Two steps forward, one step back? A commentary on the disease-specific core sets of the international classification of functioning, Disability and Health (ICF)

The International Classification of Functioning, Disability and Health (ICF) is advocated as a biopsychosocial framework and classification and has been received favourably by occupational therapists, disability rights organisations and proponents of the social model of disability. The success of the ICF largely depends on its uptake in practice and it is considered unwieldy in its full format. Therefore, to make the ICF user friendly, the World Health Organisation (WHO) have condensed the original format and developed core sets, some of which are disease specific. The authors use the ICF Core Set for stroke as an example to debate if by reverting to classification according to disease, the ICF is at risk of taking two steps forward, one step back in its holistic portrayal of health

Exploring evidence-based practice by occupational therapists when working with people with apraxia

Short Report Evidence in the literature supports a number of interventions that occupational therapists may utilise when working with people with apraxia, although there is no gold standard approach. A large-scale survey (n = 304, 36% response rate) was conducted with the membership of the College of Occupational Therapists Specialist Section – Neurological Practice to explore therapists’ understanding of apraxia and to provide a benchmark of current practice. Consensus was found in the majority of belief statements regarding the condition, although the respondents were unclear about the relationship between cognition and apraxia. When the therapists were asked to indicate their choice and use of interventions for apraxia, the results showed that the main consideration was the context in which a person performs activities, with moderate use of specific techniques including errorless learning and chaining. The results are related to the evidence base and the implications for occupational therapy practice and education are discussed

Using the ICF to clarify team roles and demonstrate clinical reasoning in stroke rehabilitation

Purpose: The International Classification of Functioning, Disability and Health (ICF) is advocated as a tool to structure rehabilitation and a universal language to aid communication, within the multi-disciplinary team (MDT). The ICF may also facilitate clarification of team roles and clinical reasoning for intervention. This article aims to explore both factors in stroke rehabilitation. Method: Following a review of the literature, a summary was presented and discussed with clinicians working within stroke rehabilitation, to gather expert opinions. The discussions were informal, being part of service development and on-going education. The clinicians summarised key themes for the potential use of the ICF within clinical practice. Results: Two key themes emerged from the literature and expert opinion for the potential use of the ICF in stroke rehabilitation: i) to aid communication and structure service provision ii) to clarify team roles and aid clinical reasoning. Expert opinion was that clarification of team roles needs to occur at a local level due to the skill mix, particular interests, setting and staffing levels within individual teams. The ICF has the potential to demonstrate/ facilitate clinical reasoning, especially when different MDT members are working on the same intervention. Conclusion: There is potential for the ICF to be used to clarify team roles and demonstrate clinical reasoning within stroke rehabilitation. Further experiential research is required to substantiate this vie

Using accreditation of prior experiential learning (apel) to replace a practice placement: A controversial option?

The Accreditation of Prior Experiential Learning (APEL) is established in higher education, but there are no studies on its use in occupational therapy. Brunel University wanted to investigate whether APEL could enable occupational therapy students meeting certain criteria to be exempt from the first-year practice placement, and so devised an APEL proposal. Practice placement educators and students were invited to give their opinion on the proposal through a questionnaire; additionally, the students attended a nominal group discussion. Three themes emerged from the six practice placement educators who agreed to participate: logistics, student experience and learning opportunities. The three students who participated valued APEL for confirming and recognising learning from previous experience. The low response impedes establishing any definite views on the topic, but could suggest that APEL is not a controversial option to practice placement educators and students. Further study is required on the adoption of APEL in occupational therapy education

To adopt is to adapt: The process of implementing the ICF with an acute stroke multidisciplinary team in England

Copyright @ 2012 Informa Plc. The article can be accessed from the link below.This article has been made available through the Brunel Open Access Publishing Fund.Purpose: The success of the International Classification of Functioning, Disability and Health (ICF) depends on its uptake in clinical practice. This project aimed to explore ways the ICF could be used with an acute stroke multidisciplinary team and identify key learning from the implementation process. Method: Using an action research approach, iterative cycles of observe, plan, act and evaluate were used within three phases: exploratory; innovatory and reflective. Thematic analysis was undertaken, using a model of immersion and crystallisation, on data collected via interview and focus groups, e-mail communications, minutes from relevant meetings, field notes and a reflective diary. Results: Two overall themes were determined from the data analysis which enabled implementation. There is a need to: (1) adopt the ICF in ways that meet local service needs; and (2) adapt the ICF language and format. Conclusions: The empirical findings demonstrate how to make the ICF classification a clinical reality. First, we need to adopt the ICF as a vehicle to implement local service priorities e.g. to structure a multidisciplinary team report, thus enabling ownership of the implementation process. Second, we need to adapt the ICF terminology and format to make it acceptable for use by clinicians.This study is funded by The Elizabeth Casson Trust. This article is made available through the Brunel Open Access Publishing Fund

Interprofessional learning in practice: The student experience

Interprofessional learning and the development of teamworking skills are recognised as essential for patient care and are also a government priority for undergraduate education. Sixteen occupational therapy students worked on an interprofessional training ward as part of their practice placement and three of them participated in an evaluation using the nominal group technique. Despite this small number, the evaluation identifies the value of this learning experience in giving the students an opportunity to appreciate the importance of interpersonal skills; to learn about other team members’ roles; and to experience the challenges of working on a busy rehabilitation ward for older people

Structure of the met protein and variation of met protein kinase activity among human tumour cell lines.

An in vitro autophosphorylation assay has been used to demonstrate that there is considerable variation in met associated protein kinase among human tumour cell lines. Of particular note was the very high level of autophosphorylation of the 140 kD met protein (p140met) in experiments with A431 human cervical carcinoma cells. In contrast in experiments with Daoy human medulloblastoma cells we failed to detect phosphorylation of p140met; instead a high level of phosphorylation of a 132 kD protein was observed. To help understand the basis for the variation in kinase activity and to learn more about the structure of the mature met protein we have analysed p140met in SDS-polyacrylamide gels under non-reducing conditions. Under these conditions the met protein had an apparent molecular weight of 165,000 indicating that the mature met protein may exist as an alpha beta complex in which p140met (designated the beta subunit) is joined by disulphide bonds to a smaller, 25 kD, alpha-chain. We have identified a potential proteolytic cleavage site with the sequence Lys-Arg-Lys-Lys-Arg-Ser at amino acids 303-308 in the human met protein that may account for cleavage of the met protein into alpha and beta subunits