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Date Presented 4/8/2016 This project contributes important knowledge about the use of information and communication technologies (ICT) among older adults at risk for stroke. This information is important both because of the risks and possibilities of ICT in health care and to develop future practice innovations for occupational therapy. Primary Author and Speaker: Eric Asaba Contributing Authors: Eric Asaba, Ann-Helen Patomells, Susanne Guidetti, Anders Kottorp, Kerstin Tham

Date Presented 4/9/2016 Participation in everyday occupations and satisfaction were explored with the Occupational Gaps Questionnaire in persons after a stroke. Findings empirically show that people are satisfied when participating in occupations that they want to do, supporting an assumption in occupational therapy. Primary Author and Speaker: Aileen Bergström Contributing Authors: Gunilla Eriksson, Susanne Guidetti, Kerstin Tham

The aim of this study was to describe occupational therapists' expectations and experiences of integrating a new intervention programme within an RCT pilot study, in collaboration with a researcher.Six occupational therapists participated in a five-day training course (during a one-month period) including lectures, reading articles, and discussions. The data were collected through interviews and written reflections, analysed by a qualitative constant comparative approach.The findings displayed a process of change, primarily in the participants' way of integrating research in their clinical practice. Three main categories were identified as: hope of taking part in a research project, confirmation of anchoring, and experience of scepticism. These categories constituted the core category "The occupational therapist's process of integrating research in a clinical context with the prerequisite being a dialogue and a sharing of responsibility and authority between researcher and occupational therapist". A tentative model was formulated which described how the various categories were related to one another as well as how change occurred over time in the context in which the study was carried out.One conclusion is the importance of providing opportunities for creating dialogues among researcher and practitioners to narrowing the gap between research and "everyday practice of occupational therapy".

Objective: To explore and describe factors associated with occupational gaps and to identify factors at 3 months that predict occupational gaps one year post-stroke. A gap, a restriction in participation, is considered to be present when there is a discrepancy between what the individual wants to do and what they actually do in everyday life. Design: Prospective longitudinal study. Subjects: Two hundred persons with stroke. Methods: Data from the Occupational Gaps Questionnaire, one year post-stroke, was used as the dependent variable in 3- and 12-month regression analyses. Domains of the Stroke Impact Scale, global life satisfaction, demographic and medical factors were used as independent variables. Results: At 3 months, activities of daily living abilities, social participation and not being born in Sweden predicted occupational gaps at 12 months. Stroke severity and not being born in Sweden and 3 factors at 12 months: social participation, self-rated recovery, and global life satisfaction were associated with occupational gaps. Conclusion: Activities of daily living ability at 3 months predicted occupational gaps after stroke. Thus, it is possible to identify early on, and provide interventions for, those that risk participation restrictions. Not being born in the country might be an indicator of a risk for participation restrictions.

To describe and compare how occupational gaps were reported in everyday occupations in a rehabilitation group of people with musculoskeletal pain or stress-related ill health and in a reference group from the Swedish population.Seventy-two persons with musculoskeletal pain or stress-related ill health and 261 people from the Swedish population were included. The Occupational Gaps Questionnaire, measuring to what extent individuals perceive a discrepancy between what they want to do and what they actually do, was completed by the participants. Descriptive statistics were used to analyse the data.Occupational gaps were reported more often in the rehabilitation group. Leisure activities were the gaps reported most often. The occupational repertoire seemed to decrease over time as the number of activities was decreasing, particularly leisure and work-related activities. Instrumental ADL were more desirable as the length of sick leave extended.Being on sick leave appears to start a process towards occupational deprivation where the areas that remain in the occupational repertoire become more important. Our study highlights the need to emphasize the whole occupational repertoire in rehabilitation and to facilitate engagement in valued activities to create a sound base for the process of returning to work.

To examine eating difficulties among stroke patients - a comparison between women and men.Gender differences have been reported in studies of stroke, but the findings are inconclusive and few of these studies have specifically focused on gender differences in eating difficulties.This study was a descriptive, cross-sectional, comparative study.Patients with stroke were recruited at a general hospital in Sweden. To detect eating difficulties, individual observations of the patients were made during one meal using a structured observation protocol. Assessment also included measurements of nutritional and oral status, degree of independence, stroke severity, neglect and well-being.One hundred and four patients (53·8% women) were included in the study. The proportion of stroke patients with one or more eating difficulties was 81·7%. The most common eating difficulties were 'managing food on the plate' (66·3%), 'food consumption' (54·8%) and 'sitting position' (45·2%). Women had lower 'food consumption', more severe stroke (p = 0·003), worse functional status (p = 0·001) and lower quality of life (QoL) (p=0·038) than men. More women than men were malnourished and living alone. After adjustment for functional status and motor arm, the odds ratio of having difficulties with food consumption was four times higher among women than men (1·7-9·4, confidence interval 95%).More women than men with stroke suffered from inadequate food consumption. The women had more severe strokes, experienced poorer QoL and showed lower functional status than the men. In the rehabilitation process of women with stroke, these factors should be taken into consideration.Structured observation of meals, including assessment of food consumption, might be necessary in acute stroke care to detect patients, especially women, who might need closer supervision and nutritional intervention.

This paper is a report of a study comparing eating difficulties among patients 3 months after stroke in relation to the acute phase.There is limited knowledge of patients with eating problems early after stroke, hence the progress of eating abilities needs to be further explored.From March 2007 to June 2008 36 stroke patients with 2-7 eating difficulties or problems with reduced alertness or swallowing in the acute phase were included. Eating difficulties were detected using a structured protocol of observation of meals. In addition, stroke severity (National Institute of Health Stroke Scale), functional status (Barthel Index), unilateral neglect (Line Bisection test and Letter Cancellation test), psychological well-being (The Well-being Questionnaire-12), nutritional status (Mini Nutritional Assessment) and oral status (Revised Oral Assessment Guide) were assessed.There were 36 participants (58% female) with a median age of 74·5 years. The proportion of eating difficulties decreased significantly from the acute phase to the 3-month follow-up in 'sitting position', 'managing food on the plate' and 'manipulating food in the mouth' and increased regarding inadequate food consumption. Improvements were shown at 3 months in stroke severity, functional status, nutritional status and neglect. Oral status and psychological well-being remained unchanged.The majority of eating problems persisted 3 months after stroke despite a marked improvement in most of the physical functions. The unchanged psychological well-being and sustained problems with food consumption indicate that factors other than physical function should be taken into account regarding eating difficulties poststroke.

Objective To describe perceived participation and autonomy among a sample of persons with stroke in Iran and to identify different aspects of functioning and contextual factors predicting participation after stroke. Design A cross-sectional study. Subjects A total of 102 persons, between 27 and 75 years of age, diagnosed with first-ever stroke. Methods Participants were assessed for different aspects of functioning, contextual factors and health conditions. Participation was assessed using the Persian version of the Impact on Participation and Autonomy questionnaire. Results This study demonstrated that the majority of the study population perceived their participation and autonomy to be good to fair in the different domains of their participation, but not with respect to the autonomy outdoors domain. In addition, physical function was found to be the most important variable predicting performance-based participation, whereas mood state was the most important variable predicting social-based participation. Conclusion The results emphasize the importance of physical function, mood state and access to caregiving services as predictors of participation in everyday life after stroke. Whilst there are two dimensions of participation in this Persian sample of persons with stroke, the factors explaining participation seem to be the same across the cultures.

Background Little is known about the life satisfaction of the person with stroke combined with their caregiver, i.e. the dyad, despite the fact that life satisfaction is an important rehabilitation outcome. The aim of this study was to describe the dyads combined life satisfaction and to understand this in relationship to the perceived impact of stroke in everyday life and caregiver burden. Methods In this cross-sectional study, the life satisfaction of persons and their informal caregivers was measured in 81 dyads one year post stroke. Their global life satisfaction, measured with LiSat-11, was combined to a dyad score and the dyads were then categorized as satisfied, dissatisfied or discordant. The groups were compared and analyzed regarding levels of caregiver burden, measured with the Caregiver Burden scale, and the perceived impact of stroke in everyday life, measured with the Stroke Impact Scale (SIS). Results The satisfied dyads comprised 40%, dissatisfied 26% and those that were discordant 34%. The satisfied dyads reported a significantly lower impact of the stroke in everyday life compared with the dyads that were not satisfied. As expected, dyads that were not satisfied reported a significantly greater caregiver burden compared with the satisfied dyads. The discordant group was further broken down into a group of dissatisfied and satisfied caregivers. The caregivers that were not satisfied in the discordant group perceived a significantly greater level of caregiver burden compared with the satisfied group. Even caregivers who were satisfied with life but whose care recipients were not satisfied reported caregiver burden. Conclusions Measuring combined life satisfaction provides a unique focus and appears to be a feasible way of attaining the dyads' perspective. The findings suggest that those dyads with a discordant life satisfaction could be vulnerable because of the caregivers' reported caregiver burden. These findings support the importance of a dyadic perspective and add to the understanding of the reciprocal influences between the caregiver and recipient. This knowledge has clinical implications and contributes to the identification of possible vulnerable dyads in need of tailored support.

Objective To investigate the meaning of acting with others, in different places over the course of 1 year post-stroke. Methods Qualitative interviews with 9 persons, age range 42-61 years (7 persons with cerebrovascular accident and 2 with subarachnoidal haemorrhage) over the course of a year (i.e. 3, 6, 9 and 12 months) were analysed using a grounded theory approach. Results Four categories were identified from the analysis of the participants' experiences during the year of rehabilitation: (i) not recognized as the person I am; (ii) the burden of burden; (iii) inspiration and belonging through acting with others; (iv) reality adjustment through acting with others. From these categories a core category emerged: a process of belonging for integration. Conclusion The 4 categories identified suggest that belonging is integral to participation, which is viewed as the goal of rehabilitation.

Objective:In many studies, everyday life has been shown to be of great significance in the context of life-threatening cancer. The aim of this study was to investigate how people with cancer who are receiving palliative care engage in and undertake activities in their everyday lives.Method:This is a qualitative interview study adopting a grounded theory approach. The sample was composed of participants receiving services from palliative hospital-based home care and day care services. A total of 47 individuals were interviewed.Results:Despite experiencing the threat of progressive loss of functioning, the participants were striving to remain involved in and to be active in everyday life. Continued involvement in everyday life with lowered expectations concerning performance gave the participants the possibility to continue doing daily activities as well as to perform new and engaging activities that were a source of pleasure and enabled the patients to feel a sense of competence.Significance of results:This study has demonstrated the power of being involved in everyday life activities. The proposed model, explaining individuals' desire to continue to live an active life despite a progressive loss of functioning, can provide a model to help the reasoning of professionals when supporting patients in their everyday life.

The purposes of this study was to examine the possibilities of a home-based electronic memory aid with sensors for persons with memory impairments, as support to carry out everyday activities in their own home environments.The method involved a single-subject study with a multiple baseline AB design. Five participants identified three activities each that they usually forget to carry out. An electronic memory aid with individually spoken reminders was installed in the participant's home. There were automatic computer registrations of completed activities during the study phase of 12 weeks. Assessments of functioning and quality of life (QoL) were conducted before and after the intervention and at follow-up after 2 months.Four participants improved in completing most of the self-chosen activities when the electronic memory aid was used. Performance and satisfaction with performance and QoL improved, but there was no memory function improvement. There were technical problems with the aid, which had a negative effect for users.Electronic memory aids have a large potential for supporting persons with cognitive impairments. It is important to conduct follow-up afterwards, because the use of an aid and the need of support change over time and put high demands on technical reliability of the electronic memory aid.

Eating difficulties are common after stroke. However, to better meet individuals' needs, in terms of care, support and rehabilitation after stroke, it was considered important to know more about how patients with stroke experience their eating difficulties while in process of regaining their ability.The aim of this study was to explore the experience of eating difficulties among patients with stroke 3 months after stroke onset.A qualitative interpretive descriptive approach was used. The analysis was based on constant comparative approach, using the principles of grounded theory.The study included 14 participants with stroke and eating difficulties. A semi-structured interview guide with open-ended questions and probes was used. The interview guide was gradually modified during the data collection process. The interviews were digital audio recorded and fully transcribed. Memos were documented simultaneously with the analysis. A structured observation of a meal verified eating difficulties, and semi-structured interviews were conducted.'Striving for control' emerged as a tentative core category. The participants related their striving for control to 'eating safely', and 'eating properly'; they also had to analyse the consequences of their eating difficulties, being careful when eating, and/or avoiding activities. Some also felt a need of help from others. Those others could remind and provide advice in this matter.This study highlights the complexity of having eating difficulties after stroke. Aspects related to the participants' striving for control are based on different strategies to eat safely and properly. Nurses can use this knowledge to support patients in their strive for control by observing them in eating situations. In addition, nurses can also ask them to describe and make explicit the experience of eating situations after stroke.

The aim of the study was to identify and describe two couples' approaches to changes in everyday life during the first year after a stroke. An additional aim was to describe how the couples viewed rehabilitation as well as their own personal training relative to changes in everyday life during the first year at home after stroke.The study design was a prospective longitudinal case study based on two couples where one of the spouses in each couple had experienced a stroke. Data collection consisted of interviews and a questionnaire and took place in the participants' homes. Data analysis utilized a constant comparative method.The findings showed a divergence in the couples' approaches to changes in their everyday life at home and were described through the following categorizations: engaging in occupations, getting experience and thereby feedback from doing, changing one's occupational needs and demands, contributing to a picture of a possible future and, integrating training in everyday life. Getting experience and feedback from doing was found to be a key category or "driver" in the change process.The couples' experiences of changes in everyday life after stroke illustrated two very divergent approaches, which is discussed in the paper. The approaches in turn had consequences for how daily life was spent after stroke which is also discussed.

The aim was to describe how former clients with stress-related disorders and rehabilitation team members experience the rehabilitation process, and to describe how experiences from the rehabilitation have been integrated into the former clients' everyday lives. A qualitative grounded theory approach was used. The sample consisted of seven team members working at a vocational rehabilitation clinic and eight former clients who were interviewed. The participants were involved in four different rehabilitation programmes, all of which used cognitive approaches. In addition, two of the programmes offered activities in a therapeutic garden. The result highlighted experiences that might have contributed to changes in the former clients' self-image, development of conscious strategies for handling stressful situations, and changes in values attached to everyday occupations. In addition, two different modes of integrating experiences from rehabilitation into the former clients' everyday lives were identified: changing approaches to handling stressful situations in everyday life and changing occupational repertoire in everyday life. Important implications might be that activities which promote relaxation and enjoyment should be included in the rehabilitation of people with stress-related disorders since experiences from these activities seemed to facilitate occupational balance in everyday life.

Objective: To explore the relationship between occupational gaps, depressive mood and life satisfaction in persons who have acquired a brain injury during the past 1–4 years and to test the Occupational Gaps Questionnaire. Design: A cross-sectional study. Subject: A total of 116 persons with traumatic brain injury or subarachnoid haemorrhage acquired 1-4 years previously. Methods: A postal survey with questions on occupational gaps, focusing on the domains instrumental activities of daily living, social life, leisure and work (Occupational Gaps Questionnaire), life satisfaction (LiSat-11 checklist) and depressive mood (Hospital Anxiety and Depression Scale). Rasch analyses and principal component analyses were performed to ensure that data from the LiSat-11 and Occupational Gaps Questionnaire could be used subsequently as valid unidimensional measures in regression and correlational analyses. Results: Calibration of the Occupational Gaps Questionnaire and the LiSat-11 revealed that the items and persons demonstrated acceptable goodness-of-fit to the Rasch models respectively, supporting internal scale validity and person-response validity. In addition, principal component analyses revealed that the measures could be used as valid uni-dimensional estimations of occupational gaps and life satisfaction. There was a strong relationship between the extent of occupational gaps and perceived life satisfaction, a weaker relationship with depressive mood and a non-significant relationship with the aetiological diagnoses and life satisfaction. The factors explained 32% (occupational gaps), 6% (depressive mood), and 2% (diagnosis), respectively, of the total explained variance (40%). Conclusion: There was a strong correlation between participation in desired everyday occupations and life satisfaction 1–4 years after an acquired brain injury. This indicates that individually perceived occupational gaps, as recorded by the Occupational Gaps Questionnaire, could be relevant targets for tailored interventions in order to improve life satisfaction among clients with acquired brain injuries.

This study describes and expands our understanding of the lived-experience of driving ability after stroke in the context of being under a driving evaluation.Four men with stroke were interviewed on three occasions. The interviews were open-ended, taped and transcribed verbatim, and analysed using Karlsson's Empirical, Phenomenological and Psychological method.The findings revealed five main characteristics expressed in the participants' lived experiences: (1) the meaning of driving remained throughout life; (2) being questioned and advised not to drive--an untenable situation; (3) being out of control and violated by the driving evaluation; (4) driving safely (as usual) during the on-road test; and (5) perceiving consequences in everyday living.The findings indicate that driving is important and taken for granted even after stroke. To lose the ability to drive was unexpected and aroused strong feelings and reactions. The present study contributes to a deeper understanding of how people with stroke experience their driving ability and the evaluation process, which can be integrated in clinical procedures to help improve information, emotional support and clinical procedures.

The aim of this study was to explore and describe awareness of driving disability in people with driving difficulties after stroke. The study comprised a consecutive sample of 38 participants with stroke who showed difficulties in a technically advanced, interactive driving simulator. Driving ability in the simulator was measured using Performance Analysis of Driving Ability (P-Drive). Awareness of driving disability was measured using a modified version of Assessment of Awareness of Disability (AAD), measuring the discrepancy between observed driving actions and self-reported disability after a driving evaluation in a simulator. A majority of the participants (n = 36) demonstrated driving ability that was below the cut-off criterion for P-Drive. Furthermore, a majority of the items measuring awareness of driving disability were scored low, indicating that participants with stroke who did not pass a driving evaluation also had limited awareness of driving disability. A General Linear Model analysis indicated that awareness of driving disability and cognitive screening outcome explained 74% of the variance in driving ability. This study indicated that a majority of the people with stroke who fail a driving evaluation also have limited awareness of their disability, which indicates the need to address awareness in driving evaluations.

OBJECTIVES. This study examined the relationship between awareness of disability and occupational performance in a group of elderly persons during the year after stroke. METHOD. Data on awareness of disability and occupational performance (i.e., activities of daily living [ADL] motor and process ability) were collected 1, 3, 6, and 12 months after stroke. A mixed-linear-effects model was implemented to examine the relationship between awareness of disability and ADL motor and process ability over time. RESULTS. Increased awareness of disability was related to improvements in occupational performance (ADL motor and process ability). The 2 relationships were different, with a positive linear relationship between awareness of disability and ADL motor ability, and a stronger, positive, nonlinear relationship between awareness of disability and ADL process ability. CONCLUSION. Clients’ awareness of disability and their ability to perform occupations should be assessed several times during a rehabilitation process so that interventions can be adjusted to match each client's potential to benefit from them.

Background and Purpose Intervention programs for home-based rehabilitation are not fully described in the literature, and rehabilitation team members' experiences and tacit understanding of working with patients after stroke in the home environment need to be further understood. The aim of this study was to identify the meaning of rehabilitation in the home environment after stroke from the perspective of members of a multiprofessional team. Subjects Thirteen members of a multiprofessional outreach team (physical therapists, occupational therapists, speech and language therapists, and a social worker) working at a geriatric hospital in Stockholm, Sweden, participated in the study. Methods A qualitative method (the Empirical Phenomenological Psychological method) was used, with data being obtained from retrospective interviews of the team members after completing home-based rehabilitation of patients after acute stroke. Results One main theme (“supporting continuity”) and 4 subthemes (“making a journey together from hospital to home,” “enabling experiences of functioning,” “refraining from interventions—encouraging patient problem-solving skills,” and “looking for a new phase—uncertain endings”) were revealed. Discussion and Conclusion The findings suggest that contextual factors, both environmental and personal, were considered to be of great importance by the members of the multiprofessional team and were accounted for when they were working in the home environment in the rehabilitation of patients after stroke. Contextual factors detected in the home environment gave valuable information to the team members, who used the information in their strategies to assist the patients in finding continuity in their daily life and to link the past to the present and the “new body” to the “old body.”

OBJECTIVE: To investigate aspects of validity and stability of Performance Analysis of Driving Ability (P-Drive), for people with stroke when used in a driving simulator. DESIGN: A cross-sectional observational study. SUBJECTS: The study included a consecutive series of 101 participants with stroke referred for evaluation or selected from a stroke registry. METHODS: P-Drive was used to observe driving performance in order to assess driving ability. P-Drive comprises 20 items assessing the quality of the participant's driving performance. Aspects of validity and reliability in P-Drive were evaluated using Rasch statistics. RESULTS: The items (95%) and participants (97%) demonstrated acceptable goodness-of-fit and met statistical expectations according to the Rasch model. The results support internal scale validity and person response validity. P-Drive could separate the participants with different driving abilities and the standard errors were within reasonable criteria for drivers with a moderate-to-low ability to drive. CONCLUSION: The findings from this study indicated that P-Drive is an assessment tool with properties of internal scale validity, person response validity, and which also contains aspects of reliability in relation to precision of the estimates and separation. P-Drive seems to be a valid and stable assessment tool for assessing the driving ability in a simulator of people with stroke. Language: en

Two different epistemological projects within medical research are presented and compared in this article. One project is the statistical approach that has long occupied a dominant position in medical science. The other project deals with the interpretation of meaning. The authors contend that these projects are different, but not contradictory. The importance of respecting the peculiarities of each is stressed. Several aspects of the projects are compared, including the character of the research object, the knowledge interests, and the use of empirical data. It is argued, among other things, that the phenomenological interpretation of meaning is epistemologically prior to the statistical correlation of facts. The article ends with a discussion of validation procedures based on the idea that all research is conducted starting from a certain perspective.

To explore adaptation, by examining the occupational gaps occurring between what individuals want to do and what they actually do in terms of their everyday activities before and after brain injury. In addition, the relationships between occupational gaps and impairment/activity limitations and the time lapse since the brain injury were explored.A cross-sectional study.A total of 187 persons, affected by traumatic brain injury or subarachnoid haemorrhage 1-4 years previously.A postal questionnaire encompassing questions concerning gaps in the performance of activities in everyday life before and after the brain injury and perceived impairment/activity limitations.The numbers of occupational gaps increased after the injury, with the number of gaps having increased from 46% to 71%. The number of occupational gaps was significantly related to executive impairment/activity limitations, and motor impairment/activity limitations and other somatic impairments, such as headache, also had an impact. The time lapse since the brain injury had no significant effect on the number of occupational gaps.The results suggests that there is a need for adaptation in everyday activities, even several years after a brain injury, which indicates that follow-up and access to individualized rehabilitation interventions in the long-term are required.

OBJECTIVE. The objective of this study was to investigate how persons with acquired brain damage experienced their 1-week stay in an apartment fitted with electronic aids to daily living (EADL). The study focused on how the individuals adapted to this artificial environment in their performance of daily activities and how their occupational experiences influenced their view of the future. METHODS. The 11 participants were interviewed on the last day of their rehabilitation period in an EADL-equipped training apartment. The data were collected and analyzed using the Empirical Phenomenological Psychological (EPP) method. FINDINGS. The findings revealed four main characteristics that described an adaptation process that occurred during the week in the EADL-equipped training apartment: plunging into an EADL-equipped environment, “landing” and feeling comfortable with the new environment, incorporating the “new” in daily activities, and “taking-off” for the future. CONCLUSION. In a short time, the combination of the EADL and the aesthetically attractive environment gave the participants experiences that contributed to a “taking off” for their future life. Findings from this study suggest that, in clinical practice, clients may need initial guidance from the therapists to “land” and feel comfortable in a new environment, like a training apartment, before they can learn how to incorporate new electronic aids in their every day activities.

OBJECTIVE. The objective of this phenomenological study was to understand the meanings of the lived experiences of persons with long-term mental illness at a social working cooperative. METHOD. Eighteen participants were interviewed either two or three times while participating in a working cooperative in a community psychosocial rehabilitation program. Data were analyzed and interpreted using the Empirical, Phenomenological, Psychological (EPP) method (Karlsson, 1993). RESULTS. The findings revealed a meaning-structure consisting of one main constituent that characterized the cooperative as a normalizing life-world. Three phases contributed to the normalization process. In the first phase the participants experienced a shift from an unsatisfying occupational context to an enriching occupational life-world. In the second phase participants had the possibility to satisfy some of their occupational and social needs. During this phase, experiences of being productive and needed, commitment to others, development of their skills, and competence in work tasks and social activities were expressed, all of which contributed to personal growth and a more positive view of self. In the third phase, the meaning of the cooperative changed for some participants, who expressed this through their readiness to leave and take a further step into the life-world outside the cooperative. CONCLUSION. The study emphasizes that the cooperative is an important alternative to employment for participants with severe mental illness who do not have the capacity to be employed in the community or who do not want to leave the life-world of the cooperative that gives them pride, joy, and satisfaction.

Objective. Awareness of disabilities is known to be a central problem of rehabilitation among clients with large right cerebrovascular lesions and unilateral neglect. The aim of this study was to evaluate the effect of an intervention program focused on improving the awareness of disabilities in four participants with unilateral neglect. The intervention program developed for this study was based on the assumption that awareness of disabilities is a prerequisite for being able to learn and use compensatory techniques in the performance of activities of daily living (ADL). Method. The study followed a single-case experimental ABA design. The Assessment of Awareness of Disability was used to measure awareness of disabilities; the Assessment of Motor and Process Skills was used to measure ADL ability; and neuropsychological tests were used to assess unilateral neglect and sustained attention. The intervention program used meaningful and purposeful occupations as therapeutic change agents to improve awareness of disabilities. Results. Awareness of disabilities and ADL ability improved in all four participants; unilateral neglect decreased in three participants; and sustained attention improved in two participants. Conclusion. The preliminary findings indicate that training to improve awareness of disabilities might improve the ability to learn the use of compensatory techniques in the performance of ADL in clients with unilateral neglect. The effects of the intervention strategy need to be evaluated further in future research.

The possible causative role of defective sustained attention and awareness of disability on the persistence of neglect was explored. The study included stroke patients who had had moderate or severe neglect 1–5 years before the start of the present examination. Questionnaire responses showed that the patients were aware of their disability. Impaired sustained attention was associated with poor performance in two out of three tests most sensitive in detecting neglect. This, together with indications of compensation on neglect tests, is interpretated as providing support for the hypothesis that chronic neglect is related to an impaired sustained attention.

Many studies have shown a co-variation of unilateral neglect with nonlateralised attentional functions. Recently, Posner has argued that there are two separate neural systems that influence the posterior attentional system which is presumed to be impaired in unilateral neglect, namely, the posterior system itself (located partly in the inferior parietal lobules) as well as a secondary modulatory sustained attention or vigilance system. This latter system is linked to the nor-epinephrine system, which is known to be more strongly represented in the right compared to the left hemisphere of the brain. If this hypothesis is true, then unilateral neglect should be improved by increasing activation of the sustained attention system. Eight patients suffering from chronic left unilateral neglect were trained to sustain their attention by a self-alerting procedure partially derived from Meichenbaum's self-instructional methods. Using a multiple-baseline-by-function design, as well as multiple-baseline-by-subject designs, statistically significant improvements in unilateral neglect as well in sustained attention were found following onset of sustained attention training, without corresponding improvements in control measures. Theoretical implications for the attentional underpinnings of unilateral neglect are discussed, as well as the rehabilitation implications of this training procedure.

The purpose was to study the ability of persons with memory impairments after acquired brain injury to learn how to and use electronic aids to daily living (EADL) and to describe changes in function and quality of life.Eight participants stayed in two apartments equipped with a set of basic and advanced EADL for either 4 or 6 months during an intervention time of 2 years. The teaching and learning method was influenced by certain principles of errorless learning. Ability to learn to use EADL was measured by structured observations. Function and quality of life were assessed with self-rating questionnaires.Results indicate that the participants learned to use EADL in their everyday activities. They perceived that EADL were very useful and easy to learn. Occupational performance and satisfaction with occupational performance and quality of life was improved.The results indicate that EADL may play an important role in facilitating everyday activities and improve satisfaction with occupational performance and quality of life for people with memory impairments. The study indicates the importance of adjusting technology to the user's needs and calls for more consideration for human-technology interaction factors.

Self-care training is one of the most frequently used interventions in rehabilitation. However, there is a need for clear descriptions of what occupational therapists do during self-care training with clients. The aim of this qualitative study was to describe what characterizes the therapeutic strategies used by occupational therapists during self-care training. Twelve occupational therapists working with clients who had had a stroke (n = 6) or spinal cord injury (n = 6) were interviewed and asked to tell a therapeutic story focusing on the self-care training process of one client. Data were transcribed and analysed using the Empirical, Phenomenological, Psychological (EPP) method, a qualitative method that aims to describe the essence, structure and character of the studied phenomenon (that is, therapeutic strategies). The characteristics of eight intervention strategies, used by all participants during self-care training, were identified. Findings showed that the occupational therapists' strategies focused primarily on how to create a relationship built on trust with their clients, how to find the right way to motivate clients, how to support the setting of goals, and how to provide enabling occupational experience and adjust training to the needs of the client, rather than focusing on teaching clients how to use technical and compensatory strategies. The general aim for using the strategies was to support the clients in taking control of their lives again. One conclusion from this study is that occupational therapists could, through understanding the individual's unique situation, vary their strategies and adapt themselves, like a chameleon, to meeting clients' experiences and needs during self-care training. However, the therapeutic outcome of using these strategies needs to be verified in future studies focusing on clients' experiences from self-care training.

The objective of this study was to identify what characterized the lived experience of memory impairment in daily occupations during the first year after acquired brain injury. Four participants were interviewed on four occasions during the year after the brain injury. The data were collected and analyzed using the Empirical Phenomenological Psychological method. The findings revealed four main characteristics that described the individual's experiences during the year of rehabilitation: a chaotic life-world, struggling for coherent doing in new contexts, conscious strategies in new contexts, and achieving new habits. After the brain injury, the life-world changed from a taken-for-granted existence to a chaotic world that was difficult to understand. The routine performance of daily activities and the habit patterns had broken down, so it was mostly the familiar activities that were already integrated in the “habit-body” that enabled coherent doings in everyday life during the year. The findings contribute to an understanding of how to use familiar and meaningful occupations as a therapeutic medium in the rehabilitation of clients with memory impairment following acquired brain injury.

It is common for clients with stroke to lack awareness of their disabilities, which is an obstacle in the rehabilitation process. The aim of this article is to describe how Rasch measurement method ...

Objective. Clients with right brain damage and unilateral neglect often lack awareness of their disabilities. This study examined how 4 participants with neglect experienced, discovered, and handled their disabilities in the context of their everyday life. Method. The 4 participants were interviewed five to seven times during their rehabilitation process. The data were collected and analyzed using the EPP (empirical, phenomenological, psychological) method. Findings. Findings revealed seven features that described a discovery process for the 4 participants. During this process, each participant began to discover and understand the consequences of her unilateral neglect in the performance of everyday tasks. This increased understanding was a prerequisite to being able to use compensatory strategies. Conclusion. By experiencing meaningful occupational situations, the participants gradually discovered and began to compensate for their disabilities in everyday life.

Background People who have suffered a stroke commonly report unfulfilled need for rehabilitation. Using a model of patient satisfaction, we examined characteristics in individuals that at 3 months after stroke predicted, or at 12 months were associated with unmet need for rehabilitation or dissatisfaction with health care services at 12 months after stroke. Methods The participants (n = 175) received care at the stroke units at the Karolinska University Hospital, Sweden. The dependent variables “unfulfilled needs for rehabilitation” and “dissatisfaction with care” were collected using a questionnaire. Stroke severity, domains of the Stroke Impact Scale (SIS), the Sense of Coherence scale (SOC) and socio demographic factors were used as independent variables in four logistic regression analyses. Results Unfulfilled needs for rehabilitation at 12 months were predicted by strength (SIS) (odds ratio (OR) 7.05) at three months, and associated with hand function (SIS) (OR 4.38) and poor self-rated recovery (SIS) (OR 2.46) at 12 months. Dissatisfaction with care was predicted by SOC (OR 4.18) and participation (SIS) (OR 3.78), and associated with SOC (OR 3.63) and strength (SIS) (OR 3.08). Conclusions Thirty-three percent of the participants reported unmet needs for rehabilitation and fourteen percent were dissatisfied with the care received. In order to attend to rehabilitation needs when they arise, rehabilitation services may need to be more flexible in terms of when rehabilitation is provided. Long term services with scheduled re-assessments and with more emphasis on understanding the experiences of both the patients and their social networks might better be able to provide services that attend to patients’ needs and aid peoples’ reorientation; this would apply particularly to those with poor coping capacity.