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Background: As individuals age, the incidence and mortality rates of cerebrovascular accidents significantly rise, leading to fine motor impairments and cognitive deficits that impact daily life. In modern occupational therapy, assessing manual dexterity and cognitive functions typically involves observation of patients interacting with physical objects. However, this pen-and-paper method is not only time-consuming, relying heavily on therapist involvement, but also often inaccurate. Digital assessment methods, therefore, have the potential to increase the accuracy of diagnosis, as well as decrease the workload of health care professionals., Objective: This study examined the feasibility of an interactive electronic pegboard for the assessment and rehabilitation of patients with stroke., Methods: We explored the pegboard's clinical applicability by examining the relationship among stages, timing, and difficulty settings, as well as their alignment with patient capabilities. In total, 10 participants used a prototype of the pegboard for functional and task assessments; questionnaire interviews were conducted simultaneously to collect user feedback., Results: Patients with stroke consistently required more time to complete tasks than expected, significantly deviating from the initial time frames. Additionally, the participants exhibited a slight reduction in performance levels in both manual dexterity and cognitive abilities. Insights from questionnaire responses revealed that the majority of participants found the prototype interface easy and enjoyable to use, with good functionality., Conclusions: This preliminary investigation supports the efficacy of interactive electronic pegboards for the rehabilitation of the hand functions of patients with stroke, as well as training their attentional and cognitive abilities. This digital technology could potentially alleviate the burden of health care workers, positioning it as a valuable and intelligent precision health care tool., (©Shih-Ying Chien, Ching-Yi Wu, Alice May-Kuen Wong, Chih-Kuang Chen, Sara L Beckman. Originally published in JMIR Formative Research (https://formative.jmir.org), 24.10.2024.)

Background: Strokes pose a substantial health burden, impacting 1 in 6 people globally. One-tenth of patients will endure a second, often more severe, stroke within a year. Alarmingly, a younger demographic is being affected due to recent lifestyle changes. As fine motor and cognitive issues arise, patient disability as well as the strain on caregivers and health care resources is exacerbated. Contemporary occupational therapy assesses manual dexterity and cognitive functions through object manipulation and pen-and-paper recordings. However, these assessments are typically isolated, which makes it challenging for therapists to comprehensively evaluate specific patient conditions. Furthermore, the reliance on one-on-one training and assessment approaches on manual documentation is inefficient and prone to transcription errors., Objective: This study examines the feasibility of using an interactive electronic pegboard for stroke rehabilitation in clinical settings., Methods: A total of 10 patients with a history of stroke and 10 healthy older individuals were recruited. With a limit of 10 minutes, both groups of participants underwent a series of challenges involving tasks related to manual operation, shape recognition, and color discrimination. All participants underwent the Box and Block Test and the Purdue Pegboard Test to assess manual dexterity, as well as an array of cognitive assessments, including the Trail Making Test and the Mini-Mental Status Examination, which served as a basis to quantify participants' attention, executive functioning, and cognitive abilities., Results: The findings validate the potential application of an interactive electronic pegboard for stroke rehabilitation in clinical contexts. Significant statistical differences (P<.01) were observed across all assessed variables, including age, Box and Block Test results, Purdue Pegboard Test outcomes, Trail Making Test-A scores, and Mini-Mental Status Examination performance, between patients with a history of stroke and their healthy older counterparts. Functional and task testing, along with questionnaire interviews, revealed that patients with a history of stroke demonstrated prolonged completion times and slightly inferior performance. Nonetheless, most patients perceived the prototype as user-friendly and engaging. Thus, in the context of patient rehabilitation interventions or the evaluation of patient cognition, physical functioning, or manual dexterity assessments, the developed pegboard could potentially serve as a valuable tool for hand function, attention, and cognitive rehabilitation, thereby mitigating the burden on health care professionals., Conclusions: Health care professionals can use digital electronic pegboards not only as a precise one-on-one training tool but also as a flexible system that can be configured for online or offline, single-player or multiplayer use. Through data analysis, a more informed examination of patients' cognitive and functional issues can be conducted. Importantly, patient records will be fully retained throughout practices, exercises, or tests, and by leveraging the characteristics of big data, patients can receive the most accurate rehabilitation prescriptions, thereby assisting them in obtaining optimal care., (©Shih-Ying Chien, Alice MK Wong, Ching-Yi Wu, Sara L Beckman. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 21.06.2024.)

As the efficacy of low vision service provision is facilitated by clients' access to and proper use of low vision devices, the objective of this study was to evaluate an outpatient clinic-based low vision device lending library program and the functional and psychosocial impact that device use had upon clients. Twenty individuals borrowed portable video magnifiers during the study period. Line items from the Revised-Self-Report Assessment of Functional Visual Performance and the Reading Behavior Inventory were analyzed before and after device loan at two months. The Psychosocial Impact of Assistive Devices Scale-10 and a semi-structured interview were also completed at two months. Reported improvements in reading performance and satisfaction levels on the Reading Behavior Inventory were significant (p<.001). The Revised-Self-Report Assessment of Functional Visual Performance indicated improved independence in reading medications, bills and labels. Higher scores in happiness, independence, sense of control and adaptability on the Psychosocial Impact of Assistive Devices Scale-10 indicated device retention at two months. Qualitative themes included improved independence, time needed to acclimate to the device, personal appraisal impacting motivation and challenges specific to low vision. This article provides occupational therapists a model to facilitate access, person-device fit and successful use of low vision devices to promote therapy outcomes.

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Background: Regaining hand function is the top priority for people with tetraplegia, however access to specialised therapy outwith clinics is limited. Here we present a system for hand therapy based on brain-computer interface (BCI) which uses a consumer grade electroencephalography (EEG) device combined with functional electrical stimulation (FES), and evaluate its usability among occupational therapists (OTs) and people with spinal cord injury (SCI) and their family members., Methods: Users: Eight people with sub-acute SCI (6 M, 2F, age 55.4 ± 15.6) and their caregivers (3 M, 5F, age 45.3 ± 14.3); four OTs (4F, age 42.3 ± 9.8). User Activity: Researchers trained OTs; OTs subsequently taught caregivers to set up the system for the people with SCI to perform hand therapy. Hand therapy consisted of attempted movement (AM) of one hand to lower the power of EEG sensory-motor rhythm in the 8-12 Hz band and thereby activate FES which induced wrist flexion and extension. Technology: Consumer grade wearable EEG, multichannel FES, custom made BCI application., Location: Research space within hospital. Evaluation: donning times, BCI accuracy, BCI and FES parameter repeatability, questionnaires, focus groups and interviews., Results: Effectiveness: The BCI accuracy was 70-90%. Efficiency: Median donning times decreased from 40.5 min for initial session to 27 min during last training session (N = 7), dropping to 14 min on the last self-managed session (N = 3). BCI and FES parameters were stable from session to session. Satisfaction: Mean satisfaction with the system among SCI users and caregivers was 3.68 ± 0.81 (max 5) as measured by QUEST questionnaire. Main facilitators for implementing BCI-FES technology were "seeing hand moving", "doing something useful for the loved ones", good level of computer literacy (people with SCI and caregivers), "active engagement in therapy" (OT), while main barriers were technical complexity of setup (all groups) and "lack of clinical evidence" (OT)., Conclusion: BCI-FES has potential to be used as at home hand therapy by people with SCI or stroke, provided it is easy to use and support is provided. Transfer of knowledge of operating BCI is possible from researchers to therapists to users and caregivers. Trial registration Registered with NHS GG&C on December 6th 2017; clinicaltrials.gov reference number NCT03257982, url: https://clinicaltrials.gov/ct2/show/NCT03257982 .

Background: Prior to the COVID-19 global health emergency, reducing direct contacts between therapists and patients is an important issue, and could be achieved by using robots to perform certain caring activities., Objective: This study compares therapeutic factors of singing group activities directed by social robots and by occupational therapists at elderly care centers during this COVID-19 outbreak., Methods: This project has a quasi-experimental research design, based on a pilot study of 14 subjects aged above 65 years. They received eight sessions of singing group therapy given by a social robot or an occupational therapist. Completed copies of a therapeutic-factor questionnaire were then collected., Results: At the 4th week, the scores for 8 therapeutic factors were higher in sessions with the occupational therapist than the robot-directed sessions, reaching a statistically significant level; at the 8th week, the scores for 3 therapeutic factors, including imparting of information, were higher in sessions with the occupational therapist than in sessions with the robot. The top scoring therapeutic factor in the robot sessions was group cohesiveness., Conclusions: Social robots may be good companion tools for elderly care during this COVID-19 outbreak, but group therapy sessions supervised by real-person therapists still have higher therapeutic factor scores than those conducted by robots. The number of subjects needs to be increased to enhance the validity of future study results.

Most post-stroke patients experience upper limb functionality challenges. Emergent therapies using upper limb-based robot machines present opportunities to resolve the limitations inherent in Occupational therapy such as increased therapist-patient exhaustion, monotonous methods, and so forth. The aim of this parallel trial was to compare the effects of the upper limb robotic training with matched Occupational therapy training on upper limb function and independence-related quality of life in post-stroke patients within the Brunnstrom arm motor recovery stages 1 to 4. During one-year (2018-2019), 50 post-stroke patients were enrolled and randomly assigned to 2 groups; robot and Occupational therapy (n = 25) and Occupational therapy (n = 25). Both groups were trained for 50-70 minutes per day, 5 days a week for 6 weeks. The Chinese-adapted Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was the primary outcome measure. The secondary outcome measures were the Brunnstrom Recovery Stages Scale (BRS) and the Chinese-adapted Barthel Index (BI). The treatment effect sizes of both groups were large in the following variables; transfers (1), BI total score (2.2), FMA-UE upper limb (1.1), wrist (1.8), elbow (1), fingers (0.9), and FMA-UE total scores (1.4). The treatment group in comparison to the control group had larger BRS changes, significant improvements in upper limb function, and partial independence in activities of daily living during the baseline to post-treatment period. Robotic-assisted training with occupational therapy may improve the upper limb movement foundation blocks; however, it does not translate into complete functional independence and improved quality of life. This study has been registered at the ISRCTN registry, https://doi.org/10.1186/ISRCTN84804731.

Background: An analysis of data from an international survey was undertaken to determine the impact of the COVID-19 pandemic on telehealth practice in occupational therapy worldwide, in addition to facilitators and barriers in utilising this form of service delivery., Method: The global online survey was circulated in the occupational therapy community by the World Federation of Occupational Therapists (WFOT) between April and July 2020, collecting responses to closed-ended questions, in addition to free-text comments. Descriptive statistics and bivariate analyses were used to assess relationships between respondent characteristics and the utilisation of telehealth. Thematic statement analysis provided further insight regarding factors impacting telehealth use., Results: Findings revealed a significant increase in the use of telehealth strategies with the onset of the pandemic among survey respondents, with many reported benefits. Bivariate analyses indicated telehealth users were more likely to score higher feelings of safety and positive work morale, as well as perceive employer expectations to be reasonable. Restricted access to technology, limitations of remote practice, funding issues and slow pace of change were identified as barriers for some respondents to utilising telehealth. Facilitators included availability of supportive policy, guidelines and strategies, in addition to education and training., Conclusion: This study advances the understanding of the current scope of occupational therapy telehealth practice in the context of the ongoing COVID-19 pandemic. Although results suggest long-term potential for telehealth use as an adjunct to traditional service provision, important considerations were identified regarding factors influencing integration of such strategies.

Introduction: Scientific evidence that supports the psychometric properties of the COPM as a tool to enable personalized care has been repeatedly shown. However, there is a lack of studies about its utility within the Spanish research community., Aim: This qualitative study seeks to ascertain the perceptions of professionals from social health centers, nursing homes, and Spanish rehabilitation services about the clinical utility of the COPM as a standardized instrument., Methods: Thirty occupational therapists and physiotherapists in four focus groups discussed the experience of applying the COPM. The interpretative phenomenological analysis (IPA) incorporated a multidimensional model of clinical utility based on the components of acceptable, appropriate, accessible, and practicable by the clients, professionals, and institutions. Results and Discussion . The results of the utility study showed that the COPM helped professionals and clients to gain significant involvement in the treatment process. The COPM contributed to the process of further goal setting, occupation-based, and client-centered, thus achieving considerable satisfaction from the clients that had treatment. The professional training and adaptation to the geriatric population were vital to this process., Conclusion: The COPM is a useful and viable tool for the institutions that are supportive of a client-centered approach in the Spanish context., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Elisabet Capdevila et al.)

Background.: Individuals with Parkinson's disease (PD) can experience motor impairments related to their hand-use that restrict participation in daily activities. Feeding is one activity impacted by this health condition. The use of adapted utensils can improve performance and independence in this activity., Purpose.: To investigate if a locally designed and made eating-adaptive device helps a person with PD to improve their feeding performance., Method.: Single-case ABC-type experimental design. Performance and satisfaction of a 60-year-old man with PD were assessed during feeding tasks in 70 sequential days in three phases. Celeration Line, Two-Standard Deviation Band, and Visual Analysis were the methods used for data analysis., Findings.: Performance and satisfaction increased significantly after the introduction of the adaptive eating device. The addition of weight also contributed to the increase in the participant's performance., Implications.: Adaptive eating device with low production costs and possibility of customized adjustments improves performance of people with PD.

Study Design: Descriptive., Introduction: Rehabilitation programs that focus on motor recovery of the upper limb require long-term commitment from the clinicians/therapists, require one-to-one caring, and are usually labor-intensive., Purpose of the Study: To contribute to this area, we have developed a sensored hand glove integrated with a computer game (Flappy Bird) to engage patients playing a game where the subject's single/multiple fingers are involved, representing fine motor skill occupational therapeutic exercises., Methods: We described the sensored rehab glove, its hardware design, electrical and electronic design and instrumentation, software design, and pilot testing results., Results: Experimental results supported that the developed rehab glove system can be effectively used to engage a patient playing a computer game (or a mobile phone game) that can record the data (ie, game score, finger flexion/extension angle, time spent in a therapeutic session, etc.) and put it in a format that could be easily read by a therapist or displayed to the therapists/patients in different graph formats., Conclusions: We introduced a sensored rehab glove for home-based therapy. The exercise training using the glove is repetitious, functional, and easy to follow and comply with., (Published by Elsevier Inc.)

Objective: To investigate the effects of pressure (Lycra) garment on the spasticity and function of the arm in the early stages after stroke., Design: A randomized controlled trial., Setting: Occupational therapy unit of a public hospital., Subjects: A total of 46 adults with stroke., Intervention: After random assignment, for six weeks, both intervention group and control group received a 2 hour/week conventional occupational therapy program, with the intervention group receiving an extra 6 hour/day pressure garment application (long glove)., Main Measures: Modified Modified Ashworth Scale, Disabilities of Arm, Shoulder and Hand Outcome Measure, and Jebsen-Taylor Hand Function Test. Eligibility measures: Mini Mental State Examination and Modified Modified Ashworth Scale. Assessments were performed at baseline and six weeks postintervention., Results: There were 21 participants with the mean age of 51.19 (8.28) years in the intervention group and 22 participants with the mean (SD) age of 52.82 (8.71) years in the control group. The intervention group had median (interquartile range (IQR)) post-stroke duration of 1 (1) month, while for the control group, they were 2 (2) months. There was no difference in spasticity, and both perceived and actual arm functions between the groups at six weeks after baseline., Conclusion: Wearing a pressure garment on the arm for 6 hours daily had no effect in controlling spasticity or on improving arm function in the early stages after stroke.

Objective: To explore the impact of rehabilitation robot training (RRT) on upper limb motor function and daily activity ability in patients with stroke., Methods: Forty patients meeting the inclusion criteria were randomly divided into the treatment group (TRE) and the control group (CON). Group TRE was trained with an upper limb rehabilitation robot and group CON was trained with traditional occupational therapy. The training time was six weeks, and the upper limb function and daily activities were then assessed., Results: (1) There was no statistical significance in the Fugl-Meyer (FM) score, Wolf Motor Function Test (WMFT) score, and Modified Barthel Index (MBI) score between the two groups before treatment (P > 0.05). (2) After treatment, the FM score, WMFT score, and MBI score were significantly higher than before treatment (P < 0.01). (3) There was no significant significance between the two groups after treatment (P > 0.05)., Conclusions: Both RRT and traditional occupational therapy training are useful for the recovery of upper limb motor function and daily life ability in the sub-acute stage of stroke.

Study Design: Case report., Introduction: Radial nerve injury can cause severe functional impairment due to paralysis of wrist and digit extensors. Various orthotic designs have been described, including static, dynamic, and tenodesis. All provide wrist stabilization or extension assistance. Some, but not all, also provide extension assistance to the wrist, thumb, and fingers., Purpose and Methods: This article tells the story of Max, a 27-year-old male university student, who sustained a radial nerve injury after a left humeral shaft fracture. He was treated at a Brazilian tertiary hospital, where the choice of thermoplastics and dynamic components resulted in limited options for orthotic fabrication. Max was provided with custom-molded static wrist orthosis and a bulky, older style, high-profile dynamic forearm-based wrist-finger-thumb assistive-extension orthosis., Results and Discussion: Grip strength and functional status improved, and Max was completely satisfied because with the dynamic orthosis, he could play the guitar again, which was his favorite activity., Conclusion: Max's story illustrates that a convenient functionally oriented orthotic intervention can be performed even in resource-limited environments by following the client-centered bio-occupational orthotic framework proposed by McKee and Rivard. This framework addresses the client's biological needs (addressing paralyzed muscles and maintaining length of soft tissues) and occupational/functional needs., (Copyright © 2018 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Background: Increasingly, occupational and physical therapists are using safe patient handling and mobility (SPHM) equipment, such as mechanical lifts, in rehabilitation. However, there is little guidance in the literature on how SPHM equipment can be used to assist patients to reach rehabilitation goals. The purpose of this projectwas to document and categorize common and innovative ways rehabilitation therapists use SPHM equipment in their clinical practice., Objective: This article investigates common and innovative uses of SPHM equipment in rehabilitation practice., Methods: Occupational, physical and kinesio therapist employed at the Veterans Health Administration wrote narratives and took photos describing rehabilitation therapy activities where they used SPHM equipment in their clinical practice. The authors used a systematic process to review and categorize the narratives and subsequent photos by using the World Health Organization's International Classification of Functioning, Disability and Health (ICF)., Results: Thirty narratives (13 innovative and 17 common) were coded into four categories on the ICF section of mobility. The most common category was "changing and maintaining basic body position"(21) followed by "walking and moving" (5). The category "carrying, moving and handling objects" garnered two narratives and there were no narratives for "using transportation.", Conclusions: Project findings may serve as a guide for therapists who would like to enhance their use of SPHM equipment in rehabilitation. Additional research is needed to expand the use of SPHM in rehabilitation practice and evaluate the impact on patient rehabilitation outcomes and therapist safety outcomes.

Objectives: To evaluate whether occupational therapy, provided in the period between referral and surgical consultation, might delay or reduce the need of surgery in thumb carpometacarpal joint (CMCJ) osteoarthritis and to explore predictors for CMCJ surgery., Methods: This multicentre randomised controlled trial included patients referred for surgical consultation due to CMCJ osteoarthritis. An occupational therapy group received hand osteoarthritis education, assistive devices, CMCJ orthoses and exercises. A control group received only hand osteoarthritis information. Primary outcome was the proportion of patients that had received CMCJ surgery after 2 years. We examined the primary outcome and predictors for surgery with regression models, and time to surgery with the log-rank test and cox regression analyses., Results: Of 221 patients screened for eligibility, 180 were randomised. Information on the primary outcome was collected from medical records for all included patients. Surgery was performed on 22 patients (24%) that had received occupational therapy and 29 (32%) control patients (OR 0.56, 95% CI 0.26 to 1.21; p=0.14). Median time to surgery was 350 days (IQR 210-540) in the occupational therapy group and 296 days (IQR 188-428) in the control group (p=0.13). Previous non-pharmacological treatment (OR 2.72, 95% CI 1.14 to 6.50) and higher motivation for surgery (OR 1.25, 95% CI 1.09 to 1.43) were significant predictors for CMCJ surgery., Conclusions: Occupational therapy showed a small non-significant tendency to delay and reduce the need for surgery in CMCJ osteoarthritis. Previous non-pharmacological treatment and higher motivation for surgery were significant predictors for surgery., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The commercial popularity of smart home (SH) technology has broadened the scope of aging-in-place and home health occupational therapy. The objective of this article is to examine ownership of SH technology by older adults, their readiness to adopt SH technology, and identify the client factors relating to the adoption. A survey of older adults aged 60 and above living in the community was conducted. Respondents ( N = 445) who were women; in the age group of 60 to 70 years; living in a two-level home, with a body function impairment; with a fall history; and experienced in information and communication technology (ICT) were significantly likely to be "brisk adopters" of SH ( p < .05). Stepwise regression model identified marital status, home security, and overall ICT ownership as the predictors of SH ownership, whereas being female, concern over home security, and perceived independence contributed to SH readiness ( p < .05). Consideration of the identified client profiles, health, and personal factors will strengthen SH integration for aging-in-place.

Background/aim: Task-specific repetitive training, a usual care in occupational therapy practice, and robotic-aided rehabilitation with bilateral practice are used to improve upper limb motor and task performance. The difference in effects of two strategies requires exploration. This study compared the impact of robotic-assisted therapy with bilateral practice (RTBP) and usual task-specific training facilitated by therapists on task and motor performance for stroke survivors., Methods: Forty-three community-dwelling stroke survivors (20 males; 23 females; 53.3 ± 13.1 years; post-stroke duration 14.2 ± 10.9 months) were randomised into RTBP and usual care. All participants received a 10-minute per-protocol sensorimotor stimulation session prior to interventions as part of usual care. Primary outcome was different in the amount of use (AOU) and quality of movement (QOM) on the Motor Activity Log (MAL) scale at endpoint. Secondary outcomes were AOU and QOM scores at follow-up, and pre-post and follow-up score differences on the Fugl-Meyer Assessment (FMA) and surface electromyography (sEMG). Friedman and Mann-Whitney U tests were used to calculate difference., Results: There were no baseline differences between groups. Both conditions demonstrated significant within-group improvements in AOU-MAL and FMA scores following treatment (P < 0.05) and improvements in FMA scores at follow-up (P < 0.05). The training-induced improvement in AOU (30.0%) following treatment was greater than the minimal detectable change (16.8%) in the RTBP group. RTBP demonstrated better outcomes in FMA wrist score (P = 0.003) and sEMG of wrist extensor (P = 0.043) following treatment and in AOU (P < 0.001), FMA total score (P = 0.006), FMA wrist score (P < 0.001) and sEMG of wrist extensor (P = 0.017) at follow-up compared to the control group. Control group boost more beneficial effects on FMA hand score (P = 0.049) following treatment., Conclusions: RTBP demonstrated superior upper limb motor and task performance outcomes compared to therapists-facilitated task training when both were preceded by a 10-minute sensorimotor stimulation session., Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03847103., (© 2019 Occupational Therapy Australia.)

The Activity Card Sort (ACS) measures the level of participation, as perceived by each person which, unlike other scales, makes it both personal and significant. However, there is a limitation to applying the ACS to Spanish older adults as it is restricted to culturally relevant activities solely in the United States. Therefore, the aim of this study was to select activity items that reflected Spanish older adults' lifestyles in order to develop the Activity Card Sort-Spain Version (ACS-SP). Frequently, activities performed in Spain ( n = 103) were listed in an initial draft. The Likert scale was administrated to a large group of Spanish nationals over the age of 60 years ( n = 98) to establish which type of activities will be eventually included in the Spanish version. The final version was drawn up comprising 79 activities distributed between four performance areas. In addition, other activities that were not previously included by other assessment tools were considered and have been listed in this review, such as taking a nap, going out for a drink or "tapas," or searching for a job. The gradual adaptation to ACS for Spaniards will make it possible to measure the level of an individual's participation within a community. However, further work on psychometric properties is needed., Competing Interests: The authors report no conflicts of interest concerning the research, authorship, and/or publication of this article.

Background: Occupational self-analysis programmes have been developed to promote health, mainly in older adults. However, we have found no published studies dealing with this in people with intellectual disability (ID). The aim of this study was to examine the effectiveness of an occupational self-analysis programme in people with ID, focusing on the areas of subjective health perception and participation., Methods: This study explored the benefits of the 'Occupational Self-Analysis Programme' in people with ID. The intervention group comprised 12 participants and the control group comprised 13 participants. Outcomes were measured using the SF-36 Health Survey and the Role Checklist. The contents of participants' journals and a focus group discussion were also analysed., Results: Compared with the control group, the intervention group showed statistically significant improvements in role limitations because of physical health and role limitations because of emotional problems, social functioning and the cumulative scores of the mental component in the SF-36 Health Survey. The qualitative analysis revealed that participants in the intervention group increased their participation in activities related with daily living, leisure, employment seeking and acquisition, and social participation. These participants also became more aware of issues that lead to a greater engagement in meaningful occupations., Conclusion: This programme allowed participants to engage in meaningful activities with other people and to increase their perceived health status by raising awareness of the strengths and difficulties of participation., (© 2019 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Children with hand motor impairment due to cerebral palsy, traumatic brain injury, or pediatric stroke are considerably affected in their independence, development, and quality of life. Treatment conventionally includes task-oriented training in occupational therapy. While dose and intensity of hand therapy can be promoted through technology, these approaches are mostly limited to large stationary robotic devices for non-task-oriented training, or passive wearable devices for children with mild impairments. Here we present PEXO, a fully wearable actuated pediatric hand exoskeleton to cover the special needs of children (6 to 12 years of age) with strong impairments in hand function. Through three degrees of freedom, PEXO provides assistance in various grasp types needed for the execution of functional tasks. It is lightweight, water proof, and inherently interacts safely with the user. It meets mechanical requirements such as force, fast closing movement, and battery lifetime derived from literature and discussions with clinicians. Appealing appearance, user-friendly design, and intuitive control with visual feedback of forearm muscle activity should keep the user motivated during training in the clinic or at home. A pilot test with a 6-years old child with stroke showed that PEXO can provide assistance in grasping various objects weighing up to 0.5 kg. These are promising first results on the way to make hand exoskeletons accessible for children with neuromotor disorders.

Background: DriveSafe measures awareness of the driving environment. It is one subtest of DriveSafe DriveAware, a cognitive fitness-to-drive screening instrument. We converted DriveSafe to a touchscreen format for ease of administration; this necessitated the development of an automatic data collection and scoring system to reflect the decision that would otherwise have been made by an expert rater. We applied a structured process to determine what constituted 'correct' scores. We then examined the resulting scoring parameters to determine if these discriminated at-risk drivers from a comparison sample., Methods: Thirty at-risk older drivers and 30 younger drivers took touchscreen DriveSafe. Following presentation of images containing between one and four objects/hazards for 4 seconds, participants indicated their recall of object/hazard characteristics (type, location and direction of movement) by touching the screen. We analysed responses via descriptive statistics to compare spread, accuracy and consistency; and via a Fisher's exact test to determine whether the set scoring parameters could discriminate between at-risk and comparison drivers., Results: Fisher's exact test results indicated 24 of 28 location zones and 18 of 28 direction ranges discriminated at-risk drivers from the comparison group (P < 0.05). Frequency of missed or incorrectly identified hazards was much higher for the at-risk group for all variables. At-risk drivers missed or misidentified significantly (P < 0.00) more object types (34%), directions (47%), and locations (36%) than the comparison group (≤4% for each variable). At-risk drivers entered 31 additional responses for objects/hazards not displayed; the comparison group entered no additional responses., Conclusion: The automatic variable data collection and scoring system reflected decisions that would have been made by an expert rater. This systematic process provided automated scoring decisions that enabled us to discriminate at-risk drivers from a comparison group. Psychometric evaluation of data gathered with touchscreen DriveSafe is required prior to use in clinical practice., (© 2019 Occupational Therapy Australia.)

Study Design: Cross-sectional study., Objectives: To examine the construct validity and the ability to detect change, of the Italian version of the Canadian Occupational Performance Measure (COPM) in a spinal cord injury (SCI) population., Settings: Rehabilitation service of the Paraplegic Center of Ostia, Italy., Methods: Thirty-nine spinal cord injury participants were recruited. The clinimetric properties of the measure were assessed following international guidelines. Cronbach's alpha and the intraclass correlation coefficient were assessed for internal consistency and test-retest reliability, respectively. Construct validity was evaluated, by calculating correlation between COPM and the Spinal Cord Independence Measure (SCIM) through Pearson's correlation coefficient and Spearman's Rho. The ability to detect change was evaluated on the overall sample., Results: The COPM was shown to be reliable in a spinal cord injury sample with positive and statistically significant results for Cronbach's alpha (0.89) and ICC (0.99 for the performance subtest and 0.98 for the satisfaction subtest). Correlation coefficients did not show a correlation between the COPM total score and the SCIM. The COPM scores improved significantly during in-patient rehabilitation, moreover the mean change between the start of treatment and the end of the therapy as evaluated with the Wilcoxon signed-rank test was -4.25 points for the performance score and -2.96 points for the satisfaction score., Conclusions: This study showed that the COPM is a reliable tool for assessing SCI clients' perceived performance of daily activities and their satisfaction with their performance., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© International Spinal Cord Society 2019.)

Background: The continuous development of mobile apps has led to many health care professionals using them in clinical settings; however, little research is available to guide occupational therapists (OTs) in choosing quality apps for use in their respective clinical settings., Objective: The purpose of this study was to use the user version of the Mobile Application Rating Scale (uMARS) to evaluate the quality of the most frequently noted mobile health (mHealth) apps used by OTs and to demonstrate the utility of the uMARS to assess the quality of mHealth apps., Methods: A previous study surveying OTs' use of apps in therapy compiled a list of apps frequently noted. A total of 25 of these apps were evaluated individually by 2 trained researchers using the uMARS, a simple, multidimensional analysis tool that can be reliably used to evaluate the quality of mHealth apps., Results: The top 10 apps had a total quality score of 4.3, or higher, out of 5 based on the mean scores of engagement, functionality, and aesthetics. Apps scored highest in functionality and lowest in engagement. Apps noted most frequently were not always high-quality apps; apps noted least frequently were not always low-quality apps., Conclusions: Determining the effectiveness of using apps in clinical settings must be built upon a foundation of the implementation of high-quality apps. Mobile apps should not be incorporated into clinical settings solely based on frequency of use. The uMARS should be considered as a useful tool for OTs, and other professionals, to determine app quality., (©Kelsea LeBeau, Lauren G Huey, Mark Hart. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 01.05.2019.)

Natural contexts and family involvement are key features of effective intervention approaches. However, the measurement of community participation and parent engagement with children remains complex. Therefore, we examined the feasibility of combining use of the Language ENvironment Analysis (LENA ® ) system and a global positioning system (GPS; i.e., Qstarz ® BT-Q1000XT). The LENA is a small speech recognition device that captures and quantifies full-day recordings of the natural language environment. The Qstarz BT-Q1000XT is a wearable GPS data logger that allows identification of the locations a person visits. The marrying of these measures allows for an accurate representation of community settings that afford children greater social communication opportunities. Our results show that the combination of measures provides meaningful social communication location data. Also, the participating caregiver reported that the collection of measures was feasible across community settings., (Copyright © 2018 by the American Occupational Therapy Association, Inc.)

Objective: This study examined the parallel-forms reliability of a web application (app) of the Activity Card Sort Australia for adults ages 18-64 and assessed its clinical utility., Method: Forty-eight participants completed the app and card versions of the tool within a 2- to 3-wk interval and provided feedback via a purpose-designed survey. Intraclass correlation analysis tested parallel-forms reliability., Results: The app demonstrated acceptable parallel-forms reliability for overall retained activity level (r = .75, p < .001), the daily life domain (r = .77, p < .001), and the recreation and relaxation domain (r = .74, p < .001), but not for the physical activity domain (r = .59, p < .001). Clinical utility responses suggested good acceptance of both versions., Conclusion: The results suggest that further studies are required before the app version can be used for research or in clinical settings., (Copyright © 2018 by the American Occupational Therapy Association, Inc.)

Background.: Adaptive equipment (AE) is frequently provided during stroke rehabilitation by occupational therapists., Purpose.: This study aimed to identify the AE that people typically use after a stroke and the outcomes achieved as a result, and to explore people's experiences obtaining and using AE, to inform both practice and policy in this field., Method.: A mixed-methods study, involving a postal questionnaire and interviews, used descriptive statistics and grounded theory to analyze the quantitative and qualitative data, respectively., Findings.: Questionnaire data ( n = 258) revealed mobility AE was issued most frequently, with increased safety as the primary reported outcome. Interview data ( n = 15) indicated relationships with health professionals and the hospital environment shaped early AE selection and use. Once home, making sense of AE and community participation were more influential., Implications.: Therapeutic relationships and reflection time are critical to maximize AE use after stroke. Policy and related funding for AE need to prioritize community participation.

Background/aim: Pinch and grip strength assessment is commonly performed in occupational therapy practice. However, the typically utilised methods are limited to pinch or grip dynamometers and do not readily translate to handling everyday objects. With the advent of consumer-grade 3D printing and low-cost sensor systems, the possibilities for creating customised assessment devices are expanding. As a first step in determining the validity of low-cost sensor systems, their data must be compared to a gold standard. Consequently, this study examined the criterion validity of two such systems for measuring pinch strength, specifically a small load cell and pressure-sensing fabric, with a mechanical pinch gauge., Methods: A total of 33 participants performed strength tests using a mechanical pinch grip device, which had a plastic 3D printed cover with a pressure-sensing fabric overlaid on it to allow for simultaneous criterion validation, and a small load cell with a plastic 3D printed casing designed for comfortable pinch grip assessment., Results: The simultaneously assessed fabric sensor and mechanical pinch grip device showed excellent absolute (ICC 2,k  = 0.94) and relative (Pearson's R = 0.90) agreement. Both devices showed similar excellent relative (R > 0.75) agreement with the load cell despite non-simultaneous assessment. These findings indicate that 3D printed sensors incorporating a load cell and a pressure-sensing fabric can be used to replicate a pinch grip assessment performed with a mechanical pinch gauge., Conclusions: This study lays the foundation for these sensor systems to be modified for use as assessment tools during the performance of functional tasks using everyday objects. Additionally, because both systems generate real-time force data they could be used for biofeedback as part of rehabilitation and strengthening programs. To aid uptake and future research using these systems, the 3D print models, step-by-step hardware design and software programs used are provided in an open-source format at www.rehabtools.org/otsensors.html., (© 2018 Occupational Therapy Australia.)

Mealtime is an important family routine commonly affected for families with children with autism spectrum disorders (ASD). Limited research is available regarding strategies families incorporate to support mealtime engagement. The purpose of this study was to explore the frequency and characterize the purpose of Props used during mealtimes with children with ASD. A total of 12 families with a child(ren), N = 14, aged 2 to 7 years, with ASD and mealtime challenges or eating difficulties participated in video-recorded mealtimes in their home. Independent coders analyzed mealtimes for the frequency and purpose of Props (items used to support child participation during mealtime). Props were used by 75% of families ( n = 9); common Props included toys, electronics, and books. Props were used primarily as a self-regulation tool for the child and occasionally as positive reinforcement for specific behaviors. Overall, Props were used to support child engagement in mealtime. Occupational therapists should consider using Props as individualized, accessible, and supportive mealtime interventions for families and children.

The effectiveness of sleep intervention developed by occupational therapists was reviewed, and a conceptual framework for organizing the developing practice of sleep management in occupational therapy was proposed in this paper. Evidence-based articles on sleep management practice in occupational therapy from 2007 to 2017 were retrieved. Four types of effective sleep management intervention were identified from the literature, including the use of assistive devices/equipment, activities, cognitive behavioral therapy for insomnia, and lifestyle intervention, and the use of assistive device was the most popular intervention. Applying the Person-Environment-Occupation Performance (PEOP) framework, we developed a conceptual framework for organizing occupational therapy practice in sleep management. The future development of occupation-based sleep intervention could focus on strategies to (1) minimize the influence of bodily function on sleep, (2) promote environment conducive to sleep, and (3) restructure daytime activity with a focus on occupational balance.

Background: Despite the popularity of commercial games in lower limb prosthetic rehabilitation, data about their prevalence of use as well as therapists' perspectives about these games are still lacking., Objectives: To learn about the prevalence of use of commercial games in lower limb prosthetic rehabilitation and therapists' perspectives about these games., Study Design: Cross-sectional., Methods: An online survey was sent to physical and occupational therapists across prosthetic rehabilitation facilities in Canada. The survey had questions about the use of commercial games and therapists' perspectives., Results: Data were collected from 82 therapists. Overall, 46.3% (38/82) reported that they use commercial games; of those, 94.7% (36/38) used the Nintendo Wii Fit. The most reported perceived benefits were the Wii Fit helping to improve weight shifting ( n = 76/82, 92.7%) and balance ( n = 75/82, 91.5%), and being motivating and complementing traditional therapy ( n = 75/82, 91.5%). The most reported perceived barriers/challenges were lack of time and familiarity with the games ( n = 58/82, 70.7%)., Conclusion: Commercial games, particularly the Wii Fit, are commonly used in lower prosthetic rehabilitation in Canada. Most of the queried therapists view the Wii Fit positively. Knowledge translation activities and developing standard treatment protocols would be helpful in minimizing the barriers identified in this study. Clinical relevance The Wii Fit is prevalent in lower limb prosthetic rehabilitation in Canada and it is viewed positively by therapists as having the potential to improve balance and weight bearing, making rehabilitation more motivating, and complementing traditional therapy. Future studies should investigate the efficacy of the Wii Fit in prosthetic rehabilitation.

Background: Occupational therapists use technologies to manage wandering-related risks to promote safety and independence among individuals with dementia living in the community., Purpose: The purpose of this review was to examine types of technologies used to manage wandering behaviour., Method: Using a modification of Arksey and O'Malley's methodology, we systematically searched peer-reviewed and grey literature on technologies used in home or supportive care environments for persons with dementia at risk for wandering. Data from the studies were analyzed descriptively., Findings: The literature described 83 technologies. Nineteen devices were clinically tested. Interventions ranged from alarm products to mobile locator devices. Benefits included reductions in risk and caregiver burden., Implications: Occupational therapy strategies include technologies to enhance function in persons with dementia. Technologies can also reduce risks of wandering and should be affordable. Ethical issues of the use of technology must be addressed. More research is needed to increase levels of evidence.

Purpose of Review: In the span of a few months, fidget spinners have caught the eyes of millions of children, parents, educators and paediatricians. Fidget spinners, hand-held toys designed to spin freely in your grasp, have become a source of entertainment for consumers of all ages. Despite a lack of scientific evidence, toy marketers have advertised the benefits of fidget spinners for children with attention-deficit/hyperactivity disorder and other disorders (e.g. autism, anxiety, sensory issues). Parents are incentivized by these purported benefits to purchase fidget spinners to improve their child's concentration and decrease stress., Recent Findings: While fidget spinners are a new phenomenon, existing therapy toys (e.g. sensory putty) have been used by occupational therapists for similar reasons, with comparably little research supporting these claims. The purpose of this review is to explore literature regarding sensory toys and examine educator/professional-reported concerns and medical adverse effects of using fidget spinners., Summary: Due to a recent surge in popularity, fidget spinners and other self-regulatory occupational therapy toys have yet to be subjected to rigorous scientific research. Thus, their alleged benefits remain scientifically unfounded. Paediatricians should be aware of potential choking hazards with this new fad, and inform parents that peer-reviewed studies do not support the beneficial claims.

Introduction: This case study describes the application of a commercially available, custom myoelectric elbow-wrist-hand orthosis (MEWHO), on a veteran diagnosed with chronic stroke with residual left hemiparesis. The MEWHO provides powered active assistance for elbow flexion/extension and 3 jaw chuck grip. It is a noninvasive orthosis that is driven by the user's electromyographic signal. Experience with the MEWHO and associated outcomes are reported., Materials and Methods: The participant completed 21 outpatient occupational therapy sessions that incorporated the use of a custom MEWHO without grasp capability into traditional occupational therapy interventions. He then upgraded to an advanced version of that MEWHO that incorporated grasp capability and completed an additional 14 sessions. Range of motion, strength, spasticity (Modified Ashworth Scale [MAS]), the Box and Blocks test, the Fugl-Meyer assessment and observation of functional tasks were used to track progress. The participant also completed a home log and a manufacturers' survey to track usage and user satisfaction over a 6-month period., Results: Active left upper extremity range of motion and strength increased significantly (both with and without the MEWHO) and tone decreased, demonstrating both a training and an assistive effect. The participant also demonstrated an improved ability to incorporate his affected extremity (with the MEWHO) into a wide variety of bilateral, gross motor activities of daily living such as carrying a laundry basket, lifting heavy objects (e.g. a chair), using a tape measure, meal preparation, and opening doors., Conclusion: Custom myoelectric orthoses offer an exciting opportunity for individuals diagnosed with a variety of neurological conditions to make advancements toward their recovery and independence, and warrant further research into their training effects as well as their use as assistive devices., (Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.)

Purpose: One of the many difficulties a person with dementia can experience is difficulty with way finding and subsequently getting lost in the community. Prescriptions of assistive technology are a key role for occupational therapists. This study aimed to describe the attitudes and practices of occupational therapists in recommending and using assistive technology for persons with dementia who have difficulties with way finding in the community., Methods: An online survey was distributed to members of Occupational Therapy Australia NSW and included 25 items on demographics, frequency of use of assistive technology and assessment., Results: A total of 85 occupational therapists responded to the survey. Significant differences were identified in the approaches used, the types of assistive technology used and the evaluation of outcomes, between community-based and hospital-based occupational therapists. Over half of the participants had never prescribed any of the assistive devices listed in the survey for people with dementia. The most frequently prescribed assistive devices were low-tech items that were already freely available to carers and other professions., Conclusion: Therapists used a conservative approach to problem solving with their clients with dementia. There is a limited understanding from occupational therapists about available interventions for people with dementia. Implications for Rehabilitation There is limited awareness on how assistive technology might be used to support occupational performance for persons with dementia. This survey suggests that occupational therapists experience barriers in identifying and providing appropriate assistive technology for this group. Access to targeted education and online resources for occupational therapists is recommended to provide better awareness of the types of assistive technology available to assist persons with dementia and their caregivers.

Many mechatronic devices exist to facilitate hand rehabilitation, however few directly address deficits in muscle activation patterns while also enabling functional task practice. We developed an innovative voice and electromyography-driven actuated (VAEDA) glove, which is sufficiently flexible/portable for incorporation into hand-focused therapy post-stroke. The therapeutic benefits of this device were examined in a longitudinal intervention study. Twenty-two participants with chronic, moderate hand impairment [Chedoke-McMaster Stroke Assessment Stage of Hand (CMSA-H = 4)] enrolled > 8 months post-stroke for 18 1-h training sessions ( 3 × week) employing a novel hand-focused occupational therapy paradigm, either with (VAEDA) or without (No-VAEDA) actuated assistance. Outcome measures included CMSA-H, Wolf Motor Function Test (WMFT), Action Research Arm Test, Fugl-Meyer Upper Extremity Motor Assessment (FMUE), grip and pinch strength and hand kinematics. All outcomes were recorded at baseline and endpoint (immediately after and four weeks post-training). Significant improvement was observed following training for some measures for the VAEDA group (n = 11) but for none of the measures for the No-VAEDA group (n = 11). Specifically, statistically significant gains were observed for CMSA-H (p = 0.038) and WMFT (p = 0.012) as well as maximum digit aperture subset (p = 0.003, n = 7), but not for the FMUE or grip or pinch strengths. In conclusion, therapy effectiveness appeared to be increased by employment of the VAEDA glove, which directly targets deficits in muscle activation patterns.

Objectives: To investigate the treatment effects of bilateral robotic priming combined with the task-oriented approach on motor impairment, disability, daily function, and quality of life in patients with subacute stroke., Design: A randomized controlled trial., Setting: Occupational therapy clinics in medical centers., Subjects: Thirty-one subacute stroke patients were recruited., Interventions: Participants were randomly assigned to receive bilateral priming combined with the task-oriented approach (i.e., primed group) or to the task-oriented approach alone (i.e., unprimed group) for 90 minutes/day, 5 days/week for 4 weeks. The primed group began with the bilateral priming technique by using a bimanual robot-aided device., Main Measures: Motor impairments were assessed by the Fugal-Meyer Assessment, grip strength, and the Box and Block Test. Disability and daily function were measured by the modified Rankin Scale, the Functional Independence Measure, and actigraphy. Quality of life was examined by the Stroke Impact Scale., Results: The primed and unprimed groups improved significantly on most outcomes over time. The primed group demonstrated significantly better improvement on the Stroke Impact Scale strength subscale ( p = 0.012) and a trend for greater improvement on the modified Rankin Scale ( p = 0.065) than the unprimed group., Conclusion: Bilateral priming combined with the task-oriented approach elicited more improvements in self-reported strength and disability degrees than the task-oriented approach by itself. Further large-scale research with at least 31 participants in each intervention group is suggested to confirm the study findings.

Background/aim: Assistive technologies have the potential to increase the amount of movement practice provided during inpatient stroke rehabilitation. The primary aim of this study was to investigate the feasibility of using the Saebo-Flex ™ device in a subacute stroke setting to increase task-specific practice for people with little or no active hand movement. The secondary aim was to collect preliminary data comparing hand/upper limb function between a control group that received usual rehabilitation and an intervention group that used, in addition, the Saebo-Flex ™ device., Methods: Nine inpatients (mean three months (median six weeks) post-stroke) participated in this feasibility study conducted in an Australian rehabilitation setting, using a randomised pre-test and post-test design with concealed allocation and blinded outcome assessment. In addition to usual rehabilitation, the intervention group received eight weeks of daily motor training using the Saebo-Flex ™ device. The control group received usual rehabilitation (task-specific motor training) only. Participants were assessed at baseline (pre-randomisation) and at the end of the eight-week study period. Feasibility was assessed with respect to ease of recruitment, application of the device, compliance with the treatment programme and safety. Secondary outcome measures included the Motor Assessment Scale (upper limb items), Box and Block Test, grip strength and the Stroke Impact Scale., Results: Recruitment to the study was very slow because of the low number of patients with little or no active hand movement. Otherwise, the study was feasible in terms of being able to apply the Saebo-Flex ™ device and compliance with the treatment programme. There were no adverse events, and a greater amount of upper limb rehabilitation was provided to the intervention group. While there were trends in favour of the intervention group, particularly for dexterity, no between-group differences were seen for any of the secondary outcomes., Conclusions: This pilot feasibility study showed that the use of assistive technology, specifically the Saebo-Flex ™ device, could be successfully used in a sample of stroke patients with little or no active hand movement. However, recruitment to the trial was very slow. The use of the Saebo-Flex TM device had variable results on outcomes, with some positive trends seen in hand function, particularly dexterity., (© 2016 Occupational Therapy Australia.)

Background: This pilot study aimed to understand the importance of assistive technology (AT) aesthetics on the intention to purchase, using grab rails as the example. Furthermore, the study explored the economic value consumers placed on aesthetic appeal., Method: Structured interviews were conducted with 25 participants, nine female, mean age 59; where seven grab rails were presented and feedback obtained on the level of appeal and 'willingness to pay'. Responses to open-ended and fixed response questions were transcribed by the interviewer during the interview and a qualitative content analysis conducted., Results: Positive and negative terms in relation to aesthetics were used to describe appealing and unappealing grab rails; however, all grab rails were felt to have negative aesthetic aspects by at least five participants. Physical design and finish emerged as the two main themes regarding the appeal of the grab rail designs. Participants' 'willingness-to-pay' for appealing options was mixed, with both over and under valuations. The most likely grab rails to be purchased were considered both appealing and cost effective by participants., Conclusion: Aesthetic appeal plays an important role in acceptance and uptake of AT. Designers and manufacturers should be encouraged to provide appealing options as the study has shown consumers prefer aesthetically appealing grab rails. However, the challenge is creating more appealing designs, without increasing cost as consumers seem to not want to pay more for them. Furthermore, clinicians need to acknowledge the importance of aesthetics when recommending interventions and be familiar with a range of options to provide clients with more choice., (© 2016 Occupational Therapy Australia.)

Background: In the absence of disease-modifying interventions for hand osteoarthritis (OA), occupational therapy (OT) comprising patient education, hand exercises, assistive devices and orthoses are considered as core treatments, whereas surgery are recommended for those with severe carpometacarpal (CMC1) OA. However, even though CMC1 surgery may reduce pain and improve function, the risk of adverse effects is high, and randomized controlled trials comparing surgery with non-surgical interventions are warranted. This multicentre randomized controlled trial aims to address the following questions: Does OT in the period before surgical consultation reduce the need for surgery in CMC1-OA? What are patients' motivation and reasons for wanting CMC1-surgery? Are there differences between departments of rheumatology concerning the degree of CMC1-OA, pain and functional limitations in patients who are referred for surgical consultation for CMC1 surgery? Is the Measure of Activity Performance of the Hand a reliable measure in patients with CMC1-OA? Do patients with CMC1-OA with and without affection of the distal and proximal interphalangeal finger joints differ with regard to symptoms and function? Do the degree of CMC1-OA, symptoms and functional limitations significantly predict improvement after 2 years following OT or CMC1-surgery? Is OT more cost-effective than surgery in the management of CMC1-OA?, Methods/design: All persons referred for surgical consultation due to their CMC1-OA at one of three Norwegian departments of rheumatology are invited to participate. Those who agree attend a clinical assessment and report their symptoms, function and motivation for surgery in validated outcome measures, before they are randomly selected to receive OT in the period before surgical consultation (estimated n = 180). The primary outcome will be the number of participants in each group who have received surgical treatment after 2 years. Secondary and tertiary outcomes are pain, function and satisfaction with care over the 2-year trial period. Outcomes will be collected at baseline, 4, 18 and 24 months. The main analysis will be on an intention-to-treat basis, using logistic regression, comparing the number of participants in each group who have received surgical treatment after 2 years., Discussion: The findings will improve the evidence-based management of HOA., Trial Registration Identifier: NCT01794754 . First registrated February 15 th 2013.

Background: Adults with cognitive disabilities often have difficulties in dealing with the complexity of everyday life. With cognitive assistive technology (e.g. electronic planning devices [EPDs] and individual support), they can bring order to their often chaotic life. Assumptions are that environmental factors influence with non-use of EPDs., Objective: To explore how adults with cognitive disabilities perceive the influence of environmental factors in the use of EPDs., Methods: A reference group with experience of use of EPDs assisted the researchers. Twelve adults with cognitive disabilities and experience of using EPDs participated. An interview guide was implemented covering environmental factors according to the International Classification of Functioning, Disability and Health. Qualitative content analysis was applied in the analyses., Results: Five categories and two themes emerged, which were integrated into a model of facilitating factors influencing the use of EPDs. Measures to prevent or eliminate negative influences of the device use are important to be taken., Conclusions: Professionals need more knowledge about EPDs, while users need individual adaption of the EPDs. EPDs need to be user-friendly, manageable and work in any seasons. Implications for Rehabilitation The users should have access to specially trained prescribers. There is a need for development of user-friendly and manageable products to function in any climate. Knowledge is lacking on how to implement the users in all stages of the prescribing process. Prescribers should increase knowledge in the use of EPDs to influence the attitudes of the social environment.

Bimanual coordination underlies many daily activities. It is tested by various versions of the old Minnesota Dexterity Test (dating back to 1931, 'turning' subtest). This, however, is ill standardized, may be time-consuming, and has poor normative data. A timed-revised form of the turning subtest (MTTrf) is presented. Age-related norms and test-retest reliability were computed. Sixty-four healthy individuals, 24-79 years, comprising 34 women, were required to pick up 60 small plastic disks from wells, rotate each disk, and transfer it to the other hand, which must replace it, as quickly as possible. Two trials were requested for each hand (ABBA sequence). The average time (seconds) across the 4 trials gave the test score. Participants were grouped (CART algorithm) into 3 statistically distinct (P<0.05) age×score strata, with cutoff 53+ and 73+ years, and tested at baseline and after 1 week. Test-retest reliability was measured both as consistency [intraclass correlation coefficient (ICCs) model 2.1] and as agreement (Bland-Altman plot). From the ICCs, the individual test-retest minimal real difference (in seconds) was computed. The whole MTTrf took less than 4 min to administer. Baseline scores ranged from 40 to 78 s. The ICCs ranged from 0.45 to 0.81 and the minimal real difference ranged from 6.68 to 13.40 s across the age groups. Fifty-nine out of 64 observations (92%) fell within the confidence limits of the Bland-Altman plot. The MTTrf is a reliable and practical test of bimanual coordination. It may be a useful addition to protocols of manual testing in occupational therapy.

Treatment options for stroke survivors with severe hand impairment are limited. Active task practice can be restricted by difficulty in voluntarily activating finger muscles and interference from involuntary muscle excitation. We developed a portable, actuated glove-orthosis, which could be employed to address both issues. We hypothesized that combining passive cyclical stretching (reducing motoneuronal hyperexcitability) imposed by the device with active-assisted, task-oriented training (rehabilitating muscle activation) would improve upper extremity motor control and task performance post-stroke. Thirteen participants who experienced a stroke 2-6 months prior to enrollment completed 15 treatment sessions over five weeks. Each session involved cyclically stretching the long finger flexors (30 min) followed by active-assisted task-oriented movement practice (60 min). Outcome measures were completed at six intervals: three before and three after treatment initiation. Overall improvement in post-training scores was observed across all outcome measures, including the Graded Wolf Motor Function Test, Action Research Arm Test, and grip and pinch strength (p ≤ 0.02), except finger extension force. No significant change in spasticity was observed. Improvement in upper extremity capabilities is achievable for stroke survivors even with severe hand impairment through a novel intervention combining passive cyclical stretching and active-assisted task practice, a paradigm which could be readily incorporated into the clinic.

Background: The functional performance of currently available body-powered prostheses is unknown., Objective: The goal of this study was to objectively assess and compare the functional performance of three commonly used body-powered upper limb terminal devices., Study Design: Experimental trial., Methods: A total of 21 able-bodied subjects (n = 21, age = 22 ± 2) tested three different terminal devices: TRS voluntary closing Hook Grip 2S, Otto Bock voluntary opening hand and Hosmer Model 5XA hook, using a prosthesis simulator. All subjects used each terminal device nine times in two functional tests: the Nine-Hole Peg Test and the Box and Blocks Test., Results: Significant differences were found between the different terminal devices and their scores on the Nine-Hole Peg Test and the Box and Blocks Test. The Hosmer hook scored best in both tests. The TRS Hook Grip 2S scored second best. The Otto Bock hand showed the lowest scores., Conclusion: This study is a first step in the comparison of functional performances of body-powered prostheses. The data can be used as a reference value, to assess the performance of a terminal device or an amputee., Clinical Relevance: The measured scores enable the comparison of the performance of a prosthesis user and his or her terminal device relative to standard scores., (© The International Society for Prosthetics and Orthotics 2014.)

This systematic review describes the published evidence related to the effectiveness of frequency modulation (FM) devices in improving academic outcomes in children with auditory processing difficulties. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were used to identify articles published between January 2003 and March 2014. The Cochrane Population, Intervention, Control, Outcome, Study Design approach and the American Occupational Therapy Association process forms were used to guide the article selection and evaluation process. Of the 83 articles screened, 7 matched the systematic review inclusion criteria. Findings were consistently positive, although limitations were identified. Results of this review indicate moderate support for the use of FM devices to improve children's ability to listen and attend in the classroom and mixed evidence to improve specific academic performance areas. FM technology should be considered for school-age children with auditory processing impairments who are receiving occupational therapy services to improve functioning in the school setting., (Copyright © 2016 by the American Occupational Therapy Association, Inc.)

The cognitive deficits in persons with dementia (PwD) can produce significant functional impairment from early stages. Although memory decline is most prominent, impairments in attention, orientation, language, reasoning, and executive functioning are also common. Dementia is also characterized by changes in personality and behavioral functioning that can be very challenging for caregivers and patients. This paper presents results on the use and adoption of an assisted cognition system to support occupational therapy to address psychological and behavioral symptoms of dementia. During 16 weeks, we conducted an in situ evaluation with two caregiver-PwD dyads to assess the adoption and effectiveness of the system to ameliorate challenging behaviors and reducing caregiver burden. Evaluation results indicate that intervention personalization and a touch-based interface encouraged the adoption of the system, helping reduce challenging behaviors in PwD and caregiver burden.

Objectives: To investigate the acceptability and potential efficacy of two commercial video games for improving upper extremity function after stroke in order to inform future sample size and study design., Design: A controlled clinical trial design using sequential allocation into groups., Setting: A clinical occupational therapy department., Subjects: Twenty-four first-stroke patients., Interventions: Patients were assigned to one of three groups: conventional group, Wii group, and XaviX group. In addition to regular one-hour conventional rehabilitation, each group received an additional half-hour of upper extremity exercises via conventional devices, Wii games, or XaviX games, for eight weeks., Main Measures: The Fugl-Meyer Assessment of motor function, Box and Block Test of Manual Dexterity, Functional Independence Measure, and upper extremity range of motion were used at baseline and postintervention. Also, a questionnaire was used to assess motivation and enjoyment., Results: The effect size of differences in change scores between the Wii and conventional groups ranged from 0.71 (SD 0.59) to 0.28 (SD 0.58), on the Fugl-Meyer Assessment of motor function (d = 0.74) was larger than that between the XaviX and conventional groups, ranged from 0.44 (SD 0.49) to 0.28 (SD 0.58) (d = 0.30). Patient enjoyment was significantly greater in the video game groups (Wii mean 4.25, SD 0.89; XaviX mean 4.38, SD 0.52) than in the conventional group (mean 2.25, SD 0.89, F = 18.55, p < 0.001), but motivation was not significantly different across groups., Conclusion: Patients were positive to using video games in rehabilitation. A sample size of 72 patients (24 per group) would be appropriate for a full study., (© The Author(s) 2014.)

Purpose: To determine a quantifiable measure to identify patients with dementia who can choose an illustration of meaningful activity using an iPad application, Aid for Decision-making in Occupation Choice (ADOC)., Method: We recruited 116 patients from 5 institutions in Japan. Occupational therapists interviewed patients with dementia to determine meaningful activities using ADOC. The most meaningful activity was confirmed by their primary caregivers. The cut-off was estimated from Mini-Mental State Examination (MMSE)., Results: Receiver operating characteristic analysis indicated that an MMSE score of 8 was the cut-off for choosing meaningful activities using ADOC. Sensitivity and specificity was 91.0% and 74.1%, respectively, and the area under the curve value was 0.89., Conclusion: ADOC can provide individualized information regarding meaningful activities for patients with moderate dementia. Implications for Rehabilitation As dementia progresses, difficulty in expressing needs or desires regarding meaningful activity may increase. The iPad application (Aid for Decision-making in Occupation Choice; ADOC) can be useful to promote shared decision-making through a systematic goal-setting process involving a choice of 95 illustrations describing daily activities. Mini-Mental State Examination (MMSE) score greater than 8 points is required to use the ADOC to choose most meaningful activities. ADOC provides individual information regarding meaningful activities for patients with moderate dementia.