Occupational Therapy Assessment Research Articles

Assistive technology: Occupational therapy assessment and services for people with dementia

Introduction: Research suggests that services are not effectively providing suitable assistive technology for people with dementia. There is a need to understand the challenges facing practitioners to identify where service changes should be focussed to improve this situation. Method: This study used an online survey to explore the experiences of 41 occupational therapists working with people with dementia, and/or assistive technology. Eight participants subsequently agreed to participate in online discussion groups. Group discussions were transcribed and checked. Data responses from group discussions and open questions in the survey were analysed thematically using the person-centred framework to identify domains supporting or obstructing effective assistive technology service delivery. Results: Forty-one occupational therapist participants described challenges to providing person-centred assistive technology services. These included restricted access to assistive technology interventions, limited knowledge regarding developments in the field, variable funding, unsupportive systems, limited relevant training and difficulties working across health and social care sectors. Conclusion: There is a need to revise the systems surrounding the provision of assistive technology for people with dementia. Occupational therapists need access to training relative to this field, and systems need to be adapted to support the provision of person-centred care by widening access to assistive technology.

Occupational therapy assessments and interventions for patients with ankylosing spondylitis: a scoping review protocol.

The proposed scoping review aims to explore the literature on the occupational therapy (OT) scope of practice for patients with ankylosing spondylitis (AS), including assessment methods and intervention approaches used by OT practitioners, areas of impairment addressed, and practice settings where OT practitioners provide services. AS is a type of spondyloarthritis primarily involving inflammation of the spine. Studies have begun to examine the role of OT in addressing pain, function, and disability among AS patients. Given the increased recognition of OT services for this population, a comprehensive understanding of the assessment methods and intervention approaches used by OT practitioners when working with AS would benefit clinicians, providers, and patients and support future research efforts. The review will consider studies that include participants of any age diagnosed with AS and any form of OT assessment and intervention. All relevant published and unpublished studies will be considered, without date or language limitations, including all primary studies, gray literature, text and opinion papers, and clinical guidelines. The review will follow the JBI methodology for scoping reviews. Searches will be conducted in MEDLINE (PubMed), Embase, CINAHL (EBSCOhost), Scopus (EBSCOhost), PsycINFO, ProQuest Dissertations and Theses Global, SportDiscus (EBSCOhost), OTDBase, OTSeeker, and Google Scholar. Two independent reviewers will extract data from selected papers using a standardized tool modified for the review. The results will be presented using frequency tables and will be accompanied by a narrative summary. https://doi.org/10.17605/OSF.IO/VPY56.

Comparison of Visual Symptom Frequency and Occupational Issues Between Patients With and Without Concussion.

Occupational therapy practitioners' knowledge of and advocacy for clients with visual symptoms postconcussion can have a considerable impact on recovery. To compare the frequency of vision symptoms and occupational performance deficits in a sample of participants with and without concussion. Cross-sectional study. Sports medicine clinic. Adolescents and adults with concussion (n = 20) and musculoskeletal injuries (n = 19). Measures included monocular amplitude of accommodation, near point of convergence, Binocular Vision Assessment (BVA) computerized screening for phoria, BVA computerized screening for fusional vergence, the Developmental Eye Movement Test, the Canadian Occupational Performance Measure, and the Convergence Insufficiency Symptom Survey-Concussion Version (CISS-CON). We found significant differences between participants with and without concussion using the CISS-CON (p = .001), positive fusional vergence (p = .02), and near point of convergence (p = .02). Participants with concussion scoring above cutoffs on multiple measures reported poorer performance (p = .005) and satisfaction (p = .004) with valued occupations. Concussion has a detrimental effect on vision and occupation, and occupational therapy practitioners are well-positioned to assess and address issues arising from this relationship. Plain-Language Summary: Vision symptoms commonly experienced after a concussion are associated with reduced occupational performance and satisfaction and can have a considerable impact on recovery. Occupational therapy assessment for clients with concussion should include screening for vision difficulties.

Occupational therapists’ assessment and reporting of functional cognition in stroke care

Purpose To investigate how functional cognition of people post-stroke is evaluated and reported by occupational therapists in Ireland. Functional cognition refers to the use and integration of cognitive skills for daily function. Methods This study used a qualitative design. Six focus groups and one individual interview were conducted with 20 occupational therapists purposively sampled for variation across different clinical grades. Data were analysed according to the Braun and Clark thematic analysis framework. Results Participants felt that assessment of functional cognition was an integral feature of occupational therapy assessment in stroke care but acknowledged that terminology used by occupational therapists for functional cognition was inconsistent. Non-standardised observational assessment was routinely used by participants. Challenges were reported with respect to written documentation of non-standardised observations. Participants reported that use of standardised cognitive assessments required considered clinical reasoning before administration. Standardised performance-based assessments were not widely implemented by participants. Conclusion Occupational therapists in Ireland reported a multi-component assessment process to evaluate functional cognition post-stroke. Establishing practice guidelines for the assessment of functional cognition may be of benefit to occupational therapists working in stroke care. Further research is needed to quantify procedures in this assessment process to account for variation in practice.

An Initial Study of Current Malaysian Occupational Therapy Off-road Driving Assessments

An off-road driving assessment includes a variety of tests. However, in Malaysia, the availability of standardised tools is still lacking. Some standardised driving assessment tools are costly, and the contents are less suitable for Malaysian settings. Therefore, this study aimed to develop a standardised, sensitive to local culture, affordable, and comprehensive pre-driving assessment for occupational therapists in Malaysia. The research design for this study was an explanatory sequential design. The initial draft of the Malaysia Pre-driving Occupational Therapy Assessment (M-POTA) was developed based on the literature review and validated by the ten experts. The initial draft was refined using a focus group discussion of ten expert panels. The recorded data were transcribed verbatim and analysed using thematic analysis and member-checking procedures to refine the items, structures, and scoring of the M-POTA. The second draft of M-POTA then went through the content and face validation process by the six expert panels. The M-POTA 1.0 version was produced from this process. The M-POTA 1.0 version was found to have good content and face validity, S-CVI/Ave= 0.998; S-CVI/UA= 0.986; modified kappa= 0.81 to 1.000). The validated M-POTA 1.0 version is a standardised, local culture-sensitive, and cost-effective off-road driving assessment that is hoped to improve Malaysia’s current driving rehabilitation practice.

Occupational Therapy Assessments of Cortical or Cerebral Visual Impairment: A Systematic Review.

Cortical or cerebral visual impairment (CVI), a leading cause of visual dysfunction in children across the globe, can result in delayed development of fine and gross motor skills, functional mobility, and socialization, which affects all areas of occupation. No assessments are recommended for occupational therapy practitioners working with children with CVI. To appraise the measurement properties and clinical utility of CVI assessments appropriate for use by occupational therapy practitioners. MEDLINE via PubMed, Scopus, and Web of Science. We followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines for systematic reviews of patient-reported outcome measures for relevant studies. A total of 590 records yielded 15 studies of the measurement properties of 12 assessment tools, 8 patient-reported outcome measures and 4 clinician-reported or performance-based outcome measures. We report on the quality of measurement properties of 10 of the 12 outcome measures. None had high-quality evidence of content validity, structural validity, or test-retest reliability. Most had indeterminate internal consistency as a result of a lack of confirmatory factor analysis. Three instruments demonstrated high quality and sufficient construct validity. On the basis of the COSMIN guidelines, all 12 outcome measures have the potential to be recommended but require further study before definitive recommendations can be made. What This Article Adds: This is the first systematic review of assessments of CVI feasible for use by occupational therapy practitioners. High-quality studies of measurement properties are lacking. Further examination of the measurement properties of outcome measures is required.

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.

Ten Steps for NPH Management: Advancements in Diagnosis and Treatment of Adult Hydrocephalus

Abstract Objectives The authors of the present study intend to describe a straightforward protocol for normal pressure hydrocephalus diagnosis and management, with the employment of a multidisciplinary team approach effort. Methods Using a strict methodological approach for initial diagnosis, taking into consideration occupational therapy and physical therapy assessment, the authors have set out to elaborate a simple protocol for suspicion and, once diagnosed, treatment of normal pressure hydrocephalus. We have used the MoCA (Montreal Cognitive Assessment) and walking assessment that included speed, independence, and distance (SID), 10 m walk test, TUG (timed up and go) evaluation, 6-minute Walk Test, MiniBESTest, as the main factors for pre and post lumbar drainage assessment, after which, the alternatives were deliberated and followed, or not, by ventriculoperitoneal shunt insertion. Results The authors have described a protocol, consisting of ten easy steps, which involves a multidisciplinary team, including occupational therapy and physical therapy professionals, as well as neurologists and neurosurgeons for improved and objective assessment prior to insertion of lumbar drain and, thereafter, detecting the population at most benefit for ventriculoperitoneal shunt insertion. We have described the Ten Step Approach for Normal Pressure Hydrocephalus management, including from initial clinical presentation and imaging, to pre and post lumbar drainage, for lastly deciding upon necessity for ventriculoperitoneal shunt insertion. Conclusions A straightforward protocol for normal pressure hydrocephalus seems not only feasible, but simple to implement in most neurosurgical departments, with good accuracy of prediction of lumbar drainage assessment to shunting outcomes.

The Effect of a Short-Term Occupational Therapy Intervention on the Participation and Personal Factors of Preschoolers with Developmental Disabilities.

Preschoolers with developmental disabilities are referred to occupational therapy due to their decreased participation in daily life occupations. The purpose of this study was to evaluate the improvement in preschoolers' participation and sensory-motor abilities following an occupational therapy intervention. A prospective cohort study of 38 preschoolers and their parents was conducted using an interrupted time-series design, including assessments at three time points: base line (upon referral to an occupational therapy assessment), pre-intervention, and post-intervention after 9-12 sessions of occupational therapy interventions. Children were evaluated with the Developmental Test of Visual-Motor Integration, as well as the balance and fine motor precision sub tests of the Bruininks-Oseretsky Test of Motor Proficiency. Parents completed the Children's Participation Questionnaire and the Child Performance Skills Questionnaire. Each intervention session was documented by the therapists using the Documentation of Occupational Therapy Session Intervention form. Significant improvement in children's sensory-motor abilities were found in balance, visual integration, and fine motor precision post-intervention. There were also improvements in the measures of diversity, children's independence, and parental satisfaction. A short-term occupational therapy intervention applied to preschoolers with developmental disabilities is effective in improving their sensory-motor abilities, as well as in promoting their participation in daily activities.

Use of a Performance-Based Occupational Therapy Assessment of Executive Function with the Homeless Population: A Case Report

Use of a Performance-Based Occupational Therapy Assessment of Executive Function with the Homeless Population: A Case Report

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.

Conceptualizing Spirituality in Occupational Therapy Practice: A Systematic Review

Abstract Background: Spirituality is a key domain of occupational therapy practice, and for some individuals and communities, all occupations are viewed as spiritual. However, occupational therapists find conceptualizing spirituality and its meaning for both themselves and their patients challenging. The purpose of this concept analysis was to clarify the concept of spirituality and provide occupational therapists with guidance on how to integrate spirituality into practice. Objectives: This concept analysis was to clarify the concept of spirituality and how it has been articulated in studies. Study Design: A concept analysis approach, inspired by Walker and Avant, was used for a systematic review and selection of studies to be included. Methods: After selecting spirituality as a concept and having determined the aim of the analysis, the systematic selection of studies adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of seven articles was performed. Articles from 2005 to 2020 were considered as there was scarcity in this area of work; a long time frame was considered. The literature was found using research databases including CINAHL, Pub Med, OT Search, and SCOPUS. Results: Through the conceptual analysis of spirituality in occupational therapy, current concepts and themes of spirituality, occupational therapy assessments, and intervention in spirituality integration were identified. The empirical references highlight the application of addressing spiritual needs in occupational therapy practice. The key findings within each study were analyzed to identify the antecedents, defining attributes, and consequences of addressing spiritual needs in occupational therapy practice. Conclusion: The results led to a description of spirituality that could facilitate future research communication and common definition in occupational therapy practice.

Investigation of cognitive functions in children with bone tumours and lymphoma in treatment process.

Neurocognitive sequelae are among the most debilitating effects of cancer observed in children. Yet we know very little about the impact on neurocognitive functioning, especially cancer types that develop outside the central nervous system. This study aimed to assess and compare the cognitive functions (CoF) of children with bone tumours and lymphoma in the treatment process. The CoF of children with bone tumours (n = 44), lymphoma (n = 42) and their non-cancer peers (n = 55) were assessed with Dynamic Occupational Therapy Assessment for Children. The CoF of children with cancer were compared with their non-cancer peers. Then, children with bone tumours and lymphoma were compared in binary. One-hundred forty-one children aged 6-12 years with a mean age of 9.4 (SD = 1.5) were included in this study. The orientation and visuomotor construction functions of children with bone tumours and orientation, praxis and visuomotor construction functions of children with lymphoma performed worse than their non-cancer peers (pk < 0.001). While orientation, spatial perception, visuomotor construction and thinking operations functions of children with bone tumours and lymphoma were similar (pk > 0.016), praxis functions of children with lymphoma were found to be worse than children with bone tumours (pk < 0.016). Our findings show that children with bone tumours and lymphoma in the process of treatment are at risk for impairment of their CoF. The findings highlight the importance of assessing CoF in children with bone tumours and lymphoma and considering specific differences between groups. It is essential to assess CoF and develop early intervention plans in these children.

AN ANALYSIS OF A PREOPERATIVE PHYSIOTHERAPY AND OCCUPATIONAL THERAPY LIMB RECONSTRUCTION SERVICE FOR CHILDREN WITH PERTHES’ DISEASE IN THE REPUBLIC OF IRELAND

IntroductionLegg-Calve-Perthes (Perthes Disease) was first recognised by three physicians, Arthur Legg (1874–1939), Jacqui Calve (1875–1954) and George Perthes (1869 – 1927) in 1910. Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the femoral head is disrupted. Without this blood supply, the bone cells die and avascular necrosis can occur. The Herring classification is used to diagnose the stages of Perthes Disease. It is an important prognostic factor. There are three classifications, Herring A, B and C. Herring A has no involvement of the lateral pillar with no density changes noted on x-ray. Herring B has at least 50% of the lateral pillar height maintained on x-ray. Herring C has less than 50% of the lateral pillar height on x-ray (Herring et al, 1992). Children with Perthes disease require specialist Limb Reconstruction team throughout their treatment journey, this includes Orthopaedic surgery and therapy (Physiotherapy and Occupational Therapy). The National Limb Reconstruction Therapy Team is based at the National Orthopaedic Hospital, Cappagh. The therapy team consists of 1 Clinical Specialist Physiotherapist, 1 Senior Physiotherapist and 1 Senior Occupational Therapist who provide input to this cohort. This study aims to analyse the importance of a comprehensive pre-operative assessment by the therapy team (Physiotherapist and Occupational Therapist) to maximise patient outcomes post operatively.MethodologyThis is a quantitative research study conducted by the National Limb Reconstructive Therapy Service of the National Orthopaedic Hospital in Cappagh, Dublin. The inclusion criteria for this study consisted of:Age – Patient must be part of the Paediatric Service, i.e., under the age of 16.Diagnosis – Patient must have a diagnosis of Perthes Disease with a Herring Classification documented.Application of a Hip Distractor Frame formed part of the patient's surgical management.Surgery was completed by Mr Connor Green.Surgery was completed between January 2021 and December 2022.Patient were required to have their external hip distractor frame removed by December 2022.Exclusion Criteria: Those not meeting the above inclusion criteria. Following the inclusion criteria, a number of cases were identified of which 10 cases were selected at random. A retrospective analysis of these samples was completed. The medical charts were reviewed as well as patient electronic healthcare records. Microsoft Excel was utilised to analyse the data and capture results.ResultsFrom analysing the data, the following results were identified:80% of the sample cohort had a length of stay of 5 days following surgery. There were two outliers due to infection who had a length of stay of 14 days.90% of the sample received a pre-operative Physiotherapy and Occupational Therapy assessment. This assessment included information gathering regarding the child's home and social environment; their functional baseline and anticipated post-operative needs. Standardised and non-standardised assessments were used.88.89% of those who completed a pre-operative assessment required referral to community Occupational Therapy teams for equipment provision (wheelchair, transfer aids) to allow for timely discharge.On average, each patient in the sample required 17 physiotherapy outpatient sessions prior to handover to the community teams.100% of our sample required post operation onward referral for MDT input in the community (Occupational Therapy and Physiotherapy).ConclusionsThe importance of a multi-disciplinary approach towards family and children was highlighted in this study. A comprehensive pre-operative therapy assessment optimizes care for this cohort by preparing them in terms of equipment provisions, local team input and expectations for therapy. The data suggests future Limb Reconstruction team should include Physiotherapy and Occupational Therapy as part of the multi-disciplinary team, in the treatment of children with Perthe's Disease. We suggest an MDT pre-assessment is completed to optimize patient care, reduce length of stay and improve patient satisfaction in the acute hospital setting.

Occupational Therapy Practitioner Interventions for Individuals with Hoarding Tendencies: A Descriptive and Associational Survey

Hoarding Disorder is a condition often referred to occupational therapy for comprehensive assessment and intervention, however the strategies that occupational therapy professionals use in the clinical management of hoarding behaviors is poorly understood. The purpose of this mixed methods survey design research was to collect and analyze information on the beliefs, attitudes, and perceptions of common and effective intervention techniques currently used among occupational therapy professionals to address hoarding behaviors. A total of 18 (n = 18) responding occupational therapy professionals met inclusion criteria. Occupational therapy professionals universally indicated that environmental modification strategies were utilized as an intervention to manage hoarding behaviors, and the majority of participants also indicated the use of ADL training, IADL training, household mobility training, occupation-based therapeutic activity, personal safety training and self-management training as interventions for Hoarding Disorder. Regression analysis between the perceived effectiveness of a given intervention and the reported frequency of how often the intervention was used indicated that occupational therapy professionals found that the following interventions were generally most effective for the management of Hoarding Disorder: environmental modification, <i>rs</i>(18) =.550, <i>p</i> =.018, VS-MPR = 5.09; personal safety training, <i>rs</i>(18) =.543, <i>p</i> =.020, VS-MPR = 4.70; creative expression activities, <i>rs</i>(18) =.624, <i>p</i> =.006, VS-MPR = 11.98; ADL training, <i>rs</i>(18) =.412, <i>p</i> =.066, VS-MPR = 2.05; self management training, <i>rs</i>(18) =.443, <i>p</i> =.075, VS-MPR = 1.89; and occupation-based therapeutic activities, <i>rs</i>(18) =.444, <i>p</i> =.063, VS-MPR = 2.11. The results of this study affirm that occupational therapy professionals generally find complex systems of techniques as more effective than single techniques for treating those with hoarding disorders, however further research is needed to better understand which occupational therapy assessments and interventions work well together as effective treatment systems.

Occupational therapy in the rehabilitation management of obesity in adults

Obesity is a global human problem due to its high prevalence and negative consequences for health, life duration and quality of life of the population. This situation makes it necessary to pay more attention to effective rehabilitation of overweight and obese persons. The article considers approaches to the application of occupational therapy measures in the rehabilitation management of obesity: the impact of the disease on occupation is described, the methods of occupational therapy assessment and the goals of occupational therapy interventions are defined, the role of occupational therapy measures is substantiated, an overview of the main occupational therapy strategies that have confirmed their effectiveness in the treatment of obesity in the adult population is provided. A client-centered approach to occupational therapy has been found to be particularly valuable in the treatment of chronic relapsing obesity. Using analysis of occupation performance and understanding the client's performance skills helps occupational therapists implement meaningful and effective interventions that promote the client's active participation in changing the daily life habits, roles, and patterns that underlie the development of obesity. Prospects for further research are practical testing and research of the effectiveness of occupational therapy programs for people with obesity in the context of the Ukrainian health care system.

Occupational therapy assessment and interventions for young autistic children in South Africa.

Occupational Therapy is among the top interventions for autistic children, hence the need for equitable and effective services in the public and private health and education sectors. Ongoing research into the therapies for autism spectrum disorders in different contexts is also required. To explore and describe occupational therapists' assessment and intervention for autistic children in South Africa. A descriptive qualitative research design using semi-structured interviews to gather data from purposively recruited OTs (n=20). Data were audio-recorded, transcribed and analysed thematically, and compared across three sectors public health, special needs schools and private practice. South African practice across all three sectors was similar to international patterns of informal play-based assessment, sensory processing and Ayres Sensory Integration (ASI®) treatment. Developmental frameworks guided specific approaches. Strong team collaboration was present across sectors, with some transdisciplinary teamwork and co-treatment. Undergraduate and postgraduate training opportunities were, however limited. Occupational therapy assessments had diagnostic value. Informal tools such as developmental checklists were found to have clinical utility, whilst standardised tools were most commonly used to assess sensory processing and visual perception. Recommendations included incorporating ASI® into undergraduate curricula and postgraduate training opportunities with multidisciplinary input to develop ASD professionals in South Africa. It is imperative to advocate for services in under-resourced rural areas and marginalised communities that lack financial and social resources. Occupational therapists need to find new ways of working collaboratively across sectors to ensure effective and comprehensive services in public health and special schools.

Preliminary Rasch Construct and Reliability Validation of TeleWrite: A Telehealth-Based Handwriting Assessment.

Telehealth is rapidly expanding, and telehealth-based occupational therapy assessments must be developed and validated to keep pace with this transition. TeleWrite aims to bridge this gap. To analyze the tool's initial psychometric properties using Rasch methods. Internal construct validity and test reliability were analyzed using data from 148 children from first to third grade. Rasch analysis helped to identify that TeleWrite is composed of three separate constructs for rate, accuracy, and fluency. All Infit/Outfit mean square (MNSQ) values fell within acceptable ranges of 0.5 to 1.7 logits. Separation analysis indicated lower but acceptable person separation values for rate (0.68-0.76) and fluency (0.61-0.73), but accuracy scales were in the poor-fair range (0.20-0.60), given sample limitations. TeleWrite is comprised of three separate constructs, showed a good fit with the Rasch model, indicated strong construct and internal validity, and moderate ability to reliably separate abilities of students in terms of handwriting skills.

Community mobility: psychosocial experiences of stroke survivors who use wheelchairs in Worcester, South Africa

BACKGROUND: Despite policies promoting transport inclusivity, persons with disabilities in South Africa experience difficulties when accessing public transport. Poor community mobility hampers community integration and participation in occupations outside the home. This article describes the psychosocial community mobility experiences, of stroke survivors using wheelchairs in a town in the Western Cape province of South Africa METHOD: The study used a descriptive qualitative design. The study population were community dwelling stroke survivors, from Worcester, using wheelchairs. Data was collected from eight participants through semi-structured telephonic interviews. Inductive thematic analysis was used FINDINGS: The four themes derived from the data were: Freedom of movement (My power chair, my Ferrari'), Social anxiety (People stare at you like they do not have a heart), Dependency (I must dance along to his fiddle), and Social isolation (You feel done in, dejected). Participants identified wheelchairs, private vehicles, and mini-bus taxis as modes of community mobility CONCLUSION: When transport barriers prevent dignified, spontaneous community integration negative psychosocial consequences (social anxiety, dependency, and social isolation) followed. Community mobility barriers hampered participants' ability to participate in meaningful occupations and left them isolated. Occupational therapists should take cognisance of the community mobility challenges wheelchair users might experience and implement intervention strategies to mediate these Implications for practice • Community mobility is essential to perform occupations outside the residential setting and must be included in occupational therapy assessment and intervention strategies. • Occupational therapists can empower individuals with mobility impairments with the life skills to manage psychological challenges caused by accessing public transport and decreased community mobility. • Occupational therapy intervention for wheelchair users accessing public transport should include effective, appropriate transfer strategies to embark and disembark from minibus taxis. • In certain circumstances the occupational therapist should consider the possibility of a motorised wheeled mobility device to facilitate community integration.

The clinical profile of amyotrophic lateral sclerosis patients presenting to the National Hospital of Sri Lanka

OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease. Published data on ALS in Sri Lanka is scarce. The aim of this study was to describe the clinical profile of ALS patients presenting to the National Hospital of Sri Lanka(NHSL). METHODS A descriptive cross-sectional study was carried out in 33 consecutive patients with “clinically definite ALS” according to revised El-Escorial and Awaji criteria, who presented from May 2018-May 2020 to two neurology units at NHSL. RESULTS The mean age was 59.7 (±12.3) years while 57.6%(n=19) were males. The average duration for diagnosis was 15.48 (±12.4) months. The commonest first symptom was upper limb weakness 39.4%(n=13) followed by lower limb weakness 33.3%(n=11) and bulbar symptoms 27.3%(n=9). According to King’s Staging System, 18.2%(n=6) were in stage 1, 39.4%(n=13) were in stage 2, 36.4%(n=12) were in stage 3 and 3%(n=1) each were in stage 4A and 4B at the time of diagnosis. None had a family history of ALS. Four were treated with Riluzole. Out of all, 45%(n=15), 24.2%(n=8) and 6.1%(n=2) were referred for physiotherapy, occupational therapy and psychiatry assessment respectively. Seventy five percent (18/24) patients with bulbar symptoms, were referred to speech therapists and one had gastrostomy. Advance directives were not discussed with any of the patients. CONCLUSION The ALS patients presenting to the NHSL had a mean age of 59.7yrs with a slight male preponderance. The average duration taken for diagnosis was 15.5months while the commonest first presentation was upper limb weakness. Most present in King’s stage 2 or 3 and only a few were treated with disease modifying agents. Multidisciplinary care provided and management of disease related complications were suboptimal. Discussing about advance directives with ALS patients, is yet not part of Sri Lankan practice. This emphasizes the need to enhance standards of care for ALS patients to improve their quality of life.