CCR5 Is a Therapeutic Target for Recovery after Stroke and Traumatic Brain Injury.

We tested a newly described molecular memory system, CCR5 signaling, for its role in recovery after stroke and traumatic brain injury (TBI). CCR5 is uniquely expressed in cortical neurons after stroke. Post-stroke neuronal knockdown of CCR5 in pre-motor cortex leads to early recovery of motor control. Recovery is associated with preservation of dendritic spines, new patterns of cortical projections to contralateral pre-motor cortex, and upregulation of CREB and DLK signaling. Administration of a clinically utilized FDA-approved CCR5 antagonist, devised for HIV treatment, produces similar effects on motor recovery post stroke and cognitive decline post TBI. Finally, in a large clinical cohort of stroke patients, carriers for a naturally occurring loss-of-function mutation in CCR5 (CCR5-Δ32) exhibited greater recovery of neurological impairments and cognitive function. In summary, CCR5 is a translational target for neural repair in stroke and TBI and the first reported gene associated with enhanced recovery in human stroke.

Playfulness and Interaction: An Exploratory Study of Past and Current Exposure to Domestic Violence.

Violence against women affects mother-child interactions, which may in turn affect their children's playfulness. We examined the effect of a history of violence against mothers on mother-child interactions and children's playfulness. This cross-sectional pilot study consisted of 36 mother-child dyads residing in family crisis shelters due to serious violence from an intimate partner. One subgroup had experienced violence during childhood, another had posttraumatic stress disorder (PTSD). Instruments included Posttraumatic Diagnostic Scale, Test of Playfulness, and Coding Interactive Behavior System. Mann-Whitney test and Spearman's rank correlation coefficients were calculated. Results indicated that children of mothers without PTSD were more playful than children of mothers with PTSD. Mothers who had not reported of childhood exposure to violence and who did not have PTSD had better interactions with more playful children.

Ecological Validity of the Multiple Errands Test (MET) on Discharge from Neurorehabilitation Hospital.

The purpose of this prospective study was to examine the predictive and ecological validity of the Multiple Errands Test (MET) on discharge from neurorehabilitation hospital to the community. The specific objective was to examine the relationships between discharge MET scores and follow-up scores on the Participation Index (M2PI). The study sample included 30 participants with acquired brain injury who were independent in basic activities of daily living 1 week prior to discharge from a neurorehabilitation unit. The MET Hospital-Version was administered at discharge and the M2PI was administered to participants and their caregivers during a home visit 3 months after discharge. Moderate significant correlations were found between the MET and the M2PI scores (self and caregiver MET total error score with total M2PI r = .403, r = .510), with a greater correlation coefficient for caregiver ratings than for self ratings. Partial correlation analysis demonstrated the stability of this relationship while controlling for basic cognitive status scores. The results provide supporting evidence for the ecological validity of the MET at discharge from neurorehabilitation. In addition, the findings highlight the need for community-based rehabilitation that will reduce the impact of executive function deficits on participation in daily life.

Effectiveness of occupational goal intervention for clients with schizophrenia.

OBJECTIVE: The effectiveness of Occupational Goal Intervention (OGI) in clients with schizophrenia was compared with that of the Frontal Executive Program and a control group. METHOD: We used a quasi-experimental design with 18 adult participants ages 20-38 who were randomly assigned to three groups. Testing was performed before treatment, after treatment, and at 6-mo follow-up (Time 2). Instruments assessed executive functions (EFs) and activity and participation. Participants received 18 treatment sessions over a period of 6-8 wk. RESULTS: We found no significant differences among the groups on pretest-posttest change; however, we did find significant differences within groups before and after intervention and moderate to high effect sizes. The OGI group showed relative improvement on all measures of EF and activity and participation. Most participants' achievements were maintained at Time 2. CONCLUSIONS: Results provide initial support for the OGI's effectiveness for clients with schizophrenia. Further studies are needed to verify these initial findings.

Sleep dysfunctions influence decision making in undemented Parkinson's disease patients: a study in a virtual supermarket.

In the early-middle stages of Parkinson's disease (PD), polysomnographic studies show early alterations of the structure of the sleep, which may explain frequent symptoms reported by patients, such as daytime drowsiness, loss of attention and concentration, feeling of tiredness. The aim of this study was to verify if there is a correlation between the sleep dysfunction and decision making ability. We used a Virtual Reality version of the Multiple Errand Test (VMET), developed using the NeuroVR free software (http://www.neurovr2.org), to evaluate decision-making ability in 12 PD not-demented patients and 14 controls. Five of our not-demented 12 PD patients showed abnormalities in the polysomnographic recordings associated to significant differences in the VMET performance.

The Feasibility and Efficacy of an Israeli Lifestyle Redesign®-Based Program for Well Older Adults: A Pilot Study.

The Israeli Lifestyle Program (ILP) was adapted from the original Lifestyle Redesign® intervention, aiming to enhance health, functioning, and quality of life (QoL) of older adults. The purpose of this study was to examine the feasibility and effectiveness of the ILP. The design of the study entailed a non-randomized trial with a 3-month follow-up including 18 women aged 65 to 81 recruited from a community center. The research group (n = 9) participated in 15 weekly group meetings and three individual sessions. The control group (n = 9) received an information booklet based on the ILP content. Between-group comparisons revealed significant differences in change scores in favor of the research group for occupational performance (U = 19.0, p = .03), environmental (U = 21.5, p = .04), and social (U = 20.5, p = .03) QoL factors. Findings also revealed reduction in depressive symptoms (U = 24.0, p = .07). These findings suggest community group programs for improving occupational performance and QoL.

Executive functions in a virtual world: a study in Parkinson's disease.

In Parkinson's disease executive functions are altered. We used a Virtual Reality version of the Multiple Errand Test in order to evaluate decision-making ability in 12 patients and 14 controls. Patients with Parkinson's disease, even if not-demented, showed strategies full of errors, suggesting that impulse control disorder, very frequent in course of disease, could precede cognitive dysfunctions.

Independent Older Adult's IADL and Executive Function According to Cognitive Performance.

Participation in Instrumental Activities of Daily Living (IADL) is essential in occupational therapy aiming to improve the life situation of elderly. Effective executive function (EF) is important to successful functioning in IADL. The purpose of this study was to examine EF and IADL performance differences according to cognitive levels as measured by the Montreal Cognitive Assessment (MoCA), age, and gender. In all, 80 elderly (49% female; age M = 73.4) were assessed at home, with Weekly Calendar Planning Activity (WCPA-10), IADL scale, and MoCA as a cognitive screening tool for dividing into normal cognitive (NC) level and mild cognitive impairment (MCI). The comparison between the MoCA groups on the WCPA-10 and IADL shows significant differences between the groups; gender and age differed only in IADL. IADL and WCPA-10 performance among independent elderly relates to their cognitive level. We suggest that intervention that will focus on EF may assist in improving performance and maintaining participation in occupation.

Emotional Functioning and Sense of Hope as Contributors to Healthy Aging.

Cognitive and physical factors affect participation in later life. It is imperative to explore the contribution of emotional factors on older adults' participation and wellbeing. Seventy-eight older adults were recruited for this cross-sectional study and grouped based on their level of independence. Emotional functioning, hope, cognition, participation, and wellbeing were measured. Analyses of variance, correlational analysis, and prediction models were employed. Significant differences were found between independent and dependent older adults' participation and wellbeing, F(2, 72) = 12.71, p < .00, η2 = .26. Independent older adults' participation was predicted by cognition, ß = 0.40, and hope, ß = 0.58. Wellbeing was predicted by cognition, ß = 0.39, emotional status, ß = -0.46, and hope, ß = 0.36. Dependent older adults' wellbeing was predicted by emotional status, ß = -0.68, and hope, ß = 0.32. Occupational therapists play a key role in promoting healthy aging by incorporating psychosocial factors at the individual, community, and societal levels.

Assessment of spatial neglect using computerised feature and conjunction visual search tasks.

The purpose of this study was to assess the diagnostic sensitivity of tasks employing feature and conjunction visual searches in stroke patients with unilateral spatial neglect (USN). Seventy-two stroke patients (right/left hemispheric damage with/without USN) and 39 healthy controls participated in the study. Hit rate and reaction time measures of feature and conjunction searches were tested using a newly developed computerised programme for the assessment of visual spatial attention (VISSTA). In addition, subjects received a set of diagnostic paper-and-pencil tests, and were also assessed for the impact of neglect on activities of daily living. Results indicated that the computerised test clearly differentiated between stroke patients and healthy controls, and between the different patient groups. USN patients showed significant contralesional disadvantage in both feature and conjunction visual search tasks. It is proposed that computerised assessment of visual search capacity is a useful and sensitive adjunct to standard paper-and-pencil tests of USN, with the advantage of testing responses based on attention shifts under a time constraint. The learning effects that limit the usefulness of paper-and-pencil tests in longitudinal studies are less likely to affect a computerised test, making it more suitable for monitoring treatment-induced or natural recovery by way of repeated testing.

Validation of the Virtual MET as an assessment tool for executive functions.

The purpose of this study was to establish ecological validity and initial construct validity of a Virtual Multiple Errands Test (VMET) as an assessment tool for executive functions. It was implemented within the Virtual Mall (VMall), a novel functional video-capture virtual shopping environment. The main objectives were (1) to examine the relationships between the performance of three groups of participants in the Multiple Errands Test (MET) carried out in a real shopping mall and their performance in the VMET, (2) to assess the relationships between the MET and VMET of the post-stroke participant's level of executive functioning and independence in instrumental activities of daily living, and (3) to compare the performance of post-stroke participants to those of healthy young and older controls in both the MET and VMET. The study population included three groups; post-stroke participants (n = 9), healthy young participants (n = 20), and healthy older participants (n = 20). The VMET was able to differentiate between two age groups of healthy participants and between healthy and post-stroke participants thus demonstrating that it is sensitive to brain injury and ageing and supports construct validity between known groups. In addition, significant correlations were found between the MET and the VMET for both the post-stroke participants and older healthy participants. This provides initial support for the ecological validity of the VMET as an assessment tool of executive functions. However, further psychometric data on temporal stability are needed, namely test-retest reliability and responsiveness, before it is ready for clinical application. Further research using the VMET as an assessment tool within the VMall with larger groups and in additional populations is also recommended.

Kettle test--a brief measure of cognitive functional performance. Reliability and valdity in stroke rehabilitation.

OBJECTIVES: We examined the reliability and validity of the Kettle Test, a brief performance measure based on a complex everyday task designed to tap into basic and higher level cognitive processes. METHOD: Participants included 21 people attending stroke rehabilitation and 4 occupational therapists for the reliability analysis, 36 people at discharge from stroke rehabilitation, and 36 age-matched healthy control participants for the validity analyses. Instruments included a battery of conventional cognitive measures and functional outcomes. RESULTS: Interrater reliability was found to be high. Stroke survivors at discharge from rehabilitation were found to require significantly more assistance on the Kettle Test than control participants (p < .000); their scores on the Kettle Test were significantly and moderately correlated with the conventional cognitive and functional outcome measures. CONCLUSIONS: The results support the reliability and validity of the Kettle Test as a top-down measure of cognition-in-function in people at discharge from stroke rehabilitation.

Training multitasking in a virtual supermarket: a novel intervention after stroke.

OBJECTIVE: To explore the potential of the VMall, a virtual supermarket running on a video-capture virtual reality system, as an intervention tool for people who have multitasking deficits after stroke. METHOD: Poststroke, 4 participants received ten 60-min sessions over 3 weeks using the VMall. The intervention focused on improving multitasking while the participant was engaged in a virtual shopping task. Instruments included the Multiple Errands Test-Hospital Version (MET-HV) in a real mall and in the VMall. RESULTS: Participants achieved improvements ranging from 20.5% to 51.2% for most of the MET-HV measures performed in a real shopping mall and in the VMall. CONCLUSIONS: The data support the VMall's potential as a motivating and effective intervention tool for the rehabilitation of people poststroke who have multitasking deficits during the performance of daily tasks. However, because the sample was small, additional intervention studies with the VMall should be conducted.

Executive functioning, awareness, and participation in daily life after mild traumatic brain injury: a preliminary study.

OBJECTIVE: We investigated the relationship of executive functioning and self-awareness to participation in daily life of people after mild traumatic brain injury (mTBI) referred to occupational therapy in the postacute phase. METHOD: Thirteen participants who sustained mTBI (average time since injury = 4.7 months, mean age = 43.4 years) were evaluated with the Behavioral Assessment of the Dysexecutive Syndrome, the Dysexecutive Questionnaire, the Self-Awareness of Deficits Interview, and the Participation Index (PI) of the Mayo-Portland Adaptability Inventory. RESULTS: Analysis revealed high frequencies of deficits in executive functions such as planning and shifting. However, self-awareness of the executive deficits was intact. A significant percentage (62%-85%) of participants experienced restrictions in everyday life activities, and PI scores were significantly correlated with measures of executive functioning. CONCLUSIONS: After mTBI, people may be at significant risk for persistent executive deficits and restrictions in participation that warrant occupational therapy intervention.

Weekly Calendar Planning Activity for University Students: Comparison of Individuals With and Without ADHD by Gender.

OBJECTIVE: To introduce a revised version of the Weekly Calendar Planning Activity (WCPA) adapted for university students (Weekly Calendar Performance Activity for students [WCPA-S]) and compare the performance of this activity between students with and without ADHD and across gender groups. METHOD: Participants included a total of 157 students, ages 20 to 30, enrolled in universities/colleges and divided into two groups: students with ADHD (male = 23, female = 38) and without ADHD (male = 33, female = 63). A two-way ANOVA was used for data analyses. The WCPA-S was administered to each student individually. RESULTS: Significant differences were found between students with and without ADHD and across genders in performance, duration of performance, and in the number of strategies used. CONCLUSION: The WCPA-S proved to be an effective performance-based diagnostic tool for the utilization of executive functions in the daily life of university students. This instrument can be used to predict success in higher education and to support learning among university students with ADHD.

Evaluation of a long-term community based rehabilitation program for adult stroke survivors.

OBJECTIVES: To evaluate the functional status, leisure activity and satisfaction in adult stroke survivors participating in a community rehabilitation program, and to compare these outcomes with stroke survivors not attending any program. METHOD: Subjects included in the study were survivors of a first stroke that received inpatient rehabilitation and were living at home at least one year post onset. Twenty seven were participants in a community rehabilitation program and 56 were non-participants. The outcome measures were the Stroke impact Scale (SIS), Functional Independence Measure (FIM), Instrumental Activities of Daily Living Questionnaire (IADLq), Activity Card Sort (ACS), and the Life-Satisfaction questionnaire (Li-Sat-9). RESULTS: The results revealed severe stroke impact and low functioning in activities of daily living in the participant group, yet the level of participation in leisure activities improved significantly after attending the program (t=-8.1, p=0.000). The comparison with the non participant group revealed that participants were even more disabled in basic activities of daily living (as measured by the FIM) than non-participants (t=-3.1, p=0.004). However, the satisfaction rates of the participants were significantly higher than non participants from "life as a whole" and from their leisure situation (p<0.05). CONCLUSIONS: Stroke survivors participating in a community based rehabilitation program did not show an advantage in terms of disability levels over non-participants. However, their activity level increased due to the program and their satisfaction scores were higher than non-participants.

Evaluation of virtual shopping in the VMall: comparison of post-stroke participants to healthy control groups.

OBJECTIVE: To investigate the potential use of the VMall as an evaluation tool for rehabilitation by (1) describing its use with 14 post-stroke participants and (2) by comparing performance within the VMall of the post-stroke participants to healthy control participants. DESIGN: Criterion standard. SETTING: University of Haifa and the Chaim Sheba Medical Center. PARTICIPANTS: Fourteen post-stroke participants and 93 healthy participants from three age groups (children, young adults and older adults). PROCEDURE: The participants experienced the VMall and shopped for four grocery items and then completed feedback questionnaires. MAIN OUTCOME MEASURES: The experience of the stroke participants is described in detail. The duration and number of mistakes made during a four-item shopping task within the VMall, overall feedback, and perceived exertion. RESULTS: Significant differences were found between each of the three healthy groups and the stroke group for the mean total time to shop (F(3,97) = 23.28, P < 0.000). The participants' overall feedback on the VMall was positive with no differences between the groups. CONCLUSIONS: The VMall as used with the four-item shopping task was found to significantly differentiate between healthy to stroke participants. The shopping task was challenging for the stroke participants which have positive implications for treatment effectiveness.

Activities, participation and satisfaction one-year post stroke.

PURPOSE: To evaluate the chronic consequences of stroke in terms of activity limitations, restricted participation and dissatisfaction from life, and the relationship between these variables, in stroke survivors living in the community one-year post onset. METHOD: A total of 56 stroke patients (mean age: 57.7) who completed an in-patient rehabilitation programme, were evaluated one-year post onset in their homes, using the following instruments: Functional Independence Measure (FIM), Instrumental Activities of Daily Living Questionnaire (IADLq), Activity Card Sort (ACS), a work questionnaire, Life-Satisfaction Questionnaire (Li-Sat 9) and the Geriatric Depression Scale (GDS). RESULTS: One year post stroke onset the mean FIM motor score was 75.88 (max score: 91), yet more than 50% of the sample still required assistance (usually mild to moderate) in dressing, bathing and use of stairs. The majority of the sample required full assistance in some IADL domains, notably meal preparation (77%), housekeeping (70%) and laundry (82%). Only one subject returned to paid employment and the mean activity level (ACS), representing the percentage of leisure and IADL activities retained from before stroke, was 42.8%. Satisfaction ratings were generally low but varied between domains. Only 39% were satisfied from 'life as a whole'. The lowest satisfaction rates were noted for 'vocational situation' (14%), 'leisure situation' (34%) and 'ability in self-care' (43%), whereas the satisfaction rate from family life was high (84%). Significant correlations were found between overall life satisfaction scores and the overall FIM motor, IADLq, and ACS scores (Pearson r values: 0.32, 0.48 and 0.57, respectively). Activity level was found to be a significant predictor of satisfaction (p = 0.007) beyond that accounted for by demographic variables and depression. CONCLUSIONS: Stroke survivors dwelling in the community demonstrate long-standing dissatisfaction one-year post onset, correlating with activity limitation and restricted participation. The findings present a compelling need for rehabilitation services with a focus on participation in IADL and leisure activities, in order to improve the satisfaction of this population.

The Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch): a new instrument for assessing learning potential.

OBJECTIVE: To describe the development and psychometric properties of the Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch), a dynamic criterion-referenced assessment of cognitive abilities and learning potential for children with cognitive and learning difficulties. METHOD: A series of studies analyzed the age standards, criterion cutoff scores, and percentage of mediation cues required for typically developing children 6-12 years of age, as well as reliability and validity. RESULTS: MANOVA analyses determined four age groups that best fit the outcome data: 6-6.11, 7-8.11, 9-10.11, and 11-12 years. Criterion cutoff scores of 25% for at-risk and under 10% for deficient performance were obtained for each age group. Dynamic percentage scores were determined. Significant high interrater reliability and moderate to high internal consistency reliability were found. Construct validity was supported by comparing children with traumatic brain injury and learning disabilities to typically developing children, and ecological validity of children with attention deficit hyperactivity disorder by comparing performance on the DOTCA-Ch to the School Function Assessment. CONCLUSIONS: The DOTCA-Ch is a reliable and valid assessment that provides learning potential and can facilitate intervention for cognitive difficulties that manifest themselves in daily functions among school-age children.

Relationships of categorization on tests and daily tasks in patients with schizophrenia, post-stroke patients and healthy controls.

The purpose of this study was to explore the relationships between performance on formal categorization-sorting tests and daily tasks that require sorting skills among individuals with schizophrenia compared with post-stroke and healthy control groups. Furthermore, the relationships among the performances of patients with schizophrenia on the various tests were studied. The study included 70 participants: 37 patients with schizophrenia treated at a community day center, 18 post-stroke patients, and 15 healthy controls. Subjects were evaluated on four different categorization tests (Wisconsin Card Sorting Test (WCST), Short Category Test (SCT), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), and Riska Object Classification (ROC); and five different functional daily tasks that require categorization abilities. Results showed significant differences between the performance of patients and control subjects on both tests and daily tasks. Spearman correlations within the schizophrenic group between test scores showed moderate significant correlations, and between tests and daily tasks showed low to moderate significant correlations. These findings suggest that weaker, yet significant relationships were found between performance on cognitive tests and daily tasks than between cognitive tests tapping the same or similar constructs. This type of difference would be expected; however, further research is needed to clarify the underlying components of categorization tests and their relations to daily task performance of individuals with schizophrenia.