognitive flexibility with the Delis-Kaplan Executive Function System Trail Making subtest, and stroke impact with subscales of the Stroke Impact Scale. A total of 35 participants were randomized, and 26 completed the intervention. CO-OP demonstrated measurable effects over usual care on all measures. These data provide early support for the use of CO-OP to improve performance and remediate cognitive and arm movement impairments after stroke over usual care; however, future study is warranted to confirm the effects observed in this trial.

Combined Cognitive-Strategy and Task-Specific Training Improve Transfer to Untrained Activities in Subacute Stroke: An Exploratory Randomized Controlled Trial.

PURPOSE: The purpose of this study was to estimate the effect of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach compared with usual outpatient rehabilitation on activity and participation in people <3 months poststroke. METHODS: An exploratory, single-blind, randomized controlled trial, with a usual-care control arm, was conducted. Participants referred to 2 stroke rehabilitation outpatient programs were randomized to receive either usual care or CO-OP. The primary outcome was actual performance of trained and untrained self-selected activities, measured using the Performance Quality Rating Scale (PQRS). Additional outcomes included the Canadian Occupational Performance Measure (COPM), the Stroke Impact Scale Participation Domain, the Community Participation Index, and the Self-Efficacy Gauge. RESULTS: A total of 35 eligible participants were randomized; 26 completed the intervention. Post intervention, PQRS change scores demonstrated that CO-OP had a medium effect over usual care on trained self-selected activities (d = 0.5) and a large effect on untrained activities (d = 1.2). At a 3-month follow-up, PQRS change scores indicated a large effect of CO-OP on both trained (d = 1.6) and untrained activities (d = 1.1). CO-OP had a small effect on COPM and a medium effect on the Community Participation Index perceived control and on the Self-Efficacy Gauge. CONCLUSION: CO-OP was associated with a large treatment effect on follow-up performances of self-selected activities and demonstrated transfer to untrained activities. A larger trial is warranted.

Giving Light to Narrative. The Use of Images in Early Modern Learned Journals.

This paper examines the visual and verbal cross-pollination between the Philosophical Transactions and the Journal des Sçavans with a specific focus on the role of the visual as an open form of communication, which overcame the linguistic barriers implied by journals published in vernacular languages, rather than Latin. Studying the illustrated articles published in the two journals in 1666 highlights the ways in which the authors viewed the images as providing clarity to their prose and how the images provided access to useful information that was otherwise invisible.

Development of additional tasks for the executive function performance test.

OBJECTIVE. The Executive Function Performance Test (EFPT) is a reliable and valid performance-based assessment of executive function for people with stroke. The objective of this study was to enhance the clinical utility of the EFPT by developing and testing additional tasks for the EFPT in the Alternate EFPT (aEFPT). METHOD. We performed a cross-sectional study with poststroke participants (n = 25) and healthy control participants (n = 25). All participants completed a neuropsychological assessment battery and both the EFPT and the aEFPT. RESULTS. No statistically significant differences were found between the EFPT and the aEFPT when examining total scores, construct scores, and two overall task scores. Correlations between the aEFPT and the neuropsychological measures were adequate to strong (r2s = .59-.83). CONCLUSION. The aEFPT tasks are comparable to the original EFPT tasks, providing occupational therapy practitioners with additional tasks that can be used clinically to identify performance-based executive function deficits in people with stroke.