Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014

Objective To conduct an updated, systematic review of the clinical literature, classify studies based on the strength of research design, and derive consensual, evidence-based clinical recommendations for cognitive rehabilitation of people with TBI or stroke. Data Sources Online Pubmed and print journal searches identified citations for 250 articles published from 2009 through 2014. Study Selection 186 articles were selected for inclusion after initial screening. 50 articles were initially excluded (24 healthy, pediatric or other neurologic diagnoses, 10 non-cognitive interventions, 13 descriptive protocols or studies, 3 non-treatment studies). 15 articles were excluded after complete review (1 other neurologic diagnosis, 2 non-treatment studies, 1 qualitative study, 4 descriptive papers, 7 secondary analyses). 121 studies were fully reviewed. Data Extraction Articles were reviewed by CRTF members according to specific criteria for study design and quality, and classified as providing Class I, Class II, or Class III evidence. Articles were assigned to 1 of 6 possible categories (based on interventions for attention, vision and neglect, language and communication skills, memory, executive function, or comprehensive-integrated interventions). Data Synthesis Of 121 studies, 41 were rated as Class I, 3 as Class Ia, 14 as Class II, and 63 as Class III. Recommendations were derived by CRTF consensus from the relative strengths of the evidence, based on the decision rules applied in prior reviews. Conclusions CRTF has now evaluated 491 papers (109 Class I or Ia, 68 Class II, and 314 Class III) and makes 29 recommendations for evidence-based practice of cognitive rehabilitation (9 Practice Standards, 9 Practice Guidelines and 11 Practice Options). Evidence supports Practice Standards for attention deficits after TBI or stroke; visual scanning for neglect after right hemisphere stroke; compensatory strategies for mild memory deficits; language deficits after left hemisphere stroke; social communication deficits after TBI; metacognitive strategy training for deficits in executive functioning; and comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability after TBI or stroke

An exploration of the experiences and utility of functional electrical stimulation for foot drop in people with multiple sclerosis

Purpose: Functional electrical stimulation (FES) is effective in improving walking in people with multiple sclerosis (MS) with foot drop. There is limited research exploring people’s experiences of using this device. This study aims to explore the utility, efficacy, acceptability, and impact on daily life of the device in people with MS. Methods: An interpretative phenomenological approach was employed. Ten participants who had used FES for 12 months were interviewed. Transcripts were analysed, and emergent themes identified. Results: Nine participants continued to use the device. Three relevant super-ordinate themes were identified; impact of functional electrical stimulation, sticking with functional electrical stimulation, and autonomy and control. Participants reported challenges using the device; however, all reported positive physical and psychological benefits. Intrinsic and external influences such as; access to professional help, the influence of others, an individual’s ability to adapt, and experiences using the device, influenced their decisions to continue with the device. A thematic model of these factors was developed. Conclusions: This study has contributed to our understanding of people with MS experiences of using the device and will help inform prescribing decisions and support the continued, appropriate use of FES over the longer term

The effect of context on learning functional living skills for a population of people with schizophrenia

Thesis (Ed.D.)--Boston UniversityThis quasi-experimental study was undertaken to determine the effect of context on learning a functional living skill for individuals with cognitive deficits associated with the negative symptoms of schizophrenia. Forty-six people (ages 27-62) with non-paranoid schizophrenia or schizoaffective disorder were matched on cognitive level (Allen Cognitive Level Screen- 90, Allen, Kerberg, & Bums, 1992), cooking experience, and living situation (group home or apartment). They were then randomly assigned to one of two treatment conditions, clinic or home. All participants were evaluated and taught basic cooking skills in either the clinic or their homes. Finally, all participants were evaluated in their homes. Both groups scored significantly higher after cooking lessons (t=5.57, df = 21, p<.0001 for those in the clinic; t = 7.81. df = 21, p<.0002 for those learning at home); there was no significant difference between the two groups in where the learning took place (B = -1.8, df = 42, p<0.23). Those who learned in the clinic scored lower than the home group when tested at home (t = -2.07, df = 42, p<.0489) although this result must be accepted with caution because of a significant difference between the two groups on the first assessment of cooking skill. Additional questions yielded the following: there was a positive correlation between cognitive level and cooking skill (df = 44, r =.55, p <.001); there was a positive correlation between cognitive level and transfer of learning (df = 21, F = 52.49, p < .0000); no significant correlation was found between amount of practice and increase in cooking skill ( df = 27, r = .256, r2 = .066). People with cognitive deficits associated with schizophrenia can learn a specific functional living skill in different contexts. Qualitative aspects of those contexts are discussed. Further research is recommended to describe/understand transfer of learning from one context to another. Cognitive level is highly correlated with both ability to learn and ability to transfer learning. Additional research is recommended to adequately describe the effect of practice on learning a functional living skill. Implications for treatment and suggestions for clinical research are presented

Mad Dog Nutrition Program Consult: Effects on Dietary Self-Efficacy, Behaviors and Health Outcomes

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Structured music workshops for individuals with learning difficulties : an evaluation study

Music has been employed in numerous different therapeutic settings throughout history. However, there are few empirical studies and inadequate research guidelines in relation to investigating the process and outcomes of this intervention in a modern context. Anecdotal and descriptive accounts of improvements in psychological adjustment as a result of a music intervention exist but the need for empirical evaluation is paramount. The aim of this thesis is to evaluate the effect of structured music workshops on the musical ability, communication skills, self-esteem, self-perception, disruptive behaviour and short term memory of adults with learning difficulties. This series of studies employs previously validated assessments materials in addition to materials specifically designed and validated for use in this project. The first study utilises a two group design with 20 individuals in an experimental group and 20 individuals in a non-intervention control group. After all participants were assessed for communication skills, musical ability, disruptive behaviour and self-esteem the experimental group received 10 weekly, one hour music workshops focused on the playing of a Javanese Gamelan. After completion of the workshops individuals in both the experimental and control group were post-tested on the dependent variables. Results indicate significant improvements for the experimental group in musical ability and one measure of communication. No significant improvements in disruptive behaviour or self-esteem were obtained. The second study employs a similar design to study 1 in addition to controlling for experimenter effects and investigating cognitive developments and self-perception changes

The role of meditation in psychosocial occupational therapy

This study targets occupational therapists currently treating those with chronic schizophrenia in order to determine their opinion on the use of meditation in their practice. [This is an excerpt from the abstract. For the complete abstract, please see the document.

The Lived Experiences and Occupational Performance and Satisfaction of Young Adults with Multiple Sclerosis (MS) as Related to Fine Motor Skills

Background: Young adults with multiple sclerosis (MS) may experience fine motor (FM) challenges that prevent them from engaging in age-appropriate occupations. Disease mediated changes in occupational skills can affect how a young adult perceives their occupational performances. This study aimed to gain an understanding of how young adults with MS perceive their FM abilities and social and emotional performance during daily activities. Method: Eighteen young adults with MS who previously scored equal to or less than the low average range on FM pegboard tests and who reported high satisfaction and low performance on a modified self-report were interviewed. The interviews explored the participants’ perceptions of their occupational performance regarding FM skills and social-emotional performance. Results: Analysis of interviews resulted in the following themes: relationship changes, attribution theories, FM deficits and symptoms that affect daily performance, avoidance of assistive equipment, and lack of knowledge of occupational therapy services. This analysis found that despite low performance on their FM testing, the participants were satisfied with their ability to perform tasks. Conclusion: Young adults with MS presented with FM deficits that affect their occupational performance in age-related tasks

Include 2011 : The role of inclusive design in making social innovation happen.

Include is the biennial conference held at the RCA and hosted by the Helen Hamlyn Centre for Design. The event is directed by Jo-Anne Bichard and attracts an international delegation

Examination of Participation and Occupation After Cancer

Cancer and treatments for cancer can have negative consequences on one’s ability to participate in life. Side effects of treatment, including pain, cognitive changes, and fatigue can last months to years after treatment. Community based support and services are emerging to fill a gap in care, specifically related to the psychosocial needs of the survivor. The purpose of this project was to provide information to Gilda’s Club Twin Cities (GCTC), a community based cancer support center, on the participation levels and quality of life (QOL) of their new members, with the secondary goal of collecting data on fatigue and cognitive issues. The study employed a cross sectional descriptive approach with self-report tools to examine the cancer population receiving services at a community based center. Standard, quantitative measures were used to describe participation in life activities, QOL, fatigue and cognition. Overall activity levels decreased 27% following a cancer diagnosis, with the subscale of high physical demand affected most. Participation in new activities was reported by 56%, with most of those activities falling into the instrumental category (doctor visits, resting). Social activities were identified as most important. QOL and fatigue mean scores were lower than the normative data for the general population and the cancer population in the United States. Opportunity and need exist in community based centers to provide effective programming related to participation levels, including fatigue management, role resumption, and the necessary performance skills to achieve personal participation goals. Occupational therapists should take the lead in supporting survivors in community based settings to achieve improved health, well being, and participation