Kitchen-related tasks used in occupational therapy during rehabilitation of adults with acquired brain injury : a systematic review

Introduction Kitchen-related tasks are widely used in occupational therapy for adults with acquired brain injury. This study aimed to investigate the effectiveness of kitchen-related, task-based occupational therapy interventions for improving clinical and functional outcomes in the rehabilitation of adults with acquired brain injury. Method A systematic review of the literature was conducted with narrative synthesis (PROSPERO registration CRD42019141898), by searching relevant electronic databases (BNI, CINAHL Plus, MEDLINE, DORIS, OT Seeker etc.), registries of ongoing studies (ISRCTN, PROSPERO, etc.), and grey literature (OpenGrey, etc.). English-language studies that evaluated kitchen-related tasks in the rehabilitation of adults with acquired brain injury were included and independently appraised for their methodological quality by two reviewers. Results Seventeen primary studies met the eligibility criteria. Studies were heterogeneous in methods, methodological quality, setting, sample size, purpose, and design of kitchen-related tasks. Fifteen studies evaluated kitchen-related, task-based treatments for improving function, and two studies examined kitchen-related task assessments for safety and task performance. This provides very limited evidence for the effectiveness of kitchen-related, task-based interventions compared to interventions not based on kitchen-related tasks. Conclusion While kitchen-related, task-based occupational therapy interventions in acquired brain injury rehabilitation are common practice, there is currently limited research evidence to support this. Further studies are warranted to strengthen the evidence base

Cough frequency monitors : can they discriminate patient from environmental coughs?

BACKGROUND: Objective cough frequency measurements are increasingly applied in clinical research. Technological advances enable automated detection and counting of cough events from sound recordings of many hours’ duration. A possible limitation of sound-based cough frequency measurement is the contamination of recordings by environmental coughs (coughs from persons other than the patient). This study aimed to investigate the accuracy of a sound-based cough monitor for detecting and discriminating patient cough from environmental cough. METHODS: As part of a stroke trial (ISRCTN40298220), patients on a hospital ward underwent 15-minute recordings using the Leicester Cough Monitor (LCM), a sound-based cough monitor (‘semi-automated counts’). Participants and other persons in the environment were prompted to cough. An observer present in the room recorded the number of patient and environmental coughs (‘live counts’). LCM counts were also compared against a manual cough count, the most commonly used gold standard to determine accuracy (‘manual sound counts’ from listening to recordings), by a blinded assessor who cross-referenced timed cough events from the respective methods. Data for automated, manual and live cough counts were analyzed using agreement statistics. RESULTS: On sound recordings from five patients, there were 65 patient coughs and 78 environmental coughs (manual counts). Absolute agreement for patient cough count between all three measurement methods (LCM automated, live, and manual sound counts) was high, with intra-class correlation coefficient of 0.94 [95% confidence intervals (CI): 0.74, 0.99]. The proportion of exact agreements for patient cough between LCM and manual count was 0.92, and kappa was 0.84 (95% CI: 0.75, 0.93). The LCM showed sensitivity of 0.94 (95% CI: 0.84, 0.98), specificity of 0.91 (95% CI: 0.82, 0.96), positive predictive value of 0.90 (95% CI: 0.79, 0.95) and negative predictive value of 0.95 (95% CI: 0.86, 0.98) for detecting patient coughs. CONCLUSIONS: This preliminary study supports the validity of the cough monitor for detecting and discriminating patient from environmental cough. Further validation is recommended, to describe the level of accuracy with greater precision

"I'm still me - I'm still here!" Understanding the person's sense of self in the provision of self-management support for people with progressive neurological long-term conditions.

PURPOSE: There is increasing interest in tailoring self-management support, but little detail is available on the relevance and impact of such approaches for people with progressive neurological conditions. The aim of this study was to draw on individuals' experiences to inform the practice of self-management support for these groups. METHOD: Community rehabilitation service users were purposively recruited and took part in in-depth qualitative interviews. Interviews were audio-recorded and transcribed. Data analysis was iterative and interpretative, taking a phenomenological approach. Strategies to enhance rigor were auditability, peer review, and researcher reflexivity. RESULTS: The sample consisted of 10 adults (age 20-79 years) who were living with a range of progressive neurological conditions. Individuals demonstrated resourcefulness in developing practice-based self-management strategies. Beyond practical strategies, interviewees' experiences were signified by reflecting on and upholding a sense of identity and a desire for purpose against the background of losses and gains over time. Linking with this overarching theme of "Sense of self" were aspects of "My body and mind", "Time", "Space", "Relationships", and "What I do". CONCLUSIONS: Self-management approaches for individuals with progressive neurological conditions will benefit from incorporating ways of recognizing, articulating, and supporting the person's sense of identity and purpose. Implications for rehabilitation Self-management approaches for people with progressive neurological conditions need to take account of individuals' wishes to contribute, connect with others, and be valued as a person. Person-centred self-management support can be realized through a broader approach than solely managing disease progression. The experiences and words of people with progressive neurological conditions can be used to inform meaningful evaluation of self-management support to drive service delivery by measuring what really matters. Rehabilitation practitioners need to adapt their conceptualisations of goal setting to account for how people with progressive neurological conditions themselves interpret "progress" and "improvement". Person-centred conversation that values who the person is can be an effective starting point for self-management interventions in people with progressive neurological conditions

Managing the severely impaired arm after stroke: a mixed-methods study with qualitative emphasis.

Purpose: There is a paucity of research into self-management strategies employed by stroke survivors outside of formal rehabilitation. This study aimed to explore stroke survivors' experiences of, and strategies for self-managing their severely impaired upper limb.Materials and methods: English-speaking stroke survivors whose upper limb had been non-functional at 3 months post-stroke took part in interviews (n = 16), a focus group (n = 6) and a survey (n = 20). Quantitative data were analysed descriptively. Qualitative data were analysed through thematic framework analysis using NVivo© software.Results: Participants' median (range) age group was 50-59 years (30-39, 70+). Median (range) time post-stroke was 39 months (4 months, 46 years). The overarching theme across the data was "choosing and expanding." Participants enacted professionally driven management strategies for their affected arm, and then chose to continue with what worked for them. Strategies were expanded through self-discovery and interaction with peers. There were sadness and frustration at the loss of arm function, but also satisfaction and self-confidence when progress was being made. Participants described an attitude of not giving up and remaining hopeful.Conclusions: These findings extend our understanding about how individuals manage their severely impaired upper limb and can be used to inform a novel stroke self-management intervention.Implications for rehabilitationStroke survivors' experiences of managing the severely affected upper limb may inform rehabilitation practice to foster self-management.Rehabilitation professionals may actively support stroke survivors in choosing from, and expanding on professionals' advice and guidance.Maintaining a positive and hopeful outlook is important to many stroke survivors. Professionals should be mindful of the potential impact of their interactions and negative predictions.Stroke survivors' experiences of managing the severely affected upper limb may inform the development of a novel tailored self-management intervention

Reference values for fatigued versus non-fatigued limb symmetry index measured by a newly designed single-leg hop test battery in healthy subjects : a pilot study

There is sparse evidence for return to sport criteria after knee injury. Functional performance deficits, particularly in fatigued muscular condition, should be verified prior to the attempt to return to high-risk pivoting sports. The purpose of this study was to generate reference values for the limb symmetry index (LSI) of healthy subjects in fatigued and non-fatigued muscular condition in a newly designed test battery

The problem with self-management : problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation

Self-management is a concept which is now firmly established in Western healthcare policy and practice. However, the term remains somewhat ambiguous, multi-faceted and contentious. This is evident in stroke care and rehabilitation, in which a self-management approach is increasingly adopted and advocated, yet interpreted in different ways, resulting in contradictions and tensions around control, responsibility, power and discipline. This paper aims to further our understanding of tensions and contradictions in stroke self-management, by critically examining contemporary self-management practices. We use a Foucauldian theoretical lens to explore the various power dynamics in the operationalisation of self-management, in addition to the complexity of the term self-management itself. Conducting a secondary analysis of interview and focus group data from the Self-Management VOICED study, supplemented with analysis of relevant documentary evidence from policy and practice, we describe the multiple aspects of power in operation. These include rhetorical, hierarchical, personal and mutual forms of power, representing interweaving dynamics evident in the data. These aspects of power demonstrate underlying agendas and tacit and explicit understandings of self-management which exist in clinical practice. These aspects of power also give insight into the multiple identities of 'self-management', acting as a simultaneous repressor and liberator, directly in keeping with Foucauldian thinking. The findings are also consistent with Foucault's notions of bodily docility, discussions around governance and biopower, and contemporary discipline. Our analysis positions self-management as a highly nuanced and complex concept, which can fluctuate in its conceptualisation depending on the structures, routines, and the individual. We encourage healthcare professionals, policymakers and commissioners in the field of self-management to reflect on these complexities, to make transparent their assumptions and to explicitly position their own practice accordingly