Comprehensive Occupational Therapy Research Articles

Early detection of spinal cord compression: screening, clinical presentation, outcome and prognosis

Spinal cord compression (SCC) is a critical medical condition characterized by pressure on the spinal cord, which can lead to severe and potentially irreversible neurological damage if not promptly addressed. The causes of SCC are varied, including primary and metastatic tumors, traumatic injuries, degenerative diseases, and infections. Early detection of SCC is paramount for improving patient outcomes, minimizing risk of permanent deficits, and enhancing quality of life. This review examines etiology and clinical presentation of SCC, highlighting the significance of early screening and detection. Effective screening involves identifying high-risk individuals through risk stratification, utilizing advanced imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, and maintaining clinical vigilance. Recognizing early symptoms, such as localized pain, neurological deficits, and autonomic dysfunction, is crucial for timely intervention. Prognosis of SCC improves significantly with early diagnosis and intervention. Treatment options include surgical decompression to relieve pressure, radiation therapy for tumor-related compression, and corticosteroids to reduce inflammation. Early intervention can prevent irreversible neurological damage and enhance recovery potential. Comprehensive rehabilitation, involving physical and occupational therapy, is critical for restoring function and improving quality of life.

Effect of pre-transplant functional status on length of hospital stay in patients undergoing allogeneic hematopoietic stem cell transplant in an outpatient transplant program.

6560 Background: The use of reduced intensity conditioning regimens including non-myeloablative regimens in allogeneic hematopoietic stem cell transplant (allo SCT), has expanded the pool of transplant candidates in the United States. Nonetheless, allo SCT, is associated with significant morbidity and mortality especially in patients 65 and older. In our outpatient transplant program, allo SCT patients undergo a comprehensive physical and occupational therapy (PT/OT) evaluation pre-transplant. Methods: We retrospectively reviewed all patients undergoing an allo SCT between January 2019 and December 2022 who had a PT/OT evaluation pre-transplant. We analyzed lower extremity functional scale (LEFS) and fatigue score (FACIT). The FACIT score is a patient reported outcome tool where the lower the score, the less fatigue impacts a patient’s performance. Results: We identified 218 patients who had at least one variable reported. Eighty-one patients were 65 years of age or older. All patients in the 65 and older group had a RIC or NMA conditioning regimen. In the 65 and older group, 72.8% had an HCTCI score of 3 or more compared to 59.1% in the group younger than 65. In patients younger than 65, those who had a lower LEFS (ie less lower extremity strength), had a statistically significant longer hospital stay of 15.5 days compared to 9 days (p=0.003). In patients 65 and older, lower FACIT scores (ie less patient reported fatigue), resulted in a statistically significant shorter hospital stay of 7.5 days compared to 13 days (p=0.019). In addition, there was a trend towards shorter hospital stays in patient 65 and older who had a higher LEFS of 5 days compared to 12.5 days (p=0.07). There was no difference in survival outcomes but there was a trend towards better overall survival in patients 65 and older with high LEFS (p=0.08) and a trend towards better NRM in this group (p=0.11). Conclusions: Our study highlights the need for comprehensive assessments in patients undergoing allo SCT. Geriatric functional status assessments are necessary to determine patients at risk for complications and to optimize such patients with exercise and cognitive rehabilitation programs prior to allo SCT. [Table: see text]

Application of the Model of Human Occupation (MOHO) in Psychosocial Needs of Adolescents With Type 1 Diabetes: A Case Study

Background and Objectives: Using the model in the clinical reasoning of occupational therapy practitioners create a mental framework and the ability to organize the variables involved in the rehabilitation process. The most comprehensive occupational therapy model, the Model of Human Occupation (MOHO), is based on open systems theory. This model can be widely used in rehabilitation and even education. However, several sources indicate that it is used in pediatrics. So, this study aimed to investigate the application of MOHO in an adolescent with type 1 diabetes. Case Presentation: The participant was assessed and treated at home by an occupational therapist based on MOHO principles. MOHO analyzes the transaction among the individual's internal factors (volition, habituation, and performance capacities), the activity, and the environmental conditions. Discussion: Since in adolescents with type 1 diabetes, volition, habituation, and performance capacities are affected by disability, designing and structuring goals and treatment based on MOHO will help occupational therapists perform more effectively, however, further studies with more methodological rigor are needed on this topic.

Examining the impact of a health report card on follow through with fall risk recommendations: an observational study

BackgroundIncreasing older adults’ awareness of their personal fall risk factors may increase their engagement in fall prevention. The purpose of this study was to explore the impact of and participant satisfaction with a comprehensive occupational therapy fall risk screening and recommendations for evidence-based fall prevention strategies based on personalized fall risk results for community-dwelling older adults.MethodsCognitively normal participants (Clinical Dementia Rating = 0) were recruited from an ongoing longitudinal study of memory and aging. Participants completed 2 annual in-home visits, fall risk questionnaires, and 12 months of fall monitoring between visits. Participants received a health report card with their fall risks and tailored recommendations in 6 domains. Participants completed follow-up questions at their next annual in-home visit about the fall risk recommendations and their satisfaction with receiving their fall risk results.ResultsTwo hundred five participants completed 2 annual visits and 12 months of fall monitoring. Of the 6 domains of recommendations provided, participants were most likely to follow through with getting an annual eye exam and reviewing their medications with their doctor or pharmacist. Older adults who fell were significantly more likely to receive recommendations for finding fall prevention classes (p = 0.01) and having a doctor or pharmacist review their medications (p = 0.004). The majority of participants were satisfied receiving their fall risk results (92%) and believed it to be beneficial (90%), though few participants shared their results with their doctor (20%).ConclusionsAn occupational therapy fall risk screening and tailored recommendations were not sufficient to encourage follow through with fall risk recommendations. Older adults may benefit from additional support and encouragement to reduce their fall risk. Additional research is needed to examine awareness of fall risks and follow through with fall risk recommendations among community-dwelling older adults.

The Impact of Occupational Therapy on the Self-Management of Rheumatoid Arthritis: A Mixed Methods Systematic Review.

To determine the impact of occupational therapy (OT) on the self-management of function, pain, fatigue, and lived experience for people living with rheumatoid arthritis (RA). Five databases and gray literature were searched up to June 30, 2022. Three reviewers screened titles and abstracts, with two independently extracting and assessing full texts using the Cochrane risk of bias (quantitative) and Critical Appraisal Skills Programme (qualitative) tools to assess study quality. Studies were categorized into four intervention types. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (quantitative) and GRADE- Confidence in Evidence from Reviews of Qualitative research (qualitative) were used to assess the quality of evidence for each intervention type. Of 39 eligible papers, 29 were quantitative (n=2,029), 4 qualitative (n=50), and 6 mixed methods (n=896). Good evidence supports patient education and behavior change programs for improving pain and function, particularly group sessions of joint protection education, but these do not translate to long-term improvements for RA (>24 months). Comprehensive OT had mixed evidence (limited to home OT and an arthritis gloves program), whereas limited evidence was available for qualitative insights, splints and assistive devices, and self-management for fatigue. Although patient education is promising for self-managing RA, no strong evidence was found to support OT programs for self-managing fatigue or patient experience and long-term effectiveness. More research is required on lived experience, and the long-term efficacy of self-management approaches incorporating OT, particularly timing programs to meet the individual's conditional needs (i.e., early or established RA) to build on the few studies to date.

131 A review of the implementation of a specialist older persons 7 day service within an acute setting

Abstract Background As part of Winter Planning Initiatives 2021–2023 additional funding was allocated to expand the service being offered to older persons within the acute hospital setting, across the disciplines of Occupational Therapy (OT), Physiotherapy (PT) and Nursing. This is aimed at providing a person centred 7 day service, supporting admission avoidance and promoting patient flow through the hospital by enhancing timely discharges and transfers of care. Methods Referrals to the specialist older persons service were primarily received from the Homefirst team (Frailty at the front door). Those who were referred had been admitted onto an acute ward and had been identified as requiring specialist therapy input to enhance the quality of their stay in addition to supporting safe and timely discharges home or transfers of care. A comprehensive OT assessment was carried out with all patients. A reduced 7 day service was commenced in order to gather information to assist future service planning. Results 2 Occupational Therapists were recruited prior to additional team members therefore, initial referrals accepted were those with identified OT needs. All referrals were accepted with a triaging system being developed as the service became more established. All referrals had a Clinical Frailty Score (CFS) of between 3–7. Patient Outcomes included discharge direct to home or transfer of care including rehab, stepdown, nursing home and hospice facilities. These outcomes were impacted by social support systems, availability of community resources and limited access to ongoing specialist team input. Conclusion The introduction of a specialist older persons 7 day service working within an integrated model of care, has wide ranging impacts for patients and the organisation. Access to specialist acute older persons services provides targeted assessment and intervention, supporting early decision making, quality and flow.

Measurement Properties of the Stroke-Predischarge Occupational Therapy Assessment.

There is no comprehensive predischarge occupational therapy assessment tool in South Korea. The objective of this study was to determine Stroke-Predischarge Occupational Therapy Assessment (S-POTA) validity and reliability. Twenty-seven occupational therapists (OTs) assessed 97 patients with stroke. Concurrent validity was evaluated by comparing S-POTA scores with stroke-specific quality of life (SS-QOL). Discriminant validity was evaluated by comparing S-POTA scores between outpatient and readmitted groups, and a receiver operating characteristic analysis was conducted. The test-retest was conducted twice in 20 patients, and the inter-rater test was conducted with two OTs per patient. S-POTA positively correlated with SS-QOL. S-POTA rating differs significantly across outpatients and readmitted groups. All S-POTA areas under curve values ranged from .70 to .85, and cut-off points were derived. Cronbach's α for internal consistency was .953, the intraclass correlation coefficient for test-retest was .990, and .987 for inter-rater reliability. The results suggest S-POTA is a reliable tool for efficient implementation of discharge planning.

The Effects of Comprehensive Occupational Therapy for Hemiplegic Upper-extremity both with Rotator Cuff Calcific Tendinopathy and Shoulder Subluxation：A Case Report

The Effects of Comprehensive Occupational Therapy for Hemiplegic Upper-extremity both with Rotator Cuff Calcific Tendinopathy and Shoulder Subluxation：A Case Report

48 Higher Admission Frailty Scores Predict Increased Mortality, Morbidity and Healthcare Utilization in the Elderly Burn Population

Abstract Introduction The Rockwood Clinical Frailty Scale is a validated rapid assessment of frailty phenotype, predictor of mortality and other clinical outcomes in the geriatric population, even when applied retrospectively. Using data from a large tertiary care burn center, we assessed the association between admission frailty in an elderly burn population and outcomes. Methods Retrospective analysis of burn patients > 65 years, admitted to a tertiary care referral burn center from 2015–2019 (n= 652). Patients were assigned to Rockwood frailty subgroups, low (1–3), moderate (4–6), or high (7–9), based on comprehensive medical, social work, physical and occupational therapy assessments. Patients who did not have complete assessments to allow for appropriate frailty scoring were excluded. Hospital-associated infections (HAIs) were identified through the institutional epidemiology database and healthcare utilization data were extracted from burn registry and medical records. Cox proportional hazards regression was used to estimate associations between admission frailty and 30-day inpatient mortality. Results Our study included 644 patients (low: 262, moderate: 345, and high: 37 frailty subgroups). Frailty was associated with higher percent TBSA (median TBSA: low 2.0%; moderate 3.0%; high 3.0%; p=0.01) and older age at admission (p=0.0004). The 30-day cumulative incidence of mortality was 2.3%, 7.0%, and 24.3% among the low, moderate, and high frailty strata, respectively. After adjustment for age, TBSA and inhalation, high frailty was associated with increased 30-day mortality (HR 5.73; 95% CI 1.86, 17.62). Moderate frailty appeared to increase 30-day mortality, although estimates were imprecise (HR 2.19; 95% CI 0.87–5.50). Morbidity and healthcare utilization results are reported in Table 1. Higher frailty was associated with any ICU stay during the hospitalization, need for mechanical ventilation, and higher median hospital cost/day. HAIs were infrequent in all frailty subgroups. The proportion of patients discharged to hospice, rehab, long and short-term care facilities was highest in the high frailty subgroup. Those in the moderate and low subgroups were more likely to be discharged home or home with services. Conclusions High admission frailty is associated with an increased 30-day mortality regardless of age group. Higher frailty correlates with increased morbidity and healthcare utilization.

Validity of the Occupational Performance Scale of the Sensory Processing Three Dimensions Measure.

The Sensory Processing Three Dimensions (SP3D) Occupational Performance Scale (OPS) is a new parent-report measure developed for use as part of a comprehensive occupational therapy evaluation for children with sensory processing and integration challenges. To examine the internal consistency and discriminant validity of the SP3D OPS, examine relations between sensory processing subtypes and areas of occupational performance (OP), and determine the extent to which specific sensory processing challenges predict problems with OP. Nonexperimental, descriptive design using correlations, group comparisons, and stepwise regression. Three outpatient clinic sites in the United States. Parents of 66 children (33 typically developing and 33 with clinical problems) ranging in age from 4 to 12 yr. The SP3D OPS and SP3D Inventory were completed by parents to address psychometrics of the SP3D OPS and determine the association between sensory processing and integration challenges with OP. Internal consistency reliability and discriminant validity of the SP3D OPS were supported. Scores on the Dyspraxia and Sensory Overresponsivity subscales best predicted deficits in OP. Significant relations were found between sensory processing and integration and competency in multiple OP areas. The SP3D OPS shows promise as a measure of OP. The OP deficits among children with sensory processing and integration challenges are in part due to subtype presentation. Further studies of the SP3D OPS's reliability and validity are needed. This new occupational performance measure shows associations between sensory processing and OP areas. It can provide information to support therapists in identifying family concerns relevant to goal setting and intervention.

Effect of occupational therapy on cognitive functions and occupational performances in hospitalized patients with mental-health disorder: A single-arm interventional study

Background: Cognitive dysfunction, a distressing outcome of mental-health disorders (MHDs), hinders an individual's occupational performance (OP). OP is the outcome of dynamic interaction between a person, their unique environment and occupation. With only pharmacological treatment, symptom reduction was not in pace with the recovery rate of cognitive and OP dysfunction resulting persistence of these dysfunctions even post-hospital discharge. Hence, occupational therapy (OT) intervention before discharge would be required, for patient's functioning at premorbid level postdischarge. However, till date, very few Indian studies on the effect of OT on cognition and OP in individuals with MHDs are done with under-representation of the client population. Objectives: To study the effect of OT on cognitive functions and OP in hospitalized patients with MHDs. Study Design: A single-arm interventional study was conducted. Methods: Based on the selection criteria, 88 patients who were (aged 18–55 years) diagnosed with MHDs and were admitted in the hospital were enrolled after screening during their first visit to OT department using the purposive sampling method. Participants recruited were categorized into diagnostic groups: schizophrenia, neurotic disorders, mood disorders, and alcohol-substance use disorders for data analysis. Patients were assessed on Mini-Mental State Examination (MMSE) and comprehensive OT evaluation (COTE) scale pre- and post-therapy after 3 weeks, i.e. after 6 sessions. Cognitive-OP focused-OT intervention was given twice a week. Results: The descriptive data analysis showed an increase in performance posttherapy for all subtests (except Language-praxis subtest in Group-Neurotic Disorders) and overall scores of both assessments in all the groups. Total MMSE performance both pre- and post-therapy was better than total COTE performance in all the groups. Posttherapy, maximum improvement was observed in Recall among MMSE subtests and in Task-behavior among COTE subtests across all groups. Inferential data analysis showed highly significant improvement posttherapy for total MMSE and total COTE scores (P < 0.01, 95% confidence interval: Groups: schizophrenia [(−3.218, −2.302) and (15.991, 18.329)], neurotic disorders [(−3.169, −1.631) and (13.230, 18.970)], mood disorders [(−3.100, −1.650) and (15.095, 19.155)] and Group: alcohol and substance-use disorders [(−4.210, −1.456) and (17.855, 22.47)] respectively). Conclusion: OT intervention is effective in improving cognitive and OP in hospitalized patients with MHDs.

Test-Retest Reliability and Minimal Detectable Change of the Comprehensive Occupational Therapy Evaluation Scale (COTES) in People With Schizophrenia.

A reliable observational measure is necessary to measure clients' behaviors as they participate in activities. The Comprehensive Occupational Therapy Evaluation Scale (COTES) is designed to measure strengths and difficulties in various behaviors that support occupational performance. To examine the test-retest reliability of the COTES (overall score and scores on the General Behavior, Social Behavior, and Work Behavior subscales) and calculate the minimal detectable change (MDC) for people with schizophrenia. Prospective, observational study. A psychiatric center. COTES data for 118 people with schizophrenia were collected from occupational therapy records. Data from the initial and second COTES measurements were chosen for analysis. Test-retest reliability of the overall scale and three subscales was evaluated using the intraclass correlation coefficient (ICC). The MDC was calculated on the basis of the standard error of measurement. ICCs for the overall scale and three subscales ranged from .91 to .97. The MDC values (MDC%) were 6.5 (10.5%) for the overall scale, 3.4 (13.5%) for the General Behavior subscale, 2.3 (15.2%) for the Social Behavior subscale, and 2.4 (11.0%) for the Work Behavior subscale. The COTES has good test-retest reliability. Clinicians and researchers can use the MDC values provided in this study to explain the implications of change scores for behaviors that affect occupational performance for people with schizophrenia. The COTES has sound reliability and support for its use in determining whether people with schizophrenia make real improvements in behavior that affects occupational performance over time.

From folk therapy to evidence-based psychiatry practice: The benefit of evidence-based psychiatry in treatment-naive psychotic patients.

As Taiwan's Mental Health Act (MHA) clearly states that the human rights and legal rights of psychotic patients should be respected and guaranteed; however, a temple asylum violates the law in the 21st century. Hundreds of patients were constrained in the asylum for years without consent. Because of outbreak of infectious diseases, patients were evacuated from the asylum by the official intervention. To evaluate the outcomes of these patients from folk therapy to conventional treatment. The study recruited the drug-naive psychotic patients constrained in an asylum for decades. Before and after the formal treatment, 253 patients were diagnosed with schizophrenia and other psychotic disorders with assessment of using the Mini Positive and Negative Syndrome Scale (Mini-PANSS) and Comprehensive Occupational Therapy Evaluation (COTE) scale. In addition, family function, self-care ability and nutritional status were also evaluated. The initial data show the improvement in psychotic symptoms and occupational function in these patients. Furthermore, the ratio of patients who were classified as being at risk for malnutrition was decreased by 21.7% after treatment. There was no statistically significant difference in self-care ability before and after treatment. The psychotic symptoms and occupational function of these patients were improved after the formal treatment compared to the folk therapy. The care model for the psychotic patients in the temple asylum should be more thoroughly discussed in consideration of the medical ethics principles.

Construct Validity and Reliability of the Comprehensive Occupational Therapy Evaluation Scale (COTES) in People With Schizophrenia.

We evaluated the construct validity (i.e., unidimensionality and convergent validity) and Rasch reliability of the 20-item Comprehensive Occupational Therapy Evaluation Scale (COTES) in people with schizophrenia. Retrospective chart review was used to collect COTES data from 505 inpatients with schizophrenia. For construct validity, we first examined unidimensionality of each of the three COTES subscales using Rasch analysis. After unidimensionality was supported, we examined convergent validity using Pearson's r and Rasch reliability of the individual subscales. After deleting two misfitting items, the remaining items (i.e., the COTES-18) showed unidimensionality. Infit and outfit mean squares were 0.73-1.25. Moderate correlations were found among the three COTES-18 subscales (rs = .57-.71). The Rasch reliabilities of the three subscales were .83-.92. The COTES-18 has sufficient construct validity and reliability to assess three specific dimensions of behavior affecting occupational performance in people with schizophrenia.

Reliability and Validity of a Functional Cognition Screening Tool to Identify the Need for Occupational Therapy.

The Centers for Medicare & Medicaid Services (CMS) has identified the need to assess functional cognition as part of the postacute care planning process. We examined the reliability, validity, and clinical utility of the Menu Task (MT) as a screening measure of functional cognition to assess the need for occupational therapy services. Cross-sectional study testing a convenience sample of community-dwelling older adults (n = 130) and adults hospitalized for elective orthopedic surgery (n = 60). The MT and four neuropsychological screening tests-the Brief Interview of Mental Status, the Montreal Cognitive Assessment, Trail Making Tests A and B, and an instrumental activities of daily living (IADL) scale-were administered. Community-dwelling participants were tested at the University of Wisconsin occupational therapy program and in community settings. Hospitalized participants were tested at the University of Missouri Orthopedic Institute. We recruited healthy community-dwelling adults in Madison, WI (community sample; n = 130) and patients hospitalized for elective orthopedic surgery in Columbia, MO (hospital sample; n = 60). Inclusion criteria were age 55 yr or older, living in the community, and willingness to be tested in English; for the hospital sample, participants had to be referred for elective orthopedic surgery requiring a hospital stay and be independent in activities of daily living before being admitted for surgery. We found significant differences between groups classified as impaired or not impaired on the basis of MT scores. Participants classified as impaired on the MT performed significantly less well than those classified as not impaired on the neurocognitive and IADL measures. The reliability and validity of the MT were supported. The American Occupational Therapy Association and the occupational therapy experts advising CMS have stressed the importance of a brief performance-based screening tool to identify people who need more comprehensive occupational therapy evaluation. The implementation of a functional cognition screening tool as part of the required CMS assessment protocol should greatly increase the number of patients referred for occupational therapy evaluation and treatment. The MT has the capacity to address the gap in the proposed CMS assessment of Medicare recipients across postacute care settings.

Neuromuscular electrical stimulation-enhanced rehabilitation is associated with not only motor but also somatosensory cortical plasticity in chronic stroke patients: an interventional study.

Background:Somatosensory function has been frequently overlooked in clinics and research in the field of chronic stroke. The effects of neurorehabilitation interventions on sensory processing have still to be investigated using electrophysiological means.This study investigated the effect of hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy utilizing closed-loop electromyography-controlled neuromuscular electrical stimulation (NMES), on sensory changes and cortical plasticity among patients with chronic stroke.Methods:This study was a prespecified analysis of 23 participants involved in an ongoing large interventional study. Patients with severe upper limb hemiplegia dues to chronic stroke underwent 3 weeks of inpatient HANDS therapy, where daily treatment consisted of 8 h of NMES combined with wrist splinting, 90 min of comprehensive occupational therapy, and the practice of bimanual activities of daily living. Somatosensory evoked potentials (SEPs) and functional sensory assessments, including the Semmes–Weinstein monofilament test (SWMT) and thumb localizing test (TLT), were compared pre and post-treatment.Results:While no significant recovery of tactile sensation was observed, significant improvements in proprioception and motor function were induced. The number of cortical peaks significantly increased in the median nerve, but not in the tibial nerve. A total of 9 out of 11 participants who initially lacked certain peaks responded to treatment. Further analysis revealed a significant improvement in latency and amplitude of SEP peaks.Conclusions:Our results suggest that NMES-based neurorehabilitation induces certain plastic changes in the primary sensory cortex and in cortices associated with sensorimotor processing in people with chronic stroke sequelae, which may explain the observed improvements in proprioception.

Defining the Needs of Elder Ex-Offenders Integrating Into the Community

Abstract Date Presented 4/20/2018 This study generated occupational profiles of elder ex-offenders to define their goals, prioritized roles, performance abilities, health concerns, and patterns of community engagement. Comprehensive occupational therapy assessment can delineate the challenges to occupational adaptation of elder ex-offenders. Primary Author and Speaker: Jaime Phillip Muñoz Additional Authors and Speakers: Moira Miller, Yinao Wang

Comprehensive and synthetic occupational therapy protocol for post-stroke hemiplegic patients / Protocolo terapia ocupacional abrangente e sintético para pacientes hemiplégicos após o acidente vascular cerebral

Objective. The aim of this study was to devise an Occupational Therapy protocol for post-stroke patients and to measure the functional evolution of the group. Methods: The study included 210 post-stroke hemiplegic patients, undergoing treatment at the Occupational Therapy Sector of the Rehabilitation Center of the Irmandade da Santa Casa de Misericórdia de São Paulo, and was conducted between March 2008 and December 2010. The protocol comprised twenty 60 minute therapy sessions once a week, during five months, and was split into five phases: Warm-up, Guided activities in standing position, Guided activities using functional electrical stimulation, Training on Activities of Daily Living (ADL) and specific free activities. Results: The pre and post therapeutic intervention results were compared and analyzed. A statistically significant improvement was found for all assessments, FIM (&lt;0.01) and Box and Blocks Hand Dexterity Test (p&lt;0.01). Conclusions: On the study, the Comprehensive and Synthetic Occupational Therapy protocol was able to improve functionality hemiplegic post-stroke patients.Key words: Stroke, Activities of daily living, Rehabilitation; Hemiplegia, Occupational therapy,

Breaking paradigms, new breast cancer rehabilitation methods from occupational therapy: case report

Introducción. El cáncer de mama es una enfermedad recurrente en el mundo y en Colombia. Miles de mujeres que la padecen se someten a tratamiento, sobreviven y necesitan una oportuna, y sobre todo holística, intervención desde la terapia ocupacional. Se presenta un estudio de caso de rehabilitación en concordancia al modelo biopsicosocial y centrado en la persona. Presentación del caso. Mujer de 64 años remitida al servicio de terapia ocupacional con diagnóstico de cáncer ductal infiltrante de mama izquierda con neoadyuvancia por radioterapia, posterior a mastectomía radical modificada y linfedema etapa III, quien presenta restricciones en la participación y desempeño ocupacional, en específico en actividades de la vida diaria con alteraciones psicosociales y socioemocionales relevantes. Se planteó una intervención centrada en la persona, con enfoque biopsicosocial, en donde se aplicaron diferentes estrategias en actividades de tipo restaurativo, potenciación y mantenimiento de destrezas ocupacionales implicadas en actividades de la vida diaria. Se hizo énfasis en las áreas socioemocional, de biomecánica ocupacional y de educación con especial cuidado de involucrar los intereses de la mujer. Conclusiones. La rehabilitación del cáncer de mama no solo implica atención biomédica, sino también abordaje de aspectos psicosociales que en ocasiones tienen que ser resueltos con antelación para conseguir resultados que se evidencien en la salud. En este caso la elaboración de una prótesis de mama por y para la persona vinculó toda clase de estrategias que respondían a ejes biomédicos y comprendían en su totalidad el bienestar y la salud.

Effect of Occupational Therapy-Led Playgroups in Early Intervention on Child Playfulness and Caregiver Responsiveness: A Repeated-Measures Design.

This study's objective was to investigate the effects of a community playgroup on the playfulness of children with special needs ages 15 mo to 3 yr and the responsiveness of their caregivers. Using a pretest-posttest, repeated-measures design, we evaluated 8 child-caregiver dyads participating in an 8-wk occupational therapist-led community playgroup recruited from a purposive sample enrolled in early intervention. Video recordings from four time points over 4 mo were used to determine playfulness (Test of Playfulness) of the child and the responsiveness of the caregiver. Blinded raters assessed playfulness and responsiveness outcomes. A repeated-measures analysis of variance demonstrated that participation in the playgroup significantly increased child playfulness (ηp² = .89, p < .01). Analysis did not detect a change in caregiver responsiveness. The results of this study have implications for the use of playgroups in comprehensive occupational therapy practice in early intervention.