Adina Maeir

Do ADHD and Executive Dysfunctions, Measured by the Hebrew Version of Behavioral Rating Inventory of Executive Functions (BRIEF), Completely Overlap?

The centrality of executive function deficits (EFD) in attention deficit/ hyperactivity disorder (ADHD) is well accepted albeit EFD is not synonymous with ADHD. The purpose of the present study was to examine the extent to which ADHD and EF overlap and to validate the Hebrew version of the Behavioral Rating Inventory of Executive Functions (BRIEF). Parents of 178 children with and without ADHD completed the BRIEF and the ADHD-Rating Scale. Significant differences were found between groups on each scale even after controlling for the other scale. Internal consistency analysis supported the reliability of the Hebrew version of the BRIEF. We conclude that ADHD and Executive Dysfunctions do not completely overlap.

What are the correlates of cognition and participation to return to work after first ever mild stroke

Abstract Background: The percentage of working age people with mild stroke has risen. Evidence indicates that even mild stroke impact cognition, executive functioning, and daily functioning, consequently affecting participation, quality of life (QoL) and return to work (RTW). Objectives: (1) Compare cognition, participation and QoL between people 3 months post-mild stroke who RTW and those who did not; and (2) To determine the correlates of these variables to RTW of participants 3 months post-stroke. Methods: We visited at home 163 stroke survivors (117 men, 46 women) 3 months post-mild stroke ranging from 50 to 89 years. Participants who returned to work (n = 114) and those who did not (n = 49). Data collection at home included measures for cognitive status (MoCA), executive functions (EFPT, DEX), depression (GDS), participation (RNL), and QoL (SIS recovery). Results: Significant differences were found between RTW participants and those who did not RTW in measures of cognition, depression, participation and QoL (t = 2.36 to − 5.62, P < 0.022–0.001). No difference was found on age or gender. Stepwise regression showed that significant correlates of RTW were participation (RNL), executive functions (EFPT), and QoL (SIS recovery). Conclusions: To enable RTW after mild stroke, participation, executive functions and QoL must be considered in planning interventions.

Putting Executive Performance in a Theoretical Context

This article provides a theoretical context to understand the role of executive functions in occupational performance. The authors provide definitions of the components of executive functions and their occupational significance. Assessment and intervention strategies for individuals with executive function deficits are discussed.

The Relationship Between Executive Functions and Quality of Life in Adults With ADHD.

Objective: Adult ADHD is associated with impaired quality of life (QoL) and deficient executive function (EF). Given the absence of studies examining the relationship between EF and health-related quality of life (HRQL) in this population, the purpose of the present study was to do so, by the use of rating scales and tests. Method: Adults with ADHD (n = 81) completed ADHD and EF questionnaires and a neuropsychological battery. Results: Small to large significant correlations were found between EF ratings and HRQL for most of the variables. No significant correlations were found between all but one EF test and HRQL. Both ADHD symptoms and EF rating, but not the EF test, were found to have a unique contribution to the HRQL. Conclusion: These results strengthen the ecological validity of the EF rating scales and their utility in identifying EF deficits with real-world implications for adults with ADHD.

Effectiveness of Cognitive-Functional (Cog-Fun) occupational therapy intervention for young children with attention deficit hyperactivity disorder: a controlled study.

OBJECTIVE The purpose of this study was to examine the effectiveness of the Cognitive-Functional (Cog-Fun) intervention for young children with attention deficit hyperactivity disorder (ADHD). METHOD Nineteen children ages 5-7 yr diagnosed with ADHD were allocated to treatment and wait-list control groups. After the 12-wk intervention, the control group was crossed over to treatment. Follow-up was conducted 3 mo after treatment. Outcome measures included the Behavior Rating Inventory of Executive Function and the Canadian Occupational Performance Measure. RESULTS Before crossover, significant differences were found between groups in change scores on the outcome measures. After crossover, no significant differences were found in treatment effects, and significant moderate to large treatment effects were found for both COPM and BRIEF scores. Treatment gains were maintained at follow-up. CONCLUSION The study supports the effectiveness of the Cog-Fun intervention in improving occupational performance and executive functions in daily life for young children with ADHD.

Ecological Validity of the Multiple Errands Test (MET) on Discharge from Neurorehabilitation Hospital.

The purpose of this prospective study was to examine the predictive and ecological validity of the Multiple Errands Test (MET) on discharge from neurorehabilitation hospital to the community. The specific objective was to examine the relationships between discharge MET scores and follow-up scores on the Participation Index (M2PI). The study sample included 30 participants with acquired brain injury who were independent in basic activities of daily living 1 week prior to discharge from a neurorehabilitation unit. The MET Hospital-Version was administered at discharge and the M2PI was administered to participants and their caregivers during a home visit 3 months after discharge. Moderate significant correlations were found between the MET and the M2PI scores (self and caregiver MET total error score with total M2PI r = .403, r = .510), with a greater correlation coefficient for caregiver ratings than for self ratings. Partial correlation analysis demonstrated the stability of this relationship while controlling for basic cognitive status scores. The results provide supporting evidence for the ecological validity of the MET at discharge from neurorehabilitation. In addition, the findings highlight the need for community-based rehabilitation that will reduce the impact of executive function deficits on participation in daily life.

Validating the measurement of executive functions in an occupational context for adults with attention deficit hyperactivity disorder.

OBJECTIVE. The objectives of this study were to better understand the cognitive profile of adults with attention deficit hyperactivity disorder (ADHD), their occupational performance, and their quality of life (QoL) and to examine the validity of a cognitive-functional evaluation (CFE) battery for these adults. METHOD. Eighty-one adults with ADHD and 58 without ADHD completed ADHD symptom ratings, the Behavior Rating Inventory of Executive Function-Adult Version, and the Adult ADHD Quality-of-Life Scale. An occupational performance interview was administered to the ADHD group. RESULTS. A broad range of occupational concerns were reported. We found significant differences between groups on all measures. In the ADHD group, we found medium significant correlations among the measures. CONCLUSION. Adults with ADHD experience cognitive and functional difficulties in their daily lives associated with QoL. The results support the use of a CFE battery that has been shown to be sensitive and specific for these adults.

Neurofunctional treatment targeting participation among chronic stroke survivors: a pilot randomised controlled study.

Long-term disabilities are common among stroke survivors and are associated with reduced quality of life (QoL). Research on occupation-based intervention for chronic stroke survivors is sparse. The objective of this study was to examine the effectiveness of neurofunctional treatment (NFT), an occupation-based client-centred treatment approach, for attaining individualised goals in chronic stroke survivors. A pilot randomised control study with a crossover design was employed. The participants were randomly allocated to treatment or control groups, with the intervention replicated for the control group after three months. Twenty three community dwelling stroke survivors, at least one year post-stroke attending a community day centre participated in this study. The 12-week intervention included NFT with individualised occupational goal setting. The treatment methods included task-specific training, environmental or task adaptation, assistive devices, motivation recruitment, and advocacy. Significant differences between the groups were found on occupational performance measures, but not on QoL. These findings were replicated after crossover for the control group. The results support the efficacy of NFT for attaining occupational goals in individuals in the chronic stage after stroke, yet further research is needed to validate these findings in additional treatment settings and over time.

Using the international classification of functioning to examine the impact of trigger finger

Abstract Purpose: To evaluate the impact of trigger finger (TF) on hand motor function, activity and participation (A&P) and quality of life (QOL), and to evaluate the association between personal factors (age and gender, disease severity) and body functions (dexterity and strength) with A&P and QOL in patients with TF. Methods: Sixty-six patients with TF (study group) and 66 healthy volunteers (control group) participated in the study. TF symptoms were graded using the Quinnell classification. A&P was evaluated using the Disabilities of Arm Shoulder and Hand questionnaire and the QOL using the World Health Organization Quality of Life questionnaire. Dexterity was evaluated using the Functional Dexterity Test and the Purdue Pegboard Test; hand strength was evaluated using the Jamar Dynamometer and Pinch Gauge. Results: The comparisons between the study and control groups revealed significant differences in all measures. The study group reported lower perceived QOL, A&P and reduced hand strength and dexterity. Hierarchical regression analyses revealed that (a) the severity of TF contributed significantly to the explained variance of QOL, while demographics and hand functioning did not; (b) demographics, TF severity and hand function all contributed significantly to the explained variance of A&P. Conclusion: The findings of the study point to the importance of addressing the functional implications and QOL of individuals with TF. Implications for Rehabilitation Although trigger finger is considered to be a mild hand pathology, it has a wide-ranging impact on hand functioning, daily activities and quality of life. Clinicians should include assessments of these outcomes in the treatment of individuals with trigger finger. Treatment efficacy should be evaluated with International Classification of Functioning outcomes, and not limited to symptomatology.

Occupation-based Assessments and Treatments of Trigger Finger: A Survey of Occupational Therapists from Israel and the United States†

The purpose of this study was to describe the reported evaluation and treatment methods commonly administered by occupational therapy (OT) specialists in hand therapy for patients with trigger finger (TF). Sixty-one therapists from Israel and the United States completed an electronic survey. Sixty-nine per cent of the therapists reported evaluating TF symptoms (body function level) as part of their assessment protocol; however, only 25% reported the use of occupation-based measures for the assessment of people with TF. All therapists reported using orthoses to treat TF, yet significant differences were found between the groups regarding the frequency of using physical agent modalities, exercise and activity modifications. The results of the study point to the limited use of occupation-based assessments and to a lack of consensus regarding treatment guidelines for TF. The study is limited by a restricted sample size and a low response rate from US therapists, which warrant caution in generalization of the findings. Further research is needed to study the broad implications of TF in order to inform the assessment of TF in OT and to establish the foundations for future treatment efficacy studies.