Occupational therapy for the upper limb after stroke: implementing evidence-based constraint induced movement therapy into practice

Background Constraint induced movement therapy (CIMT), an intervention to increase upper limb (UL) function post-stroke, is not used routinely by therapists in the United Kingdom; reasons for this are unknown. Using the Promoting Action on Research Implementation in Health Services (PARIHS) framework to analyse CIMT research and context, a series of related studies explored implementation of CIMT into practice. Methods and Findings Systematic review: nineteen CIMT randomised controlled trials found evidence of effectiveness in sub-acute stroke, but could not determine the most effective evidence-based protocols. Further review of qualitative data found paucity of evidence relating to acceptability and feasibility of CIMT. Focus group: perceptions of the feasibility, including facilitators and barriers, of implementing CIMT into practice were explored in a group of eight therapists. Thematic analysis identified five themes: personal characteristics; setting and support; ethical considerations; education and training; and practicalities, which need to be addressed prior to implementation of CIMT. Mixed-methods, pilot study (three single cases): pre- and post-CIMT (participant preferred protocol) interviews explored perceptions and experiences of CIMT, with pre- and post-CIMT measurement of participation and UL function. Findings indicated: (i) provision of evidence-based CIMT protocols was feasible, although barriers persisted; (ii) piloted data collection and analysis methods facilitated exploration of stroke survivors’ perceptions and experiences, and recorded participation and UL function. Conclusions Findings traversed PARIHS elements (evidence, context, facilitation), and should be considered prior to further CIMT implementation. Future studies of CIMT should explore: effects of CIMT protocol variations; characteristics of stroke survivors most likely to benefit from CIMT; interactions between CIMT and participation

Europa Lander Irradiation of Propellant at Marshall Space Flight Center

No abstract availabl

Evaluation of a Head-Worn Display with Ambient Vision Cues for Unusual Attitude Recovery

A Commercial Aviation Safety Team (CAST) study of 18 loss-of-control events determined that a lack of external visual references was a contributing factor in 17 of these events. CAST recommended that manufacturers should develop and implement virtual day-VMC display systems, such as synthetic vision (SV) or equivalent systems (CAST Safety Enhancement, SE-200). In support of this recommended action, CAST has requested studies to define minimum requirements for virtual day-visual meteorological conditions (VMC) displays to improve flight crew awareness of airplane attitude. NASAs research in Virtual day-VMC displays, known as synthetic vision systems, are intended to support intuitive flight crew attitude awareness similar to a day-VMC-like environment, especially if they could be designed to create visual dominance. A study was conducted to evaluate the utility of ambient vision (AV) cues paired with virtual Head-Up Display (HUD) symbology on a prototype head-worn display (HWD) during recovery from unusual attitudes in a simulated environment. The virtual-HUD component meets the requirement that the HWD may be used as an equivalent display to the HUD. The presence of AV cueing leverages the potential that a HWD has over the HUD for spatial disorientation prevention. The simulation study was conducted as a single-pilot operation, under realistic flight scenarios, with off-nominal events occurring that were capable of inducing unusual attitudes. Independent variables of the experiment included: 1) AV capability (on vs off) 2) AV display opaqueness (transparent vs opaque) and display location (HWD vs traditional head- down displays); AV cues were only present when the HWD was being worn by the subject pilot

Men’s experiences of the transition to fatherhood during the first postnatal year: A qualitative systematic review

Introduction: Fatherhood is a significant transition in a man’s life, introducing new challenges. Yet men’s experiences of this period remain poorly understood. Occupational therapists possess skills and knowledge to support individuals during transition. This study explored the experiences of men during the transition to fatherhood over the first postnatal year. Method: Underpinned by an occupational therapy theoretical perspective, a systematic review was conducted. Following searches of databases: AMED, CINAHL, Medline and PsycINFO, qualitative studies meeting selection criteria were retrieved and quality assessed. Data was extracted and synthesised using an established meta-ethnographic approach. Findings: Seven articles were included in the review. Four interconnected themes: (1) A New Occupational Identity, (2) Relationship Changes, (3) Challenges and Impact, (4) Unmet Occupational Needs, and four subthemes: Roles and Responsibilities, and Adjusting Priorities (theme 1); An Emotional Journey and Exhaustion (theme 3) were identified. Discussion: Fathers’ postnatal transitional experiences were reflective of a journey of adjustment and growth. Experiences indicated the requirement for greater support of fathers throughout the antenatal and postnatal transition. Occupational therapists have the skills to work with fathers to balance occupations, manage fatigue and adjust to new roles. Further research should focus on understanding experiences of men in under-represented groups

Picture This: Evaluating Healthcare Education Using Student Generated Pictorial Data

Objective: Healthcare student expectation and experience of professional training is likely to impact retention on their chosen programme. Understanding the experience of healthcare students is essential to support programme completion and ensure a future workforce with sufficient staff. The objectives of this study were to: (1) investigate the similarities and differences between undergraduate nursing and radiotherapy students’ expectations and experiences of the first year of their programme through pictorial data, and (2) develop a process of interpreting pictorial data for student evaluation. Methods: With written consent, students participating in nursing (n=31) and radiotherapy (n=22) completed a pictorial data collection tool on commencement and completion of year one. Data were analyzed using an adapted thematic content analysis. Independent data analysis, use of an audit trail and a reflective approach ensured a rigorous process. Results: Three themes were identified: professional identity, expectation of workload, and confidence. The students in both cohorts indicated an expectation that they would complete their studies, demonstrating a growing understanding of their profession over the first year of their studies, alongside a high workload. Nursing students indicated pride associated with being a nurse that was evident at the start and end of their first year of training. They experienced fatigue and lacked time to spend in activities other than studying and sleeping. Radiotherapy students indicated a better work-life balance. Conclusion: Informed by the findings, recommendations for healthcare programmes are made. Pictorial data were found to be quick, accessible, and inexpensive to collect and analyse. Impact of the visual data was powerful, giving novel insights into student expectation and experience. Pictorial data may provide a valuable complement to traditional methods of evaluation in healthcare education

The lived experiences of adults with learning disabilities: Taking part in a community gardening group

Introduction: People with Learning disabilities (LD) are marginalised within society and experience reduced occupational participation compared to the general population. Research exploring the lived experiences of adults with LD is limited. Gardening has a long history as an Occupational Therapy (OT) intervention with evidence of its benefits for well-being. Yet, previous work with adults with LD has focused on the perspective of the practitioner and has failed to address participant experience. This study aimed to understand the lived experiences of people with LD taking part in a gardening group. Methods: Adults with LD, participating in a charity-run gardening group were recruited to a qualitative, phenomenological study. With consent, participants engaged in a semi-structured interview exploring their experiences of being a member of the gardening group. Thematic analysis was utilised to interpret the results. Results: Seven interviews were completed. Four main themes indicated that the gardening group helped aid relaxation, provided sense of achievement, developed practical and social skills, and was a lifeline to make friendships. Conclusions: OTs should utilise these findings to inform practice and reduce occupation deprivation. Future research should explore how environment, activities and participation time, impact the occupation of gardening for adults with a LD

Current therapy for the upper limb after stroke: a cross-sectional survey of UK therapists

Objectives To survey the reported content, frequency and duration of upper limb treatment provided by occupational and physiotherapists for people after stroke in the UK.Design A cross-sectional online survey was used. Description and analysis of the data were based on items from the Template for Intervention Description and Replication (Who, Where, What and How much).Setting The online survey was distributed via professional and social networks to UK-based therapists.Participants Respondents were occupational or physiotherapists currently working clinically in the UK with people after stroke. Over the 6week data collection period, 156 respondents opened the survey, and 154 completed it. Respondents comprised 85 physiotherapists and 69 occupational therapists.results Respondents reported treating the upper limb a median of three times a week (range: 1 to 7) for a mean of 29min (SD: 18). Most (n=110) stated this was supplemented by rehabilitation assistants, family and/or carers providing additional therapy a median of three times a week (range 1 to 7). Functional training was the most commonly reported treatment for people with mild and moderate upper limb deficits (>40%). There was much less consistency in treatments reported for people with severe upper limb deficits with less than 20% (n=28) reporting the same treatments.Conclusions This study provides a contemporaneous description of reported therapy in the UK for people with upper limb deficits after stroke and a detailed template to inform standard therapy interventions in future research. Several evidence-based therapies were reported to be used by respondents (eg, constraint induced movement therapy), but others were not (eg, mental imagery). The findings also highlight that the current reported provision of upper limb therapy is markedly less than what is likely to be effective. This underlines an urgent need to configure and fund services to empower therapists to deliver greater amounts of evidence-based treatment for people with upper limb deficits after stroke

Are Behaviour Change Approaches Incorporated Within Digital Technology-Based Physical Rehabilitation Interventions Following Stroke? A Scoping Review

Background: Digital health technologies (DHTs) are increasingly used in physical stroke rehabilitation to support individuals to successfully engage with the frequent, intensive, and lengthy activities required to optimise recovery. Despite this, little is known about behaviour change within these interventions. Objective: This scoping review aimed to identify if, and how behaviour change approaches (i.e., theories, models and frameworks, and techniques to influence behaviour) are incorporated within physical stroke rehabilitation interventions that include a DHT. Methods: Databases (Embase, Medline, PyscINFO, CINAHL, Cochrane Library and AMED) were searched using keywords relating to behaviour change, DHT, physical rehabilitation and stroke. Results were independently screened by 2 reviewers. Sources were included if they reported a completed primary research study in which a behaviour change approach could be identified within a physical stroke rehabilitation intervention that included a DHT. Data including the study design, DHT utilised, and behaviour change approaches were charted. Specific behaviour change techniques were coded to the behaviour change technique taxonomy version 1 (BCTTv1). Results: From a total of 1973 identified sources, 103 studies (5%) were included for data charting. The most common reason for exclusion at full text screening, was the absence of an explicit approach to behaviour change (165/245, 67%). Almost half of the included studies (45/103, 44%) were described as pilot or feasibility studies. Virtual reality (VR) was the most frequently identified DHT type (58/103, 56%) and almost two-thirds of studies focused on upper limb rehabilitation (65/103, 63%). Only a limited number of studies (18/103, 17%) included a theory, model, or framework for behaviour change. The most frequently used BCTTv1 clusters were feedback and monitoring (88/103, 85%), reward and threat (56, 54%), goals and planning (33, 32%), and shaping knowledge (33, 32%). Relationships between feedback and monitoring, and reward and threat were identified using a relationship map with prominent use of both these clusters in interventions which included VR. Conclusions: Despite an assumption that DHTs can promote engagement in rehabilitation, this scoping review demonstrates that very few studies of physical stroke rehabilitation which include a DHT, overtly utilised any form of behaviour change approach. From those studies that did consider behaviour change, most did not report robust underpinning theory. Future development and research need to explicitly articulate how including DHTs within an intervention may support the behaviour change required for optimal engagement in physical rehabilitation following stroke, as well as establish their effectiveness. This understanding is likely to support the realisation of the transformative potential of DHTs in stroke rehabilitation

Fortification and health: challenges and opportunities.

Fortification is the process of adding nutrients or non-nutrient bioactive components to edible products (e.g., food, food constituents, or supplements). Fortification can be used to correct or prevent widespread nutrient intake shortfalls and associated deficiencies, to balance the total nutrient profile of a diet, to restore nutrients lost in processing, or to appeal to consumers looking to supplement their diet. Food fortification could be considered as a public health strategy to enhance nutrient intakes of a population. Over the past century, fortification has been effective at reducing the risk of nutrient deficiency diseases such as beriberi, goiter, pellagra, and rickets. However, the world today is very different from when fortification emerged in the 1920s. Although early fortification programs were designed to eliminate deficiency diseases, current fortification programs are based on low dietary intakes rather than a diagnosable condition. Moving forward, we must be diligent in our approach to achieving effective and responsible fortification practices and policies, including responsible marketing of fortified products. Fortification must be applied prudently, its effects monitored diligently, and the public informed effectively about its benefits through consumer education efforts. Clear lines of authority for establishing fortification guidelines should be developed and should take into account changing population demographics, changes in the food supply, and advances in technology. This article is a summary of a symposium presented at the ASN Scientific Sessions and Annual Meeting at Experimental Biology 2014 on current issues involving fortification focusing primarily on the United States and Canada and recommendations for the development of responsible fortification practices to ensure their safety and effectiveness

Decreased Odds for Vasospasm Treatment in Patients with Aneurysmal Subarachnoid Hemorrhage after Transitioning from Neurosurgery Led Care to a Neurology Led Multidisciplinary Approach.

Introduction: The limited research on the management of aneurysmal subarachnoid hemorrhages (aSAHs) has not assessed the efficacy of neurology-led care. Our objective was to describe aSAH patients\u27 outcomes after transitioning from a neurosurgery-led intensive care unit (ICU) to a neurology-led multidisciplinary care neurocritical care unit (NCCU). The study hypothesis was that the neurology-led multidisciplinary care would improve patient outcomes. Methods: This was a retrospective cohort study. We included patients (≥ 18) with aSAHs from 1/16 to 8/16 (pregroup) and from 3/17 to 11/17 (postgroup). The pregroup care was led by a neurosurgeon. The postgroup care included a neurologist, a pulmonary intensivist, a neurocritical care clinical nurse specialist, a neurosurgeon, and euvolemia protocol. The primary outcome was trips to interventional radiology (IR) for vasospasm treatment. Univariate analyses and multivariable ordinal logistic regression were used. Results: There were 99 patients included: 50 in the pregroup and 49 in the postgroup. On average, postgroup patients were 7 years older than the pregroup ( Conclusions: In aSAH patients, the neurology-led multidisciplinary care in the NCCU decreased the odds of repeated procedures for vasospasm treatment. Neurology-led multidisciplinary care could be more cost-effective than the neurosurgical-led care