Doctoral Capstone Experience with a Neurological Population

Through the completion of a doctoral capstone experience, an entry-level occupational therapy doctoral student is able to further develop advanced skills. The doctoral capstone experience is during the student’s last semester in the program and is 16 weeks long. The doctoral capstone experience consists of both a culminating project and the experience itself. The capstone project is “comprised of a literature review, needs assessment, goals/objectives, and an evaluation plan based on specific focus areas” (ACOTE, 2020). The Nova Southeastern University Entry-Level Doctor of Occupational Therapy Doctoral Capstone Manual states that “the goal of the doctoral capstone project and experience is to develop an occupational therapist with skills that are more advanced or those beyond the level of a generalist” (NSU OTD Program, 2020, p. 41). The areas of focus for my capstone project were advanced clinical practice skills and program development. I worked with my mentor at an outpatient neurorehabilitation clinic that was a part of a larger hospital system, Christiana Care. At that clinic I was able to treat a full caseload of individuals with various neurological diagnoses. In addition to advancing my clinical skills, I developed a community resource list for individuals with Parkinson\u27s disease which encompassed the state of Delaware and parts of surrounding states. I was also able to participate in various other learning opportunities such as shadowing a neurologist who specializes in movement disorders, attending the Parkinson’s Symposium for the healthcare system, shadowing in the acute care and inpatient rehab settings, and completing continuing education courses

Integrated and patient-centred management of Parkinson’s disease:a network model for reshaping chronic neurological care

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'Staying safe' – A narrative review of falls prevention in people with Parkinson’s -'PDSAFE'

This is the author accepted manuscript. The final version is available from Taylor & Francis via the DOI in this record.Background: Parkinson's disease demonstrates a spectrum of motor and non-motor symptoms. Falling is common and disabling. Current medical management shows minimal impact to reduce falls, or fall related risk factors such as deficits in gait, strength and postural instability. Despite evidence supporting rehabilitation in reducing fall risk factors, the most appropriate intervention to reduce overall fall rate remains inconclusive. This paper aims to 1) synthesise current evidence and conceptual models of falls rehabilitation in Parkinson's in a narrative review; and based on this evidence 2) introduce the treatment protocol used in the falls prevention, multi-centre clinical trial 'PDSAFE'. Method: Search of four bibliographic databases using the terms ‘Parkinson*’ and ‘Fall*’ combined with each of the following; ‘Rehab*, Balanc*, Strength*, Strateg*and Exercis*' and a framework for narrative review was followed. 3557 papers were identified, 416 were selected for review. The majority report the impact of rehabilitation on isolated fall risk factors. Twelve directly measure the impact on overall fall rate. Discussion: Results were used to construct a narrative review with conceptual discussion based on the 'International Classification of Functioning’, leading to presentation of the 'PDSAFE' intervention protocol. Conclusion: Evidence suggests training single, fall risk factors may not affect overall fall rate. Combining with behavioural and strategy training in a functional, personalised multi-dimensional model, addressing all components of the ‘International Classification of Functioning’ is likely to provide a greater influence on falls reduction. 'PDSAFE' is a multi-dimensional, physiotherapist delivered, individually tailored, progressive, home-based programme. It is designed with a strong evidence based approach and illustrates a model for the clinical delivery of the conceptual theory discussed.This project was funded by the National Institute for Health Research Health Technologies Assessment programme (project number 10/57/21). VG is supported by the National Institute of Health Research Collaboration for Applied Health Research and Care South West Peninsula.

Wearable Technology Supported Home Rehabilitation Services in Rural Areas:– Emphasis on Monitoring Structures and Activities of Functional Capacity Handbook

The sustainability of modern healthcare systems is under threat. – the ageing of the population, the prevalence of chronic disease and a need to focus on wellness and preventative health management, in parallel with the treatment of disease, pose significant social and economic challenges. The current economic situation has made these issues more acute. Across Europe, healthcare expenditure is expected to rice to almost 16% of GDP by 2020. (OECD Health Statistics 2018). Coupled with a shortage of qualified personnel, European nations are facing increasing challenges in their ability to provide better-integrated and sustainable health and social services. The focus is currently shifting from treatment in a care center to prevention and health promotion outside the care institute. Improvements in technology offers one solution to innovate health care and meet demand at a low cost. New technology has the potential to decrease the need for hospitals and health stations (Lankila et al., 2016. In the future the use of new technologies – including health technologies, sensor technologies, digital media, mobile technology etc. - and digital services will dramatically increase interaction between healthcare personnel and customers (Deloitte Center for Health Solutions, 2015a; Deloitte Center for Health Solutions 2015b). Introduction of technology is expected to drive a change in healthcare delivery models and the relationship between patients and healthcare providers. Applications of wearable sensors are the most promising technology to aid health and social care providers deliver safe, more efficient and cost-effective care as well as improving people’s ability to self-manage their health and wellbeing, alert healthcare professionals to changes in their condition and support adherence to prescribed interventions. (Tedesco et al., 2017; Majumder et al., 2017). While it is true that wearable technology can change how healthcare is monitored and delivered, it is necessary to consider a few things when working towards the successful implementation of this new shift in health care. It raises challenges for the healthcare systems in how to implement these new technologies, and how the growing amount of information in clinical practice, integrates into the clinical workflows of healthcare providers. Future challenges for healthcare include how to use the developing technology in a way that will bring added value to healthcare professionals, healthcare organizations and patients without increasing the workload and cost of the healthcare services. For wearable technology developers, the challenge will be to develop solutions that can be easily integrated and used by healthcare professionals considering the existing constraints. This handbook summarizes key findings from clinical and laboratory-controlled demonstrator trials regarding wearables to assist rehabilitation professionals, who are planning the use of wearable sensors in rehabilitation processes. The handbook can also be used by those developing wearable sensor systems for clinical work and especially for use in hometype environments with specific emphasis on elderly patients, who are our major health care consumers

Photo-realistic interactive virtual environments for neurorehabilitation in mild cognitive impairment (NeuroVRehab.PT) : a participatory design and proof-of-concept study

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Mild cognitive impairment (MCI) is characterized by cognitive, psychological, and functional impairments. Digital interventions typically focus on cognitive deficits, neglecting the difficulties that patients experience in instrumental activities of daily living (IADL). The global conjecture created by COVID-19 has highlighted the seminal importance of digital interventions for the provision of healthcare services. Here, we investigated the feasibility and rehabilitation potential of a new design approach for creating highly realistic interactive virtual environments for MCI patients' neurorehabilitation. Through a participatory design protocol, a neurorehabilitation digital platform was developed using images captured from a Portuguese supermarket (NeuroVRehab.PT). NeuroVRehab.PT's main features (e.g., medium-sized supermarket, the use of shopping lists) were established according to a shopping behavior questionnaire filled in by 110 older adults. Seven health professionals used the platform and assessed its rehabilitation potential, clinical applicability, and user experience. Interviews were conducted using the think-aloud method and semi-structured scripts, and four main themes were derived from an inductive semantic thematic analysis. Our findings support NeuroVRehab.PT as an ecologically valid instrument with clinical applicability in MCI neurorehabilitation. Our design approach, together with a comprehensive analysis of the patients' past experiences with IADL, is a promising technique to develop effective digital interventions to promote real-world functioning.TThis research was carried out as part of the doctoral studies of the first author (Ref: PDE/BDE/127784/2016) and for which she received scholarships from the following entities: Nippon Gases Portugal and Fundação para a Ciência e a Tecnologia through the European Social Fund and Human Capital Operational Programme, co-financed by Portugal 2020 and European Union. The work was partially supported by LASIGE Research Unit, ref. UIDB/00408/2020 and ref. UIDP/00408/2020.info:eu-repo/semantics/publishedVersio

Cognitive Rehabilitation and Telehealth Videoconferencing: Developing an Accessible Intervention for Subjective Cognitive Impairment, Mild Cognitive Impairment, and Dementia

This dissertation contributes to the growing body of research needed to make cognitive rehabilitation for individuals with dementia more accessible to rural families. Our population is aging, and with age comes both normal and abnormal cognitive aging. In Canada, the proportion of older adults is increasing at a greater rate in rural compared to urban areas, which suggests a high need for dementia care that is accessible to rural families. Teleheath videoconferencing is one way to make treatment more accessible. Over the course of three studies, this dissertation developed goal-oriented cognitive rehabilitation as an intervention for individuals with subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and dementia due to AD, and adapted treatment to be delivered through telehealth videoconferencing. Study 1 reported a strong preference for telehealth delivered treatment over in-person treatment, and initial treatment goals focused on memory, household activities, other cognitive domains, recreation, and higher order tasks. Responders were similar to non-responders in severity, depression, and caregiver burden, but results suggested differences in awareness and neuropsychiatric symptoms. Cognitive rehabilitation targets functional goals, and Study 2 worked to inform treatment development by focusing on the cognitive correlates of function. Hierarchical regression analyses suggested that immediate memory, executive functions, apathy, and depression accounted for unique variance in instrumental activities of daily living in the clinical sample of individuals diagnosed with no cognitive impairment, MCI, dementia due to AD, and non-AD dementia. The objective of Study 3 was to explore delivering cognitive rehabilitation through telehealth videoconferencing, and to compare in-person delivery to videoconferencing delivery. Using a combined between-subjects, multiple baseline single case experimental design cognitive rehabilitation was delivered to six participants with either SCI, MCI, or early stage dementia due to AD. Participants were randomly assigned to receive treatment in-person or through videoconferencing. Modifying treatment for telehealth required greater reliance on verbal description, but between-group outcomes were similar with good completion rates and high levels of improved goal performance. Overall, this body of work contributes to developing cognitive rehabilitation for individuals with SCI, MCI, and early stage AD. There is a need to continue to adapt this intervention to telehealth videoconferencing and it is feasible to do so

State of Evidence for Everyday Technology Use in Upper Extremity Motor Recovery Post-Stroke

The research team, in consultation with collaborating clinician Sarah Bicker, an OTR/L at Harborview Medical Center, researched everyday technology applications. The team conducted a systematic review considering what evidence exists about the effectiveness of commercially available everyday technology (ET) for improving upper extremity motor control and/or motivation to participate in therapy in clients post-stroke. The evidence was promising in support of the use of ET as indicated by improved upper extremity motor control outcomes and client and clinician reports of satisfaction, motivation, and engagement in post-stroke rehabilitation. Clinicians should consider the benefits of implementing ET for upper extremity motor recovery for clients post-stroke. Due to the changing nature of ET, the research team chose to minimize recommendations of specific applications. Instead, the team created a decision chart to help therapists identify what elements to consider when choosing a technology application to address the upper extremity motor control conditions/impairments with clients post-stroke. The decision tree considers performance skills according to the Occupational Therapy Practice Framework (OTPF), and includes current applications as examples. The research findings and decision chart were presented as an in-service to occupational therapy (OT) practitioners at Harborview Medical Center. Feedback from the in-service indicated that practitioners were positively receptive to the information provided and were more likely to incorporate ET into rehabilitation with their clients as a result of learning the research findings. Reviewing the literature indicates the need for more research regarding technology use for rehabilitation of individuals post-stroke