Occupational Disruption Research Articles

Elder-Clowning in Long-Term Dementia Care: Results of a Pilot Study.

To assess the effects of elder-clowning on moderate to severe behavioral and psychological symptoms of dementia (BPSD) in nursing home residents with dementia, primarily of the Alzheimer's type. Before-and-after study. Nursing home. Nursing home residents with moderate to severe BPSD, as defined according to a Neuropsychiatric Inventory-Nursing Home version (NPI-NH) score of 10 or greater (N = 23), and their care aides. A pair of elder-clowns visited all residents twice weekly (~10 minutes per visit) for 12 weeks. They used improvisation, humor, empathy, and expressive modalities such as song, musical instruments, and dance to individualize resident engagement. Primary outcomes were BPSD measured using the the NPI-NH, quality of life measured using Dementia Care Mapping (DCM), and nursing burden of care measured using the Modified Nursing Care Assessment Scale (M-NCAS). Secondary outcomes were occupational disruptiveness measured using the NPI-NH, agitation measured using the Cohen Mansfield Agitation Inventory (CMAI), and psychiatric medication use. Over 12 weeks, NPI-NH scores declined significantly (t22 = -2.68, P = .01), and DCM quality-of-life scores improved significantly (F1,50 = 23.09, P < .001). CMAI agitation scores decreased nominally, but the difference was not statistically significant (t22 = -1.86, P = .07). Occupational disruptiveness score significantly improved (t22 = -2.58, P = .02), but there was no appreciable change in M-NCAS scores of staff burden of care. Results suggest that elder-clowning reduced moderate to severe BPSD of nursing home residents with dementia, primarily of the Alzheimer's type. Elder-clowning is a promising intervention that may improve Alzheimer's disease care for nursing home residents.

Having a child with cancer: African mothers' perspective

BACKGROUND: The study was conducted in KwaZulu Natal, South Africa. Six boarder mothers, who lived with their children in the CHOC house while their children received treatment for cancer, were interviewed for the study. Objective of study: The objective was to explore the lived experiences of mothers from rural and peri-urban areas when their children had cancer. Specifically information on occupational balance and disruption, as well as shifting responsibilities, was explored. METHODS: A single focus group followed by individual interviews were conducted. FINDINGS: The findings revealed that some African communities believe that children do not get cancer. There was a lack of factual information around the condition, which perpetuated the stigmatisation of these families. They felt isolated and could not access any community support as a result. Mothers experienced occupational disruption, as well as guilt and self-blame when their children had cancer. RELEVANCE TO CLINICAL PRACTICE: Support and information for mothers hospitalised with sick children should form part of occupational therapy intervention. LIMITATION AND RECOMMENDATIONS FOR FURTHER RESEARCH: These findings are applicable to African mothers from both a peri-urban and rural context in KwaZulu Natal. Further research with mothers across South Africa would be useful to expand on the research findings and would potentially assist in programme development. Key words: mothers perspectives, cancer, stigma, occupational disruption, African beliefs

The road to recovery: Experiences of driving with bipolar disorder

Introduction It has been suggested that bipolar disorder impairs cognitive, psychomotor and emotional regulation abilities which could impact an individual’s driving behaviour. This research aimed to investigate experiences of driving with a diagnosis of a bipolar disorder, as a study on this subject has not been located in the literature. Method Two focus groups were conducted during a bipolar day programme in an independent psychiatric hospital in the Republic of Ireland ( n = 18). Data was analysed using thematic analysis. Results Themes emerging from the data include: the meaning of driving, the impact of bipolar disorder on driving behaviour and the management of driving behaviour when unwell. An unexpected theme was the perceived discriminatory nature of the Irish Road Safety Authority’s fitness to drive guidelines. Conclusion Driving is a meaningful activity, enabling engagement in areas of occupation. Participants’ desire to implement their own compensatory strategies when unwell can be viewed as a process of taking control in their recovery and minimising the effects of occupational disruption. Their view that fitness to drive guidelines are inequitable could be related to perceptions that mental illness has a lasting influence on their life narratives.

The Namaste Care programme can reduce behavioural symptoms in care home residents with advanced dementia.

The objective of the study was to evaluate the effects of the Namaste Care programme on the behavioural symptoms of residents with advanced dementia in care homes and their pain management. Six dementia care homes collaborated in an action research study-one withdrew. Inclusion criteria were a dementia diagnosis and a Bedford Alzheimer's Nursing Severity Scale score of >16. Primary research measures were the Neuropsychiatric Inventory-Nursing Homes (NPI-NH) and Doloplus-2 behavioural pain assessment scale for the elderly. Measures were recorded at baseline and at three 1-2 monthly intervals after Namaste Care started. Management disruption occurred across all care homes. The severity of behavioural symptoms, pain and occupational disruptiveness (NPI-NH) decreased in four care homes. Increased severity of behavioural symptoms in one care home was probably related to poor pain management, reflected in increased pain scores, and disrupted leadership. Comparison of NPI-NH scores showed that severity of behavioural symptoms and occupational disruptiveness were significantly lower after initiation of Namaste Care (n = 34, p < 0.001) and after the second interval (n = 32, p < 0.001 and p = 0.003). However, comparison of these measures in the second and third intervals revealed that both were slightly increased in the third interval (n = 24, p < 0.001 and p = 0.001). Where there are strong leadership, adequate staffing, and good nursing and medical care, the Namaste Care programme can improve quality of life for people with advanced dementia in care homes by decreasing behavioural symptoms. Namaste is not a substitute for good clinical care.

The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

This article presents a study of three asylum-seeking men from Iran and Afghanistan. It aimed to explore how and if they experienced occupations as occupations in a Danish asylum centre and how their life experience shaped their choice and value of current occupations. In-depth narrative interviews explored the participants' occupational history and its influence on their current occupations in the asylum centre. A thematic analysis showed that the participants had been subjected to occupational disruption and deprivation by politically oppressive systems even before their flight. Their occupations in Denmark were to a certain extent influenced by their earlier occupations and the current occupational deprivation they all experienced was due to limited possibilities in the centre. Although they tried their best to fill their days and create structure, there was a loss of valued occupations and a profound sense of occupational deprivation. One of the participants had been subjected to torture and he experienced occupational deprivation to a greater extent. The findings suggest that further research should include exposure to torture as a key component when examining the occupational deprivation of asylum seekers.

Predictors of time to complete toileting for children with spina bifida

Previous research has shown that children with spina bifida use clean intermittent catheterisation for urination, a rather complex procedure that increases the time taken to completion. However, no studies have analysed the factors impacting on the time taken to complete the urination that could inform occupational therapy practice. Therefore, the aim was to identify the variables that predict extended time children with spina bifida take to complete urination. Fifty children, aged 5-18 years old with spina bifida using clean intermittent catheterisation, were observed while toileting and responding to a set of assessments tools, among them the Canadian Occupational Performance Measure. A logistic regression was used to identify which variables were independently associated with an extended toileting time. Children with spina bifida do take long time to urinate. More than half of this study's participants required more than five minutes completing urination, but not all required extended times. Ambulant, independent girls were more likely to perform toileting in less than six minutes compared with other children with spina bifida. However, age, IQ, maintained focus on the task, Canadian Occupational Performance Measure, time processing abilities and self-reported ratings of independence appeared to be of no relevance, to predict extended toileting times. To minimise occupational disruption caused by extended toileting times, occupational therapists should utilise the relevant predictors: gender, independence and ambulation when they prioritise children for relevant interventions.

Leisure Participation and Well-being of Immigrant Women in Canada

Introduction: Migration across international borders is an identifying feature of 21st century globalization. Employment is an important criterion of integration, however, its prominence has deflected attention from other complex issues, namely how health is influenced by participation through cultural, social, and community occupations. Research on leisure participation has identified its positive impact on the well-being of various populations facing occupational disruptions, thus leisure participation and its potential role in the well-being of ‘immigrant women’ during the occupational disruption and transition of resettlement is worthy of research. Objectives: This study examined participation in leisure occupations for migrant women in the process of resettlement and experiencing changed environments. The research question was: How does the process of resettlement in Canada influence the ways women understand and participate in leisure? Methodology: This study was framed by ethnographic and critical theory perspectives. Data were collected from 14 migrant women in Canada through semi-structured interviews and analyzed thematically. Findings: The first theme, Orchestrating the Day, illustrates occupational transitions and offers a necessary context for understanding the second theme, Socializing is the Key to Leisure. Bourdieu's concepts of capital and a transactional perspective of action helped to interpret the findings. Conclusion: The participants' daily occupations helped to reveal what constitutes leisure and how leisure fits within their lives. Many women defined leisure broadly as whatever supported their physical and emotional health.

Experiencing occupations with chronic hand disability: narratives of hand-injured adults

Introduction Hand injuries commonly account for a fifth of all emergencies presenting to emergencydepartments of most hospitals in Europe. One-third of these injuries lead to chronic hand disability thatentails economical, psychological, physical and social implications on the wellbeing of hand-injured adultswith longterm consequences. However, knowledge about the impact of chronic hand disability onoccupations in the long term is limited. Methods The purpose of this narrative study was to understand how adults after a hand injury experience theimpact of chronic hand disability on their occupations over time. Participants were selected through purposive sampling. Two narrative interviews were conducted with each participant and analysed usingnarrative and structural analysis. Results All participants experienced the challenge of occupational disruption. They faced occupationallimitations with the consequence of changed occupational patterns, and later strived for normality. In the end, all participants still needed to get accustomed to occupational changes. Conclusion The findings indicate that this process of occupational adaptation continues on for at least one year after the hand injury. They further highlight the importance to support the clients through engagement in occupation during the therapy process.

Human displacement, occupational disruptions, and reintegration: a case study

Displacement places individuals in unfamiliar contexts, disrupts their occupational lives in deep ways, and consequently impacts their health and wellbeing. Displaced persons have to essentially reconstruct their lives in unfamiliar sociocultural contexts that are dramatically different from their home countries. New ways of performing familiar occupations have to be re-learnt, while negotiating their place in the new context. Occupational therapists can facilitate the adjustment and integration of migrants. They can help them re-establish daily occupational routines and habits; educate them on cultural norms, expectations, and behaviors in the new context; and empower them with skills and know-how to navigate systems. Enabling participation enhances the wellbeing and self-efficacy of migrants, and promotes integration.

Prevalencia de síntomas neuropsiquiátricos en pacientes institucionalizados con diagnóstico de demencia y factores asociados: estudio transversal multicéntrico

ObjectiveThe aim was to estimate the prevalence and severity of neuropsychiatric symptoms in patients with dementia in nursing homes, assessing their association with certain factors that may influence their occurrence. Material and methodsA cross-sectional study was carried out, and included all elderly patients diagnosed with degenerative, vascular, or mixed dementia, stage 4 to 7 on the Global Deterioration Scale of Reisberg (GDS), and residents in 6 nursing homes in the province of Ourense (Spain). A sample size of 120 individuals was determined to be necessary. The assessment of symptoms was performed using the Neuropsychiatric Inventory-Nursing Home test. The influence of the determined factors was investigated using logistic and linear regression analysis, and subsequently corrected for possible confounding factors. ResultsA total of 212 cases were included, with a mean age of 85.7 (SD=6.7) years. The prevalence of neuropsychiatric symptoms was 84.4%. The most common symptom was apathy, followed by agitation and delirium, and the least frequent were euphoria and hallucinations. The symptom that produced most occupational disruption was agitation. Multivariate analysis showed that a higher score on the NPI-NH was associated with a higher score on the Global Deterioration Scale of Reisberg, the use of neuroleptics, cholinesterase inhibitors, and memantine. ConclusionsIn nursing home patients, prevalence of neuropsychiatric symptoms was high, and associated with the severity of dementia (GDS), the use of neuroleptics, cholinesterase inhibitors, and memantine.

Exploring occupational disruption among women after onset of rheumatoid arthritis

To portray experiences of women engaging in everyday tasks, activities, and occupations, from symptom onset to 12 months after diagnosis with rheumatoid arthritis (RA), and to explore the meanings attributed to their activities and occupations. A secondary analysis of qualitative data, guided by phenomenography, explored the stories of 37 women with early RA. The original study used in-depth interviews to explore the help-seeking process from first symptom to diagnosis, and results indicated unexplored impacts on activity, stimulating the present analysis. Transcripts were read and coded by 3 investigators and then debated by the full team with this new research objective in mind. Descriptive categories were formed through a systematic, iterative approach with a focus on how early RA impacted daily routines and participation in occupation. Participants recounted a range of experiences characterized by changes in the way they engaged in occupations as a result of RA symptoms. Four interrelated categories were identified: uncertainties associated with good days, bad days, and worse days; experiencing activity disruption; doing things differently, which was perceived both positively and negatively; and changing views of self, as participants developed identities as individuals living with RA. Daily activities and occupational identity can be profoundly impacted in the first 12 months after diagnosis with RA, resulting in significant life changes. Health professionals are encouraged to identify disrupted activities, facilitate participation in valued occupations, and create environments that enable patients to explore changes in identity to prevent negative life consequences.

Assessing Neuropsychiatric Disturbances Associated With Post-Stroke Aphasia

Assessing Neuropsychiatric Disturbances Associated With Post-Stroke Aphasia

Self-Efficacy and Health Locus of Control: Relationship to Occupational Disability Among Workers with Back Pain

Although self-efficacy and health locus of control (HLC) have been extensively studied in health research, little is known about their contribution to occupational disability among workers with back pain. This 2 year prospective study examined the association between these control belief constructs and "return to work in good health" (RWGH), a four-category, composite index of back pain outcome. The participants (n = 1,007, participation = 68.4%, follow-up = 86%) were workers with occupational disruptions who sought a medical consultation for non specific back pain in primary care and emergency settings in the Quebec City area, Canada. Information about self-efficacy for return to work (SERW) and HLC, as well as potential confounders, was collected during a telephone interview about 3 weeks after the baseline medical consultation. Polytomous logistic regression was used to assess the relationship between the baseline control variables and RWGH at 2 year. Odds ratios (OR) and their 95% confidence intervals were used to quantify the strength of associations. For all analyses, the "success" category was considered the reference group. Although bivariate analyses showed a significant association between external HLC and RWGH at 2 year, this relationship was not significant in multivariate analyses. Higher scores on the self-efficacy questionnaire were however protective of "failure to return to work after attempt(s)" (OR: 0.28; 95% CI: 0.14-0.57) and of "failure to return to work" (OR: 0.19; 95% CI: 0.07-0.48) in multivariate analyses. Self-efficacy is an important determinant of the occupational outcome of back pain.

P01-369 - Prevalence and predictor factors of neuropsychiatric symptoms in institutionalized patients diagnosed with dementia

ObjectiveTo estimate the prevalence and severity of neuropsychiatric symptoms in patients with dementia in nursing homes, assessing their association with certain factors that may promote or prevent its occurrence.MethodsA cross-sectional study was carried out. We included all elderly diagnosed with degenerative, vascular, or mixed dementia, stage 4 to 7 of the GDS, and residents in 6 nursing homes in the province of Ourense (Spain). The assessment of symptoms was performed using the Neuropsychiatric Inventory - Nursing Home (NPI-NH) test. A sample size of 120 individuals was determined to be necessary.ResultsWe included 212 cases, with an average age of 85.7 (SD = 6.7) years. The prevalence of neuropsychiatric symptoms was 84.4%. The most common symptom was apathy, followed by agitation and delirium, the least frequent were euphoria and hallucinations. The symptom that produced most occupational disruption was agitation. Multivariate analysis showed that a higher score on the NPI-NH was associated with the use of neuroleptics, both typical and atypical, and with a higher score on the Reisberg Scale. Negative association was demonstrated with the number of days of institutionalization and the diagnosis of vascular dementia.ConclusionsPatients with dementia in nursing homes in our area have a high frequency of neuropsychiatric symptoms that are associated with neuroleptic use and decreases as the patient remains institutionalized for longer. Patients diagnosed with vascular dementia have lower scores on the NPI-NH test.

Chronic Fatigue Syndrome and Occupational Disruption in Primary Care: Is There a Role for Occupational Therapy?

This paper presents the findings of a postal survey that examined the experience of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in the primary care setting. The views of 51 general practitioners (GPs) (response rate of 30%) and 51 people that had experienced CFS/ME (response rate of 61%) were collected in an attempt to describe both the occupational disruption experienced due to CFS/ME and the current management offered in primary care, and to investigate whether there was an early intervention role for occupational therapy. The greatest level of occupational disruption reported was in the performance of self-care and productivity tasks and the most helpful intervention reported was that of acknowledgement of the condition and its implications. The GPs rated the use of cognitive behavioural therapy and graded exercise therapy as more beneficial than medical care for CFS/ME and many offered advice on these interventions, but 57% of people with CFS/ME reported that they had received unhelpful advice and/or treatment from their GP. Currently, there is little research evidence to support any particular interventions for people with CFS/ME in primary care and the prevention of occupational dysfunction, as often seen in secondary and tertiary care, is a role that could be fulfilled by occupational therapists.

Stevedore's tibia: an occupational tibial tuberosity disruption

Stevedore's tibia: an occupational tibial tuberosity disruption

The Experience of Occupational Disruption among Student Musicians

Student musicians frequently need to take breaks from playing their instruments because of physical playing-related injuries, yet little is known about their experiences with these occupational disruptions. We conducted a qualitative study that explored student musicians' lived experiences with unplanned disruptions stemming from engagement in their major occupation of playing an instrument. In-depth interviews with seven student musicians who attended either a special arts high school or a university were conducted. Consistent with a grounded theory approach to qualitative research, the constant comparative method of qualitative data analysis was implemented. A major finding related to the theme of “being and becoming,” where student musicians expressed a strong sense of belonging to a group of other like musicians who they learned from, relied on for support, and created music with. Another theme was motivation to excel, where students expressed a strong desire and motivation to improve and master their instrument. Occupational tensions and pressures emerged as another theme. Students were aware of the need to practice and the need to care for their bodies. A constant negotiation was required in which students struggled to find a good balance between the need to practice and to respect their bodies while maintaining an identity of a musician. These findings are discussed in relation to how health care providers and educators need to understand the demands and stresses associated with playing an instrument so that they can better support these young musicians.

Light Treatment for Neuropsychiatric Behaviors in Alzheimer's Disease

Neuropsychiatric behaviors are common in people with Alzheimer's disease (AD) and make both professional and lay caregiving difficult. Light therapy has been somewhat successful in ameliorating disruptive behaviors. This randomized trial tested the effects of morning or afternoon bright light exposure compared with usual indoor light on the presence, frequency, severity, and occupational disruptiveness of neuropsychiatric behaviors in nursing home residents with AD. Light was administered for 1 hr daily (Monday-Friday) for 10 weeks. The Neuropsychiatric Inventory-Nursing Home was used to assess behavior at baseline and end of the intervention. Analyses revealed statistically significant differences between groups on agitation/aggression, depression/dysphoria, aberrant motor behavior, and appetite/eating disorders. The magnitude of change was small and may not represent clinically significant findings. Agitation/aggression and nighttime behaviors commonly occurred and were highly correlated with occupational disruptiveness. Interventions that decrease the presence and/or severity of neuropsychiatric behaviors have the potential to significantly decrease caregiver burden.

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Occupational Disruption: Living with Motor Neurone Disease

Little is known of the day-to-day experience of living with motor neurone disease from the perspective of those who have it, apart from what can be found in personal accounts such as those published on web pages. In this study, which was informed by phenomenology, seven people living in an urban setting in New Zealand were asked to describe their experiences. This report focuses on the study findings that related specifically to disruption to occupation. It describes how early changes in occupational performance alerted the participants to the fact that something was wrong. The findings also showed the pervasive impact of an awkward and unreliable body on participation in occupations that gave meaning to life, expressed identity and filled time. Issues of how the family's world was changed, the introduction of assistive devices into their homes and the betrayal of trust were also powerfully evident in participants' stories. Although the findings are broadly consistent with those of previous studies, the disruption to occupation and the consequent role losses are new findings. Further research into the impact of the loss of participation in occupation, the ways in which people are perceived when occupations are disrupted and the experience of having occupations taken away prematurely is recommended.