ENVIRONMENTAL INFLUENCES ON OCCUPATIONAL THERAPY PRACTICE

Rehabilitation hospitals serve to foster a client’s independence in preparation to return home after an injury or insult. Having space in rehabilitation environments that is home-like and supportive for each client can facilitate participation in occupations and assist in learning and practicing the skills needed to transition to home. Yet, typically occupational therapists provide interventions to clients in therapy gyms with exercise and impairment based equipment. Currently the stroke population is changing and identifying the optimal rehabilitation environment is imperative to guide occupational therapy practice. This dissertation contains three studies relating to the rehabilitation environment and occupational therapy interventions. The first study focused on the perceptions of occupational therapists regarding their optimal rehabilitation environment, identifying that they would prefer to offer their clients a variety of rehabilitation environments and that there is a relationship between the environment and the type of intervention provided. A second study examined the effects of occupation-based interventions provided in a home-like environment to an individual recovering from chronic stroke with the results indicating enhanced occupational performance, resumed competence in desired roles, improvement in affected upper extremity function, and notable neuroplastic change. The final study investigated how the rehabilitation environment influenced the interventions used by the occupational therapists. The findings supported the relationship between the therapy environment and a specific intervention; working in the therapy gym with preparatory methods and being in a home-like space using occupation-based interventions. The environment influenced occupational therapy interventions and it is recommended that the occupational therapist match the client’s goals to the ideal environment for optimal intervention

Perceived Exercise Habits of Individuals with Parkinson’s Disease Living in the Community

Context Exercise has been shown to improve gait in individuals with Parkinson’s disease (PD). Stepping practice at higher intensity levels has been suggested as a beneficial treatment option to improve gait in the neurological population. Unfortunately, this mode is poorly understood and underutilized within the PD population. Information on what individuals with PD are doing for exercise would be beneficial to help tailor exercise programs to improve gait and provide exercise options in the community for intensity-based exercise. Objective To investigate the current exercise habits of individuals living with PD in the community aimed at improving walking and to understand the impact of perceived intensity on daily exercise practices. Design, setting, participants One hundred thirty-eight individuals with PD living in the community were surveyed online regarding their current exercise habits. Main outcome measure A total of 22 questions aimed to understand exercise selection, focus, and perceived intensity. Questions asked basic demographic, symptom presentation and management of disease related symptoms that were present while living with PD. Exercise questions focused understanding participants current function level, practice exercise habits and perceived levels of exercise intensity during daily routines. Results Of the 138 individuals surveyed for this preliminary study, eighty-seven percent of individuals with PD participated in exercise with seventy-five percent choosing walking as a mode for exercise. Sixty-five percent of the respondents noted that despite exercise, their walking speed and endurance has worsened since diagnosis. Eighty-one percent perceived exercising at moderate intensity levels, however little provocation of intensity symptoms was noted. Conclusion Our preliminary study survey results suggest that individuals with PD are exercising but not at high enough intensity levels to promote improvements in gait performance. Individuals with PD may need to be pushed at higher intensity levels, beyond their voluntary limits, to induce gait performance changes. These findings can provide a foundation for future fitness interventions within this population to target improving gait

Improving Hand Recovery in Tetraplegia Through the use of Meaningful Occupations: A Qualitative Case Series

Purpose: This qualitative descriptive study explored participants’, with chronic spinal cord injury (SCI), experiences with meaningful intensive task specific training (ITST). Methods: Three participants completed 24-ITST upper extremity motor therapy intervention sessions. Qualitative interviews were completed at three time points for a case series: baseline, within 7 days of the completion of the final ITST intervention session, and within one month of the final ITST intervention session for a total of 9 interviews. Results: Three themes were identified including: Quality of Movement Enhances Normal Use of Hands, Empowering Through Education and Motivation to Participate and Enhance Quality of Life. Through the use of motor learning concepts, positive reinforcement, and education positive outcomes were reported and promoted self-efficacy in all participants. Conclusions: A collaborative and client-centered approach to rehabilitation with a focus on performance-based goals was found to increase self-efficacy leading to greater independence and self-determination for participants. Interventions focusing on meaningful client-centered occupations are recommended. Individuals with chronic SCI typically do not have access to rehabilitation services and more research is needed on interventions to further explore the benefits of additional rehabilitation services and an increased focus on practitioner education on optimal interventions for chronic injury populations