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Brief Report  |   March 2010
Rehabilitation Research Focused on Neurorehabilitation
Author Affiliations
  • Glen Gillen, EdD, OTR, FAOTA, is Associate Professor of Clinical Occupational Therapy, Programs in Occupational Therapy, Columbia University, 710 West 168th Street, 8th Floor, New York, NY 10032; gg50@columbia.edu
Article Information
Neurologic Conditions / Departments / Centennial Vision
Brief Report   |   March 2010
Rehabilitation Research Focused on Neurorehabilitation
American Journal of Occupational Therapy, March/April 2010, Vol. 64, 341-356. doi:10.5014/ajot.64.2.341
American Journal of Occupational Therapy, March/April 2010, Vol. 64, 341-356. doi:10.5014/ajot.64.2.341
The American Occupational Therapy Association’s (AOTA’s) Centennial Vision states, “We envision that occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs” (AOTA, 2007, p. 614). Three elements that are viewed as relevant to a shared vision include evidence-based decision making, science-fostered innovation in occupational therapy practice, and the power to influence. The American Journal of Occupational Therapy clearly has the capacity to play a key role in meeting the Centennial Vision. The journal has the potential to guide practitioners to make evidence-based decisions via the dissemination of well-designed clinical trials; make practitioners, clients, and third-party payers aware of science- and evidence-based innovations that have the potential to improve participation and quality of life; and eventually influence health care decisions for present and future clients. Indeed, one of the four strategic directions that were identified to support the vision is increasing research capacity and productivity (AOTA, 2007).
Until relatively recently, the practice area of neurorehabilitation has been plagued by an overreliance on anecdotal interventions and the overuse of nonstandardized assessments. Occupational therapists have realized the need to raise the bar first and foremost so that we can provide cutting-edge and high-quality services to those we serve and ensure the viability of occupational therapy as a reimbursable and necessary service. Fortunately, a renewed focus on evidence-based and occupation-based practice has resulted in a substantial increase in the research available to interpret and implement. Even a cursory review of the American Occupational Therapy Association’s Evidence-Based Practice and Resource Directory demonstrates the significant increase in neurorehabilitation research. Certainly, over the past 10–15 yr, the literature has suggested substantial changes in neurorehabilitation techniques firmly based in current research. Commonly used interventions historically considered to be tried and true are being rethought, questioned, or, in some cases, not recommended on the basis of the available evidence. This change is particularly true in the substantial areas of motor control (Rao, 2004) and cognitive and perceptual rehabilitation (Gillen, 2009). The positive result is the development of innovative interventions that may hasten clients’ recovery and ultimately improve their quality of life. In this article, I review all neurorehabilitation research published in the American Journal of Occupational Therapy (AJOT) in the past 2 years (2008–2009) to determine the types of research published and to assess how well the journal is meeting the Centennial Vision.
Analysis: What Type of Research Studies Were Published in 2008–2009?
Table 1.
Summary of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy
Summary of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy×
Author and YearEffectiveness StudySystematic or Narrative ReviewEfficacy StudyBasic ResearchInstrument Development and TestingLink Between Occupational Engagement and HealthQuantitative, Qualitative, or Mixed MethodLevel of Evidence
Arnadóttir & Fisher, 2008 XQuantitative
Baum, Connor, Morrison, Hahn, Dromerick, & Edwards (2008)XQuantitative
Classen, Levy, McCarthy, Mann, Lanford, D., & Waid-Ebbs (2009) XN/A
Denham (2008) XQuantitativeV
Doig, Fleming, Cornwell, & Kuipers (2009) XQualitative
Erez, Rothschild, Katz, Tuchner, & Hartman-Maeir (2009) XQuantitative
Faddy, McCluskey, & Lannin (2008) XQuantitative
Fong & Howie (2009) XQuantitativeII
Goverover, Arango-Lasprilla, Hillary, Chiaravalloti, & Deluca (2009) XQuantitativeII
Guidetti, Asaba, & Tham (2009) XQualitative
Guiffrida, Demery, Reyes, Lebowitz, & Hanlon (2009) XQuantitativeII
Hartman-Maeir, Harel, & Katz (2009) XQuantitative
Hill-Hermann, Strasser, Albers, Schofield, Dunning, & Levine (2008) XQuantitativeV
Lin, Wu, Lin, & Chang (2008) XII
Nakamura, Abreu, Patterson, Buford, & Ottenbacher (2008) XQuantitative
Rand, Weiss, & Katz (2009) XQuantitativeIII
Rosenstein, Ridgel, Thota, Samame, & Alberts (2008) XQuantitativeV
Rowe, Blanton, & Wolf (2009) XQuantitativeV
Shih, Rogers, Skidmore, Irrgang, & Holm (2009) XQuantitative
Smallfield & Karges (2009) XQuantitative
Toglia & Cermak (2009) XQuantitative
Turner, Ownsworth, Cornwell, & Fleming (2009) XQualitative
Warren (2009) XQuantitative
Wolf, Baum, & Connor (2009) XQuantitative
Table Footer NoteNote. N/A = not applicable. The following rating system for levels of evidence was used to rate the effectiveness studies: Level I: systematic reviews, meta-analyses, and randomized controlled trials, Level II: two groups, nonrandomized studies such as cohort or case-control designs, Level III: one-group, nonrandomized studies such as pretest and posttest designs, Level IV: descriptive studies including analysis of outcomes such as single-subject designs or case series, Level V: case reports and expert opinion including narrative literature reviews and consensus statements.
Note. N/A = not applicable. The following rating system for levels of evidence was used to rate the effectiveness studies: Level I: systematic reviews, meta-analyses, and randomized controlled trials, Level II: two groups, nonrandomized studies such as cohort or case-control designs, Level III: one-group, nonrandomized studies such as pretest and posttest designs, Level IV: descriptive studies including analysis of outcomes such as single-subject designs or case series, Level V: case reports and expert opinion including narrative literature reviews and consensus statements.×
Table 1.
Summary of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy
Summary of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy×
Author and YearEffectiveness StudySystematic or Narrative ReviewEfficacy StudyBasic ResearchInstrument Development and TestingLink Between Occupational Engagement and HealthQuantitative, Qualitative, or Mixed MethodLevel of Evidence
Arnadóttir & Fisher, 2008 XQuantitative
Baum, Connor, Morrison, Hahn, Dromerick, & Edwards (2008)XQuantitative
Classen, Levy, McCarthy, Mann, Lanford, D., & Waid-Ebbs (2009) XN/A
Denham (2008) XQuantitativeV
Doig, Fleming, Cornwell, & Kuipers (2009) XQualitative
Erez, Rothschild, Katz, Tuchner, & Hartman-Maeir (2009) XQuantitative
Faddy, McCluskey, & Lannin (2008) XQuantitative
Fong & Howie (2009) XQuantitativeII
Goverover, Arango-Lasprilla, Hillary, Chiaravalloti, & Deluca (2009) XQuantitativeII
Guidetti, Asaba, & Tham (2009) XQualitative
Guiffrida, Demery, Reyes, Lebowitz, & Hanlon (2009) XQuantitativeII
Hartman-Maeir, Harel, & Katz (2009) XQuantitative
Hill-Hermann, Strasser, Albers, Schofield, Dunning, & Levine (2008) XQuantitativeV
Lin, Wu, Lin, & Chang (2008) XII
Nakamura, Abreu, Patterson, Buford, & Ottenbacher (2008) XQuantitative
Rand, Weiss, & Katz (2009) XQuantitativeIII
Rosenstein, Ridgel, Thota, Samame, & Alberts (2008) XQuantitativeV
Rowe, Blanton, & Wolf (2009) XQuantitativeV
Shih, Rogers, Skidmore, Irrgang, & Holm (2009) XQuantitative
Smallfield & Karges (2009) XQuantitative
Toglia & Cermak (2009) XQuantitative
Turner, Ownsworth, Cornwell, & Fleming (2009) XQualitative
Warren (2009) XQuantitative
Wolf, Baum, & Connor (2009) XQuantitative
Table Footer NoteNote. N/A = not applicable. The following rating system for levels of evidence was used to rate the effectiveness studies: Level I: systematic reviews, meta-analyses, and randomized controlled trials, Level II: two groups, nonrandomized studies such as cohort or case-control designs, Level III: one-group, nonrandomized studies such as pretest and posttest designs, Level IV: descriptive studies including analysis of outcomes such as single-subject designs or case series, Level V: case reports and expert opinion including narrative literature reviews and consensus statements.
Note. N/A = not applicable. The following rating system for levels of evidence was used to rate the effectiveness studies: Level I: systematic reviews, meta-analyses, and randomized controlled trials, Level II: two groups, nonrandomized studies such as cohort or case-control designs, Level III: one-group, nonrandomized studies such as pretest and posttest designs, Level IV: descriptive studies including analysis of outcomes such as single-subject designs or case series, Level V: case reports and expert opinion including narrative literature reviews and consensus statements.×
×
Table 2.
Systematic Review of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy
Systematic Review of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy×
Author and YearResearch Methodology UsedLevel of EvidenceSample Selection MethodSample Characteristics and Inclusion-Exclusion CriteriaInstruments or Interventions UsedStatistics UsedResultsStudy Limitations
Arnadóttir & Fisher (2008) Validity and reliability testingConvenience sample using existing dataMen and women (N = 209) with stroke, dementia, or other neurological diagnoses with completed A–ONE assessments completed by certified raters Mean age = 73.7 (SD = 13.0).Instrument: The ADL scale of the A–ONERasch analysisMisfit items could be reduced by removing 2 communication items. Threshold disordering could be corrected by combining 2 scoring categories. Separation reliability for item calibration was high and acceptable for people. Principal components analysis supported unidimensionality.Limited generalization to other neurological diagnoses because stroke and dementia were the most common diagnoses included in the study.
Baum et al. (2008) Validity (construct and concurrent) and reliability (interrater) testingConvenienceMen and women with stroke (N = 73) and 22 age and education-matched control participants Mean age = 64.49 (SD = 14.28) Inclusion criteria: Confirmed diagnoses of stroke and ≥6 mo since stroke Exclusion criteria: Dementia as measured by the Short Blessed TestInstruments: EFPT, Wechsler Memory Scale, Animal Fluency, Trail Making Test B, Digits Backward, Short Blessed Scale, Trail Making Test A, Digits Forward, FIM™, and Functional Assessment MeasureANOVA, χ2 analyses, interclass correlation coefficient, and Cronbach’s αHigh interrater reliability (.91) for total score and support for internal consistency. The EFPT can discriminate between control participants and those with stroke as well as those with mild and moderately severe stroke. Concurrent validity established with 4 neuropsychological measures and with the Short Blessed Scale. Significant correlations between EFPT and Functional Assessment Measure and EFPT and FIM.Study was limited to those with mild and moderate stroke, therefore limiting generalization to those with severe involvement.
Classen, Levy, McCarthy, Mann, Lanford, D., & Waid-Ebbs (2009) Evidence-based literature reviewReview of existing and published research13 studies; sample sizes varied Exclusion criteria: Published before 1995, not primary studies, mainly qualitative or descriptive, emphasized or established, psychometrics, driving was not main outcome, and included mixed diagnostic groupsInstruments: Neuropsychological tests, simulator tests, off-road screening tests, self- and significant other report, postinjury disability status, and comprehensive driving evaluationN/ARecommendations for assessments were made for the various assessments on the basis of the tools’ predictability related to driving performance after TBI.Studies published in languages other than English were not included. Team consensus was used as opposed to rater reliability. The authors did not control for publication bias and did not seek unpublished manuscripts.
Denham (2008) Case studyVConvenienceOne 63-yr-old woman with chronic left hemiplegia secondary to a strokeIntervention: Botulinum toxin A combined with occupational therapy (splinting, active and passive range of motion, stretching, practice of bilateral functional activities) Instruments: Modified Ashworth Scale, active range of motion, and ADL evaluation (nonstandardized)N/AImproved on all measures that were maintained for 2 yrAuthors were not able to generalize findings secondary to case study format. Functional measure was nonstandardized. Multiple interventions make it difficult to interpret main therapeutic factor.
Doig, Fleming, Cornwell, & Kuipers (2009) Qualitative approach using semistructured interviewsConveniencePeople with TBI (N = 12) living in the community and 10 of their nominated significant others Mean age = 24.7 (SD = 6.9) Inclusion criteria: Between ages 16 and 65, recently discharged from inpatient rehabilitation, receiving outpatient occupational therapy, confirmed TBI, and had significant other available to participate Exclusion criteria: Low arousal, coma, confusion, significant premorbid psychiatric illness, and significant drug or alcohol useIntervention: 12-wk goaldirected, community-based occupational therapy. The COPM was used to identify goals and the Goal Attainment Scale was used to measure goal progress. Instruments: Semistructured interviews of participants, significant others, and occupational therapists involved in the programN/AAll expressed satisfaction with progress. Findings emphasized the value of goals providing structure and motivation, importance of goal ownership, importance of family involvement, the impact of cognitive impairments, and meeting the challenges of goal setting.Small sample size and recruitment from only one site limited generalizability.
Erez, Rothschild, Katz, Tuchner, & Hartman-Maeir (2009) DescriptiveConvenienceMen and women with mild TBI (N = 13) Mean time since injury = 4.79 mo Mean age = 43.4 (SD = 13.07)Instruments: Participation Index from the Mayo Portland Adaptability Inventory, Behavioral Assessment of the Dysexecutive Syndrome, Dysexecutive Questionnaire, and the Self- Awareness of Deficits InterviewDescriptives, t tests, Mann–Whitney U, and Spearman ρ correlation analysisHigh frequencies of executive function impairments were documented. Selfawareness to these deficits was intact. A high percentage of participants experienced restrictions in daily life. Participation scores were significantly correlated with measures of executive functioning.Sample size was small. Measures of emotional state were not included.
Faddy, McCluskey, & Lannin (2008) Interrater reliabilityConvenienceMen and women with brain injury (N = 10) and 2 occupational therapist raters Inclusion criteria: ≥18 yr, TBI diagnosis, 1 yr since injury, difficulty holding and using a pen, and being able to attempt to write unpromptedInstrument: Handwriting Assessment Battery for Adultsκ and intraclass coefficientsPen control and manipulation subtests showed high or perfect agreement, speed subtest showed perfect agreement, and writing legibility showed high agreement for all 5 subtests.Ceiling effects were noted. Sample size was small. The clinical profile of the participants was not included. Difficult to generalize findings.
Fong & Howie (2009) Controlled trial using matched pairsIIConvenienceN = 34 men and women s/p various acquired brain injuries Mean age = 33.4 (SD = 11.5) Excluded if <18 or >55 or had vision–hearing impairment, aphasia, or poor concentrationIntervention: Explicit problem-solving skills training using a metacomponential approach vs. conventional cognitive training that did not include explicit metacognitive training Instruments: Subtests of Behavioral Assessment of Dysexecutive Syndrome, Social Problem Solving Video Measure, Means- Ends Problem Solving Measure, Raven’s Progressive Matrices, and Metacomponential InterviewMann–Whitney UNo differences between the experimental and control groups except for 2 components from the Metacomponential Interview that favored the experimental group. Results did not generalize to everyday function.11 participants did not attend follow-up assessment. Drop-out rate was 32%. The intervention did not generalize to everyday function
Goverover, Arango-Lasprilla, Hillary, Chiaravalloti, & Deluca (2009) Within-subjects designIIConvenienceN = 25 (10 people with TBI ≥1 yr after injury and 15 healthy control participants) Mean ages = 42.5 (participants with TBI) and 43.3 (control participants) Inclusion criteria: Positive computed tomography or MRI results or loss of consciousness for ≥24 hr Exclusion criteria: Neurologic illness other than TBI, history of major psychiatric illness or alcohol or drug abuse, or severe visual or motor impairment that would interfere with study proceduresIntervention: Paragraph learning and route-learning tasks using a spacing effect strategy or via massed presentation Instruments: Performance on experimental tasksANOVAMaterial learned under the spaced learning condition was recalled better than that learned under the massed learning conditions for both the TBI group and the control group.Sample size was small. Authors were not able to ascertain whether gains were maintained. Severity of injury was not accounted for.
Guidetti, Asaba, & Tham (2009) Qualitative study using the empirical, phenomenological, psychological methodConvenienceMen and women (N = 11) s/p stroke or spinal cord injury Inclusion criteria: <65 yr, in need of self-care training, ability to understand interview questions and ability to share experiencesInstruments: Open-ended interviewsN/AThe authors documented 6 main characteristics describing the role of context in regaining selfcare ability, including support from others, an air of expectation, extended time, new daily structure, therapeutic relationship as enabling, and gradual change in challenge.Interviews were conducted on 1 occasion, risk for interviewer bias, and inclusion of 2 diagnoses could influence the documented experiences.
Guiffrida, Demery, Reyes, Lebowitz, & Hanlon (2009) 2 groups, nonrandomizedIIConvenienceMale participants (N = 6) with chronic and severe TBI Mean age = 28 Inclusion criteria: Single TBI; ≥18 mo since injury; no history of substance abuse, learning disability, attention deficit disorder, or severe psychiatric illnessIntervention: Practice of functional skills using either random or blocked practice schedules; practiced occurred 55 min per day for 13 days Instruments: Performance of experimental tasks—typing, data input, and learning a subway schedule Transfer-of-learning task: typing dictationANOVABoth groups showed improvements across tasks at the end of training and retained this improvement 2 wk after training. Only the random practice group was able to transfer learning to a new and similar task.Sample size was small.
Hartman-Maeir, Harel, & Katz (2009) Validity (construct, convergent, ecological) and reliability (interrater) testingConvenienceFor reliability study: Men and women with stroke (N = 21) and 4 occupational therapists Age: Site 1, M = 79.3 (SD = 5.8); Site 2, M = 77.82 (SD = 5.1). Inclusion criteria: Alert, receptive language intact, and independent in community before stroke For validity study: Men and women with stroke (N = 36) and 36 healthy control participants Mean age = 74.81 (SD = 7.32) for participants with stroke and 72.67 (SD = 6.59) for control participants Inclusion criteria: Same as for reliability studyInstruments: Kettle Test, MMSE, Clock Drawing Test, Star Cancellation, Cognitive and Motor scales of the FIM, IADL Scale, the Fugl-Meyer Motor Assessment, and the Safety Rating ScaleDescriptives, ANCOVA, Pearson correlations coefficientsInterrater reliability is high. Those with stroke required significantly more assistance on the Kettle Test than control participants. Kettle Test moderately and significantly correlated with conventional cognitive measures. The Kettle Test correlated significantly with the FIM, safety measures, and IADLs.Sample size was small. IADL data were collected via phone.
Hill-Hermann, Strasser, Albers, Schofield, Dunning, Levine et al. (2008) Case studyVConvenienceOne 61-yr-old woman s/p cerebrovascular accident 16 mo earlier Inclusion criteria: 10° of active extension in the affected wrist and 2 additional digits of the affected hand; stroke experienced >3 mo prior; >70 on the MMSE; age between 35 and 85; no excessive spasticity; no excessive pain; experienced only one stroke; discharged from all forms of therapy; a detectable surface electromyograph signal of ≥5 μV Exclusion criteria: Participating in any experimental rehabilitation or drug studies; being pregnant; having an uncontrolled seizure disorderIntervention: 3-hr ADL training sessions 5 days per wk for 3 wk using a neuroprosthesis Instruments: Fugl-Meyer, Action Research Arm est, Arm Motor Activity Test, and COPMN/AImprovements noted on all measures. The patient exhibited reduced impairment (Fugl-Meyer score change from 31 to 35), Arm Motor Activity Test score decreased from 99 to 98, decreased time needed to complete Arm Motor Activity Test tasks (from 998 s to 558 s), and increased Action Research Arm score (from 27 to 31). COPM performance score increased 5.8, and the COPM satisfaction score increased 4.3.Authors were not able to generalize secondary to case study format. Relatively modest gains on some measures were reported.
Lin, Wu, Lin, & Chang (2008) Counterbalanced repeated measuresIIConvenienceMen and women (N = 26) with unilateral cerebrovascular accident and 24 age-matched healthy people Average time since stroke was 2.62 mo. Mean age = 62.3 Inclusion criteria: Able to understand or respond to directions, no signs of motor apraxia or visuospatial neglect; no history of prior stroke or visual deficits Control group with no neurologic or psychiatric history by self-reportIntervention: Random assignment to one of four sequences for executing a reaching task with the less-affected limb. Experimental conditions were formed by crossing task instructions with a speed and accuracy emphasis and target locations ipsilateral and contralateral to the to the less-affected hand used for performance. Instruments: Six-camera motion analysis systemANOVAFindings for healthy control participants: Speeded instructions and ipsilateral reaches elicited more preprogrammed movements than accuracy instruction and contralateral reaches. Findings for those with stroke were similar to those for control participants with the exception of movement initiation in those with right-sided strokes. Overall, a combination of speeded instruction and ipsilateral reach seemed to optimize movement performance of the less-affected limb in those with stroke.The study used impairment-only measures. Stroke severity was not considered.
Nakamura, Abreu, Patterson, Buford, & Ottenbacher (2008) DescriptiveConvenienceN = 34; 17 with brain injury including stroke and TBI and 17 without brain injury Mean ages = 40.7 (participants with brain injury) and 41.5 (participants without brain injury) Inclusion criteria: Diagnosis of stroke or head injury, >18, able to follow multistep requests, and no history of apraxiaInstrument: Six-camera motion analysis systemANOVAThe presumed-to-beunaffected upper limb of those with brain injury demonstrated longer movement duration and slower average speed, was supported by excessive trunk movement, and had decreased smoothness during reaching than that of the group without brain injury.Sample size was small. Homogeneous sample in terms of diagnosis, stage of recovery, and handedness
Rand, Weiss, & Katz (2009) Pretest–posttest designIIIConvenienceMen and women (N = 4) who had sustained a stroke ranging in age from 53 to 70 Time since stroke ranged from 5 to 27 mo Inclusion criteria: Unilateral first stroke, discharged home, scores >26–30 on the MMSE, no neglect or depression, evidence of deficits in executive functions as tested via subtests of the Behavioral Assessment of the Dysexecutive SyndromeInterventions: Ten 60-min sessions over 3 wk using VMall (a virtual supermarket) Instruments: MET, Virtual MET, and IADL questionnairePercentage of improvementAlthough results varied, overall improvements in both the MET and Virtual MET ranged from 20.5% to 51.2% for all mistake categories except for “use of strategies,” which improved 7.7% IADL scores did not improve.Sample size was small. Properties of Virtual MET are not clear, and stroke severity was not considered. Heterogeneous sample was a limitation.
Rosenstein, Ridgel, Thota, Samame, & Alberts (2008) Case studyVConvenienceOne 32-yr-old woman who had sustained a stroke 11 mo prior presenting with aphasia and a nonfunctional right dominant upper extremityInterventions: 2 hr of training with an assistive repetitive motion robotic device and 2 hr of repetitive task practice (including one to two 10- to 15-min breaks per day). The patient completed 12 of the 15 scheduled days. Instruments: Wolf Motor Function Test, the upperextremity portion of the Fugl-Meyer Motor Assessment, bimanual dexterity task, and the Modified Ashworth ScaleN/AModest yet favorable scores on 4 subtests of the Wolf Motor Function Test, 3-point increase on the Fugl-Meyer, Modified Ashworth Scale decrease from 1 + to 1 at elbow with no change at forearm and wrist. Active range of motion increased by 35° in the shoulder, 65° in the wrist, and 70° in the thumb. Kinetic analysis of a bimanual dexterity task indicated improved grasping forces for both limbs.Authors not able to generalize because of case study format. Relatively modest gains were reported on measures.
Rowe, Blanton, & Wolf (2009) Case studyVConvenienceOne 36-yr-old woman who sustained an ischemic infarct to the left internal capsule and basal gangliaIntervention: 2 wk on modified constraintinduced movement therapy (5 days/wk, 5.5 hr/day plus independent task practice in the evening and weekends) Instruments: Wolf Motor Function Test, Stroke Impact Scale, and the Motor Activity LogN/AImprovements noted on most subtests of all measures after treatment that generally persisted at both 4- and 5-yr follow-up assessments.Authors were not able to generalize because of case study format.
Shih, Rogers, Skidmore, Irrgang, & Holm (2009) Validity (construct) and reliability testingData derived from a large prospective stroke studyMen and women 3 mo after stroke (N = 68) Mean age = 65.53 (SD = 14.03) Inclusion criteria: Diagnosis of acute stroke, available radiologic data, and physician approvalInstruments: Glasgow Outcome Scale 5-point version, Glasgow Outcome Scale 8-point version, Modified Rankin Scale, Barthel Index, and the Performance Assessment of Self-Care SkillsRasch analysisThe 5 measures evaluated independence somewhat differently, and constructs other than ADL independence are included in some measures. Construct validity and reliability of the combined measures also indicated that the tools are not interchangeable.Sample was heterogeneous in terms of type of stroke. Because this was a secondary analysis, some variables were not available in the original data set.
Smallfield & Karges (2009) DescriptiveRetrospective chart auditMen and women with stroke (N = 80) Mean age = 70.28 (SD = 11.35). Inclusion criteria: Between the ages of 18 and 85, confirmed stroke, received occupational therapy and physical therapy during inpatient rehabilitation, FIM scores documented, and completion of inpatient stayInstruments: Data collection tool devised for study using the Occupational Therapy Practice Framework to classify content of occupational therapy sessions; type of assistive devices prescribed was documentedDescriptive and frequencies65.77% of occupational therapy activities within sessions were considered prefunctional compared with 48.26% that focused on ADLs. Musculoskeletal interventions were used in >50% of sessions, and grab bars and bathroom equipment were more commonly used than dressing equipment.Authors were not able to generalize because data were collected from 1 facility. Interventions may have not been documented or may have been documented incorrectly.
Toglia & Cermak (2009) Pretest–posttestConvenienceMen and women with unilateral neglect secondary to stroke (N = 40) Mean age = 67.82 (SD = 10.97) Inclusion criteria: Evidence of neglect on at least 1 of 3 tests, follow 2-step directions, and competent to provide consentInstruments: Line crossing, Star Cancellation, picture scanning task, and object search task, which was administered either as static or dynamicχ2 analysis, independent t tests, ANOVA, MANCOVASignificant differences were detected on the object search task. Those in the dynamic assessment group had reduced neglect. In addition, those in the dynamic group had greater initiation of left-sided searches, using strategies, and near and intermediate transfer of learning.Article focused only on the spatial aspect of neglect. Small sample size was heterogeneous in terms of severity.
Turner, Ownsworth, Cornwell, & Fleming (2009) Qualitative, using a phenomenological approachConvenienceMen and women with acquired brain injury (N = 18) and 18 family caregivers Mean ages = 40.2 (SD = 14.5) for participants and 46.63 (SD = 10.9) for caregivers Inclusion criteria: Documented diagnosis of acquired brain injury, expected to return home on discharge, >16 yr old, adequate English communication skills, and capacity to provide informed consent Exclusion criteria: Premorbid neurological or psychiatric conditionInstrument: Semistructured interviews at 3 points in timeN/ATwo primary themes emerged: Desired vs. actual participation in occupation and the struggle for independenceAuthors were not able to generalize because the study was conducted in a specific setting and cultural context. The study focused only on early transition (≤3 mo). Therapist perspective was not considered.
Warren (2009) DescriptiveConvenienceMen and women with visual field deficits (N = 46) Mean age = 65 Inclusion criteria: >18, visual field loss secondary to acquired brain injury, no ocular pathology affecting acuity or field, corrected visual acuity to 20/80 or better, sufficient cognition and language to participate in sessions, no neglect, and no significant physical impairment that may interfere with ADL performanceInstruments: Early Treatment Diabetic Retinopathy Study 2000 series charts (acuity), Humphrey Visual Field Analyzer, Behavioral Inattention Test (four subtests), Visual Skills for Reading Test, semistructured interview regarding perceptions of difficult occupationsDescriptivesThose with visual field deficits reported minimal difficulty completing basic ADLs and significant difficulty with IADLs such as driving, shopping, and meal preparation.Sample was biased toward people with more significant ADL limitations. A nonstandardized ADL tool was used.Heterogeneous sample regarding type and location of visual field deficits limits generalizability.
Wolf, Baum, & Connor (2009) DescriptiveExisting databaseMen and women with stroke (N = 7,740) who were treated at a particular center between 1999 and Spring 2008Instruments: National Institutes of Health Stroke Scale and demographicsDescriptivesThe age of stroke is deceasing, most strokes are mild or moderate in severity, and discharge decisions are made largely on impairment measures.Data collected at one center.
Table Footer NoteNote. ADLs = activities of daily living; SD = standard deviation; TBI = traumatic brain injury; ANOVA = analysis of variance; N/A = not applicable; COPM = Canadian Occupational Performance Measure; s/p = status post; MMSE = Mini-Mental State Examination; ANC0VA = analysis of covariance; lADLs = instrumental activities of daily living; MET = Multiple Errands Test; MANOVA = multivariate analysis of variance; A-ONE = AD L-focused Occupation-based Neurobehavioral Evaluation; EFPT = Executive Function Performance Test.
Note. ADLs = activities of daily living; SD = standard deviation; TBI = traumatic brain injury; ANOVA = analysis of variance; N/A = not applicable; COPM = Canadian Occupational Performance Measure; s/p = status post; MMSE = Mini-Mental State Examination; ANC0VA = analysis of covariance; lADLs = instrumental activities of daily living; MET = Multiple Errands Test; MANOVA = multivariate analysis of variance; A-ONE = AD L-focused Occupation-based Neurobehavioral Evaluation; EFPT = Executive Function Performance Test.×
Table 2.
Systematic Review of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy
Systematic Review of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy×
Author and YearResearch Methodology UsedLevel of EvidenceSample Selection MethodSample Characteristics and Inclusion-Exclusion CriteriaInstruments or Interventions UsedStatistics UsedResultsStudy Limitations
Arnadóttir & Fisher (2008) Validity and reliability testingConvenience sample using existing dataMen and women (N = 209) with stroke, dementia, or other neurological diagnoses with completed A–ONE assessments completed by certified raters Mean age = 73.7 (SD = 13.0).Instrument: The ADL scale of the A–ONERasch analysisMisfit items could be reduced by removing 2 communication items. Threshold disordering could be corrected by combining 2 scoring categories. Separation reliability for item calibration was high and acceptable for people. Principal components analysis supported unidimensionality.Limited generalization to other neurological diagnoses because stroke and dementia were the most common diagnoses included in the study.
Baum et al. (2008) Validity (construct and concurrent) and reliability (interrater) testingConvenienceMen and women with stroke (N = 73) and 22 age and education-matched control participants Mean age = 64.49 (SD = 14.28) Inclusion criteria: Confirmed diagnoses of stroke and ≥6 mo since stroke Exclusion criteria: Dementia as measured by the Short Blessed TestInstruments: EFPT, Wechsler Memory Scale, Animal Fluency, Trail Making Test B, Digits Backward, Short Blessed Scale, Trail Making Test A, Digits Forward, FIM™, and Functional Assessment MeasureANOVA, χ2 analyses, interclass correlation coefficient, and Cronbach’s αHigh interrater reliability (.91) for total score and support for internal consistency. The EFPT can discriminate between control participants and those with stroke as well as those with mild and moderately severe stroke. Concurrent validity established with 4 neuropsychological measures and with the Short Blessed Scale. Significant correlations between EFPT and Functional Assessment Measure and EFPT and FIM.Study was limited to those with mild and moderate stroke, therefore limiting generalization to those with severe involvement.
Classen, Levy, McCarthy, Mann, Lanford, D., & Waid-Ebbs (2009) Evidence-based literature reviewReview of existing and published research13 studies; sample sizes varied Exclusion criteria: Published before 1995, not primary studies, mainly qualitative or descriptive, emphasized or established, psychometrics, driving was not main outcome, and included mixed diagnostic groupsInstruments: Neuropsychological tests, simulator tests, off-road screening tests, self- and significant other report, postinjury disability status, and comprehensive driving evaluationN/ARecommendations for assessments were made for the various assessments on the basis of the tools’ predictability related to driving performance after TBI.Studies published in languages other than English were not included. Team consensus was used as opposed to rater reliability. The authors did not control for publication bias and did not seek unpublished manuscripts.
Denham (2008) Case studyVConvenienceOne 63-yr-old woman with chronic left hemiplegia secondary to a strokeIntervention: Botulinum toxin A combined with occupational therapy (splinting, active and passive range of motion, stretching, practice of bilateral functional activities) Instruments: Modified Ashworth Scale, active range of motion, and ADL evaluation (nonstandardized)N/AImproved on all measures that were maintained for 2 yrAuthors were not able to generalize findings secondary to case study format. Functional measure was nonstandardized. Multiple interventions make it difficult to interpret main therapeutic factor.
Doig, Fleming, Cornwell, & Kuipers (2009) Qualitative approach using semistructured interviewsConveniencePeople with TBI (N = 12) living in the community and 10 of their nominated significant others Mean age = 24.7 (SD = 6.9) Inclusion criteria: Between ages 16 and 65, recently discharged from inpatient rehabilitation, receiving outpatient occupational therapy, confirmed TBI, and had significant other available to participate Exclusion criteria: Low arousal, coma, confusion, significant premorbid psychiatric illness, and significant drug or alcohol useIntervention: 12-wk goaldirected, community-based occupational therapy. The COPM was used to identify goals and the Goal Attainment Scale was used to measure goal progress. Instruments: Semistructured interviews of participants, significant others, and occupational therapists involved in the programN/AAll expressed satisfaction with progress. Findings emphasized the value of goals providing structure and motivation, importance of goal ownership, importance of family involvement, the impact of cognitive impairments, and meeting the challenges of goal setting.Small sample size and recruitment from only one site limited generalizability.
Erez, Rothschild, Katz, Tuchner, & Hartman-Maeir (2009) DescriptiveConvenienceMen and women with mild TBI (N = 13) Mean time since injury = 4.79 mo Mean age = 43.4 (SD = 13.07)Instruments: Participation Index from the Mayo Portland Adaptability Inventory, Behavioral Assessment of the Dysexecutive Syndrome, Dysexecutive Questionnaire, and the Self- Awareness of Deficits InterviewDescriptives, t tests, Mann–Whitney U, and Spearman ρ correlation analysisHigh frequencies of executive function impairments were documented. Selfawareness to these deficits was intact. A high percentage of participants experienced restrictions in daily life. Participation scores were significantly correlated with measures of executive functioning.Sample size was small. Measures of emotional state were not included.
Faddy, McCluskey, & Lannin (2008) Interrater reliabilityConvenienceMen and women with brain injury (N = 10) and 2 occupational therapist raters Inclusion criteria: ≥18 yr, TBI diagnosis, 1 yr since injury, difficulty holding and using a pen, and being able to attempt to write unpromptedInstrument: Handwriting Assessment Battery for Adultsκ and intraclass coefficientsPen control and manipulation subtests showed high or perfect agreement, speed subtest showed perfect agreement, and writing legibility showed high agreement for all 5 subtests.Ceiling effects were noted. Sample size was small. The clinical profile of the participants was not included. Difficult to generalize findings.
Fong & Howie (2009) Controlled trial using matched pairsIIConvenienceN = 34 men and women s/p various acquired brain injuries Mean age = 33.4 (SD = 11.5) Excluded if <18 or >55 or had vision–hearing impairment, aphasia, or poor concentrationIntervention: Explicit problem-solving skills training using a metacomponential approach vs. conventional cognitive training that did not include explicit metacognitive training Instruments: Subtests of Behavioral Assessment of Dysexecutive Syndrome, Social Problem Solving Video Measure, Means- Ends Problem Solving Measure, Raven’s Progressive Matrices, and Metacomponential InterviewMann–Whitney UNo differences between the experimental and control groups except for 2 components from the Metacomponential Interview that favored the experimental group. Results did not generalize to everyday function.11 participants did not attend follow-up assessment. Drop-out rate was 32%. The intervention did not generalize to everyday function
Goverover, Arango-Lasprilla, Hillary, Chiaravalloti, & Deluca (2009) Within-subjects designIIConvenienceN = 25 (10 people with TBI ≥1 yr after injury and 15 healthy control participants) Mean ages = 42.5 (participants with TBI) and 43.3 (control participants) Inclusion criteria: Positive computed tomography or MRI results or loss of consciousness for ≥24 hr Exclusion criteria: Neurologic illness other than TBI, history of major psychiatric illness or alcohol or drug abuse, or severe visual or motor impairment that would interfere with study proceduresIntervention: Paragraph learning and route-learning tasks using a spacing effect strategy or via massed presentation Instruments: Performance on experimental tasksANOVAMaterial learned under the spaced learning condition was recalled better than that learned under the massed learning conditions for both the TBI group and the control group.Sample size was small. Authors were not able to ascertain whether gains were maintained. Severity of injury was not accounted for.
Guidetti, Asaba, & Tham (2009) Qualitative study using the empirical, phenomenological, psychological methodConvenienceMen and women (N = 11) s/p stroke or spinal cord injury Inclusion criteria: <65 yr, in need of self-care training, ability to understand interview questions and ability to share experiencesInstruments: Open-ended interviewsN/AThe authors documented 6 main characteristics describing the role of context in regaining selfcare ability, including support from others, an air of expectation, extended time, new daily structure, therapeutic relationship as enabling, and gradual change in challenge.Interviews were conducted on 1 occasion, risk for interviewer bias, and inclusion of 2 diagnoses could influence the documented experiences.
Guiffrida, Demery, Reyes, Lebowitz, & Hanlon (2009) 2 groups, nonrandomizedIIConvenienceMale participants (N = 6) with chronic and severe TBI Mean age = 28 Inclusion criteria: Single TBI; ≥18 mo since injury; no history of substance abuse, learning disability, attention deficit disorder, or severe psychiatric illnessIntervention: Practice of functional skills using either random or blocked practice schedules; practiced occurred 55 min per day for 13 days Instruments: Performance of experimental tasks—typing, data input, and learning a subway schedule Transfer-of-learning task: typing dictationANOVABoth groups showed improvements across tasks at the end of training and retained this improvement 2 wk after training. Only the random practice group was able to transfer learning to a new and similar task.Sample size was small.
Hartman-Maeir, Harel, & Katz (2009) Validity (construct, convergent, ecological) and reliability (interrater) testingConvenienceFor reliability study: Men and women with stroke (N = 21) and 4 occupational therapists Age: Site 1, M = 79.3 (SD = 5.8); Site 2, M = 77.82 (SD = 5.1). Inclusion criteria: Alert, receptive language intact, and independent in community before stroke For validity study: Men and women with stroke (N = 36) and 36 healthy control participants Mean age = 74.81 (SD = 7.32) for participants with stroke and 72.67 (SD = 6.59) for control participants Inclusion criteria: Same as for reliability studyInstruments: Kettle Test, MMSE, Clock Drawing Test, Star Cancellation, Cognitive and Motor scales of the FIM, IADL Scale, the Fugl-Meyer Motor Assessment, and the Safety Rating ScaleDescriptives, ANCOVA, Pearson correlations coefficientsInterrater reliability is high. Those with stroke required significantly more assistance on the Kettle Test than control participants. Kettle Test moderately and significantly correlated with conventional cognitive measures. The Kettle Test correlated significantly with the FIM, safety measures, and IADLs.Sample size was small. IADL data were collected via phone.
Hill-Hermann, Strasser, Albers, Schofield, Dunning, Levine et al. (2008) Case studyVConvenienceOne 61-yr-old woman s/p cerebrovascular accident 16 mo earlier Inclusion criteria: 10° of active extension in the affected wrist and 2 additional digits of the affected hand; stroke experienced >3 mo prior; >70 on the MMSE; age between 35 and 85; no excessive spasticity; no excessive pain; experienced only one stroke; discharged from all forms of therapy; a detectable surface electromyograph signal of ≥5 μV Exclusion criteria: Participating in any experimental rehabilitation or drug studies; being pregnant; having an uncontrolled seizure disorderIntervention: 3-hr ADL training sessions 5 days per wk for 3 wk using a neuroprosthesis Instruments: Fugl-Meyer, Action Research Arm est, Arm Motor Activity Test, and COPMN/AImprovements noted on all measures. The patient exhibited reduced impairment (Fugl-Meyer score change from 31 to 35), Arm Motor Activity Test score decreased from 99 to 98, decreased time needed to complete Arm Motor Activity Test tasks (from 998 s to 558 s), and increased Action Research Arm score (from 27 to 31). COPM performance score increased 5.8, and the COPM satisfaction score increased 4.3.Authors were not able to generalize secondary to case study format. Relatively modest gains on some measures were reported.
Lin, Wu, Lin, & Chang (2008) Counterbalanced repeated measuresIIConvenienceMen and women (N = 26) with unilateral cerebrovascular accident and 24 age-matched healthy people Average time since stroke was 2.62 mo. Mean age = 62.3 Inclusion criteria: Able to understand or respond to directions, no signs of motor apraxia or visuospatial neglect; no history of prior stroke or visual deficits Control group with no neurologic or psychiatric history by self-reportIntervention: Random assignment to one of four sequences for executing a reaching task with the less-affected limb. Experimental conditions were formed by crossing task instructions with a speed and accuracy emphasis and target locations ipsilateral and contralateral to the to the less-affected hand used for performance. Instruments: Six-camera motion analysis systemANOVAFindings for healthy control participants: Speeded instructions and ipsilateral reaches elicited more preprogrammed movements than accuracy instruction and contralateral reaches. Findings for those with stroke were similar to those for control participants with the exception of movement initiation in those with right-sided strokes. Overall, a combination of speeded instruction and ipsilateral reach seemed to optimize movement performance of the less-affected limb in those with stroke.The study used impairment-only measures. Stroke severity was not considered.
Nakamura, Abreu, Patterson, Buford, & Ottenbacher (2008) DescriptiveConvenienceN = 34; 17 with brain injury including stroke and TBI and 17 without brain injury Mean ages = 40.7 (participants with brain injury) and 41.5 (participants without brain injury) Inclusion criteria: Diagnosis of stroke or head injury, >18, able to follow multistep requests, and no history of apraxiaInstrument: Six-camera motion analysis systemANOVAThe presumed-to-beunaffected upper limb of those with brain injury demonstrated longer movement duration and slower average speed, was supported by excessive trunk movement, and had decreased smoothness during reaching than that of the group without brain injury.Sample size was small. Homogeneous sample in terms of diagnosis, stage of recovery, and handedness
Rand, Weiss, & Katz (2009) Pretest–posttest designIIIConvenienceMen and women (N = 4) who had sustained a stroke ranging in age from 53 to 70 Time since stroke ranged from 5 to 27 mo Inclusion criteria: Unilateral first stroke, discharged home, scores >26–30 on the MMSE, no neglect or depression, evidence of deficits in executive functions as tested via subtests of the Behavioral Assessment of the Dysexecutive SyndromeInterventions: Ten 60-min sessions over 3 wk using VMall (a virtual supermarket) Instruments: MET, Virtual MET, and IADL questionnairePercentage of improvementAlthough results varied, overall improvements in both the MET and Virtual MET ranged from 20.5% to 51.2% for all mistake categories except for “use of strategies,” which improved 7.7% IADL scores did not improve.Sample size was small. Properties of Virtual MET are not clear, and stroke severity was not considered. Heterogeneous sample was a limitation.
Rosenstein, Ridgel, Thota, Samame, & Alberts (2008) Case studyVConvenienceOne 32-yr-old woman who had sustained a stroke 11 mo prior presenting with aphasia and a nonfunctional right dominant upper extremityInterventions: 2 hr of training with an assistive repetitive motion robotic device and 2 hr of repetitive task practice (including one to two 10- to 15-min breaks per day). The patient completed 12 of the 15 scheduled days. Instruments: Wolf Motor Function Test, the upperextremity portion of the Fugl-Meyer Motor Assessment, bimanual dexterity task, and the Modified Ashworth ScaleN/AModest yet favorable scores on 4 subtests of the Wolf Motor Function Test, 3-point increase on the Fugl-Meyer, Modified Ashworth Scale decrease from 1 + to 1 at elbow with no change at forearm and wrist. Active range of motion increased by 35° in the shoulder, 65° in the wrist, and 70° in the thumb. Kinetic analysis of a bimanual dexterity task indicated improved grasping forces for both limbs.Authors not able to generalize because of case study format. Relatively modest gains were reported on measures.
Rowe, Blanton, & Wolf (2009) Case studyVConvenienceOne 36-yr-old woman who sustained an ischemic infarct to the left internal capsule and basal gangliaIntervention: 2 wk on modified constraintinduced movement therapy (5 days/wk, 5.5 hr/day plus independent task practice in the evening and weekends) Instruments: Wolf Motor Function Test, Stroke Impact Scale, and the Motor Activity LogN/AImprovements noted on most subtests of all measures after treatment that generally persisted at both 4- and 5-yr follow-up assessments.Authors were not able to generalize because of case study format.
Shih, Rogers, Skidmore, Irrgang, & Holm (2009) Validity (construct) and reliability testingData derived from a large prospective stroke studyMen and women 3 mo after stroke (N = 68) Mean age = 65.53 (SD = 14.03) Inclusion criteria: Diagnosis of acute stroke, available radiologic data, and physician approvalInstruments: Glasgow Outcome Scale 5-point version, Glasgow Outcome Scale 8-point version, Modified Rankin Scale, Barthel Index, and the Performance Assessment of Self-Care SkillsRasch analysisThe 5 measures evaluated independence somewhat differently, and constructs other than ADL independence are included in some measures. Construct validity and reliability of the combined measures also indicated that the tools are not interchangeable.Sample was heterogeneous in terms of type of stroke. Because this was a secondary analysis, some variables were not available in the original data set.
Smallfield & Karges (2009) DescriptiveRetrospective chart auditMen and women with stroke (N = 80) Mean age = 70.28 (SD = 11.35). Inclusion criteria: Between the ages of 18 and 85, confirmed stroke, received occupational therapy and physical therapy during inpatient rehabilitation, FIM scores documented, and completion of inpatient stayInstruments: Data collection tool devised for study using the Occupational Therapy Practice Framework to classify content of occupational therapy sessions; type of assistive devices prescribed was documentedDescriptive and frequencies65.77% of occupational therapy activities within sessions were considered prefunctional compared with 48.26% that focused on ADLs. Musculoskeletal interventions were used in >50% of sessions, and grab bars and bathroom equipment were more commonly used than dressing equipment.Authors were not able to generalize because data were collected from 1 facility. Interventions may have not been documented or may have been documented incorrectly.
Toglia & Cermak (2009) Pretest–posttestConvenienceMen and women with unilateral neglect secondary to stroke (N = 40) Mean age = 67.82 (SD = 10.97) Inclusion criteria: Evidence of neglect on at least 1 of 3 tests, follow 2-step directions, and competent to provide consentInstruments: Line crossing, Star Cancellation, picture scanning task, and object search task, which was administered either as static or dynamicχ2 analysis, independent t tests, ANOVA, MANCOVASignificant differences were detected on the object search task. Those in the dynamic assessment group had reduced neglect. In addition, those in the dynamic group had greater initiation of left-sided searches, using strategies, and near and intermediate transfer of learning.Article focused only on the spatial aspect of neglect. Small sample size was heterogeneous in terms of severity.
Turner, Ownsworth, Cornwell, & Fleming (2009) Qualitative, using a phenomenological approachConvenienceMen and women with acquired brain injury (N = 18) and 18 family caregivers Mean ages = 40.2 (SD = 14.5) for participants and 46.63 (SD = 10.9) for caregivers Inclusion criteria: Documented diagnosis of acquired brain injury, expected to return home on discharge, >16 yr old, adequate English communication skills, and capacity to provide informed consent Exclusion criteria: Premorbid neurological or psychiatric conditionInstrument: Semistructured interviews at 3 points in timeN/ATwo primary themes emerged: Desired vs. actual participation in occupation and the struggle for independenceAuthors were not able to generalize because the study was conducted in a specific setting and cultural context. The study focused only on early transition (≤3 mo). Therapist perspective was not considered.
Warren (2009) DescriptiveConvenienceMen and women with visual field deficits (N = 46) Mean age = 65 Inclusion criteria: >18, visual field loss secondary to acquired brain injury, no ocular pathology affecting acuity or field, corrected visual acuity to 20/80 or better, sufficient cognition and language to participate in sessions, no neglect, and no significant physical impairment that may interfere with ADL performanceInstruments: Early Treatment Diabetic Retinopathy Study 2000 series charts (acuity), Humphrey Visual Field Analyzer, Behavioral Inattention Test (four subtests), Visual Skills for Reading Test, semistructured interview regarding perceptions of difficult occupationsDescriptivesThose with visual field deficits reported minimal difficulty completing basic ADLs and significant difficulty with IADLs such as driving, shopping, and meal preparation.Sample was biased toward people with more significant ADL limitations. A nonstandardized ADL tool was used.Heterogeneous sample regarding type and location of visual field deficits limits generalizability.
Wolf, Baum, & Connor (2009) DescriptiveExisting databaseMen and women with stroke (N = 7,740) who were treated at a particular center between 1999 and Spring 2008Instruments: National Institutes of Health Stroke Scale and demographicsDescriptivesThe age of stroke is deceasing, most strokes are mild or moderate in severity, and discharge decisions are made largely on impairment measures.Data collected at one center.
Table Footer NoteNote. ADLs = activities of daily living; SD = standard deviation; TBI = traumatic brain injury; ANOVA = analysis of variance; N/A = not applicable; COPM = Canadian Occupational Performance Measure; s/p = status post; MMSE = Mini-Mental State Examination; ANC0VA = analysis of covariance; lADLs = instrumental activities of daily living; MET = Multiple Errands Test; MANOVA = multivariate analysis of variance; A-ONE = AD L-focused Occupation-based Neurobehavioral Evaluation; EFPT = Executive Function Performance Test.
Note. ADLs = activities of daily living; SD = standard deviation; TBI = traumatic brain injury; ANOVA = analysis of variance; N/A = not applicable; COPM = Canadian Occupational Performance Measure; s/p = status post; MMSE = Mini-Mental State Examination; ANC0VA = analysis of covariance; lADLs = instrumental activities of daily living; MET = Multiple Errands Test; MANOVA = multivariate analysis of variance; A-ONE = AD L-focused Occupation-based Neurobehavioral Evaluation; EFPT = Executive Function Performance Test.×
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Most studies identified were effectiveness studies (i.e., dealing with the effect or outcome of intervention), arguably the most critical area of focus for occupational therapy research. In terms of rating these studies’ level of evidence, I used the following rating system (Lieberman & Scheer, 2002):
  • Level I: Systematic reviews, meta-analyses, and randomized controlled trials

  • Level II: Two groups, nonrandomized studies such as cohort or case-control designs

  • Level III: One group, nonrandomized studies such as pretest and posttest designs

  • Level IV: Descriptive studies including analysis of outcomes such as single-subject designs or case series

  • Level V: Case reports and expert opinion including narrative literature reviews and consensus statements.

Of the nine effectiveness studies, four (44.4%) were classified as Level II (Fong & Howie, 2009; Goverover et al., 2009; Guiffrida et al., 2009; Lin et al., 2008), one (11.1%) as Level III (Rand et al., 2009), and four (44.4%) as Level V (Denham, 2008; Hill-Hermann et al., 2008; Rosenstein et al., 2008; Rowe et al., 2009). I identified no Level I or Level IV studies.
After effectiveness studies, the most commonly identified studies focused on instrument development and testing. This area remains critical for occupational therapists to examine because the choice of assessment and the specific items included help to demonstrate occupational therapy’s unique focus. AJOT published six basic neurorehabilitation research articles (i.e., those that examined a clinical phenomenon but did not assess treatment) from 2008 to 2009. Finally, two articles examined the clinical efficacy (e.g., dealing with safety, client satisfaction, cost or time efficiency) of occupational therapy.
Assessment: How Well Did the Journal Meet the Centennial Vision in the Past 2 Years in the Practice Area of Neurorehabilitation?
Overall, I identified many articles published over the past 2 years (2008–2009) that will be helpful as we strive to meet the Centennial Vision in the practice area of neurorehabilitation. I should note that this review included a special issue of the American Journal of Occupational Therapy (Gutman, 2009) focused on stroke and brain injury rehabilitation and that 12 (50%) of the articles identified were from that one specific issue. Clearly, the publication of a special issue serves as a catalyst to generate research in a focused area of practice.
Most identified studies were related to effectiveness and testing various occupational therapy interventions. Interventions that were focused on motor control impairments used techniques such as occupational therapy combined with botulinum toxin A (Denham, 2008), task-specific training while wearing a neuroprosthesis (Hill-Hermann et al., 2008), reaching tasks with varied task parameters (Lin et al., 2008), combined repetitive task practice and robotic therapy (Rosenstein et al., 2008), and constraint-induced movement therapy (Rowe et al., 2009). Interventions that focused on cognitive impairments used techniques such as problem skills training (Fong & Howie, 2009), whereas interventions that focused on learning specific skills used techniques such as blocked and random practice (Guiffrida et al., 2009), spacing effect strategies (Goverover et al., 2009), and virtual reality (Rand et al., 2009).
Various outcome measures were used that can be categorized at the impairment level and included measures of spasticity, decreased active range of motion, executive function impairment, difficulties with problem solving, upper-extremity impairment, and altered upper-limb kinematics. Outcome measures that were used and categorized as measures of activity limitations included nonstandardized measures of activities of daily living (ADLs), performance of instrumental activities of daily living (IADLs), performance of specific skills (vocational skills, route learning, paragraph learning), using the upper extremity to support daily function, and self-report of performance of and satisfaction with occupational performance. Finally, outcome measures that can be classified as participation or quality-of-life measures were the least commonly used and in fact were used in only one case study (Rowe et al., 2009).
Because I identified no Level I effectiveness studies, I further analyzed Level II studies on the basis of intervention and outcomes. Only two (Guiffrida et al., 2009; Goverover et al., 2009) of the four Level II studies identified used learning specific daily living skills as an outcome measure. Findings from the four studies included that
  • Interventions for problem-solving impairments caused by acquired brain injury using a metacomponential approach have some advantage compared with conventional cognitive training as indicated by 2 of 10 scores included on the Metacomponential Interview but do not generalize to real-life problem solving (Fong & Howie, 2009);

  • Use of blocked or random practice has a positive effect on learning specific vocational skills that is retained for ≥2 wk for people living with a traumatic brain injury, and random practice seems to be advantageous in terms of transferring learning to a new and similar task (Guiffrida et al., 2009);

  • Use of a spacing effect strategy to learn and remember specific skills is superior to massed learning conditions for people with traumatic brain injury and healthy control participants (Goverover et al., 2009); and

  • A combination of speeded instruction and ipsilateral reach may optimize movement performance of the less affected limb in those living with stroke (Lin et al., 2008).

The one identified Level III study tested the emerging use of virtual reality with stroke survivors and, despite a small sample size, documented improvement in performing multiple errands in a shopping mall. The four remaining effectiveness studies were classified as Level V. All four studies examined the effect of various interventions on managing the neurologic upper extremity. All of the studies included various impairment measures. Specific activity and participation outcome measures used included a nonstandardized assessment of basic ADLs and IADLs (Denham, 2008), the Canadian Occupational Performance Measure (Hill-Hermann et al., 2008), and the Stroke Impact Scale (Rowe et al., 2009). In addition, some studies included measures that quantify upper-extremity function (Hill-Hermann et al., 2008; Rosenstein et al., 2008; Rowe et al., 2009).
After effectiveness studies, the most commonly identified studies focused on instrument development and testing. A clear pattern noted in these studies is a renewed focus on performance-based assessment and assessments that appear to have high ecological validity. In the realm of cognitive rehabilitation, ecological validity refers to the degree to which the cognitive demands of the test theoretically resemble the cognitive demands in the everyday environment, sometimes termed functional cognition. A test with high ecological validity identifies difficulty in performing real-world functional and meaningful tasks (Chaytor & Schmitter-Edgecombe, 2003). The issue of ecological validity is of paramount importance when developing occupational therapy assessments (Gillen, 2009). Assessments that were further developed and tested for validity and reliability included ecologically valid performance-based cognitive assessments such as the ADL-focused Occupation-based Neurobehavioral Evaluation (A--ONE), which uses observations of basic ADLs and mobility to ascertain underlying neurobehavioral deficits that affect functional status (Arnadóttir & Fisher, 2009); the Executive Function Performance Test, which uses four everyday tasks (cooking, using the telephone, managing medications, and paying bills) to document the presence or impact of executive function deficits (Baum et al., 2008); and the Kettle Test, which uses the task of preparing hot beverages to tap into basic and higher-level cognitive processes (Hartman-Maeir et al., 2009). In addition, the use of dynamic assessment to examine learning potential for those with unilateral neglect continues to develop (Toglia & Cermak, 2009).
Measurement of specific living skills also emerged as an identified pattern. Identified studies examined the development of a Handwriting Assessment Battery for Adults (Faddy et al., 2008), recommended assessments to predict driving ability for those living with traumatic brain injury using an evidence-based literature review approach (Classen et al., 2009), and examined existing measures of ADLs for stroke survivors using Rasch analysis (Shih et al., 2009).
The next most common area of inquiry was focused on basic neurorehabilitation research. Findings from basic neurorehabilitation research included
  • Documenting the presence of deficits in executive functions, participation restrictions, and a significant correlation between these two variables in those with mild traumatic brain injury (Erez et al., 2009);

  • Identifying the meaning of context in the process of regaining the ability to participate in self-care after stroke or spinal cord injury using qualitative methods (Guidetti et al., 2009);

  • Identifying motor deficits via kinematic analysis in the presumed-to-be-unaffected upper extremity after brain injury (Nakamura et al., 2008);

  • Using qualitative methods to explore the experiences of reengagement in meaningful occupations during the hospital-to-home transition after acquired brain injury (Turner et al., 2009);

  • Documenting mild difficulties performing basic ADLs and significant limitations in IADLs in those with visual field deficits (Warren, 2009); and

  • Documenting how the health care community’s understanding of stroke is changing as the age of stroke is decreasing; most strokes are mild to moderate in severity, and most discharge decisions are based on impairment measures (Wolf et al., 2009).

Many of the studies classified as basic research are easily translated into clinical practice. Examples include providing guidance for choosing appropriate assessment tools to identify areas for occupational therapy intervention after mild traumatic brain injury (Erez et al., 2009) and identifying priority areas for assessment and intervention in those with hemianopsia (Warren, 2009).
Last, two studies examined clinical efficacy:
  • Using qualitative methods, Doig et al. (2009)  documented that goal-directed therapy is described positively and that a structured goal-setting process in which the client, therapist, and significant others work in partnership seems to enhance the process of goal setting and goal-directed community-based rehabilitation.

  • Smallfield and Karges (2009)  classified the type of occupational therapy intervention used during inpatient stroke rehabilitation. They observed that most (65.77%) occupational therapy sessions were classified as prefunctional (i.e., not consisting of an actual occupation) in nature compared with 48.26% of sessions focused on relearning daily living tasks.

Notable Concerns
I noted three trends in this review that are cause for reflection: the ability of research to influence practice, an absence of highest-level research from the perspective of level of evidence, and choice of outcome measures.
The findings of Smallfield and Karges (2009)  are disconcerting and discordant with current trends in neurorehabilitation research, including the articles analyzed for this review. That is, a clear and consistent finding in current neurorehabilitation research is that specific and repetitive task practice is a key therapeutic factor in relearning specific skills (Denham, 2008; Guiffrida et al., 2009; Hill-Hermann et al., 2008; Rao, 2004; Rosenstein et al., 2008; Rowe et al., 2009). Of concern is that on the basis of Smallfield and Karges’s (2009)  findings and those of others whom those authors eloquently cite, practice trends are still not embracing this core concept. Questions emerge related to bridging research and practice and the ability of AJOT (and other professional journals) to influence practice.
Although all levels of evidence are potentially useful to practitioners, the lack of studies published in AJOT that are classified as Level I evidence is troublesome. This is not to say that occupational therapists are not generating this level of evidence but that they may be choosing to publish this research in other journals. It is imperative to identify the factors associated with researchers choosing other journals to publish their most powerful and potentially influential research.
In terms of outcome measures, our unique occupational therapy focus is assumed to be on enhancing performance in areas of occupation and likewise decreasing activity limitations and participation restrictions to ultimately improve quality of life. That being said and understanding that impairment measures are also useful, only two of the effectiveness studies that were consistent with Level II evidence used an activity-level measure, and only one identified study (Level V) used a measure of participation or quality of life as an outcome measure. It is concerning that the outcome measures that are being chosen are not reflective of overarching occupational therapy goals. By contrast, occupational therapists have developed and continue to develop powerful measures that reflect their unique focus (Law et al., 2005). This review continues to reflect the trend of occupational therapists developing and testing their own instruments. These tools should be integrated into both practice and research.
Directions for Future Research
The American Journal of Occupational Therapy is clearly a potentially powerful tool to hasten meeting the Centennial Vision. On the basis of the findings reported here, I make several recommendations for future research.
Occupational therapy researchers should commit to ensuring that in addition to impairment measures, measures of activity or participation and quality of life are consistently integrated into the profession’s research agendas. The profession as a whole must continue to support and cultivate researchers to carry out and publish all levels of evidence, but the publication of effectiveness studies categorized as Level I evidence is particularly important.
Finally, over the past few years the emphasis has been on testing new technology to improve neurorehabilitation outcomes. This trend is reflected in this review. This work is cutting edge, relevant, and exciting and has the potential to make important changes in clients’ lives. However, multiple interventions have and continue to be used on a day-to-day basis that are considered core or foundational occupational therapy interventions for this population (e.g., the use of adaptive devices to improve IADLs, adaptations for those living with one functional upper extremity, splinting, positioning, wheeled mobility prescription) that have been yet to be tested in any depth, if at all. I recommend that in addition to cutting-edge technologies, day-to-day interventions that appear to be tried and true be tested with rigor so that we can feel confident that “occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession” (AOTA, 2007, p. 614).
References
American Occupational Therapy Association. (2007). AOTA’s Centennial Vision and executive summary. American Journal of Occupational Therapy, 61, 613–614. [Article]
American Occupational Therapy Association. (2007). AOTA’s Centennial Vision and executive summary. American Journal of Occupational Therapy, 61, 613–614. [Article] ×
Arnadóttir, G., & Fisher, A. G. (2008). Rasch analysis of the ADL scale of the A-ONE. American Journal of Occupational Therapy, 62, 51–60. [Article] [PubMed]
Arnadóttir, G., & Fisher, A. G. (2008). Rasch analysis of the ADL scale of the A-ONE. American Journal of Occupational Therapy, 62, 51–60. [Article] [PubMed]×
Baum, C. M., Connor, L. T., Morrison, T., Hahn, M., Dromerick, A. W., & Edwards, D. F. (2008). Reliability, validity, and clinical utility of the Executive Function Performance Test: A measure of executive function in a sample of people with stroke. American Journal of Occupational Therapy, 62, 446–455. [Article] [PubMed]
Baum, C. M., Connor, L. T., Morrison, T., Hahn, M., Dromerick, A. W., & Edwards, D. F. (2008). Reliability, validity, and clinical utility of the Executive Function Performance Test: A measure of executive function in a sample of people with stroke. American Journal of Occupational Therapy, 62, 446–455. [Article] [PubMed]×
Chaytor, N., & Schmitter-Edgecombe, M. (2003). The ecological validity of neuropsychological tests: A review of the literature on everyday cognitive skills. Neuropsychology Review, 13, 181–197. [Article] [PubMed]
Chaytor, N., & Schmitter-Edgecombe, M. (2003). The ecological validity of neuropsychological tests: A review of the literature on everyday cognitive skills. Neuropsychology Review, 13, 181–197. [Article] [PubMed]×
Classen, S., Levy, C., McCarthy, D., Mann, W. C., Lanford, D., & Waid-Ebbs, J. K. (2009). Traumatic brain injury and driving assessment: An evidence-based literature review. American Journal of Occupational Therapy, 63, 580–591. [Article] [PubMed]
Classen, S., Levy, C., McCarthy, D., Mann, W. C., Lanford, D., & Waid-Ebbs, J. K. (2009). Traumatic brain injury and driving assessment: An evidence-based literature review. American Journal of Occupational Therapy, 63, 580–591. [Article] [PubMed]×
Denham, S. P. (2008). Augmenting occupational therapy treatment of upper-extremity spasticity with botulinum toxin A: A case report of progress at discharge and 2 years later. American Journal of Occupational Therapy, 61, 473–479. [Article]
Denham, S. P. (2008). Augmenting occupational therapy treatment of upper-extremity spasticity with botulinum toxin A: A case report of progress at discharge and 2 years later. American Journal of Occupational Therapy, 61, 473–479. [Article] ×
Doig, E., Fleming, J., Cornwell, P. L., & Kuipers, P. (2009). Qualitative exploration of a client-centered, goal-directed approach to community-based occupational therapy for adults with traumatic brain injury. American Journal of Occupational Therapy, 63, 559–568. [Article] [PubMed]
Doig, E., Fleming, J., Cornwell, P. L., & Kuipers, P. (2009). Qualitative exploration of a client-centered, goal-directed approach to community-based occupational therapy for adults with traumatic brain injury. American Journal of Occupational Therapy, 63, 559–568. [Article] [PubMed]×
Erez, A. B., Rothschild, E., Katz, N., Tuchner, M., & Hartman-Maeir, A. (2009). Executive functioning, awareness, and participation in daily life after mild traumatic brain injury: A preliminary study. American Journal of Occupational Therapy, 63, 634–641. [Article] [PubMed]
Erez, A. B., Rothschild, E., Katz, N., Tuchner, M., & Hartman-Maeir, A. (2009). Executive functioning, awareness, and participation in daily life after mild traumatic brain injury: A preliminary study. American Journal of Occupational Therapy, 63, 634–641. [Article] [PubMed]×
Faddy, K., McCluskey, A., & Lannin, N. A. (2008). Interrater reliability of a new handwriting assessment battery for adults. American Journal of Occupational Therapy, 62, 595–599. [Article] [PubMed]
Faddy, K., McCluskey, A., & Lannin, N. A. (2008). Interrater reliability of a new handwriting assessment battery for adults. American Journal of Occupational Therapy, 62, 595–599. [Article] [PubMed]×
Fong, K. N. K., & Howie, D. R. (2009). The effects of an explicit problem-solving skills training program using a metacomponential approach for outpatients with acquired brain injury. American Journal of Occupational Therapy, 63, 525–534. [Article] [PubMed]
Fong, K. N. K., & Howie, D. R. (2009). The effects of an explicit problem-solving skills training program using a metacomponential approach for outpatients with acquired brain injury. American Journal of Occupational Therapy, 63, 525–534. [Article] [PubMed]×
Gillen, G. (2009). Cognitive and perceptual rehabilitation: Optimizing function. St. Louis, MO: Elsevier.
Gillen, G. (2009). Cognitive and perceptual rehabilitation: Optimizing function. St. Louis, MO: Elsevier.×
Goverover, Y., Arango-Lasprilla, J. C., Hillary, F. G., Chiaravalloti, N., & Deluca, J. (2009). Application of the spacing effect to improve learning and memory for functional tasks in traumatic brain injury: A pilot study. American Journal of Occupational Therapy, 63, 543–548. [Article] [PubMed]
Goverover, Y., Arango-Lasprilla, J. C., Hillary, F. G., Chiaravalloti, N., & Deluca, J. (2009). Application of the spacing effect to improve learning and memory for functional tasks in traumatic brain injury: A pilot study. American Journal of Occupational Therapy, 63, 543–548. [Article] [PubMed]×
Guidetti, S., Asaba, E., & Tham, K. (2009). Meaning of context in recapturing self-care after stroke or spinal cord injury. American Journal of Occupational Therapy, 63, 323–332. [Article] [PubMed]
Guidetti, S., Asaba, E., & Tham, K. (2009). Meaning of context in recapturing self-care after stroke or spinal cord injury. American Journal of Occupational Therapy, 63, 323–332. [Article] [PubMed]×
Guiffrida, C. G., Demery, J. A., Reyes, L. R., Lebowitz, B. K., & Hanlon, R. E. (2009). Functional skill learning in men with traumatic brain injury. American Journal of Occupational Therapy, 63, 398–407. [Article] [PubMed]
Guiffrida, C. G., Demery, J. A., Reyes, L. R., Lebowitz, B. K., & Hanlon, R. E. (2009). Functional skill learning in men with traumatic brain injury. American Journal of Occupational Therapy, 63, 398–407. [Article] [PubMed]×
Gutman, S. A. (Ed.). (2009). Brain injury: Traumatic brain injury and stroke [Special Issue]. American Journal of Occupational Therapy, 63(5), 523–660. [Article] [PubMed]
Gutman, S. A. (Ed.). (2009). Brain injury: Traumatic brain injury and stroke [Special Issue]. American Journal of Occupational Therapy, 63(5), 523–660. [Article] [PubMed]×
Hartman-Maeir, A., Harel, H., & Katz, N. (2009). Kettle Test—A brief measure of cognitive functional performance: Reliability and validity in stroke rehabilitation. American Journal of Occupational Therapy, 63, 592–599. [Article] [PubMed]
Hartman-Maeir, A., Harel, H., & Katz, N. (2009). Kettle Test—A brief measure of cognitive functional performance: Reliability and validity in stroke rehabilitation. American Journal of Occupational Therapy, 63, 592–599. [Article] [PubMed]×
Hill-Hermann, V., Strasser, A., Albers, B., Schofield, K., Dunning, K., Levine, P., et al. (2008). Task-specific, patient-driven neuroprosthesis training in chronic stroke: Results of a 3-week clinical study. American Journal of Occupational Therapy, 61, 466–472. [Article]
Hill-Hermann, V., Strasser, A., Albers, B., Schofield, K., Dunning, K., Levine, P., et al. (2008). Task-specific, patient-driven neuroprosthesis training in chronic stroke: Results of a 3-week clinical study. American Journal of Occupational Therapy, 61, 466–472. [Article] ×
Law, M., Baum, C., & Dunn, W. (2005). Measuring occupational performance. Supporting best practice in occupational therapy (2nd ed.). Thorofare, NJ: Slack.
Law, M., Baum, C., & Dunn, W. (2005). Measuring occupational performance. Supporting best practice in occupational therapy (2nd ed.). Thorofare, NJ: Slack.×
Lieberman, D., & Scheer, J. (2002). AOTA’s Evidence-Based Literature Review Project: An overview. American Journal of Occupational Therapy, 56, 344–349. [Article] [PubMed]
Lieberman, D., & Scheer, J. (2002). AOTA’s Evidence-Based Literature Review Project: An overview. American Journal of Occupational Therapy, 56, 344–349. [Article] [PubMed]×
Lin, K.-C., Wu, C.-Y., Lin, K.-H., & Chang, C.-W. (2008). Effects of task instructions and target location on reaching kinematics in people with and without cerebrovascular accident: A study of the less-affected limb. American Journal of Occupational Therapy, 62, 456–465. [Article] [PubMed]
Lin, K.-C., Wu, C.-Y., Lin, K.-H., & Chang, C.-W. (2008). Effects of task instructions and target location on reaching kinematics in people with and without cerebrovascular accident: A study of the less-affected limb. American Journal of Occupational Therapy, 62, 456–465. [Article] [PubMed]×
Nakamura, T., Abreu, B. C., Patterson, R. M., Buford, W. L., Jr., & Ottenbacher, K. J. (2008). Upper-limb kinematics of the presumed-to-be-unaffected side after brain injury. American Journal of Occupational Therapy, 62, 46–50. [Article] [PubMed]
Nakamura, T., Abreu, B. C., Patterson, R. M., Buford, W. L., Jr., & Ottenbacher, K. J. (2008). Upper-limb kinematics of the presumed-to-be-unaffected side after brain injury. American Journal of Occupational Therapy, 62, 46–50. [Article] [PubMed]×
Rand, D., Weiss, P. L., & Katz, N. (2009). Training multitasking in a virtual supermarket: A novel intervention after stroke. American Journal of Occupational Therapy, 63, 535–542. [Article] [PubMed]
Rand, D., Weiss, P. L., & Katz, N. (2009). Training multitasking in a virtual supermarket: A novel intervention after stroke. American Journal of Occupational Therapy, 63, 535–542. [Article] [PubMed]×
Rao, A. K. (2004). Approaches to motor control dysfunction: An evidence-based review. In G.Gillen & A.Burkhardt (Eds.), Stroke rehabilitation: A function based approach (pp. 93–118), St. Louis, MO: Elsevier.
Rao, A. K. (2004). Approaches to motor control dysfunction: An evidence-based review. In G.Gillen & A.Burkhardt (Eds.), Stroke rehabilitation: A function based approach (pp. 93–118), St. Louis, MO: Elsevier.×
Rosenstein, L., Ridgel, A. L., Thota, A., Samame, B., & Alberts, J. L. (2008). Effects of combined robotic therapy and repetitive-task practice on upper-extremity function in a patient with chronic stroke. American Journal of Occupational Therapy, 62, 28–35. [Article] [PubMed]
Rosenstein, L., Ridgel, A. L., Thota, A., Samame, B., & Alberts, J. L. (2008). Effects of combined robotic therapy and repetitive-task practice on upper-extremity function in a patient with chronic stroke. American Journal of Occupational Therapy, 62, 28–35. [Article] [PubMed]×
Rowe, V. T., Blanton, S., & Wolf, S. L. (2009). Long-term follow-up after constraint-induced therapy: A case report of a chronic stroke survivor. American Journal of Occupational Therapy, 63, 317–322. [Article] [PubMed]
Rowe, V. T., Blanton, S., & Wolf, S. L. (2009). Long-term follow-up after constraint-induced therapy: A case report of a chronic stroke survivor. American Journal of Occupational Therapy, 63, 317–322. [Article] [PubMed]×
Shih, M. M., Rogers, J. C., Skidmore, E. R., Irrgang, J. J., & Holm, M. B. (2009). Measuring stroke survivors’ functional status independence: Five perspectives. American Journal of Occupational Therapy, 63, 600–608. [Article] [PubMed]
Shih, M. M., Rogers, J. C., Skidmore, E. R., Irrgang, J. J., & Holm, M. B. (2009). Measuring stroke survivors’ functional status independence: Five perspectives. American Journal of Occupational Therapy, 63, 600–608. [Article] [PubMed]×
Smallfield, S., & Karges, J. (2009). Classification of occupational therapy intervention for inpatient stroke rehabilitation. American Journal of Occupational Therapy, 63, 408–413. [Article] [PubMed]
Smallfield, S., & Karges, J. (2009). Classification of occupational therapy intervention for inpatient stroke rehabilitation. American Journal of Occupational Therapy, 63, 408–413. [Article] [PubMed]×
Toglia, J., & Cermak, S. A. (2009). Dynamic assessment and prediction of learning potential in clients with unilateral neglect. American Journal of Occupational Therapy, 63, 569–579. [Article] [PubMed]
Toglia, J., & Cermak, S. A. (2009). Dynamic assessment and prediction of learning potential in clients with unilateral neglect. American Journal of Occupational Therapy, 63, 569–579. [Article] [PubMed]×
Turner, B., Ownsworth, T., Cornwell, P., & Fleming, J. (2009). Reengagement in meaningful occupations during the transition from hospital to home for individuals with acquired brain injury and their family caregivers. American Journal of Occupational Therapy, 63, 609–620. [Article] [PubMed]
Turner, B., Ownsworth, T., Cornwell, P., & Fleming, J. (2009). Reengagement in meaningful occupations during the transition from hospital to home for individuals with acquired brain injury and their family caregivers. American Journal of Occupational Therapy, 63, 609–620. [Article] [PubMed]×
Warren, M. A. (2009). Pilot study on activities of daily living limitations in adults with hemianopsia. American Journal of Occupational Therapy, 63, 626–633. [Article] [PubMed]
Warren, M. A. (2009). Pilot study on activities of daily living limitations in adults with hemianopsia. American Journal of Occupational Therapy, 63, 626–633. [Article] [PubMed]×
Wolf, T. J., Baum, C., & Connor, L. T. (2009). Changing face of stroke: Implications for occupational therapy practice. American Journal of Occupational Therapy, 63, 621–625. [Article] [PubMed]
Wolf, T. J., Baum, C., & Connor, L. T. (2009). Changing face of stroke: Implications for occupational therapy practice. American Journal of Occupational Therapy, 63, 621–625. [Article] [PubMed]×
Table 1.
Summary of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy
Summary of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy×
Author and YearEffectiveness StudySystematic or Narrative ReviewEfficacy StudyBasic ResearchInstrument Development and TestingLink Between Occupational Engagement and HealthQuantitative, Qualitative, or Mixed MethodLevel of Evidence
Arnadóttir & Fisher, 2008 XQuantitative
Baum, Connor, Morrison, Hahn, Dromerick, & Edwards (2008)XQuantitative
Classen, Levy, McCarthy, Mann, Lanford, D., & Waid-Ebbs (2009) XN/A
Denham (2008) XQuantitativeV
Doig, Fleming, Cornwell, & Kuipers (2009) XQualitative
Erez, Rothschild, Katz, Tuchner, & Hartman-Maeir (2009) XQuantitative
Faddy, McCluskey, & Lannin (2008) XQuantitative
Fong & Howie (2009) XQuantitativeII
Goverover, Arango-Lasprilla, Hillary, Chiaravalloti, & Deluca (2009) XQuantitativeII
Guidetti, Asaba, & Tham (2009) XQualitative
Guiffrida, Demery, Reyes, Lebowitz, & Hanlon (2009) XQuantitativeII
Hartman-Maeir, Harel, & Katz (2009) XQuantitative
Hill-Hermann, Strasser, Albers, Schofield, Dunning, & Levine (2008) XQuantitativeV
Lin, Wu, Lin, & Chang (2008) XII
Nakamura, Abreu, Patterson, Buford, & Ottenbacher (2008) XQuantitative
Rand, Weiss, & Katz (2009) XQuantitativeIII
Rosenstein, Ridgel, Thota, Samame, & Alberts (2008) XQuantitativeV
Rowe, Blanton, & Wolf (2009) XQuantitativeV
Shih, Rogers, Skidmore, Irrgang, & Holm (2009) XQuantitative
Smallfield & Karges (2009) XQuantitative
Toglia & Cermak (2009) XQuantitative
Turner, Ownsworth, Cornwell, & Fleming (2009) XQualitative
Warren (2009) XQuantitative
Wolf, Baum, & Connor (2009) XQuantitative
Table Footer NoteNote. N/A = not applicable. The following rating system for levels of evidence was used to rate the effectiveness studies: Level I: systematic reviews, meta-analyses, and randomized controlled trials, Level II: two groups, nonrandomized studies such as cohort or case-control designs, Level III: one-group, nonrandomized studies such as pretest and posttest designs, Level IV: descriptive studies including analysis of outcomes such as single-subject designs or case series, Level V: case reports and expert opinion including narrative literature reviews and consensus statements.
Note. N/A = not applicable. The following rating system for levels of evidence was used to rate the effectiveness studies: Level I: systematic reviews, meta-analyses, and randomized controlled trials, Level II: two groups, nonrandomized studies such as cohort or case-control designs, Level III: one-group, nonrandomized studies such as pretest and posttest designs, Level IV: descriptive studies including analysis of outcomes such as single-subject designs or case series, Level V: case reports and expert opinion including narrative literature reviews and consensus statements.×
Table 1.
Summary of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy
Summary of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy×
Author and YearEffectiveness StudySystematic or Narrative ReviewEfficacy StudyBasic ResearchInstrument Development and TestingLink Between Occupational Engagement and HealthQuantitative, Qualitative, or Mixed MethodLevel of Evidence
Arnadóttir & Fisher, 2008 XQuantitative
Baum, Connor, Morrison, Hahn, Dromerick, & Edwards (2008)XQuantitative
Classen, Levy, McCarthy, Mann, Lanford, D., & Waid-Ebbs (2009) XN/A
Denham (2008) XQuantitativeV
Doig, Fleming, Cornwell, & Kuipers (2009) XQualitative
Erez, Rothschild, Katz, Tuchner, & Hartman-Maeir (2009) XQuantitative
Faddy, McCluskey, & Lannin (2008) XQuantitative
Fong & Howie (2009) XQuantitativeII
Goverover, Arango-Lasprilla, Hillary, Chiaravalloti, & Deluca (2009) XQuantitativeII
Guidetti, Asaba, & Tham (2009) XQualitative
Guiffrida, Demery, Reyes, Lebowitz, & Hanlon (2009) XQuantitativeII
Hartman-Maeir, Harel, & Katz (2009) XQuantitative
Hill-Hermann, Strasser, Albers, Schofield, Dunning, & Levine (2008) XQuantitativeV
Lin, Wu, Lin, & Chang (2008) XII
Nakamura, Abreu, Patterson, Buford, & Ottenbacher (2008) XQuantitative
Rand, Weiss, & Katz (2009) XQuantitativeIII
Rosenstein, Ridgel, Thota, Samame, & Alberts (2008) XQuantitativeV
Rowe, Blanton, & Wolf (2009) XQuantitativeV
Shih, Rogers, Skidmore, Irrgang, & Holm (2009) XQuantitative
Smallfield & Karges (2009) XQuantitative
Toglia & Cermak (2009) XQuantitative
Turner, Ownsworth, Cornwell, & Fleming (2009) XQualitative
Warren (2009) XQuantitative
Wolf, Baum, & Connor (2009) XQuantitative
Table Footer NoteNote. N/A = not applicable. The following rating system for levels of evidence was used to rate the effectiveness studies: Level I: systematic reviews, meta-analyses, and randomized controlled trials, Level II: two groups, nonrandomized studies such as cohort or case-control designs, Level III: one-group, nonrandomized studies such as pretest and posttest designs, Level IV: descriptive studies including analysis of outcomes such as single-subject designs or case series, Level V: case reports and expert opinion including narrative literature reviews and consensus statements.
Note. N/A = not applicable. The following rating system for levels of evidence was used to rate the effectiveness studies: Level I: systematic reviews, meta-analyses, and randomized controlled trials, Level II: two groups, nonrandomized studies such as cohort or case-control designs, Level III: one-group, nonrandomized studies such as pretest and posttest designs, Level IV: descriptive studies including analysis of outcomes such as single-subject designs or case series, Level V: case reports and expert opinion including narrative literature reviews and consensus statements.×
×
Table 2.
Systematic Review of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy
Systematic Review of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy×
Author and YearResearch Methodology UsedLevel of EvidenceSample Selection MethodSample Characteristics and Inclusion-Exclusion CriteriaInstruments or Interventions UsedStatistics UsedResultsStudy Limitations
Arnadóttir & Fisher (2008) Validity and reliability testingConvenience sample using existing dataMen and women (N = 209) with stroke, dementia, or other neurological diagnoses with completed A–ONE assessments completed by certified raters Mean age = 73.7 (SD = 13.0).Instrument: The ADL scale of the A–ONERasch analysisMisfit items could be reduced by removing 2 communication items. Threshold disordering could be corrected by combining 2 scoring categories. Separation reliability for item calibration was high and acceptable for people. Principal components analysis supported unidimensionality.Limited generalization to other neurological diagnoses because stroke and dementia were the most common diagnoses included in the study.
Baum et al. (2008) Validity (construct and concurrent) and reliability (interrater) testingConvenienceMen and women with stroke (N = 73) and 22 age and education-matched control participants Mean age = 64.49 (SD = 14.28) Inclusion criteria: Confirmed diagnoses of stroke and ≥6 mo since stroke Exclusion criteria: Dementia as measured by the Short Blessed TestInstruments: EFPT, Wechsler Memory Scale, Animal Fluency, Trail Making Test B, Digits Backward, Short Blessed Scale, Trail Making Test A, Digits Forward, FIM™, and Functional Assessment MeasureANOVA, χ2 analyses, interclass correlation coefficient, and Cronbach’s αHigh interrater reliability (.91) for total score and support for internal consistency. The EFPT can discriminate between control participants and those with stroke as well as those with mild and moderately severe stroke. Concurrent validity established with 4 neuropsychological measures and with the Short Blessed Scale. Significant correlations between EFPT and Functional Assessment Measure and EFPT and FIM.Study was limited to those with mild and moderate stroke, therefore limiting generalization to those with severe involvement.
Classen, Levy, McCarthy, Mann, Lanford, D., & Waid-Ebbs (2009) Evidence-based literature reviewReview of existing and published research13 studies; sample sizes varied Exclusion criteria: Published before 1995, not primary studies, mainly qualitative or descriptive, emphasized or established, psychometrics, driving was not main outcome, and included mixed diagnostic groupsInstruments: Neuropsychological tests, simulator tests, off-road screening tests, self- and significant other report, postinjury disability status, and comprehensive driving evaluationN/ARecommendations for assessments were made for the various assessments on the basis of the tools’ predictability related to driving performance after TBI.Studies published in languages other than English were not included. Team consensus was used as opposed to rater reliability. The authors did not control for publication bias and did not seek unpublished manuscripts.
Denham (2008) Case studyVConvenienceOne 63-yr-old woman with chronic left hemiplegia secondary to a strokeIntervention: Botulinum toxin A combined with occupational therapy (splinting, active and passive range of motion, stretching, practice of bilateral functional activities) Instruments: Modified Ashworth Scale, active range of motion, and ADL evaluation (nonstandardized)N/AImproved on all measures that were maintained for 2 yrAuthors were not able to generalize findings secondary to case study format. Functional measure was nonstandardized. Multiple interventions make it difficult to interpret main therapeutic factor.
Doig, Fleming, Cornwell, & Kuipers (2009) Qualitative approach using semistructured interviewsConveniencePeople with TBI (N = 12) living in the community and 10 of their nominated significant others Mean age = 24.7 (SD = 6.9) Inclusion criteria: Between ages 16 and 65, recently discharged from inpatient rehabilitation, receiving outpatient occupational therapy, confirmed TBI, and had significant other available to participate Exclusion criteria: Low arousal, coma, confusion, significant premorbid psychiatric illness, and significant drug or alcohol useIntervention: 12-wk goaldirected, community-based occupational therapy. The COPM was used to identify goals and the Goal Attainment Scale was used to measure goal progress. Instruments: Semistructured interviews of participants, significant others, and occupational therapists involved in the programN/AAll expressed satisfaction with progress. Findings emphasized the value of goals providing structure and motivation, importance of goal ownership, importance of family involvement, the impact of cognitive impairments, and meeting the challenges of goal setting.Small sample size and recruitment from only one site limited generalizability.
Erez, Rothschild, Katz, Tuchner, & Hartman-Maeir (2009) DescriptiveConvenienceMen and women with mild TBI (N = 13) Mean time since injury = 4.79 mo Mean age = 43.4 (SD = 13.07)Instruments: Participation Index from the Mayo Portland Adaptability Inventory, Behavioral Assessment of the Dysexecutive Syndrome, Dysexecutive Questionnaire, and the Self- Awareness of Deficits InterviewDescriptives, t tests, Mann–Whitney U, and Spearman ρ correlation analysisHigh frequencies of executive function impairments were documented. Selfawareness to these deficits was intact. A high percentage of participants experienced restrictions in daily life. Participation scores were significantly correlated with measures of executive functioning.Sample size was small. Measures of emotional state were not included.
Faddy, McCluskey, & Lannin (2008) Interrater reliabilityConvenienceMen and women with brain injury (N = 10) and 2 occupational therapist raters Inclusion criteria: ≥18 yr, TBI diagnosis, 1 yr since injury, difficulty holding and using a pen, and being able to attempt to write unpromptedInstrument: Handwriting Assessment Battery for Adultsκ and intraclass coefficientsPen control and manipulation subtests showed high or perfect agreement, speed subtest showed perfect agreement, and writing legibility showed high agreement for all 5 subtests.Ceiling effects were noted. Sample size was small. The clinical profile of the participants was not included. Difficult to generalize findings.
Fong & Howie (2009) Controlled trial using matched pairsIIConvenienceN = 34 men and women s/p various acquired brain injuries Mean age = 33.4 (SD = 11.5) Excluded if <18 or >55 or had vision–hearing impairment, aphasia, or poor concentrationIntervention: Explicit problem-solving skills training using a metacomponential approach vs. conventional cognitive training that did not include explicit metacognitive training Instruments: Subtests of Behavioral Assessment of Dysexecutive Syndrome, Social Problem Solving Video Measure, Means- Ends Problem Solving Measure, Raven’s Progressive Matrices, and Metacomponential InterviewMann–Whitney UNo differences between the experimental and control groups except for 2 components from the Metacomponential Interview that favored the experimental group. Results did not generalize to everyday function.11 participants did not attend follow-up assessment. Drop-out rate was 32%. The intervention did not generalize to everyday function
Goverover, Arango-Lasprilla, Hillary, Chiaravalloti, & Deluca (2009) Within-subjects designIIConvenienceN = 25 (10 people with TBI ≥1 yr after injury and 15 healthy control participants) Mean ages = 42.5 (participants with TBI) and 43.3 (control participants) Inclusion criteria: Positive computed tomography or MRI results or loss of consciousness for ≥24 hr Exclusion criteria: Neurologic illness other than TBI, history of major psychiatric illness or alcohol or drug abuse, or severe visual or motor impairment that would interfere with study proceduresIntervention: Paragraph learning and route-learning tasks using a spacing effect strategy or via massed presentation Instruments: Performance on experimental tasksANOVAMaterial learned under the spaced learning condition was recalled better than that learned under the massed learning conditions for both the TBI group and the control group.Sample size was small. Authors were not able to ascertain whether gains were maintained. Severity of injury was not accounted for.
Guidetti, Asaba, & Tham (2009) Qualitative study using the empirical, phenomenological, psychological methodConvenienceMen and women (N = 11) s/p stroke or spinal cord injury Inclusion criteria: <65 yr, in need of self-care training, ability to understand interview questions and ability to share experiencesInstruments: Open-ended interviewsN/AThe authors documented 6 main characteristics describing the role of context in regaining selfcare ability, including support from others, an air of expectation, extended time, new daily structure, therapeutic relationship as enabling, and gradual change in challenge.Interviews were conducted on 1 occasion, risk for interviewer bias, and inclusion of 2 diagnoses could influence the documented experiences.
Guiffrida, Demery, Reyes, Lebowitz, & Hanlon (2009) 2 groups, nonrandomizedIIConvenienceMale participants (N = 6) with chronic and severe TBI Mean age = 28 Inclusion criteria: Single TBI; ≥18 mo since injury; no history of substance abuse, learning disability, attention deficit disorder, or severe psychiatric illnessIntervention: Practice of functional skills using either random or blocked practice schedules; practiced occurred 55 min per day for 13 days Instruments: Performance of experimental tasks—typing, data input, and learning a subway schedule Transfer-of-learning task: typing dictationANOVABoth groups showed improvements across tasks at the end of training and retained this improvement 2 wk after training. Only the random practice group was able to transfer learning to a new and similar task.Sample size was small.
Hartman-Maeir, Harel, & Katz (2009) Validity (construct, convergent, ecological) and reliability (interrater) testingConvenienceFor reliability study: Men and women with stroke (N = 21) and 4 occupational therapists Age: Site 1, M = 79.3 (SD = 5.8); Site 2, M = 77.82 (SD = 5.1). Inclusion criteria: Alert, receptive language intact, and independent in community before stroke For validity study: Men and women with stroke (N = 36) and 36 healthy control participants Mean age = 74.81 (SD = 7.32) for participants with stroke and 72.67 (SD = 6.59) for control participants Inclusion criteria: Same as for reliability studyInstruments: Kettle Test, MMSE, Clock Drawing Test, Star Cancellation, Cognitive and Motor scales of the FIM, IADL Scale, the Fugl-Meyer Motor Assessment, and the Safety Rating ScaleDescriptives, ANCOVA, Pearson correlations coefficientsInterrater reliability is high. Those with stroke required significantly more assistance on the Kettle Test than control participants. Kettle Test moderately and significantly correlated with conventional cognitive measures. The Kettle Test correlated significantly with the FIM, safety measures, and IADLs.Sample size was small. IADL data were collected via phone.
Hill-Hermann, Strasser, Albers, Schofield, Dunning, Levine et al. (2008) Case studyVConvenienceOne 61-yr-old woman s/p cerebrovascular accident 16 mo earlier Inclusion criteria: 10° of active extension in the affected wrist and 2 additional digits of the affected hand; stroke experienced >3 mo prior; >70 on the MMSE; age between 35 and 85; no excessive spasticity; no excessive pain; experienced only one stroke; discharged from all forms of therapy; a detectable surface electromyograph signal of ≥5 μV Exclusion criteria: Participating in any experimental rehabilitation or drug studies; being pregnant; having an uncontrolled seizure disorderIntervention: 3-hr ADL training sessions 5 days per wk for 3 wk using a neuroprosthesis Instruments: Fugl-Meyer, Action Research Arm est, Arm Motor Activity Test, and COPMN/AImprovements noted on all measures. The patient exhibited reduced impairment (Fugl-Meyer score change from 31 to 35), Arm Motor Activity Test score decreased from 99 to 98, decreased time needed to complete Arm Motor Activity Test tasks (from 998 s to 558 s), and increased Action Research Arm score (from 27 to 31). COPM performance score increased 5.8, and the COPM satisfaction score increased 4.3.Authors were not able to generalize secondary to case study format. Relatively modest gains on some measures were reported.
Lin, Wu, Lin, & Chang (2008) Counterbalanced repeated measuresIIConvenienceMen and women (N = 26) with unilateral cerebrovascular accident and 24 age-matched healthy people Average time since stroke was 2.62 mo. Mean age = 62.3 Inclusion criteria: Able to understand or respond to directions, no signs of motor apraxia or visuospatial neglect; no history of prior stroke or visual deficits Control group with no neurologic or psychiatric history by self-reportIntervention: Random assignment to one of four sequences for executing a reaching task with the less-affected limb. Experimental conditions were formed by crossing task instructions with a speed and accuracy emphasis and target locations ipsilateral and contralateral to the to the less-affected hand used for performance. Instruments: Six-camera motion analysis systemANOVAFindings for healthy control participants: Speeded instructions and ipsilateral reaches elicited more preprogrammed movements than accuracy instruction and contralateral reaches. Findings for those with stroke were similar to those for control participants with the exception of movement initiation in those with right-sided strokes. Overall, a combination of speeded instruction and ipsilateral reach seemed to optimize movement performance of the less-affected limb in those with stroke.The study used impairment-only measures. Stroke severity was not considered.
Nakamura, Abreu, Patterson, Buford, & Ottenbacher (2008) DescriptiveConvenienceN = 34; 17 with brain injury including stroke and TBI and 17 without brain injury Mean ages = 40.7 (participants with brain injury) and 41.5 (participants without brain injury) Inclusion criteria: Diagnosis of stroke or head injury, >18, able to follow multistep requests, and no history of apraxiaInstrument: Six-camera motion analysis systemANOVAThe presumed-to-beunaffected upper limb of those with brain injury demonstrated longer movement duration and slower average speed, was supported by excessive trunk movement, and had decreased smoothness during reaching than that of the group without brain injury.Sample size was small. Homogeneous sample in terms of diagnosis, stage of recovery, and handedness
Rand, Weiss, & Katz (2009) Pretest–posttest designIIIConvenienceMen and women (N = 4) who had sustained a stroke ranging in age from 53 to 70 Time since stroke ranged from 5 to 27 mo Inclusion criteria: Unilateral first stroke, discharged home, scores >26–30 on the MMSE, no neglect or depression, evidence of deficits in executive functions as tested via subtests of the Behavioral Assessment of the Dysexecutive SyndromeInterventions: Ten 60-min sessions over 3 wk using VMall (a virtual supermarket) Instruments: MET, Virtual MET, and IADL questionnairePercentage of improvementAlthough results varied, overall improvements in both the MET and Virtual MET ranged from 20.5% to 51.2% for all mistake categories except for “use of strategies,” which improved 7.7% IADL scores did not improve.Sample size was small. Properties of Virtual MET are not clear, and stroke severity was not considered. Heterogeneous sample was a limitation.
Rosenstein, Ridgel, Thota, Samame, & Alberts (2008) Case studyVConvenienceOne 32-yr-old woman who had sustained a stroke 11 mo prior presenting with aphasia and a nonfunctional right dominant upper extremityInterventions: 2 hr of training with an assistive repetitive motion robotic device and 2 hr of repetitive task practice (including one to two 10- to 15-min breaks per day). The patient completed 12 of the 15 scheduled days. Instruments: Wolf Motor Function Test, the upperextremity portion of the Fugl-Meyer Motor Assessment, bimanual dexterity task, and the Modified Ashworth ScaleN/AModest yet favorable scores on 4 subtests of the Wolf Motor Function Test, 3-point increase on the Fugl-Meyer, Modified Ashworth Scale decrease from 1 + to 1 at elbow with no change at forearm and wrist. Active range of motion increased by 35° in the shoulder, 65° in the wrist, and 70° in the thumb. Kinetic analysis of a bimanual dexterity task indicated improved grasping forces for both limbs.Authors not able to generalize because of case study format. Relatively modest gains were reported on measures.
Rowe, Blanton, & Wolf (2009) Case studyVConvenienceOne 36-yr-old woman who sustained an ischemic infarct to the left internal capsule and basal gangliaIntervention: 2 wk on modified constraintinduced movement therapy (5 days/wk, 5.5 hr/day plus independent task practice in the evening and weekends) Instruments: Wolf Motor Function Test, Stroke Impact Scale, and the Motor Activity LogN/AImprovements noted on most subtests of all measures after treatment that generally persisted at both 4- and 5-yr follow-up assessments.Authors were not able to generalize because of case study format.
Shih, Rogers, Skidmore, Irrgang, & Holm (2009) Validity (construct) and reliability testingData derived from a large prospective stroke studyMen and women 3 mo after stroke (N = 68) Mean age = 65.53 (SD = 14.03) Inclusion criteria: Diagnosis of acute stroke, available radiologic data, and physician approvalInstruments: Glasgow Outcome Scale 5-point version, Glasgow Outcome Scale 8-point version, Modified Rankin Scale, Barthel Index, and the Performance Assessment of Self-Care SkillsRasch analysisThe 5 measures evaluated independence somewhat differently, and constructs other than ADL independence are included in some measures. Construct validity and reliability of the combined measures also indicated that the tools are not interchangeable.Sample was heterogeneous in terms of type of stroke. Because this was a secondary analysis, some variables were not available in the original data set.
Smallfield & Karges (2009) DescriptiveRetrospective chart auditMen and women with stroke (N = 80) Mean age = 70.28 (SD = 11.35). Inclusion criteria: Between the ages of 18 and 85, confirmed stroke, received occupational therapy and physical therapy during inpatient rehabilitation, FIM scores documented, and completion of inpatient stayInstruments: Data collection tool devised for study using the Occupational Therapy Practice Framework to classify content of occupational therapy sessions; type of assistive devices prescribed was documentedDescriptive and frequencies65.77% of occupational therapy activities within sessions were considered prefunctional compared with 48.26% that focused on ADLs. Musculoskeletal interventions were used in >50% of sessions, and grab bars and bathroom equipment were more commonly used than dressing equipment.Authors were not able to generalize because data were collected from 1 facility. Interventions may have not been documented or may have been documented incorrectly.
Toglia & Cermak (2009) Pretest–posttestConvenienceMen and women with unilateral neglect secondary to stroke (N = 40) Mean age = 67.82 (SD = 10.97) Inclusion criteria: Evidence of neglect on at least 1 of 3 tests, follow 2-step directions, and competent to provide consentInstruments: Line crossing, Star Cancellation, picture scanning task, and object search task, which was administered either as static or dynamicχ2 analysis, independent t tests, ANOVA, MANCOVASignificant differences were detected on the object search task. Those in the dynamic assessment group had reduced neglect. In addition, those in the dynamic group had greater initiation of left-sided searches, using strategies, and near and intermediate transfer of learning.Article focused only on the spatial aspect of neglect. Small sample size was heterogeneous in terms of severity.
Turner, Ownsworth, Cornwell, & Fleming (2009) Qualitative, using a phenomenological approachConvenienceMen and women with acquired brain injury (N = 18) and 18 family caregivers Mean ages = 40.2 (SD = 14.5) for participants and 46.63 (SD = 10.9) for caregivers Inclusion criteria: Documented diagnosis of acquired brain injury, expected to return home on discharge, >16 yr old, adequate English communication skills, and capacity to provide informed consent Exclusion criteria: Premorbid neurological or psychiatric conditionInstrument: Semistructured interviews at 3 points in timeN/ATwo primary themes emerged: Desired vs. actual participation in occupation and the struggle for independenceAuthors were not able to generalize because the study was conducted in a specific setting and cultural context. The study focused only on early transition (≤3 mo). Therapist perspective was not considered.
Warren (2009) DescriptiveConvenienceMen and women with visual field deficits (N = 46) Mean age = 65 Inclusion criteria: >18, visual field loss secondary to acquired brain injury, no ocular pathology affecting acuity or field, corrected visual acuity to 20/80 or better, sufficient cognition and language to participate in sessions, no neglect, and no significant physical impairment that may interfere with ADL performanceInstruments: Early Treatment Diabetic Retinopathy Study 2000 series charts (acuity), Humphrey Visual Field Analyzer, Behavioral Inattention Test (four subtests), Visual Skills for Reading Test, semistructured interview regarding perceptions of difficult occupationsDescriptivesThose with visual field deficits reported minimal difficulty completing basic ADLs and significant difficulty with IADLs such as driving, shopping, and meal preparation.Sample was biased toward people with more significant ADL limitations. A nonstandardized ADL tool was used.Heterogeneous sample regarding type and location of visual field deficits limits generalizability.
Wolf, Baum, & Connor (2009) DescriptiveExisting databaseMen and women with stroke (N = 7,740) who were treated at a particular center between 1999 and Spring 2008Instruments: National Institutes of Health Stroke Scale and demographicsDescriptivesThe age of stroke is deceasing, most strokes are mild or moderate in severity, and discharge decisions are made largely on impairment measures.Data collected at one center.
Table Footer NoteNote. ADLs = activities of daily living; SD = standard deviation; TBI = traumatic brain injury; ANOVA = analysis of variance; N/A = not applicable; COPM = Canadian Occupational Performance Measure; s/p = status post; MMSE = Mini-Mental State Examination; ANC0VA = analysis of covariance; lADLs = instrumental activities of daily living; MET = Multiple Errands Test; MANOVA = multivariate analysis of variance; A-ONE = AD L-focused Occupation-based Neurobehavioral Evaluation; EFPT = Executive Function Performance Test.
Note. ADLs = activities of daily living; SD = standard deviation; TBI = traumatic brain injury; ANOVA = analysis of variance; N/A = not applicable; COPM = Canadian Occupational Performance Measure; s/p = status post; MMSE = Mini-Mental State Examination; ANC0VA = analysis of covariance; lADLs = instrumental activities of daily living; MET = Multiple Errands Test; MANOVA = multivariate analysis of variance; A-ONE = AD L-focused Occupation-based Neurobehavioral Evaluation; EFPT = Executive Function Performance Test.×
Table 2.
Systematic Review of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy
Systematic Review of Neurorehabilitation Research Published Between 2008 and 2009 in the American Journal of Occupational Therapy×
Author and YearResearch Methodology UsedLevel of EvidenceSample Selection MethodSample Characteristics and Inclusion-Exclusion CriteriaInstruments or Interventions UsedStatistics UsedResultsStudy Limitations
Arnadóttir & Fisher (2008) Validity and reliability testingConvenience sample using existing dataMen and women (N = 209) with stroke, dementia, or other neurological diagnoses with completed A–ONE assessments completed by certified raters Mean age = 73.7 (SD = 13.0).Instrument: The ADL scale of the A–ONERasch analysisMisfit items could be reduced by removing 2 communication items. Threshold disordering could be corrected by combining 2 scoring categories. Separation reliability for item calibration was high and acceptable for people. Principal components analysis supported unidimensionality.Limited generalization to other neurological diagnoses because stroke and dementia were the most common diagnoses included in the study.
Baum et al. (2008) Validity (construct and concurrent) and reliability (interrater) testingConvenienceMen and women with stroke (N = 73) and 22 age and education-matched control participants Mean age = 64.49 (SD = 14.28) Inclusion criteria: Confirmed diagnoses of stroke and ≥6 mo since stroke Exclusion criteria: Dementia as measured by the Short Blessed TestInstruments: EFPT, Wechsler Memory Scale, Animal Fluency, Trail Making Test B, Digits Backward, Short Blessed Scale, Trail Making Test A, Digits Forward, FIM™, and Functional Assessment MeasureANOVA, χ2 analyses, interclass correlation coefficient, and Cronbach’s αHigh interrater reliability (.91) for total score and support for internal consistency. The EFPT can discriminate between control participants and those with stroke as well as those with mild and moderately severe stroke. Concurrent validity established with 4 neuropsychological measures and with the Short Blessed Scale. Significant correlations between EFPT and Functional Assessment Measure and EFPT and FIM.Study was limited to those with mild and moderate stroke, therefore limiting generalization to those with severe involvement.
Classen, Levy, McCarthy, Mann, Lanford, D., & Waid-Ebbs (2009) Evidence-based literature reviewReview of existing and published research13 studies; sample sizes varied Exclusion criteria: Published before 1995, not primary studies, mainly qualitative or descriptive, emphasized or established, psychometrics, driving was not main outcome, and included mixed diagnostic groupsInstruments: Neuropsychological tests, simulator tests, off-road screening tests, self- and significant other report, postinjury disability status, and comprehensive driving evaluationN/ARecommendations for assessments were made for the various assessments on the basis of the tools’ predictability related to driving performance after TBI.Studies published in languages other than English were not included. Team consensus was used as opposed to rater reliability. The authors did not control for publication bias and did not seek unpublished manuscripts.
Denham (2008) Case studyVConvenienceOne 63-yr-old woman with chronic left hemiplegia secondary to a strokeIntervention: Botulinum toxin A combined with occupational therapy (splinting, active and passive range of motion, stretching, practice of bilateral functional activities) Instruments: Modified Ashworth Scale, active range of motion, and ADL evaluation (nonstandardized)N/AImproved on all measures that were maintained for 2 yrAuthors were not able to generalize findings secondary to case study format. Functional measure was nonstandardized. Multiple interventions make it difficult to interpret main therapeutic factor.
Doig, Fleming, Cornwell, & Kuipers (2009) Qualitative approach using semistructured interviewsConveniencePeople with TBI (N = 12) living in the community and 10 of their nominated significant others Mean age = 24.7 (SD = 6.9) Inclusion criteria: Between ages 16 and 65, recently discharged from inpatient rehabilitation, receiving outpatient occupational therapy, confirmed TBI, and had significant other available to participate Exclusion criteria: Low arousal, coma, confusion, significant premorbid psychiatric illness, and significant drug or alcohol useIntervention: 12-wk goaldirected, community-based occupational therapy. The COPM was used to identify goals and the Goal Attainment Scale was used to measure goal progress. Instruments: Semistructured interviews of participants, significant others, and occupational therapists involved in the programN/AAll expressed satisfaction with progress. Findings emphasized the value of goals providing structure and motivation, importance of goal ownership, importance of family involvement, the impact of cognitive impairments, and meeting the challenges of goal setting.Small sample size and recruitment from only one site limited generalizability.
Erez, Rothschild, Katz, Tuchner, & Hartman-Maeir (2009) DescriptiveConvenienceMen and women with mild TBI (N = 13) Mean time since injury = 4.79 mo Mean age = 43.4 (SD = 13.07)Instruments: Participation Index from the Mayo Portland Adaptability Inventory, Behavioral Assessment of the Dysexecutive Syndrome, Dysexecutive Questionnaire, and the Self- Awareness of Deficits InterviewDescriptives, t tests, Mann–Whitney U, and Spearman ρ correlation analysisHigh frequencies of executive function impairments were documented. Selfawareness to these deficits was intact. A high percentage of participants experienced restrictions in daily life. Participation scores were significantly correlated with measures of executive functioning.Sample size was small. Measures of emotional state were not included.
Faddy, McCluskey, & Lannin (2008) Interrater reliabilityConvenienceMen and women with brain injury (N = 10) and 2 occupational therapist raters Inclusion criteria: ≥18 yr, TBI diagnosis, 1 yr since injury, difficulty holding and using a pen, and being able to attempt to write unpromptedInstrument: Handwriting Assessment Battery for Adultsκ and intraclass coefficientsPen control and manipulation subtests showed high or perfect agreement, speed subtest showed perfect agreement, and writing legibility showed high agreement for all 5 subtests.Ceiling effects were noted. Sample size was small. The clinical profile of the participants was not included. Difficult to generalize findings.
Fong & Howie (2009) Controlled trial using matched pairsIIConvenienceN = 34 men and women s/p various acquired brain injuries Mean age = 33.4 (SD = 11.5) Excluded if <18 or >55 or had vision–hearing impairment, aphasia, or poor concentrationIntervention: Explicit problem-solving skills training using a metacomponential approach vs. conventional cognitive training that did not include explicit metacognitive training Instruments: Subtests of Behavioral Assessment of Dysexecutive Syndrome, Social Problem Solving Video Measure, Means- Ends Problem Solving Measure, Raven’s Progressive Matrices, and Metacomponential InterviewMann–Whitney UNo differences between the experimental and control groups except for 2 components from the Metacomponential Interview that favored the experimental group. Results did not generalize to everyday function.11 participants did not attend follow-up assessment. Drop-out rate was 32%. The intervention did not generalize to everyday function
Goverover, Arango-Lasprilla, Hillary, Chiaravalloti, & Deluca (2009) Within-subjects designIIConvenienceN = 25 (10 people with TBI ≥1 yr after injury and 15 healthy control participants) Mean ages = 42.5 (participants with TBI) and 43.3 (control participants) Inclusion criteria: Positive computed tomography or MRI results or loss of consciousness for ≥24 hr Exclusion criteria: Neurologic illness other than TBI, history of major psychiatric illness or alcohol or drug abuse, or severe visual or motor impairment that would interfere with study proceduresIntervention: Paragraph learning and route-learning tasks using a spacing effect strategy or via massed presentation Instruments: Performance on experimental tasksANOVAMaterial learned under the spaced learning condition was recalled better than that learned under the massed learning conditions for both the TBI group and the control group.Sample size was small. Authors were not able to ascertain whether gains were maintained. Severity of injury was not accounted for.
Guidetti, Asaba, & Tham (2009) Qualitative study using the empirical, phenomenological, psychological methodConvenienceMen and women (N = 11) s/p stroke or spinal cord injury Inclusion criteria: <65 yr, in need of self-care training, ability to understand interview questions and ability to share experiencesInstruments: Open-ended interviewsN/AThe authors documented 6 main characteristics describing the role of context in regaining selfcare ability, including support from others, an air of expectation, extended time, new daily structure, therapeutic relationship as enabling, and gradual change in challenge.Interviews were conducted on 1 occasion, risk for interviewer bias, and inclusion of 2 diagnoses could influence the documented experiences.
Guiffrida, Demery, Reyes, Lebowitz, & Hanlon (2009) 2 groups, nonrandomizedIIConvenienceMale participants (N = 6) with chronic and severe TBI Mean age = 28 Inclusion criteria: Single TBI; ≥18 mo since injury; no history of substance abuse, learning disability, attention deficit disorder, or severe psychiatric illnessIntervention: Practice of functional skills using either random or blocked practice schedules; practiced occurred 55 min per day for 13 days Instruments: Performance of experimental tasks—typing, data input, and learning a subway schedule Transfer-of-learning task: typing dictationANOVABoth groups showed improvements across tasks at the end of training and retained this improvement 2 wk after training. Only the random practice group was able to transfer learning to a new and similar task.Sample size was small.
Hartman-Maeir, Harel, & Katz (2009) Validity (construct, convergent, ecological) and reliability (interrater) testingConvenienceFor reliability study: Men and women with stroke (N = 21) and 4 occupational therapists Age: Site 1, M = 79.3 (SD = 5.8); Site 2, M = 77.82 (SD = 5.1). Inclusion criteria: Alert, receptive language intact, and independent in community before stroke For validity study: Men and women with stroke (N = 36) and 36 healthy control participants Mean age = 74.81 (SD = 7.32) for participants with stroke and 72.67 (SD = 6.59) for control participants Inclusion criteria: Same as for reliability studyInstruments: Kettle Test, MMSE, Clock Drawing Test, Star Cancellation, Cognitive and Motor scales of the FIM, IADL Scale, the Fugl-Meyer Motor Assessment, and the Safety Rating ScaleDescriptives, ANCOVA, Pearson correlations coefficientsInterrater reliability is high. Those with stroke required significantly more assistance on the Kettle Test than control participants. Kettle Test moderately and significantly correlated with conventional cognitive measures. The Kettle Test correlated significantly with the FIM, safety measures, and IADLs.Sample size was small. IADL data were collected via phone.
Hill-Hermann, Strasser, Albers, Schofield, Dunning, Levine et al. (2008) Case studyVConvenienceOne 61-yr-old woman s/p cerebrovascular accident 16 mo earlier Inclusion criteria: 10° of active extension in the affected wrist and 2 additional digits of the affected hand; stroke experienced >3 mo prior; >70 on the MMSE; age between 35 and 85; no excessive spasticity; no excessive pain; experienced only one stroke; discharged from all forms of therapy; a detectable surface electromyograph signal of ≥5 μV Exclusion criteria: Participating in any experimental rehabilitation or drug studies; being pregnant; having an uncontrolled seizure disorderIntervention: 3-hr ADL training sessions 5 days per wk for 3 wk using a neuroprosthesis Instruments: Fugl-Meyer, Action Research Arm est, Arm Motor Activity Test, and COPMN/AImprovements noted on all measures. The patient exhibited reduced impairment (Fugl-Meyer score change from 31 to 35), Arm Motor Activity Test score decreased from 99 to 98, decreased time needed to complete Arm Motor Activity Test tasks (from 998 s to 558 s), and increased Action Research Arm score (from 27 to 31). COPM performance score increased 5.8, and the COPM satisfaction score increased 4.3.Authors were not able to generalize secondary to case study format. Relatively modest gains on some measures were reported.
Lin, Wu, Lin, & Chang (2008) Counterbalanced repeated measuresIIConvenienceMen and women (N = 26) with unilateral cerebrovascular accident and 24 age-matched healthy people Average time since stroke was 2.62 mo. Mean age = 62.3 Inclusion criteria: Able to understand or respond to directions, no signs of motor apraxia or visuospatial neglect; no history of prior stroke or visual deficits Control group with no neurologic or psychiatric history by self-reportIntervention: Random assignment to one of four sequences for executing a reaching task with the less-affected limb. Experimental conditions were formed by crossing task instructions with a speed and accuracy emphasis and target locations ipsilateral and contralateral to the to the less-affected hand used for performance. Instruments: Six-camera motion analysis systemANOVAFindings for healthy control participants: Speeded instructions and ipsilateral reaches elicited more preprogrammed movements than accuracy instruction and contralateral reaches. Findings for those with stroke were similar to those for control participants with the exception of movement initiation in those with right-sided strokes. Overall, a combination of speeded instruction and ipsilateral reach seemed to optimize movement performance of the less-affected limb in those with stroke.The study used impairment-only measures. Stroke severity was not considered.
Nakamura, Abreu, Patterson, Buford, & Ottenbacher (2008) DescriptiveConvenienceN = 34; 17 with brain injury including stroke and TBI and 17 without brain injury Mean ages = 40.7 (participants with brain injury) and 41.5 (participants without brain injury) Inclusion criteria: Diagnosis of stroke or head injury, >18, able to follow multistep requests, and no history of apraxiaInstrument: Six-camera motion analysis systemANOVAThe presumed-to-beunaffected upper limb of those with brain injury demonstrated longer movement duration and slower average speed, was supported by excessive trunk movement, and had decreased smoothness during reaching than that of the group without brain injury.Sample size was small. Homogeneous sample in terms of diagnosis, stage of recovery, and handedness
Rand, Weiss, & Katz (2009) Pretest–posttest designIIIConvenienceMen and women (N = 4) who had sustained a stroke ranging in age from 53 to 70 Time since stroke ranged from 5 to 27 mo Inclusion criteria: Unilateral first stroke, discharged home, scores >26–30 on the MMSE, no neglect or depression, evidence of deficits in executive functions as tested via subtests of the Behavioral Assessment of the Dysexecutive SyndromeInterventions: Ten 60-min sessions over 3 wk using VMall (a virtual supermarket) Instruments: MET, Virtual MET, and IADL questionnairePercentage of improvementAlthough results varied, overall improvements in both the MET and Virtual MET ranged from 20.5% to 51.2% for all mistake categories except for “use of strategies,” which improved 7.7% IADL scores did not improve.Sample size was small. Properties of Virtual MET are not clear, and stroke severity was not considered. Heterogeneous sample was a limitation.
Rosenstein, Ridgel, Thota, Samame, & Alberts (2008) Case studyVConvenienceOne 32-yr-old woman who had sustained a stroke 11 mo prior presenting with aphasia and a nonfunctional right dominant upper extremityInterventions: 2 hr of training with an assistive repetitive motion robotic device and 2 hr of repetitive task practice (including one to two 10- to 15-min breaks per day). The patient completed 12 of the 15 scheduled days. Instruments: Wolf Motor Function Test, the upperextremity portion of the Fugl-Meyer Motor Assessment, bimanual dexterity task, and the Modified Ashworth ScaleN/AModest yet favorable scores on 4 subtests of the Wolf Motor Function Test, 3-point increase on the Fugl-Meyer, Modified Ashworth Scale decrease from 1 + to 1 at elbow with no change at forearm and wrist. Active range of motion increased by 35° in the shoulder, 65° in the wrist, and 70° in the thumb. Kinetic analysis of a bimanual dexterity task indicated improved grasping forces for both limbs.Authors not able to generalize because of case study format. Relatively modest gains were reported on measures.
Rowe, Blanton, & Wolf (2009) Case studyVConvenienceOne 36-yr-old woman who sustained an ischemic infarct to the left internal capsule and basal gangliaIntervention: 2 wk on modified constraintinduced movement therapy (5 days/wk, 5.5 hr/day plus independent task practice in the evening and weekends) Instruments: Wolf Motor Function Test, Stroke Impact Scale, and the Motor Activity LogN/AImprovements noted on most subtests of all measures after treatment that generally persisted at both 4- and 5-yr follow-up assessments.Authors were not able to generalize because of case study format.
Shih, Rogers, Skidmore, Irrgang, & Holm (2009) Validity (construct) and reliability testingData derived from a large prospective stroke studyMen and women 3 mo after stroke (N = 68) Mean age = 65.53 (SD = 14.03) Inclusion criteria: Diagnosis of acute stroke, available radiologic data, and physician approvalInstruments: Glasgow Outcome Scale 5-point version, Glasgow Outcome Scale 8-point version, Modified Rankin Scale, Barthel Index, and the Performance Assessment of Self-Care SkillsRasch analysisThe 5 measures evaluated independence somewhat differently, and constructs other than ADL independence are included in some measures. Construct validity and reliability of the combined measures also indicated that the tools are not interchangeable.Sample was heterogeneous in terms of type of stroke. Because this was a secondary analysis, some variables were not available in the original data set.
Smallfield & Karges (2009) DescriptiveRetrospective chart auditMen and women with stroke (N = 80) Mean age = 70.28 (SD = 11.35). Inclusion criteria: Between the ages of 18 and 85, confirmed stroke, received occupational therapy and physical therapy during inpatient rehabilitation, FIM scores documented, and completion of inpatient stayInstruments: Data collection tool devised for study using the Occupational Therapy Practice Framework to classify content of occupational therapy sessions; type of assistive devices prescribed was documentedDescriptive and frequencies65.77% of occupational therapy activities within sessions were considered prefunctional compared with 48.26% that focused on ADLs. Musculoskeletal interventions were used in >50% of sessions, and grab bars and bathroom equipment were more commonly used than dressing equipment.Authors were not able to generalize because data were collected from 1 facility. Interventions may have not been documented or may have been documented incorrectly.
Toglia & Cermak (2009) Pretest–posttestConvenienceMen and women with unilateral neglect secondary to stroke (N = 40) Mean age = 67.82 (SD = 10.97) Inclusion criteria: Evidence of neglect on at least 1 of 3 tests, follow 2-step directions, and competent to provide consentInstruments: Line crossing, Star Cancellation, picture scanning task, and object search task, which was administered either as static or dynamicχ2 analysis, independent t tests, ANOVA, MANCOVASignificant differences were detected on the object search task. Those in the dynamic assessment group had reduced neglect. In addition, those in the dynamic group had greater initiation of left-sided searches, using strategies, and near and intermediate transfer of learning.Article focused only on the spatial aspect of neglect. Small sample size was heterogeneous in terms of severity.
Turner, Ownsworth, Cornwell, & Fleming (2009) Qualitative, using a phenomenological approachConvenienceMen and women with acquired brain injury (N = 18) and 18 family caregivers Mean ages = 40.2 (SD = 14.5) for participants and 46.63 (SD = 10.9) for caregivers Inclusion criteria: Documented diagnosis of acquired brain injury, expected to return home on discharge, >16 yr old, adequate English communication skills, and capacity to provide informed consent Exclusion criteria: Premorbid neurological or psychiatric conditionInstrument: Semistructured interviews at 3 points in timeN/ATwo primary themes emerged: Desired vs. actual participation in occupation and the struggle for independenceAuthors were not able to generalize because the study was conducted in a specific setting and cultural context. The study focused only on early transition (≤3 mo). Therapist perspective was not considered.
Warren (2009) DescriptiveConvenienceMen and women with visual field deficits (N = 46) Mean age = 65 Inclusion criteria: >18, visual field loss secondary to acquired brain injury, no ocular pathology affecting acuity or field, corrected visual acuity to 20/80 or better, sufficient cognition and language to participate in sessions, no neglect, and no significant physical impairment that may interfere with ADL performanceInstruments: Early Treatment Diabetic Retinopathy Study 2000 series charts (acuity), Humphrey Visual Field Analyzer, Behavioral Inattention Test (four subtests), Visual Skills for Reading Test, semistructured interview regarding perceptions of difficult occupationsDescriptivesThose with visual field deficits reported minimal difficulty completing basic ADLs and significant difficulty with IADLs such as driving, shopping, and meal preparation.Sample was biased toward people with more significant ADL limitations. A nonstandardized ADL tool was used.Heterogeneous sample regarding type and location of visual field deficits limits generalizability.
Wolf, Baum, & Connor (2009) DescriptiveExisting databaseMen and women with stroke (N = 7,740) who were treated at a particular center between 1999 and Spring 2008Instruments: National Institutes of Health Stroke Scale and demographicsDescriptivesThe age of stroke is deceasing, most strokes are mild or moderate in severity, and discharge decisions are made largely on impairment measures.Data collected at one center.
Table Footer NoteNote. ADLs = activities of daily living; SD = standard deviation; TBI = traumatic brain injury; ANOVA = analysis of variance; N/A = not applicable; COPM = Canadian Occupational Performance Measure; s/p = status post; MMSE = Mini-Mental State Examination; ANC0VA = analysis of covariance; lADLs = instrumental activities of daily living; MET = Multiple Errands Test; MANOVA = multivariate analysis of variance; A-ONE = AD L-focused Occupation-based Neurobehavioral Evaluation; EFPT = Executive Function Performance Test.
Note. ADLs = activities of daily living; SD = standard deviation; TBI = traumatic brain injury; ANOVA = analysis of variance; N/A = not applicable; COPM = Canadian Occupational Performance Measure; s/p = status post; MMSE = Mini-Mental State Examination; ANC0VA = analysis of covariance; lADLs = instrumental activities of daily living; MET = Multiple Errands Test; MANOVA = multivariate analysis of variance; A-ONE = AD L-focused Occupation-based Neurobehavioral Evaluation; EFPT = Executive Function Performance Test.×
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